An interview with fertility specialist

SYED SAJJAD HUSSAIN MD,anIVF and ICSI specialist, trained in Assisted Reproductive Technology (ART) in an interviewwith Kashmir Magazine’s Special Correspondent Ishtiyaq Ahmad Kar, explains the overcoming infertility in Jammu and Kashmir.

 Over the years, Dr Syed Sajjad has become the final hope for a majority of couples battling infertility in Jammu and Kashmir. Thanks to his command over in- vitro fertilization (IVF) scores of couples have been blessed with children.

He insists that being childless isn’t the end of the world and everybody cannot succeed with IVF.

Visiting him isn’t like meeting a doctor but a caring, humble and considerate individual who radiates a positive energy. When he talks about some of his old successful patients and cases, he gets emotional. He exudes warmth and gets attached to all his patients. It’s that personal touch that helps mitigate their pain and problem.

Extracts from an interview:

Q (KM): So many women come to you as hope. What do you tell them when they expect miracles from you?

A (Dr): In our society, a woman is appreciated when she is a wife and even more when she becomes a mother. There is always a glint of hope when couples come forward when they are having problems with having a baby. When we treat infertility it is very important for them to come as a couple. Many a times, we see women struggling with infertility even though it may be a male factor that is contributing to the lack of a baby. When women come to me, they have all their hopes pinned on the IVF treatment but I am always very realistic with them. The first meeting consists of understanding their needs, identifying the problem and counseling them.

Sometimes I advise them that they do not need IVF and simpler procedures may help them. Also one has to be more positive while undergoing IVF treatment. Our team has studied that stress plays a very important role in failures. Women or couples who are happy and look at the positive side have a much better response to the treatment.

Q: Do you think infertility is on the rise and why?

A: Yes, we are in an era where the environment is playing havoc with our systems both for men and women. This is something I have been stressing for a while. There are certain toxins which are ingested through our system and then partly excreted. So they partly remain in our system. These are substances like DDT, Organophosphorus compounds, phthalates, bisphenol which are present in things like plastic bottles that we use, which can have a negative effect on ovarian reserve of a female and sperm quantity & quality of a male partner and preferably we should avoid super-ovulations in Non ART cycles which consumes the ovarian reserve of our most childless females leading to DOR (diminished ovarian reserve) or POR (poor Ovarian reserve).

Q: Why is infertility becoming a big issue in urban city?

A: Lots of couples have demanding jobs, they come back home exhausted, perhaps eat take-away food from fast-food outlets and drop off to sleep-to be functional the next day. This is a story that I hear from couples regularly. Also a lot of educated women defer marriage till they can afford a maid, a driver, a three bedroom flat. By the time they reconcile to the thought of having a baby their biological clocks have already slowed down. Then they have to make a baby “happen.”

Though men can maintain their fertility to a ripe old age, women become less fertile the older they become. More women work than ever before and increasing numbers choose to delay starting a family until established in their careers. This makes fertility problems more likely and is thought to be a significant factor in the falling birth rate.

Q: Is IVF hard to go through?

A: Emotionally, yes. Since most patients think, this is the last option and if this fails, it is the end of their hope. Also, for many, it is financially taxing. The pain of injections during IVF stimulation and post embryo transfer is also high. However, if one is fully prepared for the process, then for many, IVF is a breeze. I have heard many patients saying that they did not know IVF was so simple and easy as they gone through here at MED AGE, since they read many misguiding stories on the internet.

Q: Is male infertility a serious threat?

A: It accounts for 30 per cent of all infertility, primarily due to sperm defects. Sometimes this is brought on by external factors like tight innerwear, very hot baths, smoking, exposure to radiation and toxic chemicals. Sometimes there’s a physiological basis-diabetes, hypothyroidism or genetic aberrations.

Sperm counts in the average male have fallen. Millions of healthy, active sperms are required in order for just one to penetrate into a woman’s egg. Many men have adequate sperm counts – but only just. Not only overall counts are going down but many men are producing large number of abnormal sperm. If current trends continue, many more men will find they are infertile.

Q What about infertility in women?

