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Sara Tanveer is one of the country’s leading embryologists. She is currently the Director of Tanwir Ahmed Medical Center in Lahore. Ms. Tanwir is known for her work on the issues of assisted reproduction and infertility. The first female embryologist in the country has 20 years of experience in the field. She is a graduate of the University of Nottingham, where she completed an MSc in Embryology and won the Charles Wallace Scholarship Award.
Sara Tanveer has attended numerous conferences worldwide and has published her work on various platforms. She is also credited with bringing Ericsson technology to Pakistan. TAMC satellite centers have been set up at Gujranwala, Kasur, Gujrat, Wazirabad, Mandi Bahauddin and Okara. Sarah Tanveer has already helped more than 4000 couples.
The news on Sunday I spoke with her recently about her take on the relevant social taboos and barriers to fertility treatment. samples:
the News on Sunday: The medical terms for various infertility treatment procedures can be quite a mouthful. Could you introduce them to the lay reader?
SR: With the advancement of medical science, several infertility conditions can now be successfully treated. Infertility treatments can range from medication to embryo implantation through assisted reproductive technology. There are treatments specifically for men or women, and some include both partners. In 85 to 90 percent of cases, infertility is treated using conventional medical therapies—medication or surgery.
There are two main procedures we use to treat infertile couples:
Intrauterine insemination, or IUI, where we stimulate the ovaries for mature follicles and then inject the sperm into the uterus. This procedure does not require sedation. The fallopian tubes must be open and the sperm quality must be good.
IVF where we stimulate the ovaries for mature follicles and once the follicles are mature (18-12mm) we retrieve the follicles for eggs. The eggs and sperm are then collected in an incubator to form an embryo. Once a good quality embryo (blastocyst or morula) is formed, we place it in the uterus. This procedure is also an outpatient procedure, but for egg retrieval we need to sedate the patient for a few minutes. This procedure does not require fallopian tubes and even if the motility or sperm count is low, we can perform it through ICSI (Intra Cytoplasmic Sperm Injection). Here we directly inject the sperm into the egg to form the embryo.
TNS: Are there situations where IVF treatment is better than IUI?
SR: There are several situations where it is more beneficial to use IVF than IUI:
when both pipes are blocked;
when the patient is over 35 years old;
when repeated IUI attempts are unsuccessful;
when the husband’s sperm count and motility are low;
when the couple has been trying for several years without success.
TNS: How long does each procedure take?
SR: IUI takes about 11 to 12 days; IVF about 15 to 16 days.
TNS: IVF and IUI treatments are considered quite expensive. Given the large number of Pakistanis living below the poverty line, how can you help them?
SR: For those who cannot afford IVF or IUI treatment, we at our center provide free treatment to one in ten patients. We also offer treatment packages at lower prices at certain times of the year. We also plan to ask our suppliers to provide the drugs used in these procedures at lower prices.
TNS: What’s the most common infertility medical misconception you’ve come across?
SR: Infertility has a significant negative social impact on people’s lives, especially women, who often experience violence, divorce, social stigma, emotional stress, depression, anxiety and low self-esteem. This is not only a medical but also a social problem in our society. Cultural customs and perceived religious maxims may equate infertility with failure on a personal, interpersonal, or social level. It is imperative that people have enough knowledge about infertility so that couples can seek timely medical help and misconceptions can be corrected. The most common medical misconception is that a baby born after infertility treatment has a higher chance of an abnormality.
TNS: Do you always recommend IVF and IUI treatments or do you also prescribe medication?
SR: People seek help for infertility evaluation and treatment only if they have not been able to conceive within a reasonable period of time. After taking a detailed history and conducting a physical examination, depending on the physical situation, medications are prescribed as a first step. Fertility drugs help the body release hormones that trigger or regulate ovulation and increase the chances of getting pregnant.
We monitor the hormonal profile and perform hysterosalpingography. If everything is passable, we simply prescribe drugs for the maturation of the egg and do ultrasound examinations to see when the egg has matured and counsel the patient.
TNS: Infertility is a taboo subject in Pakistan. What can be done to change this?
SR: There is limited public knowledge about infertility; many myths and misconceptions prevail. Alternative medicine is a popular option. Cultural and religious perspectives on assisted reproductive technologies are unclear. This led to a limitation of its acceptability.
Dealing with infertility is important because every human being has a right to high standards of physical and mental health. In addition, all couples have the right to make choices regarding family planning without being held accountable to society. Some couples go through huge changes during infertility treatment. It would be comforting if public pressure were taken out of the way. Talking about infertility and alternatives needs to become normal. Educational institutes and medical centers should collaborate to raise awareness so that there is no undue pressure on the youth. We need to educate people about the prevalence and determinants of fertility and infertility. The government can provide access to safe and effective infertility treatments. People also need to be educated about infertility treatments that worsen health or patient risks.
TNS: Infertility can often take a toll on people’s mental health. How do you help your patients in this area?
SR: Although infertility is not a disease, the problem and its treatment can affect all aspects of people’s lives. This can cause a variety of psychological and emotional disturbances or consequences, including turmoil, feelings of frustration, depression, anxiety, hopelessness, guilt, and feelings of worthlessness. We are careful to explain to our patients before starting treatment that there is an improved chance, although not 100%, that they will become pregnant. They should try before it’s too late. It is important to listen to patients and ensure they feel understood, respected and reassured. Counseling may include individual and couples therapy and/or professional support groups. Content may vary by patient and treatment choice, but will usually include at least some form of information and counseling, support, or therapeutic counseling.
The interviewer is a freelance associate
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