Inception Journey, Fertility zeal

It was a bright sunny morning, and I was fully charged to start my day with a cup of freshly made masala tea in my hand. Everything was normal. I was going through my day’s schedule which was lined up with a few follow-up calls, social media interactions and meeting with content creators. Suddenly news feed notification on my mobile popped up. I generally do not read them during my working hours, but I just felt like looking at them.

One was about India’s rapidly increasing infertility rate. It was worrisome and I was too engrossed in my thoughts; my assistant Zena called and informed me there was a last-minute new client meeting and she was too keen on meeting me as early as possible.

I asked Zena to fix it in the second half, but she said the client was already in my clinic and waiting outside. I do not like to make people wait so I asked Zena to send this new client inside my cabin in 10 minutes. I was going through the client’s preliminary data which is our routine practice before meeting any new person. It seemed like a case of obesity and PCOS (Polycystic Ovary Syndrome).

In a few minutes a well-dressed lady, most probably to go to her office entered my cabin. She seemed to be in her late thirties with a BMI on the higher side. She appeared anxious, worried, and sad and had a lot to say but was not able to express it.

She appeared too stressed with a lot of hopelessness in her eyeliner-loaded eyes. Inside my AC cabin she was sweating, I was able to feel her extraordinary fearfulness. I offered her a glass of water; it is always good to drink it to alleviate current tension.

Her name was Akshita; I realized the need to open my jumbo listening ears first. I learnt this term from my kindergarten-going nephew, it sounds slightly kiddish but very rare in today’s world where everyone just wishes to speak and not listen.

I requested Akshita to tell me about all her present complaints. She said she wants to lose weight, correct her PCOS and become a mother ASAP. Her last wish was extraordinary; I thought how can I help her because pregnancy is a time-consuming trial-and-error process?

She said she has been married for the past 8 years and has not been able to conceive despite regular efforts. Her and her husband’s reproductive reports were normal other than her obesity and PCOS everything is ok. The doctor suggested she meet a nutritionist and bring lifestyle-related changes to her daily life. Suddenly infertility news banged into my mind, and I clearly understood the reason for all the stress in Akshita’s mind.

It was a clear case of infertility, she appeared too keen to be a mother, tired of all trying to conceive practices, listening to other’s unwanted harsh comments, and slowly losing all her hope with each passing day.

Now I was able to feel her pain, unhappiness, and distress. She looked at me as a ray of hope and someone who could help by holding her hand through her conception journey.

Firstly, I assured her, that with her hard work and dedication, pregnancy is possible, but it may take time and will not happen ASAP. She was feeling slightly better and at ease, sometimes just a word of dream fulfilment is enough to start a difficult long journey.

I started discussing her with time-tested proven healthy lifestyle recommendations, which will improve her and her husbands as a couple’s, overall health, hormonal imbalance and ultimately conception chances also. It was very crucial to make positive changes in their life collectively as a team and ask them to work together to achieve their goal of being a healthy parent of a healthy baby. I explained to her the importance of a couple’s pre-pregnancy programs.

Every couple is different and born with their unique physical, mental, and emotional characteristics, in which genes they are carrying play an important role in defining their overall health system. It is suitable for a couple attending preconception counselling, to first, do their genetic profile testing and get aware of different genetic disorders that their baby may be at risk for based on both the partner’s history and ethnicity. All the preconception recommendations should be customized as per the couple’s health requirements.

Nutritional and physical activity adjustments- I had asked her to observe the irregular eating habits and make necessary mindful eating changes like not skipping her meals, not keeping too much gap between her meals, preferring homemade freshly prepared plant-based foods like green leafy vegetables, oranges, bananas, peanuts, yellow moong dal and urad dal, til and bajra and avoid excessive intake of processed, sugar-rich, deep-fried, and salty foods.

Specifically, I told her about a few unpopular nutrition and fertility linkages which are crucial in terms of today’s busy lifestyle era, which every preconception couple should be aware of, needs special attention and management should be discussed with the nutritional expert.

