According to medical professionals, understanding the problem of infertility is the first step towards solving it.
An estimated one out of six couples wanting a baby encounter problems related to infertility, a condition which afflicts couples all over the world. While treatment is possible in most cases, the situation can be exacerbated owing to the lack of awareness and understanding, particularly in developing countries such as Nepal.
In 1985, a couple was frustrated at their repeated but failed attempts at conception, despite visiting many doctors and clinics. At that time, the inability to conceive after just a few years of marriage was seen as a ‘curse’. The couple finally met Dr Bhola Rijal who checked them and found problems in the wife’s fallopian tube. She was able to conceive her first child after Dr Rijal operated on her fallopian tube.
“Cases of infertility have been increasing in recent years. In most cases, treatment is possible but the problem in Nepal is that people always blame the female for not having kids and think it is ‘God’s curse’,” says Dr Rijal, a senior gynecologist and In-vitro Fertilisation (IVF) specialist at NMC Hospital and HAMS Hospital.
According to Dr Rijal, people use the word ‘infertile’ incorrectly in Nepal. “Infertile are those who cannot have babies. There are several treatments for infertility,” he said, adding that couples who are unable to conceive for a year even when they are not using any contraceptives are considered sub-fertile.
“In the context of Nepal, around 80 percent of the sub-fertile cases can have babies after normal treatment. The remaining cases, too, may be treated with technologies like IVF, Intrauterine insemination (IUI), among others,” says Dr Rijal.
Similarly, a couple was unable to conceive for around 15 years before consulting Dr Achala Vaidya. Dr Vaidya, who is currently the head of the Department of Obstetrics and Gynecology at Norvic International Hospital, remembers that the couple had tried IVF and IUI technologies several times, but had failed to conceive. It is risky for a woman to try IUI technology for more than five times, but the couple had tried the technology for more than 30 times in the hope of having a baby. After some simple tests, Dr Vaidya found that the woman was suffering from tuberculosis of the uterus. After taking medicines for almost nine months, the couple was able to conceive. In this particular case, an incorrect diagnosis was the reason behind the couple’s woes.
“The diagnosis of infertility has been commercialised since a long time in Nepal, and the main reason behind this is the lack of awareness,” Dr Vaidya said.
Couples unable to conceive even after other normal treatment can opt for IVF or IUI technologies. According to Dr Rijal, the number of couples unable to have babies has been increasing since the past decade. “As the number of people migrating to foreign countries is massive, couples are separated for a long period. The migrants come to Nepal for a short stay, and it is tough for the wife to conceive in that short period,” he shares.
Dr Rijal’s advice to couples having a problem conceiving is to go to the doctor and seek treatment. The IVF technology is expensive; it costs up to Rs 400,000. Meanwhile, the IUI technology also costs almost Rs 10,000. “Most infertility cases in Nepal can be treated after simple tests,” Dr Vaidya says.
Around seven couples visit Dr Vaidya every day for infertility. Among them, four can be cured after normal treatment, she says.
Dr Rijal says the government since long has focused on family planning but has been reluctant to support couples having problems conceiving. He believes the government, insurance companies, pharmaceutical companies, and hospitals should work together to provide services like IVF and IUI to the public, which will reduce the cost burden.
The IVF technology is a technology in which the egg is fertilised by a sperm in a tube and then it is transferred into the uterus for the development of the baby. The technology is a blessing for females with a blocked or damaged fallopian tube, and males having ejaculatory problems and low sperm count. The success rate of the IVF technology in Nepal is about 30 to 40 percent.
Likewise, IUI is the technology in which the sperm is transferred to the fallopian tubes of women after several treatment and tests. This technology is helpful for males having a lower sperm count and ejaculatory problems. The technology is quite cheaper than the IVF technology. The technology has a success rate of almost 20 percent in Nepal.
“Nepal is still a patriarchal society where females are mostly blamed for the couple’s inability to have kids. Often the husband marries again blaming the wife, but the problem might be with the husband as well,” he says, adding that there are almost 10-12 hospitals in the country that have been providing IVF services. Paropakar Maternity and Women's Hospital is the only government hospital to provide the IVF service.
“If a couple is unable to conceive because of problems in the male, his semen is analysed and tested for the quality, quantity and motility of sperm. If there is any problem in the semen, the male is treated to improve the quality of the sperm,” Dr Vaidya said.
In Nepal, out of a 100 cases of infertility, the problem is usually in the male in 33 cases, the female in 33 cases, and both male and female in the remaining cases. Dr Rijal is also credited with bringing the IVF technology to Nepal. In 2005, Dr Rijal and his team performed a surgery on Sandhya Tamang. She gave birth to Om Mani Tamang, who is Nepal’s first test tube baby.
More than 1,000 babies have already been born through the IVF technology in Nepal since then.
The infertility rate among the youths has also been increasing because of the excessive use of tobacco products, Dr Rijal said. Dr Vaidya also says the excessive use of tobacco products decreases sperm count in males and decreases conceiving capacity in females.