Understanding Infertility and IVF: Insights from Specialist Dr. Shweta Dhakal

Kathmandu. What is the pain of being childless? Who would know better than those who experience it. Due to changing lifestyles, unhealthy eating habits, and delayed marriages, the problem of infertility is increasing among many couples recently.

The problem of infertility is seen in all classes, whether rich or poor, affluent or underprivileged, educated or uneducated. For those whose dream of having children could not be fulfilled even through various treatment methods, medical science has recently developed IVF technology. In Nepal too, the number of people giving birth through IVF technology is significant.

What is the main cause of infertility? How can one achieve the joy of parenthood through IVF technology? Here is an edited excerpt of the conversation with Dr. Shweta Dhakal, an infertility specialist at Hardik IVF and Fertility Center, focusing on these issues:

Recently, infertility seems to be increasing. First of all, what is infertility? What causes it? Please tell us about this.

Infertility has emerged as a serious health and social challenge in today's time. In the language of medical science, if a couple under the age of 35 has been trying for a child regularly for one year without using any contraceptive methods and still cannot conceive, we call it 'infertility'. If the age is above 35, one should consult a doctor if success is not achieved within 6 months of trying.

Looking at the current situation, this problem is increasing significantly. Previously, only women were blamed for infertility, but now statistics show that in 30 to 40 percent of cases, infertility is caused by men. The remaining 40 percent is due to women, and in the remaining 20 percent, it is due to both or the cause remains unknown. Especially in men who have gone for foreign employment, the problem of low sperm count and decline in quality is seen more.

How much role do our diet and modern lifestyle play in this?

This is a very important question. The current modern lifestyle has become the main factor for infertility. Our diet is dominated by processed sugar, refined flour (maida), white rice, and ready-to-eat foods (like momo, chowmein, coke, pizza). Such foods disrupt the 'insulin' levels in the body and cause hormonal imbalance.

IVF is certainly a somewhat expensive procedure. The main reason for this is the expensive injections used in it and the state-of-the-art laboratory equipment, which we have to import from abroad. The average cost of IVF in Nepal can range from 2.6 lakhs to 4-5 lakhs. This depends on the patient's condition and the amount of injections required.

The main reason for the increase in PCOS problems in women is unhealthy eating habits and lack of exercise. Also, increasing mental stress, lack of adequate sleep, smoking, and alcohol consumption are destroying the quality of both eggs and sperm. Obesity is another big enemy. Due to this, reproductive hormones in the body cannot function properly.

When couples are in pain due to not having children, 'IVF' technology has come as a great hope for them. What is this IVF? Please explain it in simple language.

IVF, or 'In Vitro Fertilization', is an artificial insemination technique. In some cases, the egg and sperm cannot meet naturally in the woman's fallopian tube. In such a situation, we extract mature eggs from the woman's body and fertilize them with the man's sperm in the laboratory (outside the body) to create an embryo.

When that embryo develops in the laboratory for three to five days, it is re-implanted into the woman's uterus. This technology has proven to be a boon for those couples whose dream of having children could not be fulfilled through other general treatments.

In what conditions is it necessary to undergo IVF? For which couples with infertility problems is IVF effective?

Not everyone needs IVF. We initially try general treatment methods like ovulation induction or IUI. But in these conditions, IVF is the best option. If both of the woman's fallopian tubes are blocked, if the number of eggs in the woman is very low or the age is around 40, if the man's sperm count or motility is very weak, if there are complex problems like endometriosis, and if success is not achieved even after long-term other treatments.

Many people think that the IVF process is very complex or painful. What are its stages?

Many might think this is a major surgery, but that is not the case. It has 4-5 main stages.

Stimulation: From the second day of the period, for about 10-12 days, small injections are given to produce many eggs.

Egg Retrieval: Once the eggs are ready, they are extracted through a small procedure. Since this is done under anesthesia, there is no pain.

Fertilization: Eggs and sperm are combined in the laboratory to create an embryo.

Embryo Culture: The embryo is kept in a special incubator for 3 to 5 days.

Transfer: This is the easiest process. The prepared embryo is placed in the uterus through a thin tube. This does not even require anesthesia and there is no pain.

There is a misconception in society that twins are always born when doing IVF. How much truth is there in this?

This is just a common perception. To increase the success rate of IVF, sometimes we transfer two embryos. In such a case, there is a possibility of twins, but this is not 100 percent. According to statistics, the chance of having twins when placing two embryos is only 10 to 15 percent. Now, we advise placing only one good quality embryo as much as possible, so that the risk to the health of both mother and child is reduced.

Are babies born through IVF as healthy as those born naturally?

Babies born through IVF are completely healthy and normal, just like babies born naturally. It has not been scientifically proven that they have a higher risk of autism or other physical disabilities. Regarding the mother, there may be some common problems for a short time due to injections, such as mood swings, slight bloating, or mild pain, which go away on their own in a few days. It has no long-term negative effects.

In the context of Nepal, how expensive is IVF?

IVF is certainly a somewhat expensive procedure. The main reason for this is the expensive injections used in it and the state-of-the-art laboratory equipment, which we have to import from abroad. The average cost of IVF in Nepal can range from 2.6 lakhs to 4-5 lakhs. This depends on the patient's condition and the amount of injections required. However, compared to abroad, this treatment is much cheaper in Nepal.

What advice would you like to give to couples who are waiting for children and struggling?

Infertility is not a sin or a curse; it is just a medical problem. So do not be ashamed and do not hesitate. Consult a specialist in time.

Improve your lifestyle. Give up sugar, refined flour, and packaged foods. Eat fresh fruits, vegetables, and healthy seeds like walnuts, almonds, and chia seeds. If you reduce your weight by just 10 to 15 percent, the chances of having a child increase by 25 percent. Reduce stress and stay positive.

Please tell us something about 'Hardik IVF and Fertility Center' as well.

At 'Hardik IVF', we do not just see patients as numbers. We treat them by understanding their emotional pain. Our laboratory meets international standards, and here a team of expert doctors provides personalized service to each patient according to their specific needs. Our success rate is also very good. The couples who come here get not only treatment but also trust and an environment like a family.