Treating infertility – the new and improved approach

Dr Aniruddha Malpani, an IVF specialist tells us how infertility treatments have changed over the years and how it can be made more effective.

By: Dr Aniruddha Malpani | | Updated: October 9, 2014 4:51 pm

Dr Aniruddha Malpani, an IVF specialist tells us how infertility treatments have changed over the years and how it can be made more effective. Also Read - Egg freezing on rise in India: Is it the best choice to make? Know the pros and cons

Infertility is always an important problem for the patient but never an urgent one. The general attitude is one of ‘let’s wait and watch’ and let ‘nature take its own course’. Since many couples know of patients who have conceived naturally after many years of previously fruitless marriage, they commonly adopt this attitude. This is not surprising. After all, no one likes going to a doctor! There is also the fear that they may have a complex problem which will be hard to treat. Lots of infertile couples continue to live in denial but wishful thinking does not cause problems to disappear. Also Read - Stress in expecting mothers impact baby: Herbs to relieve stress during pregnancy

However, the problem is aggravated by the ignorance of family physicians and gynecologists. They often take a ‘hands-off’ approach, without realizing that as the biological clock ticks on, the woman’s fertility declines irreversibly. This approach was acceptable in the past, when there was so little we could offer in any case for these couples. However today with recent advances in reproductive medicine, it is no longer acceptable for many reasons. Also Read - Mild IVF: A safer option for 37+ older women or who have low ovarian reserve

1. Couples today marry at an older age. Their biological time clock is running out and we often need to accelerate events we cannot sit back and wait and watch.

2. Effective treatment is available today to enhance nature’s efficiency (or rather its inefficiency in the case of these couples). This treatment must be judiciously employed, to give couples their best chance.

It is worthwhile drawing an analogy to the current management of labour and childbirth. In older days, when no drugs were available, doctors were often forced to wait and watch. They could do little to intervene and it was common for labours to last for over 2-3 days often resulting in stillbirths and even maternal deaths. With the advent of drugs like oxytocin and prostaglandins, all that has changed! Obstetricians now take an active approach to provide a favourable outcome in a quicker time frame.

Today, unfortunately, the investigation and management of infertility still leaves a lot to be desired. It is often slow, time-consuming and costly. The infertile couple is seldom seen together. The gynecologist only sees women, and has no idea what to do if the man has an infertility problem. The infertile man is referred to a urologist, as a result of which the care becomes fragmented. Investigations are performed in a piecemeal fashion rather than as part of an overall strategy. Doctors are also keen to ‘do something’ and repeated procedures for the hapless couples like (curettages, laparaoscopies, myomectomies, ovarian cystectomies and other unpronounceable procedures) which can actually induce adhesions and damage a previously normal pelvis.

Both patient and doctor suffer from the inefficient treatment of this problem. The doctor feels inadequate and unable to help his patient, and trust between the doctor and patient breaks down. The temptation to try many empirical, possibly useless medical treatments is considerable; and patients often end up spending large sums of monies at the hands of quacks and ‘spiritual healers’.

This is why taking an active success-oriented approach to infertility is important today.

The couple must be seen together and treated as a unit. The workup to establish a diagnosis should be completed in 1 months. The timing of the procedures is important, and we have found the following strategy cost-effective. This testing schedule costs less than Rs 10000.

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Semen analysis (during the wife’s menstrual period)

Blood tests (Prolactin, LH, FSH, TSH, AMH ) – Day 3-5;

Hysterosalpingogram-Day 5-7;

Ultrasound for ovulation monitoring and assessing endometrial thickness and texture – Day 11-16;

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With this strategy, we can tell patients that we will be able to find out what the reason for their infertility is within 1 month, and then start treatment.

As regards the treatment, it is easy not to do anything (‘planned relations’ or as the Americans call it, ‘well-timed intercourse’), or to continue repeating the same treatment month after month. Doctors often forget that not doing anything can be hell for the patient-the waiting can be agony. You need to keep on progressing to more aggressive treatment! For example, a reasonable plan for patients with unexplained infertility may be:

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Timed intercourse, 6 cycles; Superovulation with HMG plus IUI-3 cycles; then IVF. Don’t waste time! As a rule of thumb, if a treatment is going to work, it should work in 4 cycles.

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While no one can predict what the outcome of treatment is going to be for any infertile couple, at the end of it all, they should at least have the satisfaction of knowing that they tried everything that was possible.

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Published : March 20, 2014 2:51 pm | Updated:October 9, 2014 4:51 pm