|
|
The couple signs a consent form for TID after appropriate counseling. The doctor will need to ensure that at least one of the woman's fallopian tubes is open, and may advise a hysterosalpingogram or laparoscopy to confirm this.
The woman may be treated with fertility drugs to ensure ovulation. Daily vaginal ultrasound scans are done from the 11th day of the cycle to view the evolution of the egg and discover exactly when the maturing follicle bursts. Alternatively, ovulation prediction kits may be used to help time the insemination.
For frozen sperm, a straw of the appropriate donor (who best matches the husband's physical traits) is picked out and rechecked under the microscope to see that the sperm are actively motile. The doctor matches the donor and the husband for height, build, hair color, skin color, eye color, Rh factor and blood group.
Under sterile conditions, the donor sperm is injected through a plastic catheter into the cervix. The patient rests for about ten minutes and that's that. The husband is encouraged to be present at the time of the insemination -- this is one way that both the partners can be close during the process; and some clinics will even allow the husband to do the actual insemination himself, so he feels more "involved". There is no reason not to make love shortly after TID if this is what the couple wants to do.
After each insemination a two weeks waiting period has to be endured to find out if the procedure has been successful. It's an emotional roller coaster - anticipation, insemination, menstruation, desperation, and then, hopefully - elation!
Success statistics mimic nature. They are 10% in a 25 = year = old woman in one cycle; so that over six treatment cycles the chance of a pregnancy is about 60% in a 25 = year = old - and only about 20% in a 38 = year = old. It takes nature time to make babies, and patience is needed. The chances of success are highest if the female partner is young, has no fertility problem and the husband has no sperm. Irregular menstrual cycles or a history of endometriosis or tubal infection decreases the chance of pregnancy. Interestingly, pregnancy rates with TID are lower in women whose husbands have a low sperm count, as compared to those whose husbands have no sperm at all. The reason for this is not entirely clear.
Once a pregnancy occurs, it is like a normal pregnancy - with the same risks of miscarriage and birth defects as any other. If the patient changes her doctor, she does not even need to tell new doctor that she has conceived by TID. The name on the birth certificate will be the wife's and the husbands.
With TID strict confidentiality should be maintained, and the identities of the patients and donors are kept secret. Historically, parents have kept TID a secret from the child and from friends and relatives. Unlike adoption, TID is not obvious to those who know the infertile couple. It is entirely up to the parents to tell the child the circumstances of his or her birth and most Indian doctors advise against revealing the truth. However, there is always the burden of secrecy that the parents have to bear for the rest of their life.
© Dr. Aniruddha Malpani and Dr. Anjali Malpani www.drmalpani.com
Credits: How to Have a Baby: Overcoming Infertility
