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Fertile hopes
in Kandy
Sub-fertility
is the inability to conceive after one year of unprotected intercourse
or the inability to carry a pregnancy to term. When a couple
initially experience difficulties in conceiving, concerns replace
anticipation and questions like what if they never have children,
could they be impotent etc, begin to haunt them. Many couples initially
deny the possibility of a problem. However once realization and
acceptance are reached that they may need medical treatment, they
experience an even more stressful, invasive and expensive period
in their lives. Because infertility
is such a personal and private issue many couples do not share this
experience with friends and family resulting in them suffering intensely
and feeling isolated.
In
Sri Lanka there are no support groups unlike in some countries and
it is a lonelier struggle within a traditionally critical society.
However there is some relief for persons having access to the Internet
where there are many informative websites on fertility problems,
latest medications, methods of treatment, even home remedies and
support groups. The greatest
news for these couples is the new breakthroughs in sub-fertility
treatments, which however require specialized lab tests, regular
monitoring and a specialised team of doctors working in hi-tech
medical environments. As such the
crucial decision is the choice of your doctor. A fertility specialist
is an obstetrician-gynaecologist with advanced education, research
and professional skills in reproductive endocrinology. However,
it is equally important that the doctor has adequate time to listen
to you, and explain to you his treatment plan. The doctor
must also be backed by a clinic with staff/technicians able to carry
out specialised tests. The clinic should be equipped with up-to-date
instruments like trans-vaginal ultrasound scanners. For eg. treatment
with clomid or injectable fertility medication requires routine
monitoring by this equipment. The clinic ideally should also provide
access to a specialised team of consultants such as reproductive
endocrinologists, embryologists, laparoscopic surgeons, reproductive
urologists etc. Therefore,
the success rate in sub-fertility treatment may vary depending on
a combination of factors including doctors' skills and experience,
up-to-date lab facilities and instruments and ultimately the cause
of infertility and the woman's age. Experts advise that one should
carefully assess any infertility treatment centre before undergoing
treatment. A new IVF (In
Vitro Fertilisation) laboratory complete with modern state of the
art facilities, as an expansion to the Ferticare Medical Centre
now offers hope to patients in Peradeniya. This is the brainchild
of Obstetrician-Gynaecologist Dr. Neil Senawiratne, conceived after
17 years of practice with special emphasis in advanced management
of sub-fertility in the UK and in the government and private sectors
of Sri Lanka. Dr. Senawiratne
is chairman of Ferticare Medical Centre, Peradeniya and Gynaecare
Medical Centre, Kurunegala. He was the first to introduce to Sri
Lanka in 1994, the trans vaginal ultrasound scan which can monitor
follicle development and assess the thickness of the lining and
abnormalities of the uterus, detect fibroids and ovarian cysts etc,
without invasive surgery. He was also the first to get down a complete
laparoscopic surgical unit including diagnostic and surgical ability
and since 1997 manages a gynaecological endoscopic unit in Kandy. Dr. N. Lekamge,
the coordinator of the team is an obstetrician-gynaecologist, endocrinologist
and pharmacologist. The Gujarat-born Dr. Himanshu Patel, is a consultant
embryologist to 15 hospitals across India. The team also
consists of a third obstetrician-gynaecologist, consultant anaesthetist,
consultant reproductive urologist, two other doctors who will act
as counsellors, and a qualified laboratory technician. Both Dr. Senawiratne
and Dr. Lekamge trained under Professor Mahasara Gunaratne who set
up the first infertility clinic in Peradeniya 30 years ago. Commenting
on Intra Uterine Insemination (IUI) performed with unprepared sperm
by some doctors today, Dr. Senawiratne said that this dangerous
procedure, banned in developed countries, may cause infections and
subsequent infertility due to tubal blocks. There are even a few
reported cases of anaphylaxis, he said. He said that
another harmful treatment still carried out by some doctors is the
outdated ovarian wedge resection which leads to adhesions around
the ovaries resulting in subsequent sub-fertility. Ferticare is
dedicated to the introduction of new concepts like fertility fitness.
According to Dr. Lekamge, this concept much in vogue in UK and Australia
is new to Sri Lanka and involves pre-conception counselling where
an assessment on fertility could be made advising the couple whether
conception should/should not be postponed. Advice is also given
on the use of contraceptives, folic acid supplements, diabetes,
epilepsy etc. and weight loss programmes in view of conception.
According to Dr. Lekamge many sub-fertility problems today can be
treated beneficially by hi-tech treatment procedures known as Assisted
Reproductive Techniques like IVF. However, Dr. Senawiratne stressed
that IVF is never the first step in the treatment of infertility
but reserved for cases where other methods like fertility drugs,
surgery and IUIs have not resulted in pregnancy. The new centre
has a modern theatre, ICSI machine by which a single sperm is injected
into an egg to increase the chance of fertilization and thus develop
an embryo in keeping with the IVF procedure. (This infinitesimal
procedure involves the egg being held by a pipette which is 20 times
thinner than a human hair and sperm injected to by a pipette which
is 60 times thinner than a human hair. The egg itself is no bigger
than the tip of a pen.), facilities for freezing embryos and sperm
(sperm bank), Lamina floors, carbon dioxide incubators etc. The key criteria
is the maintenance of a germ-free environment giving maximum support
for the handling of eggs and sperm, said Dr. Lekamge. However the
staggering cost of an IVF sadly restricts the number of couples
who could afford it. Dr. Lekamge sets it out as an approximate Rs.
300,000 for one cycle while explaining that 80% of the cost is on
instruments, culture media and drugs. However subsequent implantation
by frozen embryos may drastically reduce the cost. How effective
is such procedure? Dr. Senawiratne said the cumulative pregnancy
rate is higher with fresh eggs. The prohibitive cost of IVF treatment
makes one wonder why the government cannot assist as in the case
of other organ transplants. |
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