The Science behind the Magic

"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.