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Latest fertility technology gaining ground in Pakistan
Infertility can be a serious problem for married couples. It can wreak havoc with an otherwise peaceful family life; yet it is a taboo to discuss the problem with a doctor — at least in our society. Ignorance among the masses, who turn to pirs and mazars for a cure, and lack of will among medical professionals to find a scientific solution have further aggravated the problem.
Many gynaecologists and obstetricians are not well aware of advantages of the latest advancements in technologies such as ICSI which can help immensely when a childless couple wants to have a child and seek professional help from the medical professionals.
Some misled religious people also oppose aided pregnancy for no valid reason. Scientific measures to aid fertility are being used in government hospitals in many Muslim countries, so it is unfair to claim that it is prohibited by Islamic injunctions.
“Media reports about cloning, surrogate mothers and using sperm from strangers have created many misconceptions about Assisted Reproductive Technology (ART). In Muslim countries such as Saudi Arabia, Malaysia and Pakistan, it is done strictly according to the norms of Shariah,” says Dr Nasim Ashraf, clinical director of Islamabad Clinic Serving Infertile Couples, adding, “We have the formal approval from Federal Ministry of Health and Ministry of Religious Affairs of the Government of Pakistan.”
Treating a disease or alleviating one’s suffering is a genuine option in any religion, and the right of a childless couple.
The latest in fertility technologies is intra cytoplasmic sperm injection (ICSI). A child born using this procedure is commonly known as a test-tube baby. More than a hundred test tube babies have born in Pakistan so far.The most recent test-tube baby was born at OMI Hospital in Karachi last month.
Dr Nasim Ashraf says: “On an average, 80 per cent of the couples are able to achieve pregnancy, and another 10 per cent take one more year. It is the remaining 10 per cent couples who need some sort of help to achieve pregnancy. Interestingly, most of the couples who have not been able to achieve pregnancy even after two years, succeed with a session of consultation with the doctor at a fertility clinic. At our clinic, the first consultation which may take two hours is free. After comprehensive consultation, many couples find that they actually needed no treatment or medical or surgical intervention, and just a little advice was all they required to achieve pregnancy.
“Of the 10 per cent couples who need assistance, 50 per cent have sperm count less than the normal which is 20-120 million/ml. More then 50 per cent of these should be actively motile. With a lower sperm count, some sort of assistance is required. In borderline cases, a very simple procedure called IUI (Intra Uterine Insemination) takes care of the problem. In case of more severe deficiency an elaborate laboratory technique called ICSI (Intra Cytoplasmic Sperm Injection) has to be used.
“Other techniques are used if the sperm production is zero or their passage is blocked. In 3 per cent of males, sperm maturity stops for some reason. These males can be helped by taking a testicular sample and microinjecting immature sperm into the egg to achieve fertilization.”
Theoretically, a fertile male keeps producing sperm cells throughout the life and remains fertile, but a female has a fixed number of eggs stored in her body since she was in her mother’s womb, waiting to be born. With menstruation, every 28 days or so, an egg matures and, if not fertilized, passes out. Her cycle of egg discharge stops at about 40 years of age.
In females under 40, the most important cause of infertility is the blockage of passage where egg and sperm meet. This can be corrected with surgery. If that is not possible for some reason, eggs can be collected by a simple procedure and mixed with the husband’s sperm in the test tube. After fertilization is confirmed in the laboratory, embryos are put back in the womb. This procedure, called IVF (in vitro fertilization), allows for physical scrutiny of the quality of eggs, sperm and whether fertilization has actually taken place.”
ICSI’s Medical Director Dr Nasim Ashraf, who is MRCOG and MMS in ART, was trained in some of the leading infertility clinics in the UK and is also a visiting consultant in Kuwait. At ICSI, he has teamed up with its Scientific Director and Senior Embryologist Dr Anjum Siddiq, who is PhD in fertility from the Cambridge University.
At a workshop held recently at ICSI’s Islamabad clinic, doctors from the capital area, Lahore, Peshawar and Rawalpindi received hands-on training in latest fertility techniques from Dr Anjum Siddiq. Earlier, Dr Nasim Ashraf delivered a detailed lecture to the participants, covering various aspects of fertility techniques and procedures, covering infertility diagnosis, hormone test, infertility treatment including controlled ovarian stimulation with timed intercourse, intra uterine insemination (IUI), in-vitro fertilization (IVF), intracytoplasmic xperm insemination (ICSI), spermatid micro injection (SMI), assisted hatching (zona drilling), embryo biopsy, blastocyst transfer, surgical recovery of sperms, and sperm and embryo freezing.
At ICSI clinic, Dr Nasim Ashraf (not to be confused with with his namesake from the United States) says, “After initial consultation and reviewing the infertility and medical histories of both the partners, a full medical examination of the woman is given by a female doctor. Husband or a female attendant is allowed to accompany her.
“If male infertility is suspected, the man is also examined and a detailed assessment is done. Other tests are carried out if considered necessary.
“The consultation report and test results are given to the patient. They are also placed on a website where the confidential data can be accessed only with a password. With the couple’s consent, may also be sent to the referring doctor.
“In IUI, clean, healthy, prepared sperms are deposited directly inside the uterus. This technique is helpful to the couples suffering from unexplained infertility of short duration (less than two years) where no apparent cause is found following a battery of diagnostic tests.
“For infertility of more than two years, IVF is recommended. It may also be helpful to the couples suffering from blockage or absence of the fallopian tubes most commonly seen after sterilization or infection, pelvic adhesions, chronic an-ovulation (absence of ovulation), endometriosis, or unexplained infertility.”
He further explains that intra-cytoplasmic sperm injection (ICSI) is helpful in the most severe male factor cases, where there are: (1) insufficient number of available sperms or severe oligozoospermia; (2) insufficient number of normal sperms or teratozoospermia; or (3) low-grade sperm motility or asthenozoospermia; (4) obstructive azoospermia or blockage in epididymis or vas deferens; (5) congenital absence of epdidymis or vas deferens; (6) anti-sperm antibodies; (7) failure of fertilization.
In females, ICSI technique can be of use in resistant zona pellucida, anti-sperm antibodies, and failure of fertilization. Spermatid micro-injection (SMI) works for those males who suffer from sperm maturation arrest; or damaged testicular tissue, where only spermatids are found.
ICSI is a relatively new but well established procedure. It helps male factor infertility, and involves injecting a single sperm into the cytoplasm of each egg using a fine glass needle. The ICSI has largely replaced the two previously developed procedures, partial zona dissection and subzonal insemination because it achieves much higher fertilization rates.
However, ICSI is generally unsuccessful when used to treat fertilization failure that is primarily due to poor egg quality.
Before any fertility procedure starts, confidentiality of the identities of the couple choosing artificial reproductive technology is essential, as is proper documentation for future reference.
An elaborate computerized documentation system takes care of this aspect. Some of the initial procedures are, therefore, carried out in the presence of both husband and wife. In unforeseen cases, when the couple gets separated or enters litigation, the samples are sealed and stored in a cryogenic container, and only a court can issue order to unseal them.
More info on:
— www.ivf-icsi.com
— www.inciid.org/icsi.html
— www.advancedfertility.com/ icsi.htm
The writer
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