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Infertility - expat woes

INFERTILITY is on the rise among the expatriate population in the Gulf but many cases are the result of partners staying away from each other for a long period or improper planning in maintaining sexual contact, said a specialist who has successfully experimented with different methods of assisted reproduction.

Most of the childless couples who sought medical assistance for reproduction needed only sound counselling and a willingness to fine-tune sexual contact, said Dr Mohammed Ashraf, an expert in assisted reproduction techniques and a visiting consultant in Dubai's Iranian Hospital.

A fair percentage of the expatriate workers in the Gulf cannot afford to bring their spouses along with them. This interruption in sexual contact, if compensated during a one or two month holiday, needed a basic knowledge of the reproductive mechanism and the physiological processes associated with it, he said. For example, it was very important that the couple have sexual contact during ovulation. Ovulation, or the process of the egg (ovum) getting released from the ovary inside the woman's body, takes place during a period of 24 to 48 hours and at that time the male sperm should be active in the uterine system. For this, sexual contact between the couple should have taken place during the ovulation period. In some cases the husband arrived on vacation immediately after the ovulation process was complete. It takes another month for the next ovulation and by that time the husband would have left again, Ashraf noted.

Some tests such as D&C performed on women would also prove harmful during the brief holiday period. Since they tamper with the process of fertilisation, it is advisable not to go for these tests during such brief vacation periods, Ashraf suggested.

The change in lifestyle that has taken place during the last few decades was the major reason for the rising cases of infertility, Ashraf pointed out. Adulterated food was the main culprit. Anabolic steroids used to adulterate foodstuff deposit female hormones inside the male body, which in turn could drastically cut down sperm production. Stress, consumption of alcohol and smoking could prove to be harmful.

Ashraf said that a lot of people, especially in the subcontinent, still considered infertility as a social stigma and shied away from seeking timely medical assistance or counselling.

Infertility was like any other physical disorder and there is no point in prolonging treatment. With age, the chances of success in assisted reproduction methods dwindle. Late pregnancy could also lead to a lot of complications in women.

Ashraf said that safer and legal methods of assisted reproduction were now quite common, given the questions of morality and legality. Surrogate motherhood, donor insemination and sometimes even adoption had been rising, he said. The latest among these was Tesa-Icsi (Testicular Sperm Aspiration - Intra Cytoplasmic Sperm Injection) which has been proved to be successful even in cases where no sperm was found in the semen. This condition, known as Azoospermia, is rated as the cause for three to four per cent of male infertility.

In the Tesa-Icsi method, cells which produce sperms are separated from the testicles and later developed into sperms in the laboratory. This takes three to four days and then these sperms are injected into the ooplasm (egg) by means of a micromanipulation technique. The Centre for Research in Assisted Reproduction and Foetal Therapy (Craft), set up by Ashraf, recently employed this technique in a childless couple for the first time in Kerala. Kerala's first ever Tesa-Icsi children are twins and were born on Dec.29, 2001. Ashraf said the chances of multiple pregnancy which leads to twins or triplets are fairly greater in Icsi method as more ovum are artificially hatched inside the female body to ensure that at least four to five embryos are fertilised.

Craft has also performed assisted growth of embryos in a woman in her forties-- another first in Kerala. The delivery is expected to take place sometime in early February.

Ashraf has undergone advanced training in the treatment of infertility from Germany, France and Singapore and was conferred the Young International Scientist award from Japan in 1996 for his achievements in endoscopic surgery for Endometriosis, a defect which leads to infertility and serious uterine complications.

He has performed over 14,000 laparoscopic (keyhole) surgery including many in Dubai. He said that the Iranian Hospital was in the process of setting up the required equipment for assisted reproduction techniques and once the work is complete, he hoped to perform Icsi and such other methods.

Courtesy Gulf Today

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