We are all aware of the aunty to be avoided at any gathering because the only thing on her mind is: “When are you getting married?” Following your (apparently long-awaited) marriage, the question changes to: “When are we going to see your babies?”
The situation of one being unable to have a child within what is considered a socially approved timeline following marriage, raises eyebrows, and earns hushed conversations. So often you hear people whisper “oh, I heard that he/she is barren” with no regard for what men and women experiencing infertility are going through.
Infertility is a perceived taboo in society. Every moment is a rollercoaster ride of emotions, and hormones, all compounded by the stigma associated with being infertile or seeking fertility treatment. There are so many questions. What is fertility treatment really like? How can infertility happen? Brunch spoke to two individuals to find out more.
[caption id="attachment_148779" align="alignright" width="240"]
"I’ve been told to not complain and that everybody is going through this, and were able to have children after 10 years. You don’t understand the gravity of that comment on somebody going through fertility treatment. People don’t want to understand what I’m saying. They would rather not talk about it, or undermine it" Chathri Sahabandu[/caption]
‘I didn’t know about PCOS until I was diagnosed’
Advocate for infertility Chathri Sahabandu (@waitingforthat_unicorn on Instagram) spoke about her ongoing struggle with PCOS (polycystic ovary syndrome) and fertility treatment.
“We’ve been on this journey for two-and-a-half years now. I use Instagram a lot and once I started fertility treatment, I wanted to see if there were others experiencing the same thing, or any resources I could use, and there was nothing. However, seeing that people in other countries were vocal about infertility, and me being somebody who is very vocal, I decided to start my Instagram account as an advocate for infertility. While my partner, parents, and a couple of close friends are very supportive of me, most friends and relatives would prefer to not discuss infertility. Sometimes, people suggest methods of ‘solving’ infertility. But most of the time, what I want is just to be heard and understood. We should not feel ashamed of infertility. It is just a condition like any other health issue, and you don’t ask for it. We also have a lack of education on infertility that needs to be addressed.”
“I didn’t know about PCOS until I was diagnosed, following eight months of unsuccessfully trying to conceive. I felt something was wrong, and went with my partner to get tested. The doctor then asked me to wait for one year, as that is the defined timeline, but I decided to talk to another professional a month later. On the first consultation, this doctor performed a transvaginal scan and informed me of my PCOS. He immediately ran blood tests and put me on medication. I am glad that I got my diagnosis, but the process remains stressful. You are always on medication that sends your hormones into disarray causing mood swings, anger, and irritability. You feel sick and nauseous. Having to monitor my cycle, having specific dates for intercourse, having to run to the doctor’s when they suddenly call you to come in, all add to the exhaustion.
“I did eight medicated cycles for IUI (intrauterine insemination) and none worked. I have never seen a positive pregnancy result. Due to PCOS, I’m unable to produce mature eggs without medication. To determine what was happening in my body, I underwent two surgeries, after each of which I was told that nothing was wrong apart from the PCOS. My husband got tested too and he is perfectly fine. It’s just me.
“Running out of options, we decided to try IVF (in vitro fertilisation) last year, in April. All the tests came out normal, save for that my prolactin (hormone) levels were high. I was referred to an endocrinologist who did a brain MRI which indicated a microadenoma. After two months of medication, my prolactin levels settled and I started IVF. I developed Ovarian Hyperstimulation Syndrome (OHSS) which only 1% of those trying IVF develop. I was hospitalised for four days. I could not walk, had difficulty breathing and my body was filled with fluid, making me look like I was five to six months pregnant. However, luckily, we ended up with three embryos from the IVF, even though they retrieved 20 eggs from me. A lot of my embryo transfers got cancelled because my uterine lining was not thick enough, despite the fact that I was on the highest dosage of medication. Finally, the doctor decided that we do the transfer anyway, as there were no options. In February this year, I did my last transfer – which did not take. I lost two embryos out of the three extracted. I am now on a break because I was not in a good place and as I’m off the medications, I feel good.”
‘Treatment does not abruptly begin with IVF’
Dr. Aysha Ziauddin (BMedSci [Hons], MBBS, MRCOG MRCGP), shared her insight about infertility and fertility treatment. Below are excerpts of her conversation with Brunch.
[caption id="attachment_148778" align="alignleft" width="245"]
"The process is physically and emotionally draining. There is both physical and emotional pain, and possibly hours of interviews, discussions, and so on. In addition, words like “barren” or “sterile” that are used in Sri Lanka especially, can have a substantially negative impact on mental health" Dr. Aysha Ziauddin[/caption]
Is any preconception care required?
