The Misconception of Infertility

By Jessica Lim

THE flood of advice from self-appointed fertility experts can frustrate childless couples who are desperate for the truth. JESSICA LIM finds answers to five common fertility treatment misconceptions.

CHILDLESS couples have heard it all. Have sex in the morning. Have sex at night. Do not move your bed. Do not paint the house. Do not do plumbing. Do not hammer nails into the wall.

Eat lin zhi. Eat ginko. Eat dong kwai. Go for traditional massages. Ask that sinseh. Try in vitro fertilisation. Take hormone drugs. Do not take hormone drugs.

Mr and Mrs Chandra, who have been married 13 years and were childless, had heard such advice and more.

"When people ask us why we didn't have a child, we forced a smile and said 'coming soon'. But it really hurt," said Chandra.

When his wife turned 35, they decided it was time to stop following unproven remedies and consult fertility experts.

Five years, two gamete intrafallopian transfers (GIFT), seven in-vitro fertilisations (IVF) and one miscarriage later, their bouncing baby boy was born.

He said their heartache was aggravated by the onslaught of often baseless advice from well-meaning relatives and friends on how best to create a 'little Chandra'.

With only one fertility specialist to 7,500 infertile couples in Malaysia, consultant obstetrician and gynaecologist and fertility specialist Dr Dev Menon said accurate information was hard to come by.

"One in six couples suffer from infertility problems. That's a lot of people who need to know the truth."

Dr Menon and consultant clinical embryologist Dr John Keith elaborated on five common misconceptions many couples had about treatments.

MISCONCEPTION #1: "If we aren't pregnant yet it means we haven't tried hard enough."

THIS is a dangerous myth to believe, and sometimes severely compromises a couple's chances of conceiving.

If you are not on contraceptives, and have had sex pretty regularly for the past one year, you have an 85 per cent of getting pregnant.

"A lot of couples think they just have to try harder - have sex more often, time it more carefully and, well, concentrate harder," says Dr Menon. "But the truth is, if you're not pregnant yet after a year, something probably isn't quite right."

He said it was not uncommon for couples to say they had been having unprotected sex for years, but only started 'really trying' a year ago.

He urged couples to go for fertility checkups when they are younger, as this would give doctors much-needed time to implement the best course of action.

In fact, he said there no harm taking the checkup before getting sexually active.

A good fertility checkup would include a detailed history taking, abdominal scan, vaginal scan, blood test and semen analysis.

MISCONCEPTION #2: "I'll be pregnant in a jiffy."

IVF is the longest (and one of the most common) procedures, generally taking five weeks per cycle.

Three weeks is needed for hormone injections to stimulate enough eggs to be created, after which they are harvested, joined with sperm, then placed in the womb.

Anxious parents-to-be then wait two weeks for the pregnancy to be confirmed.

With a 25-65 per cent clinical pregnancy rate, more often than not, couples have to grit their teeth and try again.

They would have to wait at least six weeks before their next attempt, and only if they are emotionally and financially ready.

"It is a very stressful thing to have your hopes up then dashed. Some couples take months or even years to gather enough emotional strength to try again," said Dr Keith.

"We always tell our patients it's not an overnight thing. A six-month wait for IVF patients is very normal. It may take longer than that."

MISCONCEPTION #3: "My pregnancy is guaranteed."

DR KEITH emphasised that there was no guarantee of success.

Although 75 per cent of IVF couples get pregnant within four cycles of treatment, and the rate keep improving, it is impossible to guarantee that a couple will get pregnant.

"We can keep doing IVFs indefinitely, but after four cycles, it kind of plateaus off. Maybe then we'll discuss the possibility of egg donation or surrogacy."

Age, said Dr Keith, was one of the most important factors they had to consider when determining the kind of treatments to prescribe.

He said that fertility characteristics, such as the quality of eggs, decline with age.

A 20-year-old, for instance, has a 15 per cent chance of miscarriage. When she reaches 40, her chances are 50 per cent.

"If you come in when you're 35, it drastically cuts down the options we have. We have to go straight for more aggressive treatment instead.

MISCONCEPTION #4: "Infertility treatments are risky to my health"

A PERSON is a lot more likely to have complications during pregnancy than during infertility treatment procedures, said Dr Menon.

"The aim is always to do the simplest, most appropriate treatment for each couple. Many couples may not need the more complex treatments."

The biggest "risk" associated with IVF is the possibility of developing ovarian hyperstimulation syndrome (OHSS), a condition where too many eggs are produced in a woman.

