New Hope for the Childless

When Dilip and Usha married, they decided not to have a family right away. They'd wait a few years, they thought, for Dilip to get better job, then have two or three children, a year or two apart. Five years passed and though they had been trying for more than two years, Usha still wasn't pregnant. Each month brought new disappointment.

Usha felt she was a failure as a woman. Dilip felt the same about himself as a man-and they were sure they were alone. What Usha and Dilip didn't realise was that they were but one couple among many who desperately want to have children and can't. These men and women are often ridden by guilt, despair and a sense of powerlessness. Indeed, some 15 million young couples in India-an estimated one of then young marriages-are infertile, a substantial minority largely overlooked until quite recently.

Why? Because so little was known about the cause of infertility that, according to Dr. Rustom Soonawalla, gynecological surgeon, “Most doctors simply told their patients to leave the problem to nature and everything would be all right.'' Fortunately, that is changing. “Doctors are turning their attention to the barren,'' says Dr. Rama Vaidya, Gynaecologist and endocrinologist. “Modern well-equipped infertility clinics that handle many new cases a year have begun functioning in major hospitals.

Causes and Factors :-

Dr. Vaidya points out that, ironically, today's tendency to delay child-bearing, as Usha and Dilip did, is one reason why childlessness is on the rise. “This early and mid-twenties are peak fertile years for both men and women,'' she says. “A woman's chances of conceiving lessen with age, especially over 30'' Infertility however, can appear at any age and stem from a number of causes. Operations and past illnesses, for example, sometimes create problems' tuberculosis, gonorrhea, a ruptured appendix, can all damage or block a woman's fallopian tubes, thus preventing sperm from fertilizing the ovum; certain childhood diseases can halt sperm production in male and make him sterile; phychological tensions can also make a man impotent.

Usha and Dilip, at the urging of family members, sought the advice of a specialist. Tests revealed that Dilip had obstructive azoomspermia, a condition caused by a childhood case of smallpox, in which sperm are blocked somewhere along the tubular system that transports them out of the testes. A simple operation to bypass the blockage soon brought his sperm count to normal levels. Within six months, Usha was pregnant and today the couple are the proud parents of three healthy children.

But even when the cause of infertility is correctable surgery by itself cannot guarantee a pregnancy. “Nature takes her own time to arrange the successful fertilization of an ovum by a sperm even in normal couples,'' says Dr. Soonawalla. “In fact, so many different factors contribute to pregnancy, including the elements of chance, that no couple should consider themselves infertile until after a year of regular intercourse.''

Extensive Tests :-

Persistent infertility problems then require the diligent detective work of medical experts who painstakingly eliminate one factor after another. It's an emotionally taxing and expensive process-often costing many hundred rupees. Yet, for most people the urge to have children is overwhelming, fed in part of the social stigma so often attached to barrenness. “Unsympathetic in-laws will taunt a childless wife to the point,'' says Dr. Soonawalla, “Where the couple gets desperate enough to try almost anything-even religious charlatans'' One of the first thing a qualified doctor will want to find out is whether the couple is actually having intercourse during the 12 to 36 hours each month when conception is most likely to occur.

This is usually done by having the woman record her temperature each day by using a special basal body temperature thermometer. By observing when the slight sustained rise in temperature that follows ovulation occurs every several months, the doctor can estimate the time of the next ovulation and then recommend a schedule of intercourse which will coincide with it as closely as possible. Once it is established over six to 12 months that timing is not problem, the doctor will advice more extensive tests. Specialists agree that both partners should take part in testing right from beginning. Why? “Because,'' as a consultant gynaecologist and obstetrician explains, “Studies show that 40 percent of infertility problems can be traced to the husband, 40 percent to the wife and 10 percent to a male-female combination.'' (In the remaining 10 percent of cases, doctors cannot pinpoint the problem) Many husbands initially resist examination and testing. The reason:most man equate fertility with sexual potency when, in fact, a man can perform intercourse normally without producing a single sperm.