Both partners should be of healthy weight and stop smoking, consuming recreational drugs, and bodybuilding steroids. If you have a medical condition, speak to your doctor before you start planning for a baby. You may need to discontinue some of these medications while you may have to start others. For instance, if you have diabetes, you may require a higher dose of folic acid than others. Men should also stop cycling long distances, avoid keeping the laptop on their lap, and refrain from wearing extremely tight underwear. Especially for Sri Lankan women, vitamin D supplements and folic acid are important. These can be obtained from a pharmacy, but if you do have a medical condition or a history of babies with spina bifida (a spinal condition apparent at birth, where the neural tube does not fully close) in the family, please speak to your doctor.
What factors can cause infertility in men?
You need healthy sperm which has the correct shape, size, and sperm count. If the individual had mumps as a child, or has a hormonal issue, sperm count could be lowered. Some men also have an unfortunate condition where their body attacks their sperm. Certain chemotherapy drugs can affect the functionality of sperm. Some men can have issues with genitalia at birth like testicles not descending properly. Having swollen blood vessels in the scrotum, or blockages in the tube that allows sperm to travel to the penis, or retrograde ejaculation, where the sperm ejaculates into the bladder through the penis, are other complications.
What factors can cause infertility in women?
Women can have issues in producing and releasing a healthy egg (ovulation). PCOS is the most common issue in ovulation. Hormonal issues in the brain that regulate ovulation, premature ovarian failure where women experience menopause in their 20s and 30s, and endometriosis are also problems. The fallopian tubes need to be healthy for the egg to travel. Tubes can be impacted by previous surgery, chlamydia, TB (tuberculosis), or endometriosis. Polyps in the womb and changes in the shape of the womb (for example, having a heart-shaped womb) can also make conception challenging. Generally, the quality of eggs will decline after the age of 35.
When should one seek help?
If you are a woman under 35 and you have been trying to conceive for one year with no success, seek help. If you are a woman over 35 years and you have been trying for six months with no success, seek help. A former diagnosis of PCOS also warrants medical help after six months of trying to conceive. It is important to know that one-third of all infertility has no clear cause, which is a significant number.
What investigations are required before determining fertility treatment?
It is imperative that both partners get tested. For men, the simplest test would be a semen analysis, where you will be given instructions on how to obtain a semen sample. These instructions must be followed. For women, blood tests are conducted to determine the level of hormones, and to determine the quality of eggs (some Sri Lankan fertility units offer this test). The fallopian tubes are tested through an HSG (hysterosalpingography), allowing doctors to see if the tubes are open. Some doctors, for medical reasons, may decide that you need a laparoscopy and a dye test instead of an HSG.
What options are available for men and women experiencing infertility?
Treatment does not abruptly begin with IVF. There is a treatment algorithm that doctors follow such as prescribing drugs that can induce ovulation in women, or correcting any issues in tubes for both men and women. In IVF, the sperm and the eggs are put together outside the body, with hope that they would fertilise and become a pregnancy. The process will vary from centre to centre. In general, they would follow one of two methods; the natural cycle IVF or an induced cycle IVF. In the latter, the woman will be injected medication to stop natural hormones, followed by hormone injections that induce egg production. After scans have been conducted to ascertain egg production, the eggs will be removed from the women through the vagina, under sedation. The eggs will then be put together with the sperm. If the fertilisation process is successful, it will be placed back in the womb of the woman, after which, the couple has to wait for two weeks to see if the pregnancy is successful.
In IUI, the sperm is placed into the woman's uterus to facilitate fertilisation. Here, either the woman will be allowed to have their usual menstrual cycle, or be administered medication that induces ovulation.
How does fertility treatment impact mental health in your opinion?
According to research material I have read, the worldwide success rate for IVF is 30% (Gleicher,N., et al., 2019)*, while some Sri Lankan centres have recorded higher success rates. IVF is also very expensive and I am aware of couples who have either sold or mortgaged what they have, in order to fund it. The process is physically and emotionally draining. There is both physical and emotional pain, and possibly hours of interviews, discussions, and so on. In addition, words like “barren” or “sterile” that are used in Sri Lanka especially, can have a substantially negative impact on mental health. I would suggest open communication with your partner, loved ones, work, and other relevant parties before you start treatment. The fluctuation of hormones can cause you to feel angry, moody, frustrated, and so on, and establishing clear communication and a strong support system is vital. Having coping mechanisms in place such as meditation, yoga, and a healthy lifestyle before starting fertility treatment can be helpful.
Infertility does not discriminate. Society does. Learning that your body may not be fully capable of the conceiving process on its own is challenging enough, without the added weight of stigmatisation and social and cultural expectations. For the men and women whose reality is a relentless cycle of medications and tests, an understanding and respectful support system can bring immeasurable relief.