Caused by inappropriate doses of egg-stimulating drugs, symptoms include bloating, nausea and shortness of breath.

About five per cent of women undergoing IVF treatment develop the condition, most of which are very mild.

"That is the very worst that could happen. Usually it is mild in nature. A person's long term health is not compromised."

Ninety per cent of surgeries now are done through laparoscopy, where incisions are the size of a keyhole.

This dramatically decreases the risk of infections, bleeding and scar tissue formation. It is also a lot less painful with faster recovery times (patients usually return to work within four days of the operation).

"Compare this to open surgery like a hysterectomy to remove the womb, where a woman has to be hospitalised for one week before resting at home for a further five weeks."

MISCONCEPTION #5: "It's OK to take traditional medicines when undergoing infertility treatment."

OF the thousands of herbal concoctions being prescribed out there, dismally few have been scientifically studied and documented, said Dr Menon.

"We're just worried about the effects on the patient's kidney and liver function, as well as the unknown effect on a developing embryo."

Besides that, it is probable that some herbs contain drugs that stimulate ovaries to produce eggs, which could lead to OHSS or affect the lining of the uterus.

With a procedure as delicate as IVF, any hormonal interference could throw the pregnancy off-balance.

Fertility doctors are also concerned about supplements that cause the thinning of blood, such as Spirulina.

Blood that does not clot properly could increase the risk of a miscarriage.

Quick answers to common myths:

A SEARCH on the Internet under "tips to get pregnant" unearthed a lot of claims. The experts uncover the truth behind these claims.

1. To increase chances of getting pregnant, a woman should help the sperm along by:

* Not going to the bathroom after sex;

* Lifting her legs up in the air for about 15 minutes after sex;

* Not walking around for at least half an hour after sex;

* Putting a pillow under her bottom during sex; and

* Using the 'missionary position' because it deposits sperm closer to the cervix.

- ANSWER: Not true. When a man ejaculates, he discharges sperm and seminal fluid. Normally, only sperm enters the uterus. Seminal fluid cannot enter the cervix and must come out of the vagina after sex. This doesn't mean precious sperm is "escaping".

Ejaculation blasts sperm into the cervix very quickly. We don't have to 'help it along'. There's no evidence that using different positions increases your chances either.

2. My mum had many kids, so the problem must lie with your side of the family.

- ANSWER: Not true. Most fertility problems are not inherited. It is often very much specific to individuals.

3. A woman who is more highly aroused during sex has a better chance of getting pregnant.

- ANSWER: Not really true. There is some evidence that a woman who is ovulating is more likely to have an orgasm, but that evidence is weak at best.

4. It is more often the girl's fault when a couple can't get pregnant.

- ANSWER: Not true. About 40 per cent of the time, it's the man's fault. That is quite significant, considering that most of the reproductive "apparatus" belongs to the woman, whereas the man only contributes the sperm.

5. A woman who is too active has less chance of getting pregnant.

- ANSWER: True. Extremely active women like professional athletes, for example, lose a lot of weight and fat. This affects their periods. Having a highly stressful or busy life doesn't help either. For starters, it's hard to find time to have sex, or to even get in the mood.

6. Wearing loose boxer shorts and taking cool baths may increase the man's sperm count.

- ANSWER: True. Testicles work best when cool. Remaining seated too long and wearing tight underwear will raise the testicular temperature and aren't the best conditions to optimise sperm production.

7. Avoiding coffee will help a woman get pregnant.

- ANSWER: e-span" style="color: white; font-sizee that drinking too much coffee will affect fertility, but in moderation it should be OK. class="Appl no-nos are smoking and drinking for both partners.

8. Avoiding dairy products will help a woman get pregnant because galactose, a sugar found in milk, is harmful to the ovaries

- ANSWER: Not true. There should not be any bearing on fertility unless you are lactose intolerant.

We also suggest that during fertility treatments you avoid herbal supplements because sometimes, you don't really know what's in it. It's safest not to take any of these.

9. The best time of the day to have intercourse is right before sleeping or in the morning.

- ANSWER: Not true. Any time of the day does not matter as long as you are relaxed.

10. Previously being on 'the pill' will decrease the woman's chances of pregnancy.

- ANSWER: Not true. When you are on it, your ovaries stop doing their jobs and the pill takes over. The pill does not affect fertility in any way.

NSUNT; Apr 30, 2006; Main Section; 42