What Your Doctor Isn’t Telling You About IVF!

Introduction to the Podcast and Guest's Background

[00:00] Women are finding it difficult to conceive. Today if a woman who is 30 years of age and a man who is 35

[00:20] years of age if they want to get pregnant the lady will get pregnant with an egg which is 30 years old but the man has formed this form 74 days back. I want to know from you take your own time and tell me when we have started to IVF it has been shown that every year there is an increase of IVF cycles by 5 to 10% globally. When I

[00:40] golden years in a woman's life to become pregnant is late 20s and early 30s and I want everybody to hear this. Probably as fertility doctors we have become like grandparents you know where we used to say if you know push people to get married early and have a pregnancy they were not wrong actually. Just tell me as a basic concept. As per the World Health Organization they say that in

[01:00] simple words one in six couples are struggling to get pregnant. What else can they? When you translate to a global perspective 15% which is almost equal to 48.5 million people globally are struggling as of now within fertility. Dr. Parthadas is a reproductive medicine consultant. His journey in the field of reproductive

[01:20] reproductive medicine was shaped by familial influences and a deep-rooted passion for healing and an IVF specialist. Beginning with a convent education and inspired by his grandparents' legacy, he pursued obstetrics and gynecology after his medical school to make a positive impact on others' lives. Motivated by the struggle of infotile couples, he delved into reproductive medicine, leading him to Dubai, where he embraced

[01:40] opportunities for growth and learning. He refined his skills through international experiences and technological advancements, integrating empathy and patient care rather than accolades. He traveled from Germany to US and then to Spain to enhance his expertise and to learn from the best. He brought all that experience and skill set to UAE, provided his services to University Hospital charge,

[02:00] surgery.

[02:20] Scrubs and Suits Podcast. Dr. Parthadas, welcome to Scrubs and Suits. Thank you so much for having me here today. You're the first in the first series of scrubs and suits, you're one of the doctors that we're calling in and it's our honor to have you in because in fertility and IVF is something exciting and not many of us even doctors

[02:40] doctors don't know much about it because it has progressed so much. So we'll just start off by you telling us about yourself. Where did you start and what brought you to Dubai and how are you at the moment? Well, thank you so much for having me here. It's a pleasure and I'm delighted that you are inviting me as a first guest. So I hope I

[03:00] do justice to this podcast. So yes, I'm Dr. Parth and I'm the Deputy Medical Director at Ockett Fertility Clinic in Dubai Health Society and consultant IVF trying to do as much as possible to increase the population of this world and that is what IVF is all about and trying to cater to the needs of our couples to

[03:20] to have pregnancy and children at home. So I started my journey way back in 2003 and since then continuing with the same process of IVF. I came into Dubai in 2006. Initially I was in charger and then I moved into Dubai and so far it's been good. Yes.

[03:40] So you've been doing IVF since you've been in Dubai or you were doing obstetrics before and then you moved into IVF? No, my obstetrics stopped in India. I started my super specialization training from Bombay in India and since then I have been doing IVF explicitly. I mean you've seen probably IVF in its infancy and now IVF

[04:00] its teenage years also, the whole journey. If Dr. Parthadats was not a doctor, what would you have been? That's a difficult question again. Well, I really don't know what I can be or what I would like. I have an eye for aesthetics, a little bit of what I say, finesse

[04:20] or perfectionism. I don't know whether this can translate into a profession. Into your designing maybe? Anything which is good, something where you want to do things, whatever you do, do it best. But again, as I wanted to be a healer since my childhood days, I could not think of myself as anything else but

[04:40] just to help people out. So I inculcated this hobby of mine doing the best into my medical practice and when I think that when you put in your hobby or whatever you like into your profession then I think it's grim success. But 18 years now in Dubai, do you have any regrets? 18 years in Dubai and I have no regrets. Good, excellent. So it's a full

Rising Infertility Rates and Factors Affecting Fertility

[05:00] fulfilling 18 years then. Dubai is an amazing place to be in where anyone who comes in here and you are in the right place and you do the right thing, this is the place to grow and make a good life out of it. Great. So let's just jump into it now. I'm going to ask you questions that our viewers obviously would like to ask and something that my patients even, I'm a pediatric

[05:20] neurologist. But my parents that come to me, they have these basic questions to me. I can answer some of them, but for the rest of them, we need experts like you. So I know that we all came into existence when an egg cell came with a sperm cell and they fertilized together and a human is created. That's a simple form of it. But we know that many things can go wrong. It sounds very simple.

