From time immemorial, the quest for the treatment of infertility has been a constant aspiration. With the advent of the In Vitro Fertilization technique, a ray of hope has entered into the lives infertile couples, but at the same time it has also raised q

During Satyayug, King Dasharath of Ayodhya and his three wives, who were childless, were worried that they didn’t have a progeny to carry out their lineage. King Dasharath was advised by Vasisita Rishi to perform a huge Subh Yagya to please the Gods. As the story goes, God Agni Narayan emerged from the fire during the Yagya with khir, and instructed the king to divide the same into several portions, and give them to his wives. The wives who ate the khir later gave birth to Lord Ram, Laksman, Bharat, and Shatrughan. Historical facts and mythologies aside, things have changed a whole lot since then. But for those who do not have access to such divine means to have a child, there is now hope in the form of In Vitro Fertilization (IVF).

There are certainly other simpler processes to address infertility, such as artificial insemination, in which sperm is placed in the uterus. But for more complex conditions, the IVF procedure is normally used. The procedure involves combining eggs and sperm outside the body in a laboratory dish, and transplanting thus formed embryo or embryos into the uterus.

The above description of IVF sounds very mechanical, but in real life there are many deeply personal dimensions to the process. The first instinct is to think of the IVF process as all in all harbinger of joy and happiness to the family. That is what I thought when I saw a close couple bring home their twins after a long IVF process. And that is also what I thought when I saw the first test-tube baby on Louise Brown’s 35th birthday celebration in the UK on YouTube. In fact, this process has made it possible for the birth of hundreds of thousands of babies throughout the world, and you can only imagine the joy it must have brought to that many families.

Many things have changed since Lord Agni Narayan’s Khir to Louise Brown in terms of treatment of infertility. What has remained constant is the happiness brought in by the birth of a child; and perhaps what has changed and is still changing is the definition of womanhood (as articulated by Keepa Maskey below).

Along with the uncertainty of the technology they have decided to opt for, in the hope of a fruitful result; every couple do face frustrations, agonies, financial/emotional and social burdens.

 

The Other Side of IVF: Real Life Story of  Keepa Maskey

Keepa Maskey, a resident of Kathmandu, is an artist whose paintings have been exhibited internationally. She is also someone who underwent the IVF process twice, albeit unsuccessfully. She recently recounted to the author the dynamics involved in undergoing the process, the deeply personal toll inherent in dealing with the unanticipated outcome, and the courageous attempts at overcoming that with greater understanding, greater acceptance, and through artistic expression.

Keepa, 43, who completed her B.A. in Fine Arts from Mary Mount Manhattan College in New York, New York, married her high school friend in 2007. Like any newly-wed bride in this part of the world, she had to endure a constant pressure to have a child. The couple tried unsuccessfully to have a child for three years, after which they sought consultation with renowned doctors in both Nepal and India. The doctors determined that the problem could be solved through a simple remedial procedure, and after she underwent the recommended procedure, she was indeed able to conceive. But unfortunately she had a miscarriage. She was disappointed, but did not lose hope.

She went to other doctors to find the cause and possible cure to her problem. After many rounds of tests it was found that one of her fallopian tubes was kinked. The solution to that problem, she was told, was either to undergo an operation to remove the kink, or use the IVF procedure. In consultation with her parents and her husband, she decided to go for IVF. Once that decision was made, and the process started, she regained her hope of becoming a mother. In the first attempt, the initial tests were positive, which was cause for much jubilation. But soon thereafter, due to a problem in her blood level, the whole process failed. Understandably, she was an emotional wreck, and went into depression. There was a sense that she somehow needed to see the process to its completion. She said, “I felt like I was in some kind of race. I had to finish the race somehow.”