Homocysteine and its relationship with fertility- High stress and constant tension raise the body’s normal homocysteine levels which directly affects the ovulation process, egg quality, sperm concentration and motility and may result in infertility, miscarriage, hypertension, and low birthweight babies.

Genetic composition and Vita B 12 and D3 deficiency- These are the individuals who are not able to meet their Vitamin B12 and Vitamin D3 requirements irrespective of their eating rich sources of the same. It is due to their genetic inability to metabolise and store these nutrients in their body.

Recertifying mental stressors– I explained to her how being highly stressful, anxious, and overthinking can reduce her conception possibilities. I asked her to include mind-calming and peaceful activities like meditation and deep breathing exercises in their couple's life.

Making emotions right – I guided them as a couple not to be under constant pressure to be a parent and enjoy the whole preconception and further journey, be in the moment, stop predicting the future and take everything easy.

Side by side I made her understand the importance of doing a minimum of 30 minutes of moderate physical activity like walking, jogging, slow running not being sedentary and being active throughout the day.

Slowly I introduced her to the importance of identifying the underlying cause of infertility and the best ways to manage the same.

Becoming a mother is extraordinary as it brings out the impregnable characteristic of a woman which is hidden from herself too. It starts from the first thought of conception and continues throughout life. The whole process is draining and very tiring but nurturing a life inside the womb and in the outside world is a spectacularly positive life-changing event. A mother is reborn with her baby and goes through a plethora of physical, mental, and emotional changes.

Preconception is an exciting thought for the would-be parents. It includes their physical, mental, emotional, and financial preparedness. Sometimes, in the current world, cherishing the dream of being a mother is hindered by a spiking old-known taboo known as “Infertility.” So, on this preconception journey, it is essential to address infertility in detail first and consider it as another health risk.

Accepting infertility

WHO, ICMART says infertility is a disease of the reproductive system due to which a woman fails to achieve pregnancy after regular unprotected intercourse for 12 or more months.

Can also be explained as the inability of women in their reproductive age (15–49) years to become pregnant after exposure to pregnancy for five or more years.

Primary Infertility: Couples are never able to conceive

Secondary Infertility: Couples with one child are not able to conceive again

Alarming Indian Trending facts

The World Population Prospects: The 2017 Revision Report

• 50% drop-in fertility rate. 4.97 in 1975-80 to 2.3 in 2015-2020

• Projected to be 2.1 in 2025-2030 and 1.86 in 2045-2050

Indian Society of Assisted Reproduction findings

• 10-14% of the Indian couples (27.5 million) are facing infertility

• Urban area 1 out of 6 couples are impacted

• Female infertility (35%), male infertility (30%), both (20%) and unexplained infertility (15%)

  
  

Blow of infertility

It affects life multidimensionally, is considered a social stigma, and questions a woman's femineity, her existence, and capabilities. Brings psychological pessimism like low self-esteem, lack of confidence, anxiety, depression, chronic stress, body shaming, self-guilt, worthless and hopelessness. Costly Infertility treatment puts extra pressure on a couple’s financial planning.

When to fix infertility consultation

• Not able to conceive past 1 year

• Age is more than 35

• History of repeated miscarriages, PCOS, endometriosis or any other comorbidity

  
  

Current Breakthrough remedies 

Infertility services - Approximately 1 in 8 women (15 to 49 years).

Therapy is initiated by overcoming medical, emotional, and economic difficulties and taking small steady hopeful steps. Treatment should be as per the underlying infertility cause, stress-free, happy, and more in control process.

Cheerful tips to remember throughout the process

• Do not feel alone, some more are facing the same difficulty

• It may take time, but simple and effective treatments are available

• Be strong, hopeful, and optimistic

• Not get disheartened by the waiting time to conceive and cut down daily anxious activities

Stopping birth control pills does not assure fast pregnancy, it may take a few months to years. Firstly, try holistic lifestyle changes to increase the conceiving chances naturally. It is ideal to acquire all the right information about birth control pills and their relationship with conception.

What do birth control pills do?

