JAMMU: In recent years, the impact of lifestyle choices on future fertility has become increasingly evident. The rise in Polycystic Ovary Syndrome (PCOD) among girls, attributed to lifestyle factors, has raised concerns about the long-term consequences. Experts have found that PCOD often originates from gut inflammation, highlighting the importance of maintaining a balanced and healthy home food environment.
Obesity has emerged as a major issue among adolescents, further exacerbating fertility concerns. The need to address this problem has become critical to ensure healthier reproductive outcomes. Interestingly, a growing number of male infertility cases have also been observed, a trend that was virtually nonexistent a decade or two ago. While the exact causes are still under study, potential factors such as excessive smoking, drug and alcohol use, prolonged mobile phone usage, and disrupted eating and sleeping patterns have come under scrutiny.
Healthcare professionals stress the significance of adopting a healthy and balanced lifestyle to mitigate fertility challenges. Patients facing recurrent in vitro fertilization (IVF) failures are encouraged not to lose hope, as success stories abound. The doctor-patient relationship plays a vital role in navigating this difficult path, as evidenced by instances where couples achieved the joy of parenthood after enduring seven to eight unsuccessful IVF attempts.
For those facing persistent difficulties, surrogacy has emerged as an alternative solution. However, it is essential to obtain proper permission from the government before pursuing this option. As the medical community continues to address these pressing fertility issues, the message remains clear: a healthy and holistic approach to life is pivotal in shaping future reproductive success.
In an exclusive online interview conducted by Ajmer Alam Wani, Editor-in-Chief of JK Monitor (www.jkmonitor.org) , leading IVF & Infertility Treatment Specialist and Gynaecologist, Dr. Sapna Khullar, sheds light on the pressing issues surrounding assisted reproductive technologies and shares her expert opinions. Dr. Khullar's extensive experience and expertise in the field of maternity make her a leading authority in Jammu's medical community. Here's a captivating summary of her insightful responses:
Q1. Can you tell us about your journey as an IVF and infertility treatment specialist? What motivated you to pursue this field of medicines?
Ans. I have been practicing for the last more than 30 years and I have seen a changing trend. Earlier we didn’t see so many infertility patients but for the last about 10 years, there has been a massive surge in number of infertile couples. This set me thinking as so many of our patients were going out to get treatment. So I started working on it and got trained as an infertility specialist. Now I am proud to say that our people from J&K need not to go out for this treatment as we have world class IVF centre with full facilities like ICSI, blastocyst transfer, egg freezing, embryo freezing, TESA available in Jammu.
Q2. What are some of the common misconceptions or myths surrounding IVF and infertility treatment that you often come across? How do you address them?
Ans. One common myth is that this is the last resort and we should wait till 15 years or so and if pregnancy doesn’t occur then IVF should be done. It is important to understand that there are some conditions like blocked tube, or severe PCOD, azoospermia (no sperms in seminal fluid) Endometriosis where IVF should be attempted as early as possible.
Another myth is that IVF is only done for female infertility. This is a treatment for male infertility also as by TESA we retrieve the sperms and then ICSI can be done.
Myth 3. These are not your own babies. This is wrong as in IVF we use the patient’s eggs and husband’s sperms and only fertilization is done outside the body and then fertilized embryos are transferred in the uterus.
Q3. In your experience, what are the key factors that contribute to successful IVF outcomes? Are there any specific advancement or techniques that have improved success rates?
Ans. Decision to do IVF should be done at the right age, as younger the couple better are the quality of eggs and sperms. With advanced techniques like ICSI, TESA, Embryo freezing, PGD which are readily available in Jammu at GREEN COURT IVF CENTRE, the success rates have improved.
Q4. As a leading expert in maternity care, what are some of the most significant challenges faced by women during their pregnancy journey, and how do you support them?
Ans. Pregnancy like they say is 2nd life for a woman. IVF pregnancies need special care and Green Court IVF Centre in Jammu takes pride in dealing with High Risk Pregnancies. As these patients are of advanced age, they can have associated medical disorders or hypertension in pregnancy etc and we not only do IVF but also do the ante natal, intra natal and post natal care. We have 24 hour emergency for our obstetric patients.
Q5. How do you approach individualized treatment plans for patients seeking IVF and infertility treatments? How do you access and address their unique needs and circumstances?
Ans. It is very important to take detailed history, investigation, USG and then classify patients as poor, normal or hyper responders and formulate treatment plans according to each patient. Treatments vary according to the age, cause of infertility and also in cases of recurrent failures.
Q6. Can you share any inspiring success stories of couples who have overcome infertility with the help of your expertise and treatments?
Ans. I can share numerous success stories, where we were able to bring smiles in the life of couples.
- One patient came with azoospermia (no sperm in semen) and wife had partial cervical atresia. We operated on wife and canalized the cervix, put in catheter for 3 months in the cervical canal. We did TESA on husband, retrieved sperms and after ICSI formed the embryos, which were then transferred. Patient conceived in first attempt.
- One patient came with 7 IVF failures and we were able to give her bundle of joy in the second attempt.
- We specialize in recurrent IVF failures and so many patients with previous 4-5 failures have conceived with our treatment.
There is no reason to feel disheartened and best treatment is available right in your city.
Q7. What role does psychological support play in the overall fertility treatment process? How do you ensure emotional well-being for your patients throughout their journey?
Ans. Psychological support is the most important part of the treatment as patients with years of infertility are anxious and stress decreases the success rate. So I do counseling personally and easy accessibility of doctor in case of emergency is ensured.
Q8. As an advocate for fertility preservation, what options are available for individuals or couples who wish to preserve their fertility for the future? How successful are these methods?
