Beauty

Everything you need to know about fertility treatments

The frustrations and miracles on the bumpy ride of trying to get pregnant

Disclaimer: This article is not intended to be a substitute for professional medical advice, diagnosis or treatment. ELLE does not endorse any of the therapies featured here and recommends you consult your doctor before starting any alternative treatment.

I didn’t even want a baby, to begin with. I was 27 when I moved to Kuala Lumpur with my husband. We were travelling all around the world and life was good, until December 2006. I got my period and then it went on for a month. I was diagnosed with grade IV (the most severe type) of endometriosis, a painful condition of the uterus and the leading cause of infertility. So began the toughest phase of my life. Now, 10 years, two laparoscopic surgeries and five IVF treatments later, I still don’t have a baby. But today I know what it feels like to desperately yearn for one.

Baby-making isn’t a pleasurable business these days, even if it is a lucrative one. A study done by the International Institute of Population Sciences two years ago found that 15 to 20 million Indian couples suffer from infertility. “There
are two reasons for this rise,” says Dr Firuza Parikh, director, Jaslok FertilTree International Fertility Centre, Mumbai, and visiting professor at University of California, Los Angeles, USA. “One is that people are now less hesitant to visit an infertility specialist, so it appears that more people are affected.” But our chaotic lifestyles are not helping matters, either. “We’re always in a hurry. We don’t relax, are sleep deprived, have reduced sexual desire, eat too much fast food [particularly those with a high glycemic index] and are exposed to all sorts of pollution.”

The increase in reported cases of male infertility (almost 50 per cent of all cases) is also one of the reasons for the spike in statistics, according to Dr Deepika Krishna of Milann Fertility Centre, Bangalore. “The factors causing it are the same for women: stress, lifestyle habits, obesity, alcohol and smoking. There are studies that prove that mobiles and laptops have an effect on motility and reduce sperm count too.”

Even as infertility is on the rise, science is hot on its heels and offers many choices for hopeful parents. When these new technologies are combined with age-old therapies, you’re faced with a universe of possibilities. I would often call to mind Dr Parikh’s words during my IVF treatments: the question isn’t if you’ll have a baby, it’s when.

Let’s make a baby!

Fertility cannot be boosted with one miracle drug or supplement. It needs a more wholesome approach that can be achieved partly through a balanced diet. Pooja Makhija, Mumbai-based nutritionist and author of Eat. Delete. (Harper Collins, 2012) says, “When the body is deprived of nutrition from crash dieting or excessive exercising, its survival is called into question and it reacts accordingly.” The reproductive system is the first to shut down when our calorie intake goes in the negative. Of course, being overweight also compromises your fertility. Makhija recommends that you eat every two hours, and find a balance between protein, carbs and good fat. “In my experience, vegetarians who don’t focus on the right kind of protein find it difficult to make babies because the quality of their eggs gets affected.” Good sources of protein include pulses, sprouts, low-fat yogurt, quinoa and egg whites. She also warns against refined   sugar and  alcohol, both of  which are     related   to   higher    rates     of    PCOS (polycystic ovarian      syndrome),    endometriosis    and even PMS.

Dr Parikh suggests various micronutrients, a Mediterranean diet (primarily, plant-based foods with adequate protein), foods with a low glycemic index (i.e. ones that release sugar slowly into the blood-stream, like brown rice, wholegrain bread, natural muesli, sweet potato) and supplements like folic acid, vitamin D, B complex, zinc, selenium, CO-Q10 and omega 3 and 6. Personally, I felt that turning vegetarian helped me a lot during the infertility treatments because my food digested easily and I had minimal bloating. Lastly, get at least three litres of water in you everyday. The introduction of certain hormones into the system can lead to constipation, so drink up.

Dr Parikh also puts in a word of caution about a group of chemical compounds called endocrine disruptors that are often found in household objects, cosmetics, pesticides, plasticware and fire retardants. In certain doses, they interfere with the functions of endocrine glands such as ovaries, testes and thyroid, and even the immune system. “Phthalates, bisphenol and organophosphate pesticides can accumulate in the body and cause early menopause, diminish the number of eggs in the ovaries, reduce sperm count, cause repeated miscarriages and even lead to cancer.”

Age is another key factor that determines your chances at the baby lottery. Experts recommend the years between age 24 and 34 as the best time to have a baby—and it’s ideal to have the first one before you hit 30. “The eggs start ageing by the time a woman becomes 35 and older women have a higher risk of miscarriage due to genetic issues with their eggs,” says Dr Parikh. But that’s not to say that women in their forties are not making babies—it just might take longer.