These pills are enriched with synthetic estrogen which inhibits ovulation by preventing the release of hormones FSH (follicle-stimulating hormone) and LH (luteinizing hormone). Also contains progestin which helps thicken the cervical mucus and barriers sperm to meeting the egg and results in conception.

What hormonal shift happens when they are stopped?

There arises a significant hormonal shift as the body starts relying on its natural hormone levels affecting the entire body system. There can be short-term symptoms like changes in menstrual cycles, premenstrual syndrome, headaches, mood swings and feeling low. Long-term symptoms may include increased chances of irregular, heavy and painful menstruation, acne, endometriosis, and development of cysts. 

After stopping the birth control pills, a holistic lifestyle routine incorporation is required to enhance the conception likelihood. Birth control pills may instigate nutritional deficiencies, hence taking care of the nutrition is very crucial after stopping the birth control pills and while gearing up for conception. A balanced nutrient-rich dietary regimen is required to balance the hormones post contraceptive pills stoppage. All the nutritional changes should be discussed with the nutritionist and as per the recommendations should be added to daily life.

Nutrients to focus more

B vitamins are needed for energy and blood glucose maintenance and optimizing liver functioning. Easily available food options which are rich in B vitamins are dairy products, Leafy green vegetables, Citrus fruit, and Bananas.

Folic acid is important for red blood cell formation, cell growth and conception. Healthy food sources are pulses, lentils, beans and green leafy vegetables.

Vitamin C boosts the immune system and can be obtained from fresh fruits and vegetables, especially citrus ones.

Vitamin E, zinc, magnesium, and selenium improve antioxidant levels and assist in developing a healthy body system and reproductive functioning, which can be added to the daily diet by eating nuts and seeds. Co Q 10 also helps the body fight against unwanted free radicals and can be found in foods like whole grains.

Vitamin D3 is responsible for normal bone health and its level should be checked and taken care of. Probiotics help build and maintain good digestive functioning and foods like curd, buttermilk and lass should be incorporated routinely in the diet.

In some cases, nutrient deficiency can be very high and supplementations are required. This should be done after consulting the expert and their supervision. Self-medication should be avoided.

Prohibit bad habits

Quite smoking and high consumption of alcohol and caffeine. Be careful of products high in pesticides and harmful chemicals. Get free from digital addiction and sleep adequately.

Exercise cautiously

Limit heavy exercise and physical activity. Go for light to moderate walking regularly.

Watch weight

Maintain ideal body weight, not too high or too low.

Doctor consultation

Discuss with an expert before taking any new medication regarding the side effects.

Be Peaceful

·         Restrict multitasking, concentrate on one work at a time, read books, listen to good music, and practice yoga regularly. Find inner solace and peace within.

If after introducing lifestyle changes pregnancy is not achieved within some time, talk to a gynecologist or medical professional. 

Probe the cause

Female Causes –

5% of infertility cases are due to preventable or treatable.

1. PCOS (Polycystic ovary syndrome)- the presence of hormonal imbalance, ovary dysfunction irregular periods and ovary cysts.

2. Fallopian tube blockage- occurs due to pelvic inflammatory disease, endometriosis, and past surgeries, preventing fertilization or reaching the fertilized egg to the uterus

3. Uterine Abnormalities- the appearance of fibroids, polyps, or congenital malformations

4. Endometriosis- inflammation, scarring, and fallopian tube and ovary obstruction due to eruption of tissue lining outside the uterus endometrium

5. Ovulation Disorders- hypothalamic dysfunction, PCOS and premature ovarian failure cause irregular or no periods

6. Hormonal disparity- disturbance in follicle-stimulating hormone (FSH), luteinising hormone (LH), thyroid hormone

7. Advancing Age- reduces fertility, egg quality and therapy success rates

8. Emotional health- existence of stress, anxiety, depression, negative thoughts, and anger in daily routine

9. Lifestyle choices- exposure to smoking, excessive alcohol and caffeine consumption, drug abuse, poor nutrition, underweight and obesity

10. Other reasons- contraception complications, abortion infection, sexually transmitted diseases, and postpartum infection

Common treatment

Primarily timely correct oral medicine dosage stimulates ovulation, followed by natural intercourse or artificial techniques.

