KARACHI, March 1 With anxiety visible on the faces of many couples patiently waiting their turn at a treatment facility for reproductive health problems, Shahnaz Begum and her husband Ajmal present a somewhat different, more relaxed posture.
Part of their contentment lies in the fact that Shahnaz has successfully conceived through an IVF (in-vitro fertilization) treatment that cost the couple around Rs200,000.
“It was difficult to arrange the money out of our family resources and my husband had to borrow part of it. But now, after a successful conception, I feel that it's nothing compared to what we have achieved in life,” said Shahnaz, her face radiant with happiness.
Hardly a year into their marriage, the couple soon realised they had a problem in conceiving a child.
“I had watched a few TV programmes on infertility issues and came to know that women around 30 should consult a gynaecologist if they fail to conceive within a year. Early referral increases the chances of a successful pregnancy,” she told Dawn.
Looking for expert advice, Shahnaz (29) and her husband (34) eventually came to the Sindh Institute of Reproductive Medicine (Sirm). “My fallopian tubes were found to be slightly blocked and my husband was also diagnosed with some abnormalities at Sirm. The doctor told us that we have no option but to go for an IVF.”
Shahnaz has suffered no complications so far and is looking forward to a successful delivery.
“An IVF is a safe procedure. The only two things we are concerned about are the risks of having multiple pregnancy and ovarian stimulation. Since the institute opened in 2007, we have had two to three twins, but no triplets. Ovarian stimulation has been manageable,” said Dr Shaheen Zafar, a senior gynaecologist who heads Sirm.
Trained in England, Dr Zafar was part of the team that made the delivery of Karachi's first 'test tube baby', a colloquial term for babies conceived as a result of IVF, way back in 1997. The delivery took place at the Baqai Institute of Reproduction and Developmental Sciences (Birds). Operating in Malir, Sirm is the latest treatment facility for infertility problems, besides Birds and two centres operating in Clifton.
Explaining the procedure, Dr Zafar says that IVF involves hormonally controlling the ovulatory process, removing eggs and sperm and initiating the fertilisation process in a fluid medium. The fertilised egg(s) is then transferred to the intended mother's uterus.
“It is a major treatment in infertility, when other methods of assisted reproductive technology fail. As a first option, drugs are used to overcome abnormalities and there are many cases in which patients have conceived without going through an IVF.” She added that sometimes pregnancies can be hampered due to excessive stress. The treatment is recommended when a woman's fallopian tubes (either one or both) are blocked, husbands have a very low sperm count or poor quality semen, or unexplained infertility that has not responded to other treatments, according to her.
Considered an un-Islamic practice 15 years ago, IVF is now being widely pursued by married couples as an option, despite its high cost, she said.
“What we practice here is completely Islamic. There is no third person involved and eggs and sperm from married couples are used for fertilisation. The concepts of IVF surrogacy, in which another woman offers her uterus for pregnancy, and egg donation, however, are considered un-Islamic and are banned in Muslim countries.”
The IVF success rate, according to her, has gone from 20 per cent in the 1990s to 35 to 40 per cent today. This has happened mainly due to the improved form of the commercially available chemical agent in which an embryo nourishes in the lab, increased drug efficiency and advances in technology.
Regarding the factors that adversely affect the reproductive health of both men and women, Dr Zafar said that the use of cancer-causing agents in the form of toxic food colours, consumption of paan, chaalia and gutka (all of which contain carcinogenic substances), smoking, pollution, the use of pesticides in agriculture fields without safety gear and above all stress due to social pressures for not being able to become parents all contribute to poor reproductive health.
“I have been seeing more and more cases of ovarian failure during the past few years, which, in my opinion, have a lot to do with environmental factors,” she believed.
The female's age, she said, is the single most important factor that greatly affects the chances of pregnancy. “In some cases, hormonal levels become abnormal at a younger age, but generally, women have normal hormonal levels till the age of 35. Similarly, a male's sperm quality gets poorer after the age of 45 and this increases the chances of miscarriage. There is no proven drug that can improve the quality of sperm,” Dr Zafar said.
At the Concept Fertility Centre in Clifton, Dr Shahnaz Nadir Lakhani feels that the media has played a vital role in changing people's thinking towards the treatment. “With more awareness and increasing success rate, people have now developed faith that the treatment can work for them.”
About the factors that hinder pregnancy, Dr Lakhani said that both men and women can equally share the reasons, though at times there are unexplained reasons, too.
The centre is unique in the sense that it also offers pre-implantation genetic screening (PGS). PGS, a costly treatment, requires the use of IVF to test embryos for genetic disorders.
“Through this technique, chromosomal abnormalities, if any, are detected and only a healthy embryo is implanted in the womb,” Dr Lakhani said, adding that the PGS was best in cases of repeated pregnancy loss and older maternal age.
“The world of reproductive science has progressed considerably over the years. Treatment of even severe cases of male infertility, for instance azoospermia, in which men do not have any measurable level of sperm in their semen, is available today. This happened with the introduction of intracytoplasmic sperm injection (ICSI),” she said.
Despite all the successes, there are still cases, however, in which couples are recommended to go for adoption. “When there is no sperm, no ovum, the only option is adoption. The message is that people should avoid going to quacks, seek early treatment from a health expert and if they establish that there is no chance of pregnancy, then there is no harm in adopting someone looking for love and a home,” Dr Zafar concluded.
Pakistan has no regulation for the operation of private hospitals and clinics, and as such these infertility set-ups - all private concerns - function under their own code of ethics. Talking to Dawn, Dr Samrina Hashmi, Pakistan Medical Association (PMA) general-secretary, said “There is a dire need to bring all private medical facilities under some rules and regulations.
In 2005, the PMA had prepared a document on the subject and the government also moved into action. But later, the matter was put into cold storage due to pressure from some influential quarters.
“In recent meetings with the provincial and federal health ministers, we again have raised the issue and hope that the government would do something about it.”