What Is It THAT’S stopping you?

Regular visits to the gynaecologist are essential, whether they are to ease your painful periods or to check up on your ovaries’ capability to produce healthy egg cells. But since most women only see a doctor either when they get married or start showing severe symptoms, like me, they rarely get a timely diagnosis for reproductive conditions like PCOS and endometriosis. Left unchecked, these can wreak havoc on a woman’s reproductive system and
overall health.

There is a rise in the number of women with PCOS, a hormonal imbalance, and this is down to genetic and environmental factors. It can lead to acne, obesity, depression, irregular periods and trouble getting pregnant. “It can be resolved [or controlled] by being more active,” says Dr Lalita Badhwar, senior consultant, laparoscopic surgeon, IP Apollo Hospital, New Delhi. “It’s not about losing massive amounts of weight as it is about getting regular exercise.” She explains that women suffering from PCOS are prescribed ovulation drugs to help conceive or oral contraceptive pills to prevent the ovarian bank from depleting. For cases of lean PCOS (where the woman is not overweight), Dr Krishna suggests a procedure called ovarian drilling. “It’s a minor laparoscopic process where small punctures are made on the ovaries so they ovulate on their own,” she says.

Endometriosis, on the other hand, is far more complicated. While nobody knows the cause, we do know that this condition is almost incurable once it reaches an advanced stage. “On an average, endometriosis is diagnosed seven
to 10 years too late,” says Dr Badhwar. However, early detection can control the situation through minor surgery and contraceptive pills. The funny part about endometriosis is that to cure it completely, you need to get pregnant, but
to prevent it from spreading, you need birth control pills.

Then there’s the sabotaging effects of that faithful companion of our modern lives: stress. Our body releases hormones like adrenaline, prolactin and cortisol when we’re tense, and in large amounts, these chemicals can hamper the reproductive process. “Our team of psychiatrists and counsellors have carried out a study on one of the largest numbers of infertile couples and shown how stress can cause miscarriages and increase the chances of not conceiving,” says Dr Parikh. Here’s how it works: the hypothalamus is the brain’s major nerve centre for fertility and conducts crucial functions like signalling the onset of ovulation. This same gland also helps our body regulate stress. It’s a small, walnut-sized portion of the brain we’re talking about here and the balance it has to maintain is a very delicate one. Overwhelming it with one task makes it less available to handle the other. That’s why, says Delhi-based psychologist Dr Divya Parashar, “Long-term stress affects the libido and decreases fertility”

Battling stress isn’t exactly easy, especially when you’re dealing with the anxiety of getting pregnant. Parashar explains, “Research has shown that psychological interventions such as cognitive behaviour therapy and mindfulness decrease stress and increase the chances of pregnancy.” If your mind is in knots from the fear of failure, you might find fresh hope in Joseph Murphy’s The Power Of Your Subconscious Mind (Embassy Books, 2010). “I suggest this book to all my students who are trying to conceive,” says yoga instructor Seema Sondhi. In the book, Murphy says that you must believe you’ve already achieved your goal, because miracles happen only once your subconscious believes they’re possible. Dr Parashar also recommends getting a restful eight hours of sleep every night. “Most ovulation occurs between midnight and 8am. Getting too little sleep causes hormonal imbalances and can impact conception.”

Who can help?

So how do you decide if it’s time to visit a fertility centre? Experts suggest that if you’ve been trying for a baby for more than a year and haven’t conceived, it may be a good idea to consult a fertility specialist. “When a couple comes to us we look at multiple factors like age, egg quality, ovarian reserve, tubal potency, endometrium, sperm quality and its motility,” says Dr Krishna. If everything is fine, you do not even require a major treatment like IVF. Perhaps you just get ovulation pills or some vitamin supplements to improve the health of their eggs, sperm and uterus.

If you are prescribed a treatment, the options are plenty and it’s best to rely on your doctor to make that choice. There’s the IUI (intrauterine insemination), where the sperm is injected into the uterus to facilitate pregnancy. However, the tubes must be naturally open so the sperm can pass through to fertilise the egg. Then there is IVF (in vitro fertilisation), where the egg is fertilised by the sperm in a laboratory and then implanted into the uterus. There’s also ICSI (intra-cytoplasmic sperm injection) where the embryologist selects a single sperm to be injected directly into an egg, used in cases where the sperm count is low.