Artificial techniques

IUI (Intra Uterine Insemination) 15-20% success rate

• Reproductive health test of both partners 

• Stimulate 1-3 matured egg growth with oral drugs or injections

• Monitor follicle development through ultrasound and blood test

• Give hCG (human chorionic gonadotropin) injection and induce ovulation

• 36 hours post-hCG trigger, insert IUI-collected concentrated sperm sample or donor sperm sample into the uterus

• Do a pregnancy test after 15 days

IVF (In Vitro Fertilization) 40-50% success rate

• Reproductive health check-up of the couple

• Give hormonal injection for 8-10 days to stimulate the ovary

• Monitor follicular growth

• The embryologist will fertilize eggs and semen in a controlled lab environment

• The best maximum 2 embryos are transferred 3^rd or 5^th day after egg collection

• If requested other good-quality embryos are frozen for future use

• Do a pregnancy confirmation test after 15 days

Male causes

1. Low testosterone level, high or low BMI and improper sperm concentration, motility, and quality

2. Poor sperm health due to unhealthy lifestyle, drinking alcohol, indulging in recreational drugs, smoking cigarettes, eating nutritionally lacking diets and being sedentary throughout the day

3. Working in a highly stressful job, not spending time with the partner and having low emotional bonding with the partner

Male-specific treatments

• Efforts should be made to improve sperm health by introducing positive lifestyle changes like maintaining a healthy body weight, eating a balanced diet, doing a minimum of 30 minutes of physical activity daily

• Avoiding gaining high fat near the belly area and prohibiting alcohol, cigarette, and excessive processed food intake

• Maintaining optimistic mental health and healthy rest pattern, improving the couple's quality time together and participating wholeheartedly in every part of the family planning and parenting expedition

  
  

New age treatments

1. ICSI (Intra Cytoplasmic Sperm Injection)

2. Done in case of poor sperm quality, a single meticulously selected sperm is injected into the egg to enhance fertilization followed by regular IVF treatment.

3. MACS (Magnetically Activated Cell Sorting)

4. It discards damaged sperm and accepts only the best-quality sperm.

5. PGT-A (Preimplantation Genetic Testing – Aneuploidy)

6. The numerical chromosomal abnormalities of embryos are identified.

7. PGT-M (Preimplantation Genetic Testing – Monogenic)

8. Helps recognize genetic disorders.

9. PGT-SR (Preimplantation Genetic Testing – Structural Rearrangement)

10. Recommended in case of repeated miscarriages and rectify chromosomal disarrangements.

11. Egg, sperm, and embryo freezing (40-50% pregnancy rate)

Gives the liberty to choose the best conception time to the individuals as per their feasibility in life.

Preconception economic readiness

Apart from being medical, physically, emotionally, and spiritually ready for parenthood, couples should also plan their finances and be better prepared to accommodate the new life into their present monetary status. They should discuss their financial soundness to carry out the lifelong parenting journey. This may include estimating medical costs, understanding health insurance and emergency funds, planning to quit the job, or taking maternity and paternity leave and budgeting for the new arrival. A detailed organized list is required when adding a new member to the family, it should never be done in haste and always be addressed as per the priority.

Infertility synopsis

It is a disease of a couple’s inability to conceive after 12 months of regular unprotected intercourse. It can be due to reproductive system complications like poor semen ejection, low sperm count, inadequate sperm motility and abnormal sperm shape, ovary, uterus, fallopian tubes, and endocrine functioning. The right fertility care comprises the prevention, diagnosis and treatment of infertility causes and initiates from the time the couple get their first thought of becoming a parent.

Overcoming infertility and attaining conception is an important life experience where self-identity is searched in the medically appealing processes. It is moralistic to remember that bringing a new life into the world is not only a mother’s way to reproduce, undergo medicalization and experience infertility stigma but the father’s also needs to be an equal partner in every bit of preconception-pregnancy-parenthood journey.

Closure thoughts

There is always a possibility to achieve fertility.