Technology-assisted pregnancies on the rise

Technology-assisted pregnancies on the rise

Tantri Yuliandini, The Jakarta Post, Jakarta

Waiting to get pregnant can be a very stressful time for a
couple, especially in a largely traditional community like
Indonesia where it is common to ask a newly-wed couple whether
they are already expecting a baby.

Many people still, naively, think pregnancy will result the
first month a couple try. So, how difficult can it be to get
pregnant?

According to andrologist Aucky Hinting of the Graha Medika
Fertility Center, within a single menstrual cycle, there is only
about a 20 percent to 25 percent chance of conception -- even if
the couple have sex every day.

The percentage is very low, considering a cow has about a 70
percent to 90 percent chance of pregnancy in a cycle, he added.

On top of that, it is generally known that the fertility of
couples in general has been declining in modern times, Aucky
said. He said the decline could be caused by the increasing age
of women when they get married or pregnant, the higher incidence
of sexually transmitted diseases that damage the reproductive
tract in both men and women, and a worldwide phenomenon of
decreasing sperm counts in men -- a determining factor for
conception.

"It is a well known fact that today's sperm count is far lower
than that of 30 to 40 years ago," Aucky said.

With all those factors, getting pregnant these days is a bit
like playing Russian roulette, and it's impossible to predict
when a woman will conceive.

Over a period of one year, however, the chance of a successful
pregnancy increases to between 80 percent and 90 percent --
meaning that about seven out of eight couples will be expecting
babies within a year. These lucky couples are considered normal
"fertile" couples, while the others are labeled "infertile" --
the medical textbook definition of infertility being the
inability to conceive after trying for a year.

If after having sexual intercourse two or three times a week
at about the time of ovulation -- without any form of birth
control, for a year or more and a woman does not become pregnant,
then it warrants a trip to a gynecologist for advice.

According to Aucky, in 40 percent of cases, infertility is
caused by problems with the female, 25 percent in the male and in
25 percent of cases in both partners. In some cases, about 10
percent, no cause can be identified even after exhaustive
testing.

This is where fertility centers like the ones in Graha Medika
and the Harapan Kita hospitals, both in West Jakarta, come in. So
far, there are about 10 fertility clinics across the country --
five are located in Jakarta, two in Surabaya, one in Yogyakarta,
one in Semarang and another one in Denpasar.

At these clinics, couples are provided with consultation
concerning fertility and, if needed, further steps such as in-
vitro fertilization (IVF), intra cytoplasmic sperm injection
(ICSI), and micro surgical epididymal sperm aspiration (MESA) and
testicular sperm extraction (TESE).

The doctor will conduct a series of tests to determine the
infertility problem -- whether it is caused by the female, the
male, or both. Before starting with tests, the doctor will take a
detailed medical history from the couple and perform a physical
examination on both to provide clues to the cause of the problem.

For instance, the doctor will need to find out details of the
woman's menstrual cycle, the couple's sexual habits and past
history of surgery or illness. The physical examination will
specifically look for clinical findings like abnormal hair
growth, excessively oily skin, or milky discharge from the
breast, which may have an impact on fertility.

If infertility is caused by problems with the female, an in-
vitro fertilization (fertilization outside the womb) is
conducted. This is done by taking a single egg from the female's
ovaries and combining it with the sperm in a petri dish (thus the
name test-tube baby). The sperm are then left to fertilize the
egg.

Then the fertilized egg, or embryo, is implanted into the
woman's womb. Aucky said the doctor would usually implant three
embryos at a time to increase the chances of pregnancy. But
sometimes in older women, he added, four embryos are implanted,
explaining that there is a 70 percent to 75 percent chance of a
single-birth pregnancy.

When the male sperm count is too low for an IVF, a single
sperm is directly injected into the egg. This method of
fertilization is called intra cytoplasmic sperm injection (ICSI).
And when it is difficult to obtain the sperm, a minor operation
called a micro surgical epididymal sperm aspiration (MESA) or a
testicular sperm extraction (TESE) is done.

But costs are not cheap. At Graha Medika, for instance, an IVF
costs Rp 27 million (about US$2,834), an ICSI Rp 31 million, and
a MESA/TESE Rp 37 million, which covers everything until
pregnancy is detected. The highest cost comes from hormonal
medication, which costs about Rp 500,000 an ampule, Aucky said.

In Indonesia, the success rate for these assisted reproductive
technology methods is about 35 percent for IVF and 41 percent for
ICSI, but once the implant is successful there is a 90 percent
chance of pregnancy, Aucky said.

Some things you can do to enhance your fertility:

* Weight, diet, and exercise. Proper diet and exercise are
important for optimal reproductive function and women who are
significantly overweight or underweight can have problems getting
pregnant.
* Stop smoking. Smoking cigarettes has been associated with a
decreased sperm count in men. Women who smoke also take longer to
conceive.
* Stop drinking alcohol. Alcohol (beer and wine as well as hard
liquor) intake in men has been associated with low sperm counts.
* Review your medications. A number of medications, including
some of those used to treat ulcer problems and high blood
pressure, can influence a man's sperm count. Many medications
taken during early pregnancy can also affect the fetus. It is
important to tell your doctor or pharmacist that you are
attempting to become pregnant before taking prescription
medications or over the counter medications, such as aspirin,
antihistamines, or diet pills.
* Stop abusing drugs. Drugs such as marijuana and anabolic
steroids decrease sperm counts. If you have used drugs, discuss
this with your doctor.
* Limit your caffeine (tea, soft drinks and coffee) intake. Start
vitamin supplements.
* Frequency of intercourse. The simple rule is -- as often as you
like it; the more often you have sex, the better your chances.
* Timing of intercourse. Unlike animals, who know when to have
sex in order to conceive (because the female is on "heat" or
estrus when she ovulates), most couples have no idea when the
woman ovulates. The window of opportunity during which a woman
can get pregnant every month is called her fertile phase and is
about four to five days before ovulation occurs. Timing
intercourse during the fertile period (before ovulation) is
important and can be easily learnt.
* Position and technique of intercourse. Most doctors advise a
male superior position; and also advise the woman remain lying
down for at least five minutes after sex; and not wash or douche
afterwards. A number of products used for lubrication during
intercourse, such as petroleum jelly or vaginal cream, have been
shown to affect sperm quality. Therefore, these products should
be avoided if you are trying to get pregnant (a suitable
alternative is liquid paraffin).

Source: "How to Have a Baby; Overcoming Infertility" by Dr.
Aniruddha Malpani, MD and Dr. Anjali Malpani, MD. Published on
the Internet