"Congratulations!" I beamed as I handed over a wriggling bundle
into the waiting arms of an anxious dad outside the labour room. "You're
now the father of a beautiful baby girl!"
His
eyes glistened with tears as he took her in his arms for the first time
ever. His face softened with an unmatched expression. The cluster of
relatives standing around him clapped him on the shoulders and
celebrated. Photographs were clicked, hugs exchanged, tears of joy wiped
off!
I slowly retreated back into the
surgeons' room, watching them from a distance. These are the moments
that make me realise how much I love my job! As I revelled in the warmth
spreading across my heart, my thoughts went back to the day when they'd
first met me.
It was a winter evening, when a frustrated couple had landed up in my OPD with four fat files worth of reports.
I'd
spent a great deal of time questioning them about the treatment
hitherto undertaken, and going through all the files. It had been over
five years that they'd run from pillar to post, trying to conceive. The
husband had been told that he had no sperms in his semen, and the only
way to attempt fatherhood was to surgically extract sperms from his
testicles and undergo a test- tube baby procedure. They'd already
undergone one cycle of the same unsuccessfully. The number and quality
of sperms retrieved during the same was dismal. 'Non- obstructive
azoospermia'- the report read. They had been suggested to opt for an IVF
procedure with donor sperms, for which they weren't really keen.
However,
something didn't feel right. I read and re- read their reports. His
hormonal values, and the semen parameters didn't correlate, especially
not with the history he'd given. I shook my head, "No. It doesn't add
up. I need you to do one thing for me. Can you get a semen analysis
repeated?" He looked at me in disbelief. Several senior fertility
specialists had given their verdict. Why was I going back to square one?
"Madam, but my reports..."
"I do agree, but
I don't think that with a normal testosterone and FSH, you would be
having non- obstructive azoospermia as this report mentions. That means
that your body is producing sperms normally. They're either unable to be
seen in the semen because of a blocked passage, or the hormone report
is wrong! My treatment would depend on the exact diagnosis."
They didn't look very convinced, but decided to go ahead with the test just to humour me.
A
few weeks later, he came back with the reports. "You were right, madam!
My semen does have sperms!" However, the number and quality of the
sperms wasn't upto the mark.
"This isn't as bad as we
expected," I counselled them. "It definitely is possible to try to
conceive, but we'll have to go for a specialised test- tube baby
procedure. It's called IMSI." I explained to them in detail about what
exactly they would be undergoing, the costs involved and the timeline.
The technology of 'IMSI' or 'Intracytoplasmic Morphologically selected
Sperm Injection' is one where the semen collected from the male is
scanned under several thousand times the magnification. It helps to
select the structurally best sperm, which is then injected into the egg
through a micro- needle to aid fertilization.
In the meantime, we worked on
evaluating the wife as well. The previous IVF cycle hadn't yielded a
promising number of eggs, so I was keen on knowing if she had a poor
ovarian reserve. Hormonal tests and an ultrasound revealed that she
didn't. We embarked on the test tube baby procedure. Even despite daily
injections and ultrasounds, they managed to keep their spirits up. The
entire family was highly anxious about this process. "Do whatever you
can- we trust your judgment. But we're banking on you," a senior doctor
in the family told me over the phone. The pressure on me was certainly
high, but fertility treatment is way more than just jotting down
prescriptions and giving instructions... There's a great deal of
emotional involvement- not just of the couple, but of the entire family-
which ultimately also rubs off on the doctor! It's tough to not want to
do your best, despite the obvious fact that no matter how advanced a
treatment modality you choose, there still are a great number of factors
that are beyond the control of both the doctor and the patient- and it
is these factors that ultimately determine the results!
We
managed to retrieve a good number of eggs. Our expert embryology team
also created excellent embryos, despite the poor quality of sperms.
However, the day prior to transfer of the embryos back inside her
uterus, I had a word with the embryologist. We realised that the shell
covering the embryo was too thick. We explained this to the couple and
with their consent, went ahead with a 'laser assisted hatching'
technique. In simple words, we used a laser beam to partially weaken the
tough shell, so that the embryo could implant easily. The procedure
went smoothly.
As
I explained the medications to her, I looked into their anxious eyes.
Even though my mind knew the 40- 50% chances of this being successful, I
couldn't help but cross my fingers and hope for the best!
The
day of the blood test dawned. The husband was waiting with the report
in his hands, tensely shifting from foot to foot, not knowing what to
decipher out of the numbers on the paper. He handed it over to me. I saw
the values and my heart gave a leap! She was pregnant!
The entire family thanked me profusely!
But the job was yet half- done.. we still had the entire pregnancy to go through!
She
was doubly careful, checked and cross- checked all medicines, followed
my instructions to the letter. The entire family would turn up at each
follow- up visit to the clinic, closely monitoring all milestones.
Through
the rigmarole of check- ups, sonographies and blood tests, she managed
to enjoy a healthy pregnancy and deliver normally.
After all, the value of something you've striven so hard to achieve is obviously, priceless!
The writer is a dynamic Obstetrician, Gynaecologist and Infertility specialist practicing in Pune.