Undeterred by the setback, Keepa signed up for the process again. By all measures, it was a success: she was carrying twins. She was happy, and was enjoying her pregnancy just like any new expectant mother. But in the fifth month of her pregnancy, she started to feel uneasy and had fever. She was immediately admitted to a hospital, but at around midnight, despite the doctors’ best efforts, she lost her twins. She says that she is still unable to describe the emotion she felt that night, which still haunts her till this day. She adds that only those who have undergone similar tragedy would ever come close to understanding what she went through.

After the burial of the twins, the dark days of pain and emotional roller-coaster started. This tsunami did not leave her relationship untouched; the couple soon ended up divorced. It took her two additional years to come out of the pain, even with the help of her parents and her friends. Her work – painting – also assisted her in the healing process.

Keepa now has a greater understanding of the pressure faced by women in her condition, and feels that it is high time the stigma on childless women is removed. She knows women who are going through depression just because they are unable to bear a child. She doesn’t want people to think that just because she doesn’t have a child, she is a lesser woman. Her acceptance of her situation is also evident when she says that it is important to have a child, but if we cannot have a child, no matter how hard we try, there is nothing we can do but accept the reality. She points out that to be a woman has many layers and purposes in today’s time than just conforming to being a mother. She adds that perhaps her life is meant to send out a message, and be a healing medium to others.

Keepa’s understanding of the predicament of other women in similar situation, her ability to accept the inevitable, and her clear articulation of what she went through, to a large degree portrays – much like her internationally exhibited paintings -- what it is to be a woman in the present day Nepal.

What has remained constant is the happiness brought in by the birth of a child; and perhaps what has changed and is still changing is the definition of womanhood.

What is an IVF?

The full form of IVF is In Vitro Fertilization. It is a process of fertilization by manually combining eggs and sperms in a laboratory dish, and then transferring the embryos to the uterus. Vitro is a Latin word which means dish. So IVF means fertilization in dish.

What is the process of IVF?

The first step in IVF involves injecting hormones to the patient so she produces multiple eggs each month instead of only one. Then she will be tested to determine whether she is ready for egg retrieval. Prior to the retrieval procedure, the patient is given injections to ripen the developing eggs, and start the process of ovulation. Timing is important. The eggs must be retrieved just before they emerge from the follicles in the ovaries. If the eggs are retrieved too early or too late, they won’t develop normally. The doctor may do blood tests or an ultrasound to ensure that the eggs are at the right stage of development before retrieving them. During the procedure, the doctor will locate follicles in the ovary with the help of an ultrasound, and remove the eggs with a hollow needle. The procedure usually takes less than 30 minutes, but in some cases it may take up to an hour.

Immediately after the retrieval, the eggs are mixed in the laboratory with the patient’s partner’s sperms, which he would have donated earlier on the same day. The patient is then allowed to return home, and the fertilized eggs are kept under observation in the clinic to ensure optimal growth. Depending on the clinic, the patient may need to wait up to five days until the embryo reaches a more advanced blastocyst stage.

Once the embryos are ready, the patient will return to the IVF facility so that the doctors can transfer one or more embryos into the uterus. This procedure is quicker and easier than the retrieval of the egg. The doctor will then insert a flexible tube called a catheter through the vagina and the cervix into the uterus, where the embryos will be deposited. To increase the chances of pregnancy, most IVF experts recommend transferring up to three embryos at a time. However, this could mean multiple pregnancies, which can increase the health risks for both the patient and the babies.

Is the process painful?

I think the pain is more psychological than physical.

Why should a woman opt for an IVF?

The primary reason to opt for an IVF is when a woman’s fallopian tube is blocked. There have been a few cases where the patients who came for the IVF process had their problems fixed through simple remedial procedures. So it is not necessary that all the cases have to be solved through the use of IVF procedure.

What is the cost of an IVF procedure?

This procedure is very expensive and time consuming. The cost varies, among other things, based on the medicines used, the cause of infertility, and the institution.

What advice would you give to those who are thinking of going for an IVF?

I think the patient needs to go to the doctor who has specialized on this particular field. In addition, she needs to see more than one doctor. I personally feel that the patient should choose a doctor who is sympathetic to her concerns.