Shalini Sapkota* looked a little uneasy as she waited for her turn at the infertility center in Bijulibazar in Kathmandu. It had been a long day and black clouds loomed threateningly, making her feel like running away from there. But she stayed put. It wasn't the first time she had visited the clinic, and there were important things to know from the doctor. Even after years of marriage, her husband Abhisekh* and she had been childless, and it was at this clinic that she sought a solution.
It was a friend who had sent her there. "My friend, who had been childless for 18 years after marriage, is now pregnant. Her family members don't know, but because she knew that I was suffering from the same pain, she referred me to this clinic," Shalini says. Now, she is hopeful that her dreams of being a mother will come true by the next year.The first time in-vitro fertilization (IVF) case came into light in Nepal was on March 4, 2005. IVF is a process by which an egg is fertilized by a sperm outside the body. Even 15 years after the introduction of IVF treatment in the country, doctors say that there are still many who are ashamed of being associated with the treatment and wish to remain anonymous. Dr Uma Shrivastava, reproductive endocrinologist and infertility specialist at Infertility Center Nepal, who attends to many infertile couples, says that there are a lot of complications associated with it.
"Many people who come seeking solutions for parenthood don't need IVF treatment. In fact, though ours is an infertility center we help couples recognize the problem and help them find ways to have children. We counsel them thoroughly before they come to the conclusion of going through the IVF treatment. Not everybody needs it," she says.
According to Dr Shrivastava, ten percent of the married couples are childless and over the years, she has treated thousands of them. There are hundreds of couples who have sought her help, but she says that there is no way of keeping a record of the number. She thinks it is because most of the couples think that the problem is something that is unspeakable and on top of that, IVF treatment is a shame and people don't want to be linked with it.
"Many couples come and we do our best to treat them. But once they get positive results from the treatment, they stop coming to the clinic as they don't want to be associated with it," she says. Many of her patients come and complain of how the family members or acquaintances criticize them for resorting to this treatment. Even though more people are resorting to IVF treatment, social stigma a couple faces because of it isn't any less.
However, given the number of cases and people that have resorted to IVF treatments, it's apparent that people have realized that it can be a medical gold mine. There are many clinics spread around the valley that provide the option to people and with the number of growing people interested in the services, there should be proper dissemination of the information and public awareness related to it.
Dr Bhola Rijal, who is credited to have contributed to the birth of first test tube babies in the country, says that he is happy by the advancement of medicine to provide solutions to people, but authorities need to make sure that the public has enough information regarding it.
"Despite the developments, we can't deny that ours is still a patriarchal society and husbands have a tendency of blaming their wives for being childless. They don't want to bother with all these medical procedure and instead talk of bringing in a second wife. It is sad to note that they haven't stopped saying such things, when both the father and the mother could be responsible for it," he says.
He further says that people call it a curse and don't look for possibilities. "There is still a misconception of associating it with God's curse, and the state should work rigorously to change that viewpoint," he says adding that people should realize that infertility could make a couple's marital life traumatic and take the necessary steps to negate that.
Dr Shrivastava agrees with that. "People can be very cruel to childless couples sometimes and leave no stones unturned when it comes to criticizing them for that," she says. People taking up the treatment are in need of much support which they should get from all sides and parties, as the mother has to go through a lot of pain.
Dr Shrivastava recalls a case where a mother, impregnated with the IVF process, had to abort the child at 32 weeks due to complications. "It becomes very difficult to handle the patient, as it is a traumatic experience not only for the couple, but for the doctors as well," she says. The procedure demands a lot of time and effort from the couple and dedication from the doctors. "We have to keep the mother's hormones in check, and make her fit enough for the daunting task," she says.
Such a critical task, no doubt, would need to be dealt with carefully. That is one of the reasons why the state has to regulate some rules to ensure that nothing is off the mark.
Even if a case is successful and a test tube baby is born, the parents request the doctors to keep the reality a secret. Dr Shrivastava says that many times, even they don't know if a case is successful because the patients run away once their work is done. The success stories are hidden or never admitted. She blames it on the social stigma and says that parents might not always want their children to grow up knowing their true identity.
Prasuti Griha in Thapathali was the first government hospital to provide IVF services to the people in 2012, and since then, around 19 test tube babies have been born from the 14 batches that they have worked on. The 15th batch wasn't as lucky, as the earthquake struck in the middle of the process. The IVF building fared badly in the earthquake, and they haven't been able to resume the services.
Dr Usha Singh, head of IVF department at Prasuti Griha, says, "Hopefully, we will be resuming our services after a few months. We don't want to disappoint the couples as IVF procedure here is a little cheaper than in private clinics."
However, the expensive procedure doesn't guarantee success. Each clinic has its own success rate, and there isn't any government data to represent a general number. But Dr Shrivastava says it would be difficult to round up a number or percentage as each case is different.
There are couples who try the IVF treatment up to three times. But even if it doesn't work, couples don't have to feel sad. According to Dr Rijal, couples can always consider adopting a child. "We don't force them, of course, but they should know that there are still other options," he says. And it wouldn't be a bad idea as long as the laws are supporting.
However, the ultimate goal of these clinics and the procedure is to ensure the happiness of couples. Hasana*, a 32 year old mother, appreciates the IVF treatment. They had been trying for a baby for 11 years, and finally, at six months pregnant, she is patiently waiting for the day when her son or daughter will be born. Though the fact that she resorted to the IVF treatment is a well kept secret, the goal has been achieved. For now, it looks like IVF treatment is a much sought after but stigmatized solution.
*names changed
sachimulmi@gmail.com