[05:40] but at so many different stages many things can go wrong, leading to infertility or subfertility or sterility, whatever it may be. So I want to know from you, take your own time and tell me what is the natural process first of all. So we know there is a process of intercourse that happens. What happens to these cells after that? Just take me through that. So this process of life making, what

[06:00] we see is human reproduction is very very enigmatic. I mean you know this is God's creation. Now it all starts with the eggs. Alright, every month one egg is released and if it is fertilized by a sperm then it forms an embryo and if this embryo

[06:20] sticks to the endometrial lining which is the home of the baby. So I'll just be stopping in the middle because you're talking about the uterus here. The endometrial is the inside lining of the uterus. Yeah the endometrial is the inner lining of the uterus where the embryo implants and if everything goes well then the lady gets pregnant and that's how pregnancy happens.

[06:40] Again, if you remember, I said life begins with, I would say it starts with an egg. Now this eggs a woman will have when she was in her mother's womb, all in the ovaries and starting 12-13 years of age, she starts releasing one egg every month and that is the

[07:00] initiation of a menstrual cycle. So every month the woman will release one egg and if it gets fertilized it forms a it gives us a pregnancy. Now infotility is a state nowadays we are understanding more and more about infotility from the point of view about the eggs because we have understood that

[07:20] ladies are fast depleting these eggs either in the form of quality or in the form of quantity. And initially we could not understand this much. Nowadays with the advent of good testing like technologies and doing blood tests we are able to understand and predict who has got

[07:40] the infertility problem and that's where we tell them that listen your eggs are fast depleting or you do not have much eggs it's better you try to consider doing any form of fertility treatment options like if you're married try to get a baby as soon as possible either through artificial insemination or IVF program. If you're not married and you don't have a partner then

[08:00] may be you can get this ex out and keep it in the freezer because this eggs are much better in the freezer rather than in your body because we have understood time and again that the best predictor for a successful fertility outcome is maternal age. And what it means by that is as the woman advances in her age there is a

[08:20] reverse trend going on in the ovary. We're going to dissect each one of this later on. Okay, let me just go back a little bit and ask you about, do you think infertility is a misnomer? Should it be called subfertility? Yes. See, we play with wards. These are the wards and terminologies which has been, you

[08:40] coin those years back and we haven't changed those things much. I don't like the word frankly speaking infertility it's very crude. I would say simple terminologies like anxious to conceive or you know sub fertility these are nice terminologies to be coined like you know you are

[09:00] epithelial cell, it is just that few elements are there either in these sperm problems or eggs or endometriosis or any other issues which needs a little bit of modifications and then things should be okay. What is the prevalence among females? So, I would say when we are talking about infertility, so it is a combined

[09:20] So, as per the World Health Organization, they say that in simple words, one in six couples are struggling to get pregnant. When you translate to a global perspective, 15% which is almost equal to 48.5 million people globally are struggling as of now with infertility.

[09:40] IVF when we have started doing IVF it has been shown that every year there is an increase of IVF cycles by 5 to 10% globally and from the perspective of United Arab Emirates the total fertility rate per woman was 2.3 in 2000. Now in

Understanding IVF: Process, Success Rates, and Challenges

[10:00] 2022, it has gone down to 1.3. So, fertility rate 2.3, what does it mean? 2.3 is a statistical analysis birth per woman. But keeping that in mind when we see 1.3, so that means there is something happening out there where women are finding it difficult to conceive. Why?

[10:20] because of late marriage, because they have not started yet to think about a pregnancy because of carrier options and so on and so forth. Environmental issues, sorry? Environment. Environmental issues is there everywhere. The more we want to talk about it, the more we get to know about it.

