Ans. Dear Friend, Begin feeling good about yourself ! You are bold and adventurous, married a foreigner and emigrated ! There is absolutely no fault of yours and You are in no way responsible for the condition of your fallopian tubes. Your decision to adopt a child was very wise given the limitations you have stated. Yet, the aspirations of your adopted child for a sister or brother born to you, and your own patent or latent craving for a child of your own is only natural, unexceptional and even laudable! However at 44, age is not on your side. While conception through IVF (Invitro Fertilization) or ICSI (Intracytoplasmic Sperm Injection) is the only solution and is absolutely possible at this age, the degree of certainty progressively decreases after 35 years of age ! Rate of occurrence of congenital abnormalities (Birth defects) gets higher with age after 35. This is more a problem of the Oocyte quality than that of the uterus and endometrium. However , obtaining oocytes from a fitter and younger donor, fertilizing them with the sperm of your husband and then transferring the resultant embryos into your womb, can offer certainty of a much higher degree. This can also be done along with a few embryos derived from your own oocytes. Later we allow nature to choose what to retain and develop into a continuing conception ! Religion and religious practices will always come and go, change, transform , evolve and so on. Mankind is much more evolved and matured now than it was ever before. Religion now plays lesser and lesser negative role in enabling fine people like you make their choices.
It is time that you and your spouse choose and assert your own choice and decision. Let your in-laws, and the custodians of religion make their own choices about their own lives and not that of others. The danger you fear and presume because of the blockage in your fallopian tubes is absolutely unfounded and baseless. Relax and rest assured that such blockages are absolutely normal and natural, happen to millions all over the world and have absolutely no effect whatsoever on your health. Do not ever think of death because of this or something else ! Eat well, work well, love well everyone around you, be considerate, be cheerful and happy with all the wonderful things and people you have ! You are always welcome to aspire for more , and do not forget to exercise and play regularly till your last day. And when it is time, the whistle blows for all of us! we all have to go. But there is no need to rush for it or fear it!.
Q: Can fibroids interfere with IVF?
Ans: Fibroids are benign tumors consisting of fibrous tissue and muscle which grow in the uterus. The significance of fibroids relates to not only their size but also their location. Even small fibroids located inside the cavity of the uterus where embryos need to implant, may interface with success and need to be removed. Fibroids that do not encroach on the cavity of the uterus are generally not significant unless they are larger than 5 cm in diameter and also if there are many fibroids causing significant uterine enlargement.
Q: I have endometriosis, does this affect my fertility & also success with IVF?
Ans: Endometriosis is a condition where cells that usually remain confined to the cavity of the uterus, grow outside of the uterus usually on or in the ovaries and also on the surface of the pelvic pain and may also decrease the chances of natural conception by about one-third Patients who require IVF who have endometriosis still have the same chances of a successful outcome as patients of the same age without endometriosis as long as immunological factors that may accompany endometriosis are identified and treated appropriately.
Q . I am married for past 9 years, but I am still childless. The problem is with me. My husband is perfect. I would like to know how to find a lady who can become a surrogate mother for our child. That is can she bear a child for us with my husband's sperms. Please reply to me . Awaiting your reply. We are ready to bear the costs and remunerate her well for this ?
Ans : It is necessary to have a complete fertility profile of you and your husband, before coming to the conclusion for a surrogate mother. If you have no normal production of eggs of your own, you need egg donation, either from a lady of your choice that you can organize or from the proposed surrogate herself. Once your husbands sperm and the donor eggs develop into embryos in the IVF lab, the same can be transferred for implantation into the womb of the surrogate. We do have a regular surrogate / egg donation programme at our Hyderabad and Visakhapatnam centers. In case of any difficulty for you in finding access to such a programme in your own city, you may get in touch with us.
Q : Me and my husband are 33 years old and married since three years. But we are still issueless. I am suffering from frigidity and also libido. When I consulted a gynec, I was put on medication. Ebexid, Ferty 50 mg for one month and was later started taking 100 mg and also Corion 5000. I did a follicular scan test (Report: Uterus measured 9.0 x 4.2 x 3.3cms, right ovary measured 4.8 x 2.8 cm and left ovary measured 6.8 x 3.8cms and sonography of the pelvis done on day 19 revealed that R+ ovary appears enlarged and irregular follicle of size 20 x 19 mms and L+ovary appears enlarged. There is evidence of a complex mass of size 41 x 32 mms seen in the L+ ovary and features of an endometriotic ovary) and doctor advised me for DTC but anesthesiologist suspected me of hypothyroidism. (Thyroid test results : T3 88.70 mg, T4 5.20mg, TSH third generation 3.27. My husband’s semen analysis- total count 50 mill with 60 percent active motile. What is the reason for not conceiving. Is it endometriosis and enlarged ovaries ? Please advice.
S Ella, Pondicherry
Ans : Infertility is a complex problem. Before pronouncing the reason for infertility we need to investigate both partners. It may be single factor (or) multiple factor problem. Free Thyroxin levels are the main indicator about thyroid function. It may vary from lab to lab. The normal values for free thyroxin are 9-20 miu/ml. Instead of Just total T4 get Free T4 levels. According to that, supplementation of thyroxin is necessary or not can be decided.
If there is a chocolate cyst in the ovary (menstrual blood collected in an encysted cyst) ovulation will be affected. Cyst can be removed by Ultrasound guided aspiration and methotrexate instillation in to the cyst to prevent recurrence of the cyst. Laparoscopy is also helpful if there is associated pelvic endometriosis. If there is such problem, they can be fulgurated with underwater current cauterization.
Other tests like PCT, antisperm antibody either in serum (or) cervical mucus, serum prolactin levels, base line FSH, LH have to be completed for you. For husband –semen analysis shows only physical characters. There are tests to know the sperm functions. There is one final critical test to know the DNA integrity. But this is not available yet in India. One should not take ovulation induction drugs too long. There are studies , (over use may lead to ovarian cancers in the future. So it is best to consult a competent fertility specialist 3 months ovulation induction and timing of intercourse can be tried. If no pregnancy 6 months ovulation induction and intrauterine insemination is advised. Still no pregnancy IVF maximum 3-4 attempts.
Frigidity is a psychological problem to certain extent libido also depends on psychology. Please go through good books on erotica and try to overcome frigidity. To improve libido – imagination, reading, watching, talking about erotica will be helpful . Try to shed the inhibitions and make you sex life a pleasurable one.