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INFERTILITY seems so common word on listening but it holds a storm in it which makes lives of people miserable. One can feel it instantly only when you don’t see these patients mechanically but sense their anguish humanly with compassion. While studying in medical college we had to undergo6-6 monthly semester in different college’s indifferent units. Our unit gets changed after 6 months but the treatment pattern used to be the same. In OPD for every infertile patient get routine blood and urine investigation done along with pelvic scan and husband’s semen analysis to find out responsible male or female factor. Start ovulation induction and monitor sonographically for ovulation and advice them planned relation (if male factor is ok) for few cycles. Meanwhile tubal factor assessment done. If everything seems to be ok, patients were asked to wait patiently for 3-6 months. Till that time assisted reproductive techniques like IUI, IVF-ICSI etc were not available in premium institutes like KEM& Wadia hospital, so further knowledge was limited to bookish reading and verbal advice only. More or less on the same pattern patients were treated months together or say years together till they conceive or drop out after getting frustrated. We were not much aware about the outcome as our unit gets changed every 6 monthly. After investigating patients, treatment was  started on same line ,same medicines , same ovulation induction ,follicular monitoring  ,advice for planned intercourse on certain  days…..patient and her husband has been frustrated doing same thing again and again or sex  has become so mechanical and programmed that it creates phobia and at times intercourse is not possible on 14th day/specific ovulatory day due to high stress level. We were too busy to finish OPD rush than to understand these things and patient’s mental condition.

   When we started private practice then we realized it is more of mental problem and social stigma along with physical problems. Patient had to pay for every visit, every investigation and every pill. Patient’s pocket size decides that how long and how far expensive treatment he can undergo. Patients get psychologically frustrated due to physical illness & discomfort, social taboo and economical burden. It is seen at times couple are happy and content with themselves but due to social stigma and family pressure so somehow they have to produce a child . When their feminity or masculinity is questioned or doubted, they have to deliver a child to prove their completeness. These patients need emotional support along with medicines. Doctor has to be good human being along with having a sound knowledge of the subject who can feel their anguish and agony and lend them mental and emotional support. A doctor has to  play many roles while treating infertile patients like a counselor, guide, philosopher, friend and sometimes a Guru too all rolled into one and mind you acting won’t help here. One cannot hold goody mask mechanically on the face and treat the patients for long time .You need to be a genuine person at least when you are treating infertility patients.

When we came to Gorakhpur, we realized many patients could not undergo all investigations due to financial reasons and till we investigate them properly we cannot go ahead with appropriate treatment .So along with hysteroscopy we added color Doppler USG and made such a simple protocol so that one can have assessment of uterine cavity ,endometrial  ,fallopian tubes and ovarian and follicular assessment maximum upto 10-12 minutes without surgery and under short GA, so that patient can go home in 2-3 hours. Most important part of this protocol was, it is  very economical. It became a mile stone for us in assessing infertile patients which helped in diagnosing and treating thousands of patients in short duration.During our practice in eastern UP,we have come to the conclusion that if patiently these patients are treated after proper work up and investigation for 6-8 months ,then up to 75% of patients conceive with basic medication and techniques like IUI and gynaec endoscopy. Only 5% patients require costly techniques like IVF-ICSI. Rest 20% of patient’s falls into unexplained infertility where all the reports of couple are normal still even after 4-6 times IUI, they fail to conceive.Even the patients of unexplained infertility respond well to the treatment when after a gap of 2-3 months of rest and use of integrated medicine for preparing body and mind before  undergoing  next cycle of treatment. We have achieved success in almost 60% of such cases of unexplained infertility in second round of treatment and still our trials are going on to improve the results. Even in best of the IVF centers , take home baby rates for IVF patients are not more than 30% still now. Many upcoming centers claim very high success rate for motivating patients but still the ground reality remains the same .Lots of research is going on in pharmaceutical end and in improvising IVF techniques and machinery to improve result but still we have not reached success beyond 1/3rd.

    Have you seen a farmer working in the field? Do you think just an  irrigation, fertilizer and pest control is enough to reap  a good crop?

The answer is ......No……. actualy he first cleans and prepares the land before sowing the seed. This is the basic to get good crop along with rest  of the other things.

    In our practice we followed the same principal and we got very good response. Today lots of medicines are being used to increase endometrial receptivity, we have done something more. Other than using medicines we prepare our patient’s body and mind to achieve good results.

   Male factors like oligospermia or azoospermia cause infertility in up to 40% of cases. With the advancement of assisted reproductive techniques like IUI, IVF & ICSI treatment aspect for such patients is a bit ignored. Why sperms are so less or absent in otherwise healthy looking young man- nobody thinks in this direction. Usually treatment options are dependent upon empirical or ayurvedic medicines about which allopathic doctors are usually ignorant. Then monthly semen report decides the duration of treatment or switchover of medication or use of assisted reproductive techniques. If the response does not occur as per expectation, then depending upon semen report mechanically IUI, IVF or ICSI is decided and patients are pushed to choose them. Infertility puts lots of stress on couple and creates strain in their physical relationship too. Sex is not an isolated act limited to sexual organs. First the thought comes in mind then body reacts accordingly. Sex lies in between two ears not in between two legs. If you are stressed, disturbed or in depression then the sexual desire will not arise seeing a woman even if a very beautiful woman comes in revealing outfit or lingerie. We have encountered couples where they are physically fit and fine but they get too tense to have sex on specified days of ovulation. In medical terms this partial impotency is called 14th day phobia .Due to this they miss the train by arriving late on station.

  In IVF/ICSI lab minimum 4-6 embryos are made and 2-3 embryos are transferred in uterus still success is achieved in 1/3rd patients only .Most of the  patients often ask about possibility of success with them or they want guarantee of having baby with specified treatment. Patient does not invest just their time and money but they have associated lots of hopes and emotions too. Here the role of doctor is like a person walking on a tight rope with a bamboo to balance- you have to tell the truth, encourage them by giving hope while preparing them to accept failure too without being shattered. Duty of human being is to do his work and wait for result. Nature has kept rights of life and death with itself. We can only create a idol or paint a portrait but whether it can be blessed with life only nature can decide. We have put not just 100% but  rather101% and now even we are waiting for result along with you and praying for success. We wish and pray that every couple coming to us should get blessed with child and we are continuously trying and improvising our techniques .