We recently talked with Dr Pankaj Shrivastav, a pioneer in the field of Reproductive Medicine and the Founder of Conceive Gynaecology and Fertility Hospital in Dubai/Sharjah. Dr. Shrivastav has been working in the field of reproductive medicine for more than 25 years. From seeing through the birth of first IVF baby in the UAE to devising pioneering new techniques like Ovarian Hyperstimulation and Surgical Retrieval of Sperm (PESA and TeSA), he has accomplished several milestones.
Having worked in the UAE for over two decades, Dr Pankaj Shrivastav has seen changing trends in the prevalence of Infertility in the region and also the emergence of new treatment methods over the years. We spoke with him about the latest reproductive technologies available today and how they can help couples overcome infertility.
Before we start talking about the various fertility treatments, we’d like to know when a couple should actually consider seeking treatment or consultation for infertility.
Couples could seek specialized fertility treatments for several reasons, but the following are some general factors that may indicate the need to see a fertility specialist:
a. Couples should seek immediate advice when there is an obvious problem like irregular menstrual cycles or known hormonal imbalances in a woman or some form of trauma to genitals in a man.
b. If a couple with no obvious problem have been trying to conceive for an year or more, but unable to achieve pregnancy, it is advisable to consult a specialist to look into the causes. For a woman who is less than 35years old, one would expect a natural conception to occur in 6-9 months. If she is unable to get pregnant even after one year of trying, she should certainly seek infertility advice. Women who are aged 35 or above are advised to seek specialist consultation after 6 months of trying, the reason being declining fertility with advancing age.
More couples are struggling from infertility today than ever before. But with advancements in reproductive technologies, do you think there is also more hope today than ever before?
Certainly, there is more hope today with the emergence of more successful treatment technologies. However, with changing times, there are also newer issues that continue to arise and pose challenges to the field of reproductive medicine. One of the challenges, for example, is that younger women are running out of eggs sooner than before and that is something we cannot rectify with technology. For problems that plagued fertility a decade or two ago, we do have advanced techniques that have dramatically increased the success rates, but for the newer arising concerns, science and technology still needs to find better solutions.
Of late, IVF clinics have mushroomed all over the world, and many infamous horror stories have emerged as well. Do you think couples need to do their homework before choosing a fertility specialist or clinic? What factors should they consider before making a pick?
Definitely, there is a requirement for more infertility centres today because of the rise in population as well as Infertility rates in couples. But yes, couples need to be extremely careful and do their homework before choosing a fertility Center. Internet today is the easiest way to look up on a specialist’s background. Additionally, it is sensible to speak to one’s family physician, Endocrinologist or Gynaecologist who can recommend a specialist based on professional equations and experience. Couples can also seek opinion or advice from friends/acquaintances who have undergone fertility treatment with a particular physician or clinic.
It is also important for an individual to be thoroughly informed and aware of one’s medical condition(s) and treatment process. I urge all my patients to ask me questions if they are unclear or have any doubts about their medical condition. I have seen many patients in my practice who were absolutely unaware and clueless about how many eggs were harvested in their previous IVF attempt, what was the quality of sperm, how many embryos were generated etc. It’s really unfortunate because patients have the right to know everything about their treatment. While the patients have a right to know, the physician also shares a responsibility to arm them with all information.
What exactly is Assisted Reproductive technology and how did it evolve over the past two decades?
When a couple is unable to achieve a pregnancy naturally through intercourse, they require help from a specialist physician. Sometimes all they need is a little tweaking of their reproductive hormones to get their systems to work appropriately. Although this kind of treatment is classified as infertility treatment, it is NOT Assisted Reproductive Technology.
Any treatment that requires the handling of sperm and/or egg outside the body is Assisted Reproductive Technology. There are a range of technologies with the simplest one being Intra-uterine Semination(IUI) and the most advanced technique being ICSI or Intra Cytoplasmic Sperm Injection and PGS (Pre-Genetic Screening).
Till 1990, the only treatments available were IUI and IVF. In 1991 ICSI was introduced and that gave hope in leaps and bounds to couple who had a high quotient of male infertility. Over time, we have been able to improve the culture system and grow embryos in the laboratory for longer. This enables us to collect the best and healthiest embryo(s) to be transferred back into the uterus. In 1994, we ourselves introduced PESA and TeSA to the world which are minimally invasive techniques devised to harvest sperm directly from the male genitalia in cases where men do not have any sperm in their semen.
The techniques continue to be honed and perfected — For instance we now have PICSI which helps us in selecting the best of the poor sperm that the man is producing and use it to successfully create embryos in ICSI. We’re now also able to watch embryos grow and develop by means of a ‘embryo CCTV’ (embryoscope). This further allows us to choose embryos with the highest potential to implant into the uterus.
With the introduction of PGD not only can we choose the embryos which are growing the best but also those embryos which have normal chromosome and/or are free of a genetic disease.
Who should consider IVF treatment? Are there any alternatives that can be tried before moving to IVF?
If a woman’s tubes are blocked or if a man has poor sperm they have no option but to go for IVF or ICSI. However, if the woman’s tubes are open and the gentleman has good sperm and the couple are relatively young they could initially try simpler techniques like Ovulation Induction and Intra Uterine Insemination.
What are the chances of success with Assisted Reproductive technologies? Are there any factors that can increase or decrease the probability of treatment success?
When we discuss success rates, two factors are extremely important, especially in women. One is the age and the other is the weight of the woman. The younger the woman the better is her eggs’ quality and the higher the chances of her getting pregnant. While the rate of conception with Assisted Reproductive Technology is over 50% in women who are less than 30 years old, it falls to 20-25% by age 40 years and is less than 5% after the age of 45 years.
The other factor which can improve the reproductive outcome of a couple is the weight of the woman. As weight increases, success rates decrease and women really need to wake up to this fact. Also women who smoke run out of eggs quicker than those who don’t.
Last but not the least, patient compliance in every aspect is crucial to success. Simple things like adhering to medication plan, dietary and lifestyle modifications have a huge impact on the outcome.
Many couples are concerned about possible side effects or risk factors associated with infertility treatments and Assisted Conception. What are the odds with all the latest treatment methods available today and how do you address this issue with your patients?
The question that I’m asked most often is – will this baby be normal? And the answer is, “Yes”. Even babies conceived naturally have a 2-3% risk of malformations and the risk is exactly the same with babies conceived through Assisted Reproduction Technique.
Sometimes, my patients also ask me if the woman will run out of eggs faster as a result of treatment, and again, the answer is, “No”. Some couples also express concerns like increased risk of cancer with infertility treatments, but none of these have been proved to be associated with the infertility treatments or medications.