LOW OVARIAN RESERVE - CHALLENGING SITUATION IN FERTILITY MANAGEMENT

If the couple has regular intercourse, does not use any contraception and still does not conceive within one year, they are said to be infertile. 80-85% of the couples conceive within one year of unprotected intercourse i.e. without the use of any contraceptive. However, the rest 15-20 % who are unable to conceive naturally are said to be infertile and these would require proper evaluation and help for getting pregnant.

Yes, in a woman fertility does depend on her age. A young woman is naturally more fertile as she has more number of good quality eggs than a woman who is 35 +. Hence a woman who is 35 + should not wait for a long period for a natural conception and should seek help from a proper fertility expert. Also the chance of genetic abnormalities and medical complications like Hypertension and Diabetes increases with age.

If the woman is below 35 years and has normal menstrual periods, and the couple has tried for a conception for a year with a frequency of sexual intercourse 3-4 times a week during the fertile period and has yet not conceive, then they need to consult an Infertility expert.

For increasing the chance of pregnancy, balanced body weight of the woman would be beneficial. Being obese or grossly underweight affects the maturation of eggs in the woman and hence may affect her fertility. Also, a grossly obese woman would have mechanical difficulty in having normal sexual relations. Regular, moderate exercise especially in the form of yogasanas, walking, swimming, or jogging prove beneficial for fertility. It has been observed that strenuous form of exercises for example jogging over 3 miles a day can hamper ovulation and hence may lead to decrease in fertility in the woman. Balanced and nutritious diet help increase the chances of conception and ensure proper growth of the fetus.

Chronic stress may interfere with the ovulation, may decrease the sexual desire and hence affect the frequency of sexual intercourse in the couple.

A detailed history of both partners is very helpful in giving a clue to the cause of infertility. For e.g. anovulation is the cause of infertility in a woman who has irregular periods and who is also obese, blocked fallopian tubes in a woman with previous history of pelvic infection, low sperm count in a man with past history of mumps. Examination of both the partners, and getting the required investigations would give a complete picture.

A natural conception is obviously what all couples desire and wish when they plan a pregnancy but when it does not happen and the couple is counselled for an IVF treatment, it creates lots of stress for them.

The most stressful part is the acceptance of the fact that IVF is the only best option for their problem. A good discussion with the doctor to understand about Human Reproduction and why IVF is the best option for them to conceive will help the couple .They should take their time to understand about what the treatment involves and always ask questions to get their doubts cleared. A session with the counsellor would definitely help. Speaking to friends and family who are knowledgeable is a good way to reduce the stress but at times it could be counterproductive especially if they only talk of the problems and are themselves not positive.

In an IVF treatment, the woman’s eggs and her partner‘s sperms are fertilised in a laboratory. To get her eggs, she needs to take hormonal Injections on a daily basis and at the same time every day. This could create some stress especially if she is in a demanding job. It is best that she confides in someone who is reliable and understands the intricacies of an IVF treatment. The best part is that these Injections are not painful as very fine needles are used and she could also self-administer it.

She needs to see her fertility specialist for the follicular tracking for about 4-5 times in a cycle. This could also be demanding and stressful. She should just take all this in her stride and not get unduly stressed. The follicular response may not be satisfactory especially in a woman with poor ovarian reserve and she could become stressed.

She could have stress on the day of egg retrieval because of the fear of pain but this is a small procedure which is done under safe anaesthesia. The procedure is done through the vagina and there are no cuts on her abdomen. This is simple and safe procedure, not painful. At times the male partner gets stressed and is unable to give his semen sample on the day of egg pickup. To avoid this problem, almost all fertility centres will freeze the semen sample beforehand as a backup.

Of course the other stressful point is to worry about the numbers and quality of eggs got at the time of pickup, the fertilization of the eggs, and the numbers of good quality embryos. All these are important form success point of view. A communication with the couple before the procedure will allay all their fears and will go a long way in taking care of the stress.

The most important step in IVF is Embryo transfer for which the woman should relax. Generally it is done without anaesthesia. The woman‘s cooperation is so very important for favourable results.

After the embryo transfer one has to wait for about 10 days to know the results. It could be very stressful at this stage. She should try to be calm and not just keep thinking of the results. After the embryo transfer the woman has to use either progesterone vaginal tablets or Injections and the stress of finances adds to the stress of procedure.

All in all we do understand the stress that the couple undergoes for an IVF treatment cycle. Have trust in your doctor and you would definitely become a successful.

At our IVF Clinic in Mumbai and IVF centre in Navi Mumbai, we spend quite a lot of time to make you feel comfortable. Our entire support staff and our embryologist are in constant touch with the couple. We try to see that you do not have to wait for too long to see the doctor. We have all facilities of Hysteroscopy/ Laparoscopy / IVF treatment and Maternity at Dr Sudha Tandon centre and we take utmost care of our patients.