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The good news for infertile couples is that modern technology makes it possible for almost any couple to have a baby. There are atleast 18 ways to sucessful conception and more are under development.
There is no doubt that IVF and the newer assisted reproductive technologies ( ART) represent one of modern medicine's success stories. Today, there is practically no couple whom we cannot help to make a baby. This can be best exemplified by the following story of one of our patients.
Read more- In Vitro Fertilization (IVF)
Mrs DF was a 35 year old woman who first came to us for a second opinion regarding her primary infertility in 1991. She had been married for 3 years, but had failed to conceive. Her family doctor had referred her to a gynecologist, who promptly did a laparoscopy and confirmed she was normal. She was asked to then get her husband's semen analysis done.
After a lot of persuasion, she finally managed his to get his semen tested - and much to her dismay, the report came back as azoospermia. The husband flatly refused to believe the report - how can my sperm count be zero when I can have sex thrice a night ? However, when repeated testing confirmed the report, he finally agreed to visit the doctor.
Read more- Azoospermia
The gynecologist then referred them to a urologist, who advised him to get a testis biopsy done, to find out if he had a block so they could repair it surgically, if possible. He was so worried about the prospect of surgery on his testes, that he refused to visit any doctor for further treatment.
His wife got increasingly desperate as time went by, because she had to suffer the taunts and barbs of friend and relatives for her "barrenness" - and to protect her husband's ego, she couldn't tell them about his problem.
Infertility- A Couple's Problem
I asked her to come back for a consultation with her husband, explaining to her that infertility is always a couple's problem, and we need to see both the partners together. I then requested him to repeat the semen analysis from a reliable lab, and evaluated the report carefully. This confirmed he had azoospermia; and also showed his seminal volume was normal; the fructose was positive; and the pH was alkaline.
The analysis also showed that there were sperm precursor cells present in the ejaculate. I then requested him to perform a sequential ejaculate - two semen samples, ejaculated after a one hour interval. In order to help him produce a second sample, we gave him 100 mg of Viagra.
The first sample again showed no sperm. A preliminary examination of the second ejaculate also showed no sperm, but when the sample was centrifuged and the pellet examined carefully, we saw occasional motile sperm per high power field. This confirmed he had cryptozoopsermia, and that his problem was partial testicular failure ( non-obstructive azoospermia).
We had to explain to him that there was no treatment for this problem ( remember this was in 1991) and the only treatment option we could offer him would be donor insemination. He flatly refused this option, and would not consider adoption either. He was very intelligent and highly motivated. He asked - "Doctor, why can't you inject my sperm into my wife's eggs in the test tube baby lab. After all, you only need one sperm to fertile one egg, don't you ?"
Read more- Sperm banking for donor insemination
We had to explain to him that this was not possible, and that for IVF, we needed at least 1,00,000 sperm. Since he refused to consider the option of donor sperm, he went back home disappointed. In 1994, he came back to us again, excitedly holding a newspaper report of an article about how doctors in Belgium had invented a new technique, in which they could fertilise a single egg with a single sperm.
He wanted us to do this new treatment called intracytoplasmic sperm injection or ICSI for him. We learnt about this major new advance in IVF technology, which allowed us to ensure that 1 sperm plus 1 egg = 1 embryo, and since this was the only method by which he could have a baby with his own sperm, they agreed to go ahead.
Read more- Microinjection: The Latest Advance in Treating the Infertile Man
We performed an ICSI cycle in July 1995:
She conceived in this cycle as documented by rising beta HCG levels and serial ultrasound scans which revealed a healthy twin pregnancy with growth appropriate for dates. She required a caesarean section, and now has 2 healthy babies - one son and a daughter.
This story also emphasizes the dramatic advances which assisted reproductive technology can offer today in helping infertile couples to start their own family.
A TV program produced in the USA in 2002 described 18 ways to make a baby.
If you now add additional options such as TESA ( testicular sperm aspiration) and PESA ( percutaneous epididymal sperm aspiration);assisted hatching and embryo fragment removal, the list becomes even longer !
The bottom line is that today there is a solution for every infertility problem - and doctors and patients need to apply their mind, so they can decide what's best for each individual couple !