Pioneer in fertility lists 10 facts young Arab couples should know
Declining fertility due to environmental and lifestyle factors and changing social trends like marrying late
When Dr Pankaj Shrivastav, a pioneer in the field of In Vitro Fertilization (IVF) and fertility, first came to Dubai in 1991, he recalls the situation vividly. He had been invited by the Dubai government to set up and lead the first fertility facility in the UAE - the Dubai Gynaecology and Fertility Center (DGFC) at the government-run Rashid Hospital.
He served as Deputy Director and Director of the DGFC for the next 13 years.
“At that time, it was very common to see the women coming alone for a first consultation and usually she would be accompanied by her mother-in-law. Men were quite reluctant to come to the fertility center because they felt that this was compromising their ‘Macho image’. In fact, I remember lot of couples ringing up to ask if there was a backdoor entry into the center because they did not want to be seen to be coming in from the front door where they could be seen by other local couples. They would enter from the rear and the women would wear their Sheila (scarf worn around the head to cover the hair) throughout the consultation,” says Dr Shrivastav.
Even though in 1991 fertility treatment was considered a novelty, the subsequent media publicity made the general population in the UAE more aware that fertility is a problem that can be treated.
In the 12 years from 1992 to 2004, more than 2,000 babies were born at the DGFC.
Dr Shrivastav went on to set up his own gynaecology and fertility hospital called Conceive in Sharjah in 2004, of which he is the Director.
Conceive also has a branch in Jumeirah Lake Towers in Dubai to cater to patients from Dubai.
In a wide-ranging interview with Al Arabiya English, Dr Shrivastav shares his insights as a pioneer about the advances in fertility treatment and how Arab couples who have issues in conceiving can take proactive action.
“The situation has definitely changed over the years. Today the stigma of approaching a fertility center is a lot less and we’re moving towards having it being gone completely. Most notably, men have accepted that it isn’t just a ‘woman’s issue’ and a lot of infertility is a result of the man’s semen or sperm being suboptimal. In contrast to the past, I find that today people do not wait for too long before they seek medical advice at a fertility center,” he says.
IVF treatment has changed dramatically over the last 30 years, says Dr Shrivastav. “I started IVF in 1987 where I was being trained in London at a leading fertility center there and from then to now we’ve made huge progress. Initially IVF was the only treatment that was available for Assisted Reproduction. We did not have such advanced medicines/hormones available to stimulate the ovaries. It was not just enough to stimulate the ovaries but we needed to keep the follicles intact before we took the eggs out. Egg collection was a much more complicated process at that time because we had to do a Laparoscopy for every patient who required egg collection. Now it’s become a lot simpler and less invasive. We are able to collect eggs using ultrasound techniques without even cutting the skin and the whole procedure can be done under sedation (previously general anaesthesia was required). The patient is medically fit to go home a mere 2 hours post an egg collection procedure.”
Intra Cytoplasmic Sperm Injection (ICSI) treatment came later and in its own way revolutionized the field too. Prior to 1991, men with poor sperm had no treatment specifically to assist them to reproduce. But with ICSI men with low sperm count and very poor sperm motility (movement) could be used to make embryos.
“Time and technological advancement gifted us with path-breaking techniques. These have allowed for us select the best embryo to put back in to the uterus. An example is of the Embryoscope, which is like a CCTV that monitors early embryonic growth and allows us to select those which grow the best and healthily.”
Another technique that must be highlighted is PGS (Preimplantation Genetic screening), says Dr Shrivastav. “In this technique, we extract one cell from eight from a three-day old embryo. Chromosomes and genetic content in this one cell is then studied for abnormalities and defects and mutations. If present, this embryo is then deselected and not transferred into the woman’s uterus. PGS has been a game-changer when it’s comes to hereditary diseases like Sickle Cell Anaemia and Thalassemia.”
Fertility rates in the region
Regarding observations on lower fertility rates in the region, he says: “Certainly, we are seeing more infertility in this region and I think this may be primarily due to two reasons…. One is because of lifestyle changes and the second is due to environmental toxins’ exposure. “
“The most notable lifestyle condition that adversely affects fertility rates in men and women is Obesity. In most cases, obesity gives rise to Diabetes and/or polycystic ovarian disease (PCOS). These in turn make it that much more likely for women to gain more weight and this can result in them becoming anovulatory or NOT producing eggs.”
“Another aspect we see is changing social trends in that women are marrying later in their lives,” he says. “More and more women are opting to pursue higher education and high powered careers and delaying the traditional norm of being married and settling down. While this is fantastic in every which way, it means that women have to race against a biological ticking clock. Sadly, for women unlike men, facing declining fertility with increasing age makes it that much more difficult to conceive when they do eventually marry.”
