For couples facing trouble conceiving, fertility treatments give them a chance to bring life into the world.
As a young 13-year-old, Ann showed an inclination towards reproductive medicine. She did her undergraduate degree in Medical Biotechnology and it was then that she found out about an option to pursue a masters degree in Clinical Embryology. It was quite competitive, though-there were only 5 seats for this specialisation all across Asia. She cracked the exam and soon was enrolled in the program at Manipal University. It was a 2-year rigorous programme- but she feels grateful to have done it from such a prestigious university. There was equal importance given to the theory, practicals and the clinical aspect along with the adjunct subjects. She believes that, with this program, she was moulded to think as both a clinician as well as a researcher.
How Iris Fertility was conceived
Before opening up her own practice, Ann worked in several different fertility hospitals across India (Manipal, Hyderabad, Rajasthan and Kochi) and had also done a hospitation in Germany to gain experience. While running her practice is more strenuous, she made the switch for good reason.
She soon came to realise that ethical practice in the fertility field was nil, even in the most branded of hospitals. She could not digest the fact that people were willing to shed their ethics just to get their patients two pink lines on a pregnancy test. Numbers were all that mattered- clinical pregnancy rate, success rate and biological pregnancy rates- these numbers are for the registers and nothing more. She recalls that during her Masters in Clinical Embryology in Manipal, ethics were plastered into the minds of all the students. This is not the aim of fertility medicine, she asserts. The aim should be live birth- it should be to give a couple priceless memories with their children who grows up to be healthy.
She saw an advertisement for a franchisee called Cocoon looking for partners to start their practice in Kerala. Ann envisioned this as an opportunity to attempt to do something on her part. Due to a few legal issues, they could not go forward as partners. Ann took over the shares and continued to keep the clinic- the name was changed and that’s how Iris Fertility was born.
All about Infertility
As per this year’s WHO statistics, 1 in 6 people face infertility issues. To an extent, we have brought this situation upon ourselves- it has a lot to do with our current lifestyles, food patterns and advancing maternal age.
Infertility may have to be looked into if a couple fails to conceive after one year of cohabitation and actively trying. Before trying to conceive, Ann recommends starting eating healthy- cut the consumption of carbs and chicken, try to be in your optimal BMI range and get a blood workup done to rule out Diabetes and Thyroid. It is a good idea to get basic hormone profiles done too. Lifestyle modifications to eliminate smoking and drinking should be made. Women can start taking folic acid tablets or nutraceutical supplements, available in most pharmacies.
There is definitely a taboo that surrounds discussions on infertility. Ann says there is a major disparity in the way different people approach infertility. Out of the four Indian states that she has worked in, she believes that in Hyderabad she found it easiest to communicate with the patients- they were educated on the issue.
In most places around the world, relatives do not shy away from repeatedly questioning a couple on why they haven’t had a child after a few years of marriage. A good percentage of Ann’s patients who opt for treatment do not do so because they’re running out of time or eggs or hormones; it’s because they are running out of the patience to answer to society’s questions.
For her, the most important part of her relationship with her patients is transparency. For a patient walking into Iris Fertility, the appointment is divided into three segments- the first being consulting with the gynaecologist followed by a meeting with the embryologist followed by mandatory psychological counselling.
The couple then undergoes general physical examinations, blood tests or other diagnostic tests to assess the level of infertility that they are dealing with. There are four levels to infertility as elaborated below:
Level 1: Mild Infertility
Ovulation Induction is performed at this stage by giving hormones to time the ovulation. The couple can then try to conceive naturally by timing their intercourse to this window. All that is done at this stage is artificially timing the body to create an atmosphere conducive to conceiving.
Level 2: Intra-Uterine Insemination (IUI)
This is done when there is an issue with the fertilisation process or at a more preliminary stage when the sperm has to reach the egg in the fallopian tube. In this process, the sperm sample is collected and a catheter is used to leave the sperm into the uterus. The aim of this treatment is to get the egg and sperm into proximity to fertilise naturally.
Level 3: In-Vitro Fertilisation (IVF)
IVF is done in circumstances where things are a little more out of control- the couple is prescribed medicines, the eggs and sperms have to be taken out of the body and the fertilisation process is done outside the body in a Petri dish. It has to be noted, though, that the sperm does the fertilisation process by itself. The fertilised embryo is then placed back into the uterus.
Level 4: Intra-Cytoplasmic Sperm Injection (ICSI)
In this stage, the sperm usually also displays issues, either with their motility or structure, so microsurgery is performed wherein the egg is held with suction and the sperm is surgically aspirated and injected into the egg. For ICSI cases, fertilisation is ensured.
No matter which one of these processes a couple may have to undergo, at the end of the day, implantation has to be done by the embryo by itself. So far, there hasn’t been any method to humanly ensure the implantation process. Ann says that this is where God plays a part.
The clinic also has a system- an IVF Flow Chart and Calendar- so that the patients and the staff in the clinic remain abreast along every step of the way. While Iris Fertility is still in a budding stage, they treated over 20 patients within the first three months of their independent operation with minimal marketing, which is a testament to their professionalism.
Ann acknowledges that infertility treatments are extremely taxing- physically for the woman and mentally for the couple, placing strain on their married life. The psychologist intervention as part of the fertility treatment ensures that the couple keeps receiving positive assurance.
Timing your baby
With more and more women opting to push childbearing by a few years to fulfil their career goals, egg freezing has become quite a commonplace discussion. They’ve advanced greatly in the past few years and offer excellent survival rates. Iris Fertility offers egg freezing options for those who are interested.
“Freezing eggs is not a problem,” Ann says, “but one must remember that the body ages in that time. If you’ve chosen to delay your pregnancy by a large margin, implantation may pose a problem.”
Ann herself is a mum to year-old Faye who balances running the practice and her house- she understands the importance of prioritising one’s career. She advises every woman to consider conceiving at least once before the age of thirty. She explains that the body is made such that the prime reproductive age for a woman is set from 25 to 30. Having a baby at that age makes it easier to bear the child, take care of the child postpartum and match their energy levels as they grow up.
She recalls reading an article of a doctor boasting about helping a 62-year-old woman getting pregnant. The woman came from a lower socio-economic background, did not have a support system in place and her husband passed away shortly after. She could not afford formula that she needed to supplement her feed as she did not produce milk owing to her age. Ann does not see this as the doctor’s achievement- she can’t help but look at the situation practically. Because of this, Iris Fertility has an age bar of 42 years for its patients.
Infrastructure, Team & Sessions
Iris Fertility has a 5-bed ward; all procedures are done on an outpatient basis with the patient spending approximately 4-hours in postoperative care after surgeries, after which they can head back home. The clinic also has its own Operation Theatre, Embryology Lab and Andrology Lab. They also have two consultation rooms for the specialist doctors, a large waiting area and a sample collection zone.
Iris Fertility boasts an all-women team with a resident gynaecologist, a visiting gynaecologist, a resident junior, a resident embryologist, an assistant embryologist, a psychologist, 2 nurses and a housekeeping staff member.
Other than psychological counselling, Iris Fertility also offers 2-hour yoga sessions every Saturday to offer some relief to the taxing process of trying to conceive.
Ann’s visions for the near future for Iris Fertility include expanding their clinic to include an Obstetrics department and NICU so that the babies made in Iris can be born there too!
This article has been written by Neha Nambiar.