I chose my fertility clinic based on personal reviews, reputation  and  the compassion of the doctor. Pick a  place that has  a good  reputation, not just good ads. Check their success rate by asking them how many  babies were  born from those pregnancies and what the live birth rate is. “It’s prudent to ask the doctor to select the best  treatment option to maximise your chances,” says Dr Parikh. She  suggests that  prior to IVF, correcting hormonal imbalances, thyroid, blood sugar and blood pressure levels is helpful. Personally, I also did some research on fertility treatments at websites like Babymed.com and Fertilitycommunity.com. But once the  treatment  starts,  I think it’s best  to  put  all   your   faith  in   the   doctor   and stop   Googling    symptoms    that   may   just  trigger negativity.

Dr Parikh also advises her patients to be very realistic about IVF and understand what it entails. There are several horror stories of daily injections and miscarriages, but while I was going through my cycles I felt that most of these accounts were blown out of proportion. For instance, it’s a myth that you need complete bed rest during the treatment. “You can lead a normal life, but it’s advisable to avoid intercourse and swimming,” explains Dr Parikh. However, if the IVF does not work after about six attempts, it is time to change the strategy—and this may involve the use of donor eggs, donor sperm, donor embryos or surrogacy. The point is not whether you will have a child, but which route you will take to have one.

What else can you try?

Disciplines like yoga, Ayurveda, acupuncture and traditional Chinese medicine all offer ways to improve the health of the uterus and ovaries, and increase the chances of conception. Personally, yoga has helped ease the pain caused by my endometriosis and that’s a big plus in my book. Many doctors prescribe Ayurvedic supplements or acupuncture sessions to be followed alongside the medical treatments.

Yoga: Delhi-based Sondhi has been conducting classes for pregnant women for a decade now. She has helped many students prepare for IVF with yoga. “Infertility is a sign of imbalance within the body. Yogic practices help correct hormonal imbalances by working directly on the endocrine system,” she says. In time, yogic breathing and asanas improve circulation to the reproductive organs, and help them rejuvenate and heal. “It creates a healthy environment in the mind and body—I have seen women conceive after three months of regular yoga.” This can be a minimum of 20 minutes of yoga, thrice a week.

Ayurveda: The panchkarma detox is the Ayurvedic therapy most commonly recommended to couples who want to prepare their bodies for conception. It involves five different types of cleanses that eliminate imbalanced doshas. This five-to-seven-day treatment is done at an Ayurvedic centre and is definitely not for the faint-hearted, as it involves stimulated vomiting, enemas and mildly unpleasant nasal cleansing. Every year, thousands flock to Kerala for the treatment, as it’s known to eliminate environmental toxins and help cure everything from psoriasis to IBS to osteoporosis.

Acupuncture: “When the flow of our life force energy or ‘chi’ is disrupted, it can result in pain or disease. Acupuncture helps in maintaining that normal energy flow, thereby increasing a couple’s chances of conceiving,” says Dr Jasmine Modi, Mumbai-based PhD in Oriental medicine. She believes that acupuncture can specifically target hormones and ovulation, help increase blood flow to the uterus and thicken a too-thin uterine lining. It also helps, she says, with conditions such as PCOS and endometriosis. Modi suggests consulting a specialist and waiting it out for three to six months if you’re only using acupuncture to prepare yourself for pregnancy. “It benefits men as well because the period of sperm maturation takes between 70 and 90 days,” she says. If you’re doing the procedure in conjunction with IVF, Modi encourages you to have a session close to the day of the IVF transfer and then, in case of a positive test, do it on a weekly schedule during the
first trimester.

What if nothing works?

I was haunted by this question through all my cycles. The yearning for a baby was so strong that I felt that there would be no meaning in my life without a child. Ten years later, I’m still heartbroken as I write this, but I have so many other things to be grateful for—my career is flourishing and I’m a certified yoga teacher. During the IVF years, I had just one friend and now I have a huge circle of friends and acquaintances who love and care for me. I think, as women, we have a natural instinct for motherhood, but I don’t feel ‘empty’ in any way. If I had to do it all over again, I wouldn’t get obsessive about IVF. I would stop at three cycles and then explore surrogacy and adoption. And while I do think about having a baby, I also don’t miss having one. Eventually, life is what you make of it. It has the potential to be ugly or beautiful, with or without a baby. 

Back-up plan

Pregnancy is often offered as the solution to all gynaecological conditions in young women. But what do you do if you haven’t met the person you want to make babies with? One possibility is cryopreservation or egg freezing at an IVF clinic. The process involves ovulation medication (to aid higher egg production) followed by the retrieval of eggs when they mature. These are subsequently frozen, coded and placed in a secure cryotank. “It is important to freeze the eggs around the late twenties to the early thirties. It is also important to freeze at least 15 to 20 eggs to increase the chances of pregnancy later,” says Dr Parikh.