Sara Tanwir, is one of the leading embryologists of the country. She is currently a director at the Tanwir Ahmed Medical Centre in Lahore. Ms Tanwir is known for her work on assisted reproduction and infertility issues. The first female embryologist of 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 Tanwir has attended numerous conferences all over the world and has had her work published on various platforms. She is also credited with bringing the Ericsson Technology to Pakistan. Satellite centres of the TAMC have been set up in Gujranwala, Kasur, Gujrat, Wazirabad, Mandi Bahauddin and Okara. Sara Tanwir has already helped more than 4,000 couples.

The News on Sunday talked to her recently about her take on relevant social taboos and obstacles to fertility treatments. Excerpts:

The News on Sunday: The medical terms for various procedures in infertility treatment can be quite a mouthful. Could you please introduce these for the lay reader?

SR: With advancements in medical science, several infertility conditions can now be treated successfully. Treatments for infertility can range from medication to embryo implantation through assisted reproductive technology. There are treatments specifically for men or for women and some that involve 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 semen into the uterus. This procedure does not require sedation. The fallopian tubes should be patent and the quality of sperm should be good.

In vitro fertilization, where we stimulate the ovaries for mature follicles, and once the follicles are mature (18-12 mm), we retrieve the follicles for eggs. The eggs and the sperm are then put together in an incubator to form an embryo. Once an embryo of good quality is formed (blastocyst or morula), we put it in the uterus. This procedure is also an outpatient procedure, but for egg retrieval, we have to sedate the patient for a few minutes. This procedure does not require fallopian tubes, and even if the sperm motility or count is low, we can still 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 an IVF treatment is better than an IUI?

SR: There are several situations where it is more beneficial to use IVF rather than IUI:

when both tubes are blocked;

when the patient is above 35 years;

when repeated attempts with IUI fail;

when the husband’s sperm count and motility are low;

when the couple has been trying for a few years but has not been successful.

TNS: How long does each procedure take?

SR: An IUI takes about 11 to 12 days; an 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 the IVF or IUI treatment, we at our centre provide free treatment to one out of ten patients. We also offer treatment packages at lowered rates at certain times during the year. We are also planning to ask our suppliers to provide the medicines used in these procedures at lower rates.

TNS: What is the most common medical misconception about infertility that you’ve come across?

SR: Infertility has significant negative social impacts on people’s lives, particularly women, who frequently experience violence, divorce, social stigma, emotional stress, depression, anxiety and low self-esteem. It is not only a medical but also a social problem in our society. Cultural customs and perceived religious dictums may equate infertility with failure on a personal, interpersonal or social level. It is imperative that people have adequate knowledge about infertility so that couples can seek timely medical care and the misconceptions can be rectified. The most common medical misconception is that a baby born following an infertility treatment has a higher chance of abnormality.

TNS: Do you always recommend IVF and IUI treatments or also prescribe medication?

SR: People seek help for evaluation and treatment of infertility only if they have been unable to conceive in a reasonable period of time. After taking a detailed medical history and conducting a physical examination, depending on the physical situation, medication is prescribed as a first step. Fertility drugs help the body release the hormones that trigger or regulate ovulation and boost the chances of getting pregnant.

We monitor the hormonal profile and do hystero-salpingography. If everything is passable, we just prescribe medication for egg maturation and carry out ultrasound examinations to see when the egg is mature and counsel the patient.

TNS: Infertility has been a taboo subject in Pakistan. What can be done to change that?

SR: There is limited knowledge in the society about infertility; many myths and misconceptions are prevalent. Alternative medicine is a popular option. The cultural and religious perspectives about assisted reproductive technologies are unclear. This has resulted in limiting its acceptability.

Addressing infertility is important because every human being has the right to high standards of physical and mental health. Also, all couples have the right to make choices regarding family planning without being answerable to the society. Some couples go through immense changes during fertility treatments. It would be comforting if societal pressures are removed from the way. Talking about infertility and the alternatives should be made normal. Educational institutes and medical centres should collaborate to increase awareness so that there is no undue pressure on the youth. We need to educate people regarding the prevalence and determinants of fertility and infertility. Government can make arrangements for access to safe and effective fertility treatments. People should also be educated about fertility treatments that worsen the health risks or the patients.

TNS: Infertility can frequently take a toll on people’s mental health. How do you help your patients in this area?

SR: While infertility is not a disease, the issue and its treatment can affect all aspects of people’s lives. This can cause various psychological-emotional disorders or consequences, including turmoil, frustration, depression, anxiety, hopelessness, guilt, and feelings of worthlessness. We are careful to explain to our patients before starting the treatment that there is an improved chance, though not hundred percent, that they will conceive. They should give it a try before it is too late. It is important to listen to the patients and ensure that they feel understood, respected and reassured. Counselling can include individual and couples’ therapy and/ or professionally facilitated support groups. The content may differ depending on the patient and the treatment choice but will usually involve at least some form of information and implication counselling, support or therapeutic counselling.

The interviewer is a  freelance contributor