We don’t have to have answers to their problems. Sometimes, all it takes is sitting in silence while they express themselves. All it takes is listening to their unsung lullaby.
*Gleicher,N., et al., (2019). Worldwide decline of IVF birth rates and its probable causes. Human Reproduction Open. doi: 10.1093/hropen/hoz017
Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6686986/
"I’ve been told to not complain and that everybody is going through this, and were able to have children after 10 years. You don’t understand the gravity of that comment on somebody going through fertility treatment. People don’t want to understand what I’m saying. They would rather not talk about it, or undermine it" Chathri Sahabandu[/caption]
‘I didn’t know about PCOS until I was diagnosed’
Advocate for infertility Chathri Sahabandu (@waitingforthat_unicorn on Instagram) spoke about her ongoing struggle with PCOS (polycystic ovary syndrome) and fertility treatment.
“We’ve been on this journey for two-and-a-half years now. I use Instagram a lot and once I started fertility treatment, I wanted to see if there were others experiencing the same thing, or any resources I could use, and there was nothing. However, seeing that people in other countries were vocal about infertility, and me being somebody who is very vocal, I decided to start my Instagram account as an advocate for infertility. While my partner, parents, and a couple of close friends are very supportive of me, most friends and relatives would prefer to not discuss infertility. Sometimes, people suggest methods of ‘solving’ infertility. But most of the time, what I want is just to be heard and understood. We should not feel ashamed of infertility. It is just a condition like any other health issue, and you don’t ask for it. We also have a lack of education on infertility that needs to be addressed.”
“I didn’t know about PCOS until I was diagnosed, following eight months of unsuccessfully trying to conceive. I felt something was wrong, and went with my partner to get tested. The doctor then asked me to wait for one year, as that is the defined timeline, but I decided to talk to another professional a month later. On the first consultation, this doctor performed a transvaginal scan and informed me of my PCOS. He immediately ran blood tests and put me on medication. I am glad that I got my diagnosis, but the process remains stressful. You are always on medication that sends your hormones into disarray causing mood swings, anger, and irritability. You feel sick and nauseous. Having to monitor my cycle, having specific dates for intercourse, having to run to the doctor’s when they suddenly call you to come in, all add to the exhaustion.
“I did eight medicated cycles for IUI (intrauterine insemination) and none worked. I have never seen a positive pregnancy result. Due to PCOS, I’m unable to produce mature eggs without medication. To determine what was happening in my body, I underwent two surgeries, after each of which I was told that nothing was wrong apart from the PCOS. My husband got tested too and he is perfectly fine. It’s just me.
“Running out of options, we decided to try IVF (in vitro fertilisation) last year, in April. All the tests came out normal, save for that my prolactin (hormone) levels were high. I was referred to an endocrinologist who did a brain MRI which indicated a microadenoma. After two months of medication, my prolactin levels settled and I started IVF. I developed Ovarian Hyperstimulation Syndrome (OHSS) which only 1% of those trying IVF develop. I was hospitalised for four days. I could not walk, had difficulty breathing and my body was filled with fluid, making me look like I was five to six months pregnant. However, luckily, we ended up with three embryos from the IVF, even though they retrieved 20 eggs from me. A lot of my embryo transfers got cancelled because my uterine lining was not thick enough, despite the fact that I was on the highest dosage of medication. Finally, the doctor decided that we do the transfer anyway, as there were no options. In February this year, I did my last transfer – which did not take. I lost two embryos out of the three extracted. I am now on a break because I was not in a good place and as I’m off the medications, I feel good.”
‘Treatment does not abruptly begin with IVF’
Dr. Aysha Ziauddin (BMedSci [Hons], MBBS, MRCOG MRCGP), shared her insight about infertility and fertility treatment. Below are excerpts of her conversation with Brunch.
[caption id="attachment_148778" align="alignleft" width="245"] "The process is physically and emotionally draining. There is both physical and emotional pain, and possibly hours of interviews, discussions, and so on. In addition, words like “barren” or “sterile” that are used in Sri Lanka especially, can have a substantially negative impact on mental health" Dr. Aysha Ziauddin[/caption]
Is any preconception care required?
Both partners should be of healthy weight and stop smoking, consuming recreational drugs, and bodybuilding steroids. If you have a medical condition, speak to your doctor before you start planning for a baby. You may need to discontinue some of these medications while you may have to start others. For instance, if you have diabetes, you may require a higher dose of folic acid than others. Men should also stop cycling long distances, avoid keeping the laptop on their lap, and refrain from wearing extremely tight underwear. Especially for Sri Lankan women, vitamin D supplements and folic acid are important. These can be obtained from a pharmacy, but if you do have a medical condition or a history of babies with spina bifida (a spinal condition apparent at birth, where the neural tube does not fully close) in the family, please speak to your doctor.