  1. Somehow, fertility issues are seen as a ‘woman’s problem’. Yet it takes two to make a baby. Female factors now account for 30percent of fertility problems – the same as male factors.In the remaining 40 percent of cases, the reason for the problem is either a combination of both or something which cannot be identified i.e ‘unexplained infertility’. I see many young women who show signs and symptoms of polycystic ovaries, a condition associated with metabolic disorders and obesity.Fromjob pressure to vehicular pollution, postponing parenthood to sexual liberation, fast food to sedentary lifestyle, all have been linked to infertility. Late marriages is one of the major problem here in our state. After 35, the chances of a woman to conceive fall at a dramatic rate. A woman’s fertility peaks between age 27 and 34. That’s the best time to have the first baby.

Q: What motivates you in this field?

A: The happiness, good wishes of all successful couples and the frustrations of all those who have not made it yet.

Q: What is good patient care?

A: Understanding the pain, clear communication, a good IVF lab and excellent clinical services.

Q: How do you address patient’s emotional needs?

A: Patient initial consultation where all issues are addressed. The team then takes over to comfort them through the journey. I am always there as I do all procedures myself including IVF, ICSI, TESA etc.

Q: Who is an ideal patient (Couple)? And an ideal infertility doctor?

A: An ideal patient (couple) has made up their mind. They understand the process and trust the doctor. They hope for the best but are prepared & ready for the worst. An ideal infertility doctor is well trained, has an excellent staff, has good communication skills and is overall a humane.

Q: How would you explain IVF to a layman? And what all is involved in it?

A: IVF means In Vitro Fertilization, meaning fertilization outside the body as opposed to In Vivo Fertilization which is fertilization inside the body, which happens normally. In this a woman is given hormonal injections (stimulation) for about 10 days from the second day to create many mature eggs as opposed to a single egg in a menstrual cycle. These eggs are collected with the help of an OPU needle. There is no pain and it is a day care procedure. The sperm of their partner are also collected on the same day and fertilization is done in the lab. The fertilized egg becomes an embryo which is the initial stage of the baby. The best embryos are transferred into the uterus 2-3 days after fertilization. There is then a 2 week wait when we come to know if the embryos have implanted or not and if the process has been successful.

Q: What are the first steps someone should take if they’re unable to conceive and do those steps differ based on a woman’s age?

A: Dealing with infertility is intimidating for many people. Less than 50 percent of couples who are referred to an infertility specialist end up making an appointment. They’re afraid their problem can’t be treated or that the cost will be too high. But the first step towards achieving a successful pregnancy is to have an evaluation by an experienced fertility specialist. The sooner you start this process, the better it is.

If you’re under 35 and have been trying to get pregnant for a year, you should ask your OB/GYN for a referral to a fertility specialist. For women who are older than 35, if you have not become pregnant within six months, you should see a fertility specialist. If you’re 40 or older, you should see a fertility specialist before trying to become pregnant and undergo tests that will help you and your physician to identify your chances of becoming the pregnant. A blood test known as the Anti-Mullerian Hormone test (AMH) can provide an estimate of how many eggs you have left. Because women over 40 only release a genetically balanced egg, one in every four cycles. It’s important to have a plan in place to achieve optimal timing for successful fertilization.

Q: What are the most current, effective treatment options for infertility?

A: Advances in medical treatments mean it is technically possible for many more couples with fertility problems than ever before to conceive a baby.

The best practice is to transfer a single or two embryos rather than multiple embryos, which was the common practice in the past. The technology for freezing embryos has also advanced significantly in the last two years and this allows us to let the woman’s uterine lining recover from the process of egg retrieval for a month before we transfer her embryos. This approach results in 15 to 20 percent higher pregnancy rates due to better implantation. In addition to IVF, we are doing ICSI here at MED AGE for the couples with severe male infertility issues.

Intracytoplasmic sperm injection (ICSI) is an assisted reproductive technology (ART) used to treat sperm-related infertility problems. ICSI is used to enhance the fertilization phase of in vitro fertilization (IVF) by injecting a single sperm into a mature egg. ICSI has been applied increasingly around the world to alleviate problems of severe male infertility in patients who either could not be assisted by conventional IVF procedures or could not be accepted for IVF because too few motile and morphologically normal sperm were present in the ejaculate of the male partner. If azoospermia because of block, we are going for TESA-ICSI (testicular sperm aspiration), which is performed by sticking a soft needle in the testis and aspirating fluid and tissue with negative pressure and then ICSI.

Q: What is your own wish and message to the society?

A: We at MED AGE believe in Compassion, Competence and Commitment for the social service. I personally don’t want to see our childless women feeling marginalized and stigmatized. Majority face discrimination, stigma & ostracism. Let’s try all with the grace of Almighty Allah to give every such lady one of her own.

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