Women’s Health Sees the Sunshine

Women who are afraid of the ticking biological clock have the choice of freezing their eggs

'The only way to discover the limits of the possible is to go beyond them into the impossible.'
—ArthurClarke

Dr Duru Shah

The last decade has seen amazing advancements in the medical field, and, women's health is one aspect which has been touched upon tremendously. Of the various technological advancements, assisted reproduction, ultrasononography and endoscopic (key hole surgery) are the one's which are indispensable. In fact, most gynaecologists would feel lost today without the help of these technologies.

ART

For women experiencing difficulty in getting pregnant, there is plenty of hope today. It is not a lost battle as it was in the past. Fertility treatment is now purely scientific and precise, targeted to determining the cause and treating it. Assisted Reproductive Technology (ART) includes a range of treatments for the infertile couple. With the help of procedures such as in vitro fertilisation (IVF or test tube baby) and Intra Cytoplasmic Sperm Injection (ICSI), there is hope for couples with practically any problem.

There has been a gradual delay in the age of conception with today's career-oriented women. Very often, pregnancy is desired at an age beyond 35 years after careers are stabilised. It is then that the ovaries may not comply by producing healthy eggs. Besides, one per cent of women suffer from 'premature menopause', that is, menopause before the age of 40 years. And sometimes, radiation therapy or chemotherapy used for certain cancers in young women may permanently damage the ovaries.

A woman may opt to freeze her oocytes during her younger days, especially if she wishes to plan her pregnancy after the age of 37 years. Women who are afraid of the ticking biological clock have the choice of freezing their eggs and having them fertilised whenever they are prepared to have a child.

Occasionally, there are certain conditions in which a woman is born without a womb or has to have it removed due to medical reasons. However, with the help of IVF, embryos prepared in the laboratory out of the eggs and sperms belonging to the couple, can be carried in another woman's womb. This procedure is named surrogacy or inlay terms renting a womb. Surrogates (who carry the baby) also require thorough screening, to ensure that no infectious disease is transmitted to the baby. Confirmation of the baby's parents can be done with the availability of DNA fingerprinting, if required. In such cases, the DNA of the baby will be same as the DNA of the parents to whom the eggs and sperms belong and not similar to the DNA of the woman carrying the pregnancy to term. For men with absence of sperm in the semen (azoospermia), fatherhood is still a possibility. There are two ways of helping such couples.The first option called Testicular Sperm Aspiration (TESA) involves directly obtaining sperm from the testes where they are produced. These sperms do not usually possess the ability to penetrate the egg on their own as they only mature as they go along the way from the testes to the semen. Hence, a process called ICSI (Intra Cytoplasmic Sperm Injection) is utilised in which each sperm is literally injected into a single egg under 400 times magnification with the assistance of a very special microscope called micromanipulator. ICSI is also used for men with a low sperm count or reduced ability of the sperm to move (motility).

Utilising sperm from a sperm bank is another option for men with azoospermia. In cases where donor sperm is used, an attempt to match the blood group and physical characteristics of the donor with the husband is usually made. Freezing (cryopreservation) in the field of ART is a complete breakthrough. Working couples undergoing treatment often find it difficult to synchronise their presence through a treatment cycle. Sperm freezing enables them to continue treatment in the absence of the husband. The semen is simply thawed at the time of ovulation and the wife is inseminated with it. Besides, embryos can be kept frozen for years together, and used for impregnating when required.

Ultrasonography

Ultrasonography (USG) is the use of sound waves reflected from the organs in the body to create an image. Gynaecological practice in this era is incomplete without USG. USG may be used for simply viewing the pelvic organs (uterus, ovaries) or for doing procedures such as removing a blood sample from the unborn child (cordocentesis). In combination with a medical history and examination, ultrasound has enabled the gynaecologist to complete the clinical picture and reach a diagnosis with ease. Before the advent of USG, the structural aspect of a baby was always a surprise for the parents-to-be. However, ultrasound has completely turned this around. Congenital anomalies can be picked up as early as in the third month of pregnancy, giving the couple the option to terminate the pregnancy, while it is still safe to do so.

Invasive procedures such as reducing triplets to twins, amniocentesis can be done comfortably now with the help of ultrasound. USG provides the eyes to the needle entering the body to perform the procedure.

Endoscopy

Endoscopy or key hole surgery involves performing internal procedures with the help of a camera. Laparoscopy aids in visualising the abdominal cavity, whereas hysteroscopy gives a clear picture of the uterine cavity. Initially, endoscopy was mainly used for diagnosis of conditions such as patency of the fallopian tubes in women facing difficulty in conception. However, today, endoscopy can be used for procedures such as hysterectomy (removal of the uterus) and hysteroscopic resection of myomas (removal of fibroids). Key hole surgeries help a woman to recover faster from her surgery so that she can resume her routine activities earlier. A large proportion of endoscopic surgeries can be carried out as day care surgery, making possible admission, surgery and discharge on the same day. This is in contrast to the earlier days when the stay in the hospital after a hysterectomy would be prolonged up to four weeks. The convenience of endoscopic surgery is extremely important to today's career woman.

Changes in healthcare have been dramatic over the last few years. Trying to predict the future of healthcare would be placing a limitation to it. For now, sky is the limit.

The writer is Consultant Obstretician & Gynaecologist Breach Candy Hospital Mumbai
E-mail: durushah@hotmail.com