Over fertility is a problem of Bangladesh.Still infertility is an issue 1 in 7 couples have difficulties to conceive. Inability to create a desired pregnancy that culminates in the Birth of child is likely to create a life crisis for women and their partners.

1. Challenges - In management of
infertility
Rokeya Begum
Honorary Advisor
USTC
Director, Surgiscope Fertility Centre
Chittagong

2. Over fertility is a problem of Bangladesh
Still infertility is an issue
1 in 7 couples have
difficulties to conceive.

3. Inability to create a desired pregnancy
that culminates in the Birth of child is
likely to create a life crisis for
women and their partners.

4. Primary infertility – The ability to conceive after
one year of unprotected intercourse for a women
younger than 35 or after 6 months for
women 35 or older.
Secondary infertility – The inability of women to
conceive who previously was able to do so.

5. Infertility is the problem of both
male and female but in
Bangladesh – women seeks fertility
treatment not the men.

6. The overall incidence of infertility has
remained relatively unchanged for the
last 30 years (Speroft & Fritz 2005)

7. The use of fertility enhancing drugs
has increased exponentially over the
last 3 decades.

9. Why
1. Increase education and carrier opportunity for
women pregnancy is difficult when they are
finally ready.
2. Increase public awareness of infertility and
treatment option.

10. Female age is important determinant for
fertility
1. Female are born with > 1 million of eggs.
2. Ovulation releases 300 eggs in reproductive years.
3. Remainder of eggs undergo atresia.
4. Older women are less responsive to fertility drugs.
5. Chromosomally deformed embryo and increases
miscarriage rate.

11. Causes of infertility
Long list
Fertility physician categories the causes of infertility
1. Ovulatory factor
2. Tuboperitoneal factor
3. Male factor
4. Social factor – Husband abroad
5. Unexplained

12. Four things are needed to make baby
1. Eggs
2. Sperms
3. Uterus
4. Tubes ±

13. • To Find out the Cause of infertility,
which influence the management and efficacy of care

14. • History and physical examination of both partners.

15. Semen analysis of husband – Andrologist

16. • Hormone analysis
• Transvaginal sonograpy

17. Perifollicular vascularization

18. Hysterosalphingography evaluation of interior of
uterus and fallopian tube

19. • Sonosalpingography
• Hysteroscopy
• Laparoscopy

20. Treatment approach
• Important and urgent for the patient.
• However most doctor take a wait and watch approach.
• Often patient get fed up and frustrated and drop out of
treatment.
• Need to change this attitude of physician.

21. Couple are getting married at on older age – time is
running out as the biological clock ticks on.
Science is moving, technology advancing
we can help them.

22. Common mistakes
1. Without semen analysis ovulation inducing drugs
are used.
2. Investigations are performed in a piecemeal fashion
rather than as part of an overall strategy.
3. Investigations are done in a slow time consuming
manner and patient get fed up.

23. 4. Doctors are keen to “do something” repeated curettage
and laparoscopy are often done unnecessary.
5. Husband is in abroad wife recieve ovulation inducing
drugs.

24. The harm done
• Trust between the doctor and patient breaks down.
• The temptation to try many empirical, possibly useless
medical treatment is considerable.
• Patients often end up spending large sums of monies at the
hands quacks and “spiritual healers”

25. What to do
1. The couple must be treated as a unit.
2. Find out the cause of infertility.
3. The workup / investigations must be explained to the
patient and should be completed within two months.

26. Treatment
1. Progressive to more aggressive treatment.
2. Stepped care approach.
3. Treatment according to cause.
4. Tailor the treatment according to patients age, medical
diagnosis and budget.

27. Not to do
1. Repeated ovulation induction.
2. Ovulation induction without monitoring.
3. Risk of ovarian malignancy due to repeated
ovulation induction.

28. Assisted reproductive techniques
1. IUI (intrauterine insemination)
2. IVF (In vitro fertilization)
3. ICSI (Intracytoplasmic sperm injection)
4. Cryopreservation
5. Assisted Hatching
6. PGD (Pre-implantation genetic diagnosis)

29. Simple principle of ART is to increase the
chances of the egg and sperm to meet each
other for fertilization.
Not artificial – Just assisting the nature.
No increase risk of birth defect.

30. ART is more expensive
May be
But right treatment is always costly.

31. What is success rate
For patient success means a baby. Success rate is
either 100% - 0%.
For the clinician, it is a little more complicated
since you are dealing with group of patient.
High chance and low chance.

32. Success improved with
advancement of technology
and dedicated team.

33. Complications of ART
1. Ovarian Hyperstimulation Syndrome (OHSS)
2. Abortion
3. Ectopic Pregnancy
4. High Order Birth (Multiple Pregnancies)

34. Ovum Pickup

35. Embryology work station

36. In the year 2018
> 11,000 couple attend Surgiscope fertility centre.

37. Different causes of infertility
a) Secondary infertility due to infection related tubal and
endometrial damage.
b) PCOS
c) Endometriosis
d) Male factor infertility
- Diseases
- Abroad

38. We are trying to predict
• How likely patient has chance to conceive spontaneously.
• How long she can delay trying to conceive.
• What treatment options should we use.

39. Various modalities of treatment are given
1. Ovulation induction
2. Hysteroscopy
3. Laparoscopy
4. Tubal recanalisation after tubectomy
5. Intrauterine insemination
6. IVF/ICSI

40. ART can help large number of infertile couples
it is estimated that only 5% candidates utilize
this medical service.

41. Reasons are
1. Scarcity of fertility centre
2. Lack of medical staff
3. Terrible stigma woman’s status through motherhood.
4. High fertility rate
5. High infertility treatment cost.

42. Present Status ART Service
<5% ,
Bangladesh
Serving
30,000 Couples,
Affordable
@15%
0.2 Million, Requiring
ART @ 5%
3.84 Million, Infertile Coouples
@12%
64 Million, Reproductive Age Group
Our total population: 160 Million

43. Needs more innovative approaches
for low cost ART services without
compromising the quality in Bangladesh.

44. FINANCIAL EQUATION
10.5 Billion Market
VS
70 Million (i,e., 0.07 Billion)
Current Service
Service Opportunity Loss
And
Financial Drainage > 10 Billion BDT

45. • We have to think for it how to tackle the situation.

46. Thank you