Infertility has been an issue for many couples, who find it difficult to conceive, moreover, it becomes increasingly difficult to discussing these issues for the fear of being labeled “infertile”.
At such times, informing and educating patients becomes the topmost priority, agrees Dr. Aniruddha Malpani, a leading Infertility specialist, of Malpani Infertility clinic in Mumbai.
In an exclusive interview with medimanage.com, he talks about the important aspects of infertility and explains how a couple can overcome the stress, in a one-to-one chat with Pooja Biraia.
- When is a couple considered to be infertile?
When a couple has been trying to have a baby for more than a year, and the lady fails to get pregnant, then they are considered infertile. This is the basic definition.
- After having two babies can someone get infertile?
Yes, that is known as Secondary infertility. It means that a couple that has conceived once, is having problem conceiving again. And the reasons could remain exactly the same, there could either be a tube problem or an egg or sperm problem or even a uterus problem. The reason is that patients are mentally prepared and they feel once they have had two babies, there would be no problems in getting pregnant third time. And then, when they don’t get pregnant, they spend a lot of time in denial.
- Can you provide statistics as to the number of couples facing an infertility issue in India?
It’s actually very hard to find these figures as in India. However, on an average 10% of all married couples are infertile or they have problems getting pregnant, which means it is the commonest medical problem in people between the age of 20 to 40. And these are couples who are in the prime of their life and are trying to start out and they are having difficulty conceiving. And because of lifestyle issues, especially in larger cities the problem is becoming more prevalent (as) people are getting married at an older age, and they are pushing off having babies in pursuance of their careers.
- What according to you are the factors that make infertility non claimable in India?
There are no such valid reasons that make infertility non-claimable in India. Some of the commonly stated reasons include, infertility is not a medical problem, the treatment is expensive and so on. But these are excuses that insurance companies have used and have been able to get away with it. Moreover, infertile couples are in a minority and unless they get together and fight for their rights, this problem will not be solved.
- Can a couple who have an active sex life become infertile?
The definition of infertility is that you are having an active sex life and then you fail to get pregnant and that is when medical issues come in, either there may be a problem with the egg or with the sperm, and even though their sex life is healthy, the egg and sperm for some reason cannot meet.
- Mere psychological counseling may help a couple conceive. Comment
That’s a very dangerous thing to say, because it is like telling a couple that they are not able to conceive because of tensions and stress, and relaxing will get them a child. It is important to know that, stress does not cause infertility, infertility causes stress. Yes, Psychological counseling is important, but it is not enough to make a baby.
- Where does a layperson stand vis-à-vis the various scams that are reported in the infertility field?
These things are not just particular to infertility; yet, our focus has always been on patient education. Good doctors will always remain good doctors and bad doctors are not going to improve. Hence, the need of the hour is to educate patients and if everything is documented in black and white, educated patients cannot be cheated. That’s why we try spreading awareness through our website, through comics, cartoons and books, so that the patient knows what is right and wrong.
- How is the infertility blame shared between the man and woman?
Anywhere in the world, 40% of the time it is the man who is responsible, 40% of the time it is the woman and 10% of the time the reason remains unexplained, while 10% of the time, both have a problem. But what is important is to know that it is always a couple’s problem and that couple needs to be treated as a unit. But, you’re right, traditionally man has been known as a bread earner and a woman with making babies and therefore we tell a patient that anytime they want to have a baby, the first test should always pertain to sperm analysis.
- Does weight have a role to play in infertility?
Yes, certainly. If a woman is very overweight, she can reduce her chances of fertility by not being able to produce eggs properly. Fat cells are hormonally active and they disturb the hormonal balance and a lot of patients who are obese have what is called hang ovulation or Polycystic Ovarian disease. And equally interestingly, very thin women, anorexic women can also be infertile. So, use your common sense, and try to have an optimum body weight.
- Are Alternative therapies effective in treating infertility and if yes, which one?
Every system of medicine has some good and some bad in it and it is up to the intelligent patient to make that decision. There are certain areas where we encourage patients, for example, yoga we think helps to improve ovarian blood flow, may help to improve ovulation. A lot of these things like Acupuncture, meditation are very helpful for removing the patient’s stress levels. We actually encourage patients to explore everything. None of these are mutually exclusive options, and it quite alright to combine.
We give our patients a lot of nutritional supplements, for example, wheat germ. I think it is absolutely fine to use alternative therapies.
- But can alternative therapies cure the problems by themselves?
Some problems I am sure alternative therapies will be able to fix by themselves. It is really up to the patient to make an intelligent decision. Usually what I tell patients is that there is a lot of uncertainty and there are two things they should do – One, take the path of least regret which means understand that there is uncertainty, medicine is not an exact science. Two, treat it is a controlled trial and then, depending upon the result, decide if she should stick with it or should try something else.
- Ego issues play a role, wherein the man is alright with donor eggs but not donor sperm. Comment.
This is over generalizing. Everyone is not the same. There are lots of men who are quite alright with the idea of donor sperm when they accept that their sperm count is low and on the contrary many wives don’t want it. It requires a lot of maturity on the part of a couple, they both need to have a lot of understanding and love for each other.
- How do genetic factors contribute to infertility? And is there a connection between blood group and infertility?
There is no relation between blood group and infertility, doesn’t matter if the husband’s blood group and the wife’s are same or different. Genetic factors obviously have a role to play like they have a role to play in any disease, but it is not a common cause of infertility. Cases relating to genetics are few and far between.
- Increasingly, couples are seen postponing pregnancy as career takes precedence. Until what age can a woman conceive and when are the chances dim?
Usually we would say that fertility starts to drop after the age of 20, between the age of 20 to 30 the drop is very gradual so even if the couple decides to postpone pregnancy, it doesn’t matter. Between the ages 30 and 35, the drop becomes quit sharp, and we tell the patient to think about it. After 35, we ask the patient to put pregnancy on their priority list.
But, more than the calendar age, it is the age of a woman’s eggs that is of utmost importance. Older women will have older ovaries and therefore older eggs, but not all 30 year old women will have poor quality eggs and not all 25 year old women will have good quality eggs.
So usually if a woman wants to postpone childbearing, there is a simple test through which a doctor can check the “ovarian reserve” or the “egg quality”. This test checks her egg quality. If her egg quality is fine and she wants to postpone child bearing then it is safe to do so but if her egg quality is not fine then she would have to give priority to child bearing.
- Is there any age limit to conception for men?
No, there is no age limit for men.
- How would a woman know it’s time she gets her “egg quality” checked?
There is no magic number. So, unfortunately a lot of women with poor egg quality will not be aware that the egg quality is poor because they have regular periods. So, sometimes it’s a difficult decision. Usually we would tell the patient if you are 30 and if you want to push off childbearing for two years or more, you must get the test done.
