Professor Geeta Nargund is the award-winning Medical Director of abc ivf. She is also the Medical Director of CREATE Fertility, sister clinic, and a Senior Consultant Gynaecologist and Lead Consultant for Reproductive Medicine services at St George’s Hospital, London. Here’s our exclusive Interview with Professor Geeta Nargund, Medical Director of abc ivf and senior NHS consultant for Reproductive Medicine where she discusses the challenges facing Asian communities when it comes to tackling infertility issues or seeking IVF treatment.
What are the early signs of infertility in South Asian women? Are they any different from women of other origins?
Age is an important factor affecting fertility outcomes. As women get older, the quantity and quality of eggs decline making it more difficult to conceive and also leading to increased miscarriage rates. If you are over 35 years old, and are trying to conceive, it is important that you see your GP for tests. The prevalence of Polycystic ovary syndrome (PCOS) is higher amongst South Asian women and it is one of the leading causes of irregular ovulation and infertility and its symptoms can include weight gain, irregular periods and excessive facial hair. Endometriosis can also impact a woman’s fertility, the main symptoms of which include heavy and painful periods, pelvic pain and pain during intercourse. Women who are underweight or overweight can also suffer from ovulation and fertility problems. If you suffer from underactive thyroid problems, this can also contribute to difficulty in conceiving.
Please check your mother's medical and reproductive history as well as the age she entered menopause. If your mother has undergone early menopause, you are more likely to undergo early menopause. Please ask for your tests to check your egg reserve if you have a family history of early menopause, underactive thyroid, endometriosis or have undergone ovarian surgery. Finally, if you have irregular periods or have any known gynaecological problems, or if your partner has sperm problems, it is important that you seek help without any delay.
How can women figure out the root cause of infertility and what kind of counselling is needed not just for them, but for their spouses/partners as well as family, since South Asian households still live in the stigma of not reporting or addressing infertility?
If you are having difficulty conceiving, the best first step is to speak with your GP who can suggest the appropriate course of action. It is likely you will be referred for a fertility investigation where you’ll have an ultrasound scan and blood tests taken to check your egg reserve and identify factors that could be causing infertility. A fertility doctor will then be able to talk you through the best options.
Finding out that you might have issues with your fertility can of course be very emotionally distressing, so most fertility clinics offer a fertility counsellor who can guide you through the process. They will also support with how you can approach discussing infertility with your friends and family. Many of our staff have Asian heritage, so they understand some of the sensitivities associated with infertility for some south Asian groups.
Could you list some root causes of infertility for our readers? For instance, chronic PCOS, Empty Sella Syndrome etc.
Alongside PCOS and endometriosis for women, there are of course sperm factors that impact fertility, such as low sperm count or sperm quality and blockages that prevent the delivery of sperm. Age can also play a significant role – female fertility peaks at age 25, and drops after the age of 35. Many people don’t realise that men also have a biological clock, and their fertility also declines from the age of 40.
How costly is an IVF cycle and what can partners do to prepare for it if they know that it is their only option?
Unfortunately, the UK still faces an IVF postcode lottery, meaning that access and eligibility to NHS funded fertility treatment will be based on where you live. At abc ivf, we have a mission to help as many people as possible and we have pioneered affordable IVF treatment. We are proud to offer the lowest cost treatment in the UK, with our fully inclusive IVF package costing £2750. However, there will be additional costs if you need ICSI treatment for male factor infertility and other additional specific treatments related to your clinical conditions. It is vital that we address the inequality of access to fertility treatments and we are proud to deliver affordable IVF across our country. In terms of preparing for starting IVF treatment, assessing your lifestyle choices is a good first step and preparing for pregnancy is key.
There is a fear and little information about IVF wherein many people suspect it may lead to cancer. Is that true?
There is no evidence that IVF treatment leads to cancer. It is important that you discuss your medical issues and treatment options and choose the safest options for you.
How many IVF attempts can one woman undergo healthily?
Every woman’s body is different. The physical burden and side effects of IVF treatment on the woman can be reduced by less drug intensive mild IVF options which use a lower dose of stimulating drugs for a shorter period of time. It is the best option for women with PCOS to reduced risks of Ovarian Hyperstimulation Syndrome which, in its severe form, can lead to hospital admission. Mild IVF can be used by women of all age groups and is aimed at maximising the quality and not quantity of eggs, reducing health risks and side-effects related to drugs and improving the health outcomes for mother and baby. Natural and Natural Modified IVF are particularly useful for women who have low egg reserve and who are older, where taking high doses of stimulation drugs has no benefit. Natural IVF relies on natural selection of the egg by your ovary to create an embryo for implantation. Naturally selected eggs can be of higher quality compared to eggs from conventional stimulation. The aim is to achieve the best possible success rate without compromising your safety.
Many women undergo more than one cycle of IVF treatment (up to 3 cycles). Undergoing multiple cycles of IVF can also be very emotionally challenging and it can add to the financial and physical burden. It is important that you get the best advice from your consultant and you don’t continue with trying multiple cycles unless there is a clear change in your tailored treatment plan based on science-based evidence. It might be that some women decide to stop trying due to the emotional burden caused. Our clinicians will ensure your wellbeing at every stage of treatment, guiding you through the process and giving you the opportunity to make well-informed choices, to ensure your safety throughout your cycle.
Do you think that South Asians miss the point that infertility is not just about not being able to conceive a child but a lot more about a woman's over all health conditions?
Many people don’t realise that lifestyle factors can impact your fertility, such as your age, BMI and how active you are. It is critical that we drive education and awareness of fertility amongst the south Asian community – a key part of this is encouraging couples to seek earlier diagnosis to increase their chances of success in treatment. We must transform success and access of fertility treatment for south Asian communities and opening up the conversation and tackling the stigma around infertility is our first step. I am committed to educating people about their fertility. I have done many fertility education sessions on Asian media channels and community organisations in the last three decades. Knowledge is power. We are here to help you.