Ans. Now a days oocytes and semen freezing has become important part of backup treatment. Girls are getting married late or have endometriosis or any ovarian pathology or have to undertake chemo or radio therapy for any malignancy, so oocytes preservation facilities are available at our centre. Similarly before some chemo, radio therapy treatment, semen freezing is available at our centre.
Q9. Are there any lifestyle factors that can impact fertility? What advise do you offer to patients who are trying to optimize their chances of conception naturally?
Ans. Life style has a lot of impact on future fertility. We have increasing number of girls coming with PCOD, which is a life style disease. It starts from the inflammation of gut. So it is important to have balanced, healthy home food. Obesity is a major issue with adolescents today which should be taken care of. One alarming trend is increasing number of male infertility patients coming to us which was never there 10-15 years back. May be it is due to excess smoking, drugs, alcohol, use of mobile phones or altered eating and sleeping patterns, this is still being studied. We advise them to have healthy balanced lifestyle.
Q10. How do you stay updated with the latest advancements and research in the field of IVF and infertility treatment? How do you integrate new findings into your practice?
Ans. A doctor has to constantly remain updated. I regularly study minimum 3 hours per day and remain abreast with latest development anywhere in the world. I attend as many seminars as possible and attend international and national conferences. We invest a lot in equipments so that we are at par if not better than others.
Q11. What are the ethical considerations and challenges that you face as an IVF specialist> how do you ensure the best interest of your patients while adhering to ethical standards?
Ans. With the new ART bill all the ethical issues are beautifully addressed. We stick to the government guidelines regarding IVF centers.
Q12. Could you shed some light on the process of egg freezing and its potential benefits for women who may want to delay their pregnancy for personal or medical reasons/
Ans. Egg freezing is a very important component of ART clinics. Quality and quantity of oocytes, drastically falls between 35-40 years of age and after 40 if we are able to retrieve 10 oocytes, only 2 would be of good quality. These days as girls getting married late, so egg freezing should be recommended, also in patients of endometriosis or any malignancy before chemo therapy or radiation counselling for egg freezing should be done.
Q13 In your opinion, what sets your clinic apart from others in terms of the quality of care and patient experience? How do you ensure a positive and supportive environment for your patients?
Ans. In our clinic, we have world class lab and our treatment and protocols are world class. We keep ourselves abreast with all the latest developments in the field of ART and highest academic standards are maintained. Doctors are accessible and proper counselling is done.
Q.14. Can you discuss any ongoing research or innovative techniques that you are currently involved in or excited about in the field of fertility treatment?
Ans. Lots of research projects are going on.
- We are doing genetic studies on azoospermia patients.
- Genetic studies on PCOS patients.
- Role of probiotics in IVF and many more.
Q15. What advice would you give to the couples or individual who are considering IVF or fertility treatments but are unsure or hesitant about taking the next step?
Ans. First of all IVF is not a last resort. It is the first option in cases like blocked tubes, azoospermia, endometriosis and precious time should not be wasted in deciding the treatment. You don’t need a lot of rest, just strenuous work and excess physical exercise is to be avoided. In IVF, no surgical treatment is done, it is painless as ovum pickup and embryo transfer is done under short GA (General anaesthetic). We have an elaborate counseling session where all queries are answered patiently.
Q16. How do you manage the financial aspects of IVF and infertility treatments? Are there any options or programs available to make these treatments more accessible and affordable for patients?
Ans. Some insurance companies are coming up with reimbursements for treatment. We have different packages depending on the treatment that we give to patient. Patients can undergo treatment under installment package.
Q17. What are some of the potential risks and complications associated with IVF and fertility treatments? How do you minimize these risks and ensure the safety of your patients?
Ans. Like any other treatment, little risk can be there but if done with care and proper expertise there is nothing to fear. We take all precautions while treating patients and we have enough experience in dealing with any type of complications.
Q18. Can you explain the concept of Preimplantation Genetic Testing (PGT) and its significance in the IVF process? When it is recommended and how does it benefit patients?
Ans. PGT is an important procedure done in cases of recurrent implantation failure, when the women are of higher age, where aneuploidy is more common. In cases of parents with some genetic disorders or if in previous pregnancies babies have genetic disorders, PGT is strongly recommended.
Q19. What advice do you have for individuals or couples who have experienced multiple unsuccessful IVF cycles?
Ans. My advice for patients with recurrent IVF failures is that for some path is difficult but road is there to tread. They should not get disheartened as my personal experience is that everyone gets a baby if they don’t lose hope. It is team work between the doctor and patient. We have given their bundles of joys to the patients with 7-8 IVF failures. Alternative approach is surrogacy for which proper permission from government has to be taken.
Q20. How do you Involve and support the male partners in the fertility treatment process? What role does male fertility play in the overall success of IVF treatments?
Ans. Semen analysis is a very important part of investigation. We give anti-oxydents etc to the male partner so that sperm quality is good. In case of oligospermia (less sperm count) or azoospermia or if motility of sperms is not proper, IVF with ICSI and TESA is recommended.
Q21. Looking ahead, what do you see as the future of IVF and infertility treatment? Are there any emerging technologies or breakthroughs that you anticipate will transform the field?
Ans. Lot of research is going on. Focus is on increasing the success rate and finding out the right time of window of implantation. More research on studying the embryo quality like metablomics and proteomics are being studied. Instead of PGT, trying to study cell free DNA in culture media where blastocyst is cultured to study genetic defect in embryo. We would want to achieve 100% success rate so that no one lives in despair because everyone wants one of their own.