Sharmila* and her husband Ashok* visited Dr. Aindri Sanyal at Nova IVF Fertility, Kolkata in 2015. The couple had been trying to get pregnant for a while, but all the efforts were in vain because theirs was an intriguing case of subfertility in which both the husband and wife had fertility issues.
Subfertility Vs. Infertility: What’s the difference?
Though the terms and symptoms of subfertility and infertility are used interchangeably, they both are different. Subfertility is termed as a delay in conceiving, while infertility is the inability to conceive naturally despite the continuous and prolonged efforts of a couple. A couple battling subfertility has the possibility to conceive naturally, though it might take longer than average. But in the case of infertility, conception without medical intervention is unlikely.
What are the Major Causes of Subfertility?
The majority of the factors that lead to subfertility are same as that of infertility—it could be because of a fertility issue in either of the partners or both. Sometimes the cause could even be unknown. Here’s a list of some of the major causes of subfertility:
- Ovulation Dysfunction: Disrupted/irregular ovulation is one of the most common setbacks faced by women with subfertility. When ovulation does not occur regularly, the egg will not be released from the ovaries for fertilization. The major ovulation issues include Polycystic Ovary Syndrome (PCOS), diminished ovarian reserve, premature ovarian insufficiency and certain hormonal conditions like hypothalamus or a faulty pituitary gland.
- Fallopian Tube Blockage: Adhesions or blocks in the fallopian tubes could prevent the egg from meeting the sperm. This could happen due to endometriosis, medical history of gonorrhoea or chlamydia, pelvic inflammatory disease or scar tissue from a previous surgery (for ectopic pregnancy).
- Uterine Issues: Uterine abnormalities or defects could have a significant effect on a woman’s ability to conceive. Some of these issues include fibroids (abnormal growth in the uterus), septate uterus (when a band of tissue divides the uterus into two sections), double uterus (when the uterus has two small cavities and respective openings) and bicornuate uterus (when the uterus has two cavities and resembles the shape of a heart).
- Issues with Sperm: Problems with the sperm quantity, quality or motility are the most common subfertility factors in men. This could be caused by numerous conditions including genetic defects, gonorrhoea, chlamydia, HIV, diabetes, mumps, cancer or cancer treatment, enlarged veins in the testes (varicocele) etc.
- Issues with Sperm Delivery: How the sperm is delivered matters. Some men may face problems with sperm delivery due to premature ejaculation, genetic conditions, prior injury/damage to the tester or structural defects like blockages in the testicles.
The Nova Way: Lifestyle Changes and In-vitro Fertilization
After the initial screening and in-depth analysis of the couple’s medical history, Dr. Aindri diagnosed that Sharmila’s ovarian reserve was severely diminished and Ashok’s sperm had serious defects. She certainly had a challenge ahead of her but was confident that she could help the couple achieve their dream of parenthood.
Given Sharmila’s diminished ovarian reserve, the couple was counselled to opt for IVF, and since they were determined to have their own biological child, they had to undergo some lifestyle changes to prep for the procedure and to restore Ashok’s sperm quality.
- Diminished Ovarian Reserve: Ovarian reserve refers to a woman’s fertility potential based on the number of eggs remaining in her ovaries. A woman is born with her entire life supply of eggs, which then continues to diminish with each menstrual cycle until she finally hits menopause. Lower the ovarian reserve, lesser a woman’s chances of conceiving successfully. A low ovarian reserve is also linked to a higher risk of miscarriages when trying to conceive via IVF with one’s own eggs, owing to their poor quality.
- Sperm Defects and Restoration: Problems with sperm health is closely linked to recurrent miscarriages, which is why men are advised to adopt certain lifestyle changes at least 4 months prior to any ART procedure that requires their own sperm. Avoiding tobacco, alcohol and excessive heat, maintaining optimal body weight, exercising regularly and following a balanced diet can help produce better quality sperm within 4-5 months.
A Turbulent Fertility Journey
Once Sharmila and Ashok were deemed fit mentally and physically, they decided to go ahead with IVF—a procedure that retrieves a woman’s mature eggs and a man’s healthy sperm and combines them in a lab for fertilization. Once the gametes fertilize, they form embryos, which are then transferred to the woman’s uterus. IVF can be performed with the couple’s own gametes (self-cycle IVF) or with donor gametes/embryos (donor cycle IVF).
- The First Attempt: The procedure went smoothly and the Sharmila conceived in the very first attempt. Unfortunately, she miscarried before 12 weeks due to certain genetic defects in the fetus.
- The Second Attempt: Though their hopes were shattered the first time, they pulled themselves together for another attempt at parenthood. Much to their disappointment, the second cycle too ended up a failure.
- The Final Attempt: The couple refused to give up despite the initial roadblocks, no matter how drastic they were. Determined to have a baby without having to opt for donor gametes, they decided to give IVF one last shot. Much to their joy, science and luck were on their side this time.
Persistence Pays, So Does Patience
The couple was in seventh heaven when they finally received the joyous news of a positive pregnancy result. The pregnancy progressed uneventfully and the couple was blessed with an adorable baby girl, whom they named “Aindri” in honour of Dr. Aindri, who helped bring her into this world.
Baby Aindri is the living proof that “When you want something; all the universe conspires in helping you achieve it”.
The journey towards parenthood may not be an easy one, but the destination makes everything worth it. Every hurdle you dodged, all the pain you suffered, each tear you shed will melt away when you lay eyes on the little bundle of joy you gave life to.
So, don’t give up yet.
*Names have been altered to protect the identity of the couple.