Many consider procreation to be one of life’s main purposes. Having children is a priority for most couples who aspire to have a family. While the clock is always ticking, today’s woman is also ambitious and career-oriented.In today’s world, where both the husband and the wife lead hectic careers, starting a family is often pushed back into their 30s. For many, this does not pose a challenge, but for others, delayed pregnancy often leads to complications wherein the couple realize that they are unable to conceive. While age is a risk factor for infertility, even young couples may be infertile. There are various reasons for infertility and either husband or wife, or in some cases both, may contribute to the problem. For fertilization to occur, women must produce healthy eggs and men must produce healthy sperm that find their way to the mature egg in a timely manner. Women may have issues with follicle count, quality of eggs, or even anatomical issues that prevent sperm from reaching the egg or prevent the fertilized egg from growing. Men may have issues with sperm count or function, or problems in delivering the sperm.
Technology has vastly improved, and today, there are many treatment options for those finding it difficult to conceive. These new methods are not yet close to promising a 100% chance of pregnancy, but have given a ray of hope to millions of couples who would otherwise be unable to get pregnant. Significant progress has been made in understanding the reasons for infertility and ways to overcome the shortcomings. Assisted reproductive technology, such as intrauterine insemination and in vitro fertilization, are some options commonly offered to infertile couples to facilitate pregnancy. Success rates vary widely depending on the reasons of infertility and often couples must undergo repeated cycles of assisted reproductive technology.
Mr and Mrs Agarwal were one such couple in their thirties who were unable to get pregnant and were struggling to cope with infertility. As a first step, the couple underwent testing in 2013 to understand the reasons for infertility. Mrs Agarwal underwent a hysterolaparoscopy. An endometrial tissue test indicated that she was positive for tuberculosis (TB). Genital TB is a common cause for female infertility, mainly affecting the fallopian tubes. She was therefore given anti-tuberculosis therapy and infertility treatment was placed on hold until she was TB free. To add to the couple’s woes, Mr Agarwal was hepatitis B positive. Hepatitis B is known to have a negative impact on spermatogenesis leading to low sperm count, motility, and reduced fertilization rates. There is no known treatment to eliminate hepatitis B infection.
Mrs Agarwal became TB free in 2015 and the couple consulted Dr Sneha Sathe, Infertility Specialist, Nova IVI Fertility Clinic, Mumbai, for fertility treatment. Mr Agarwal was asked to undergo sperm analysis tests. Further, keeping their medical history in mind, Dr Sathe advised that Mr Agarwal undergo testing to determine his infectivity status for hepatitis B. Since hepatitis B can be transmitted through sexual contact as well as through infected blood and other fluids, Mrs Aggarwal was asked to undergo testing to determine whether she was also hepatitis B positive. If found negative, she was advised vaccination against hepatitis B. She also underwent a transvaginal sonography, which showed that she had a low follicle count, indicating a reduced ovarian reserve. After this consultation, Mr and Mrs Aggarwal did not follow up at Nova IVI and chose to go elsewhere for fertility treatment where they underwent six rounds of intrauterine insemination and one cycle of in vitro fertilization without success.
In 2017, the couple then returned to Dr Sathe at Nova IVI Fertility Clinic for another attempt. Mrs. Aggarwal had been vaccinated for hepatitis B and was both TB and hepatitis B free. Mr Agarwal’s infectivity status showed low infectivity levels. It was explained to them that the chances of success were slim due to Mrs Agarwal having a poor ovarian reserve and the negative outcome from the previous attempts. The couple was desperate, and despite understanding the low chances of getting pregnant, wanted to try in vitro fertilization with their own eggs one more time.
Mrs Aggarwal was asked to return on the second day of her period for the first step of the procedure. Her follicle count was 4-5 and ovarian stimulation was initiated. Four eggs were retrieved and 3 of these were successfully fertilized by intracytoplasmic sperm injection (ICSI) with Mr Agarwal’s sperm. On day 3, two embryos were transferred back into Mrs Agarwal’s uterus. Her pregnancy test was positive, and the couple were delighted. Sonography indicated a twin pregnancy in the early weeks, however, one foetus aborted shortly thereafter. Thankfully, one fetus survived, and Mrs Agarwal delivered a healthy baby in 2018.
According to Dr Sneha Sathe, “Infertility affects men as well as women. The initial, most important step in the treatment of infertility is a detailed and comprehensive evaluation of both. In addition to fertility testing, couples should be offered screening for hepatitis B and hepatitis C. If either partner tests positive for either of these infections, further testing in collaboration with an infectious disease specialist and counseling regarding the risk of transmission from affected to unaffected partner and from affected mother to baby during pregnancy and childbirth is important. The fertility treatment options available to the couple depend mainly on the infectivity status and viral load of the affected partner.”