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Fertility preservation for modern Indians
| Dr. Aastha Gupta - 25 Mar 2022  1350

Not too long ago, two things, marriage, and children were a focus of Indian society. Parents would explain how important it is to start a family in time and even young partners would give themselves deadlines, with respect to age, for having kids. But, that was then, when women were expected to leave their jobs to fulfil the above needs and when the career was a second.

 

But, times changed and so did the thinking. With the career taking centerstage for both genders, life became busy and even stressful. This transformation bought an era of both men and women starting their own ventures, holding higher positions in various companies and moving ahead in every step of life. Women walked the territory that was earlier reserved for the men folks. While the working males prepared themselves for the competition that didn’t exist before.

 

All these alterations resulted in a fundamental change-delayed marriage and late pregnancy. The age of 30s became the new 20s for matrimony and bearing the first child happened only when the parents were ready to take responsibility, and not when they were approaching a deadline. This new scenario also meant to be at the realm of a significant decline in fertility. Therefore, today, let’s find out the fertility preservation options available for modern Indians.

 

But, before that, it’s important to understand what is fertility preservation?

 

It is a medical process that helps in safeguarding a person to have children later in life. This is done by preserving and protecting eggs, sperms or any other reproductive tissue to have his/her biological offspring subsequently without worrying about the biological clock. 

Who is it for and reasons?

 

It’s a known fact that with a population of over a billion people, India is the world’s second most populous nation. However, few will believe, of the actively trying to conceive couples of the country, approximately 27.5 million suffer from infertility. The data by Indian Society of Assisted Reproduction further states that a disease more of the urban class where one in six couples are affected, overall impacts nearly 10-14 percent of the population. Also, infertility is not a gender-specific disease, it can affect both sexes, equally.

 

Some reasons for this increase can be attributed to a person’s lifestyle i.e. unhealthy eating habits, no exercise; increasing marital age, high intake of alcohol and consumption of tobacco, obesity, mental stress, exposure of toxic chemicals, etc.

 

Apart from these, the below diseases or clinical factors too can cause infertility-

  • Radiation or chemotherapy during cancer treatment
  • Abnormal sperm production because of genetic defects, HIV, genetic diseases
  • Low sperm count in men
  • Early menopause

 

Thus, fertility preservation is for any couple who because of the above or other reasons cannot bear a child despite having frequent, unprotected intercourse for at least a year.

 

When to visit a doctor?

 

This is an important yet ignored factor. Many people discount or disregard the thought that infertility can happen to them. For them, it is a disease for others. But, in reality, a woman should visit a gynaecologist if she is-

  • Trying to conceive for six months or more
  • Is between the age of 35-40
  • Has irregular and painful menstruation
  • Suffered from a miscarriage before
  • Has undergone or is taking medication for a serious ailment

Whereasmenshould visit a fertility doctor if-

  • In the past suffered from sexual problems
  • Has a history of testicular, prostate or any other cancer
  • Has a low sperm count
  • Was on steroids
  • Have a family history or first-degree relatives i.e. those related by blood

Also, male fertility tends to start falling after they turn 40 years therefore, a man of that age who is in the process of making babies should also consider seeing a doctor.

What are the options available?

 

Fertility preservation is a relatively new concept in medicine. It became a reality only 40 years back with the birth of the first successful test tube baby. In India, Dr. Subhash Mukhopadhyay created history when he became the first physician to perform the In vitro fertilization (IVF) procedure for a test tube baby, while in the world it was British physicians Patrick Steptoe and Robert Edwards who performed the process 67 days before him. Thus, came to life, a baby who was born outside the body. Today, the number has increased to over 8 million babies.

This success led to medical science working harder and diligently towards ways to preserve fertility in both men and women of today’s world.

 

Possibilities for women-

 

  • Oocyte cryopreservation

 

Popularly known as egg-freezing, it is a method to preserve fertility of a woman which can support her to have her own biological child whenever she may choose. For this, she will require sperm from a partner or a sperm donor to complete the process.

 

In this method, hormones are injected to harvest the eggs from a woman’s ovaries which result in producing multiple eggs. This procedure of extraction is called egg retrieval and is performed under brief anaesthesia. These eggs are later taken to the lab where they are cooled down and then frozen unfertilized. To use, these frozen eggs are then defrosted and combined with sperms in a laboratory and implanted back in the uterus (in vitro fertilization) of a female. This kind of conservation is also known as social fertility preservation.

 

The success rate for this depends on the health of the eggs though, it is high and ranges anywhere over 60%.

 

  • Ovarian Transportation

 

This is a surgical process in which ovaries are pushed higher in the abdomen and away from any kind of radiation. This is usually done to minimize the impact of the high-intensity radiation prior to cancer treatments that may damage the fertility organs of a woman. With a high success rate of over 80% this can protect ovarian functioning from the effects of pelvic radiation; though for treatments like chemotherapy, it does not work. 

 

  • Radical Trachelectomy

 

This technique is especially for cervical cancer patients, wherein the cervix is removed while preserving the uterus. The procedure protects fertility but increases the chances of preterm baby and the pregnancy too becomes high-risk. Due to its high risk and cost, it is not popular for preservation.

 

  • Embryo cryopreservation

 

Embryo cryopreservationis the process of freezing and storing the extra embryos which are then thawedto be used later by placing it back in a woman’s uterus. An important part of most IVF procedures, it is opted by couples for reasons that vary from delaying pregnancy, chance for additional pregnancy in future, and during some medical treatments. It is also useful in case of failure in the first IVF process

 

Possibilities for men-

 

  • Sperm Banking

 

Sperm banking is one of the most popular ways to preserve fertility in men. This simple method involves producing a semen specimen in a private room in a doctor’s clinic. Once that is done the semen is analysed, frozen and stored. Though multiple specimens are recommended for banking, but for conception, even one healthy sperm can lead to the desired result. These protected sperms can be used anytime for future use and play the same role as that of egg freezing in women.

 

  • Testicular Sperm Extraction

 

Testicular sperm extraction (TESE) is a procedure that involves the collection of sperm cells by surgical removal from the testicular tissue. The tissue is then examined for the existence of mature sperm. If found, these sperms are removed, collected, and transferred to a sperm bank for freezing and storage. These are then used for IVF to have a child later. This technique done under local anaesthesia is usually performed in men once they reach puberty. It is for those males with extremely poor sperm production and even for those who maybe suffering from ailments like cancer. The success rates of this range from 30–70 percent.

 

  • Radiation therapy

 

Cancer treatment can often damage fertility and even slow down or stop sperm cell production. Thus, to protect from the high radiation which is a part of the cancer cure and can lead to hampering of childbearing capabilities in men, a covering or shield is used near the testicles. The testicles are one of the most sensitive organs in the body and can severely be affected due to radiation.

 

This procedure thereby safeguards against permanent damaging of sperm production and hormones. The success rate of this therapy varies on the radiation dose and scattering of the rays to other parts of the body. It is specifically useful during treatments for prostate, bladder, and testicular cancer, where the radioactivity energy is near the pelvis area.

 

To conclude, the reason for the delay in having a child for both men and women can differ from social or medical reasons. Nevertheless, with modern fertility preservation techniques that have a considerable success rate (depending on age, health, and quality of sperms/eggs) has given many modern Indians an opportunity to choose and bear a child when prepared than doing it under pressure because of the


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