What factors can cause infertility in men?
You need healthy sperm which has the correct shape, size, and sperm count. If the individual had mumps as a child, or has a hormonal issue, sperm count could be lowered. Some men also have an unfortunate condition where their body attacks their sperm. Certain chemotherapy drugs can affect the functionality of sperm. Some men can have issues with genitalia at birth like testicles not descending properly. Having swollen blood vessels in the scrotum, or blockages in the tube that allows sperm to travel to the penis, or retrograde ejaculation, where the sperm ejaculates into the bladder through the penis, are other complications.
What factors can cause infertility in women?
Women can have issues in producing and releasing a healthy egg (ovulation). PCOS is the most common issue in ovulation. Hormonal issues in the brain that regulate ovulation, premature ovarian failure where women experience menopause in their 20s and 30s, and endometriosis are also problems. The fallopian tubes need to be healthy for the egg to travel. Tubes can be impacted by previous surgery, chlamydia, TB (tuberculosis), or endometriosis. Polyps in the womb and changes in the shape of the womb (for example, having a heart-shaped womb) can also make conception challenging. Generally, the quality of eggs will decline after the age of 35.
When should one seek help?
If you are a woman under 35 and you have been trying to conceive for one year with no success, seek help. If you are a woman over 35 years and you have been trying for six months with no success, seek help. A former diagnosis of PCOS also warrants medical help after six months of trying to conceive. It is important to know that one-third of all infertility has no clear cause, which is a significant number.
What investigations are required before determining fertility treatment?
It is imperative that both partners get tested. For men, the simplest test would be a semen analysis, where you will be given instructions on how to obtain a semen sample. These instructions must be followed. For women, blood tests are conducted to determine the level of hormones, and to determine the quality of eggs (some Sri Lankan fertility units offer this test). The fallopian tubes are tested through an HSG (hysterosalpingography), allowing doctors to see if the tubes are open. Some doctors, for medical reasons, may decide that you need a laparoscopy and a dye test instead of an HSG.
What options are available for men and women experiencing infertility?
Treatment does not abruptly begin with IVF. There is a treatment algorithm that doctors follow such as prescribing drugs that can induce ovulation in women, or correcting any issues in tubes for both men and women. In IVF, the sperm and the eggs are put together outside the body, with hope that they would fertilise and become a pregnancy. The process will vary from centre to centre. In general, they would follow one of two methods; the natural cycle IVF or an induced cycle IVF. In the latter, the woman will be injected medication to stop natural hormones, followed by hormone injections that induce egg production. After scans have been conducted to ascertain egg production, the eggs will be removed from the women through the vagina, under sedation. The eggs will then be put together with the sperm. If the fertilisation process is successful, it will be placed back in the womb of the woman, after which, the couple has to wait for two weeks to see if the pregnancy is successful.
In IUI, the sperm is placed into the woman's uterus to facilitate fertilisation. Here, either the woman will be allowed to have their usual menstrual cycle, or be administered medication that induces ovulation.
How does fertility treatment impact mental health in your opinion?
According to research material I have read, the worldwide success rate for IVF is 30% (Gleicher,N., et al., 2019)*, while some Sri Lankan centres have recorded higher success rates. IVF is also very expensive and I am aware of couples who have either sold or mortgaged what they have, in order to fund it. The process is physically and emotionally draining. There is both physical and emotional pain, and possibly hours of interviews, discussions, and so on. In addition, words like “barren” or “sterile” that are used in Sri Lanka especially, can have a substantially negative impact on mental health. I would suggest open communication with your partner, loved ones, work, and other relevant parties before you start treatment. The fluctuation of hormones can cause you to feel angry, moody, frustrated, and so on, and establishing clear communication and a strong support system is vital. Having coping mechanisms in place such as meditation, yoga, and a healthy lifestyle before starting fertility treatment can be helpful.
Infertility does not discriminate. Society does. Learning that your body may not be fully capable of the conceiving process on its own is challenging enough, without the added weight of stigmatisation and social and cultural expectations. For the men and women whose reality is a relentless cycle of medications and tests, an understanding and respectful support system can bring immeasurable relief.
We don’t have to have answers to their problems. Sometimes, all it takes is sitting in silence while they express themselves. All it takes is listening to their unsung lullaby.
*Gleicher,N., et al., (2019). Worldwide decline of IVF birth rates and its probable causes. Human Reproduction Open. doi: 10.1093/hropen/hoz017
Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6686986/