In this part of the world especially, smoking is by far the greatest adversity that fertility faces, says Dr Shrivastav. “Both shisha and cigarette smoking are lethal for eggs and sperms. A smoker is shown to attain menopause nearly five years earlier than a woman who is a non-smoker. Similarly, the sperm production is stressed by cigarette/shisha smoke and results in low quality sperm.”
Ten facts that young Arab couples should know:
1. The ‘biological clock’ concept: Women should please remember that unlike men, there is a tick-tock on your ovaries. A woman’s fertility peaks in her 20s and after that it is downhill. Till about 38 years of age, one could say in general that the egg quality and number is still reasonable to work with but after 40 years, the fertility decline is rapid and chances of conceiving are extremely low. Men do not have this problem at all!
2. Global decline in fertility: In the last 50 years, sperm and egg quality have been declining due to environmental and lifestyle factors and changing social trends like marrying late. It is vital to be aware of these factors, to remain active and fit and eat healthily to protect your fertility. Smoking and alcohol have to be avoided as much as possible because they do you no favors at all!
3. Risk factors for couples: It is wise to practise safe sex throughout to minimize the risk of contracting infectious diseases which might hamper one’s fertility. Be aware of when is an optimal time for your body to conceive a child and try not to delay your child bearing for too late. Find that balance between work and a happy married life.
4. Lifestyle-related issues: Smoking is bad for both men and women. Obesity compromises fertility in both men and women. Make sure you get enough exercise and clock enough hours of sleep. Alcohol and recreational drugs – avoid them! For men it is very important to note that steroid use and abuse is detrimental to sperm production and quality. Indulge in bodybuilding without these drugs. Be aware of pesticides and hormones in food produce sold at markets which find their way into our bodies and adversely affect sperms and eggs. They act as hormone opposers, disrupting reproductive mechanisms in our bodies, thereby causing infertility.
5. When to seek infertility expertise: Couples should know when to seek Reproductive Medical advice. For a young couple, they could wait for a year of trying before they seek medical advice but if the wife is over the age of 35 and has not become pregnant within six months, the couple should go to the fertility doctor immediately. Do your homework and seek the center/doctor with the best reputation.
6. Treatment range: Infertility treatment ranges from simple to complicated. The simplest form would be to stimulate the woman by the use of medications and hormones to encourage her to produce better quality of eggs. A step up from this would be Intra-uterine Insemination or Artificial Insemination where a concentrated sperm sample from the husband is injected up the wife’s cervix in an attempt to conceive. The most advanced methods would involve the use of Intra Cytoplasmic Sperm Injection (ICSI) and Pre-implantation genetic screening (PGS). Each patient’s case is assessed individually and the best management plan is drawn up for a successful pregnancy.
7. In-vitro Fertilization (IVF) vs ICSI: For damaged ovarian tubes and/or the presence of other factors hampering fertility in the wife, IVF is advised. Here the egg and sperm are placed together in a lab petridish and the fertilized embryo is transferred back into the uterus. If the husband has poor sperm quality, ICSI is recommended where a single, best sperm is injected into the egg by means of a very, fine needle in the lab. Fertilization is done and the embryo is then transplanted back into the wife’s uterus. PICSI is another advanced technique which enhances the selection process in the quest for the single, best sperm.
8. Pre-implantation Genetic screening (PGS): Pre-implantation Genetic screening is an incredibly pathbreaking and advanced technique done to ensure that only the embryo which is chromosomally and genetically normal is transplanted back into the wife’s uterus. This is particularly useful in the case of older women trying to conceive. In cases where there is a history of several unexplained miscarriages and/or the presence of hereditary diseases in the genes of the husband and/or wife. PGS ensures the resulting fetus will bear none of these strains or mutations.
9. Costs involved: It is important to be aware of the cost of Infertility treatments and at Conceive this is what we offer.
Ovulation Induction – AED 1,500
Intra-uterine Insemination – AED 3,000
IVF – AED 15,000
ICSI – AED 19,000
PGS – AED 40,000
Please note that this doesn’t include the cost of medications. Simpler procedures like Ovulation Induction and Intrauterine Insemination usually stay under AED 500 but for IVF and ICSI may range from AED 4,000-5,000.
10. Mental health: Infertility is incredibly draining both emotionally and financially and the couple must be aware of the hardships they’ll face during their treatment. We offer counseling support through our staff as well as online through our blogs on www.conceiveivf.com . The husband must be especially sensitive when dealing with societal and familiar pressures because too often in Asian and Arab cultures, women are mistreated by families and friends for not being able to have a child. Fertility is private and must remain between the husband and wife in question and both are responsible in protecting each other’s dignity and privacy from the world.