[10:40] And that is the endocrine disruptors, which is a big big topic, you know that you know, the bisphenol and all these things, you know, which has its impact in our epigenetics, you know, this is a very molecular level of understanding where all these things like today, frankly speaking, this mic that we are talking in front of these these are endocrine

[11:00] The mobile we have, these are endocrine disruptors because unknowingly we are inhaling those things, we are touching them and it is going into our system and it is at a molecular level causing epigenetic changes in our DNA. Is it fair to say that the major issue now is because of late marriages, late conceiving?

[11:20] age, that's the reason the infertility, fertility has become more rampant. As I said, the golden years, when I say golden years in a woman's life to become pregnant is late 20s and early 30s and I want everybody to hear this. Probably as fertility doctors, we have become like grandparents where we used to say push people to get married early and

[11:40] have a pregnancy they were not wrong actually. It was very very true because late 20s and early 30s is the time when you release a good egg and if you plan then you have a very good chance of having a conception. That takes me to the next level of understanding that a 20 year old, a 30 year old and a 40 year old woman, all of this woman they

[12:00] They will release an egg every month, same. But the ability of a 20 and a 30 to get pregnant is different from a 40 year old. So when everybody is releasing an egg, why is a 40 year old having trouble in achieving a conception? And it is because of this Q and G. Q stands for quality of the eggs and G stands for genetics. Genetics means the chromosomal

[12:20] abnormalities which is more in advanced metanarrheic. That is fascinating until now. What about men? So obviously traditionally we thought okay, infotility is women's issue. There is a problem with the women. But obviously it is not true. Men equally if not more contribute to this, is not it? Tell us a little bit about that. Well, men can

[12:40] not escape this whole thing. But what happens is again we go back to basics. The basics is about the eggs and the sperm generation. As I told you before a woman is born with all the eggs she will ever have in her lifetime when she was in her mother's womb. All the eggs are inside the ovaries and the onset

[13:00] menstrual cycle she will be releasing those eggs until she is 45-50 when there will be none and she will be into menopause. So a woman who is in her 30 years old she will be releasing a 30 year old egg and that's what we talk about quality. Somebody who is 35 years will be releasing a 35 year old egg and a 40 year old will release a 40 year old egg.

[13:20] Men on the other hand, the sperm production is every 70 to 90 days on an average 74 days. So today if a woman who is 30 years of age and a man who is 35 years of age, if they want to get pregnant, the lady will get pregnant with an egg which is 30 years old but the

[13:40] men has formed the sperm 74 days back. Same as a 20 year old. I mean, yeah, so younger, the men the much better the sperms, but older the men, but the sperm production is 74. But they are freshly formed. They are freshly formed. So, that is why the sperms and they are in millions. So, the count and the motility does help a lot

[14:00] in achieving a pregnancy. But again, at a molecular level, at a DNA level, the sperms also undergo a lot of changes and also it has been seen that men in their higher age group, they also have challenges with a lot of defective sperms which can either lead to infertility or probably miscarriage. And what are the terminologies? Like if

[14:20] a Zeus Permia and you know there are some terminologies that you use for this. Yeah. So Zeus Permia not norm let's start with normal. So normal Zeus Permia means when the sperm count motility and morphology is within the normal range as per the criteria laid down. When

[14:40] When you have oligospermia, oligo means less. So less sperm count. And when we have azuz, azuzpermia, that means that man does not have any sperm in his testes. So that's another problem where we have to do the treatment. So do you think that if you have a couple that is not able to conceive, so infertility is an issue.

Impact of Age on Egg and Sperm Quality

[15:00] percentage is usually that comes through your door is a women's problem and what percentage is men what percentage is combined? Well most of the time when we have seen I would say 40% of our patients you know they do have a woman's you know

[15:20] Part into it and the problems are either in the form of endometriosis or it diminished over in reserve man on the other hand They have sperms. I would probably put it at a level of around 25% Approximately but it's mandatory for them to come along. Isn't it when you have the first assessment for infertility? Yes

[15:40] See, today if I have a problem like pain in my tummy or I will go to a surgeon because it's an appendix problem or a gastric problem and I will take my antibiotics. But when it comes to making a baby, it's a couple's problem because you cannot have a baby from a single

[16:00] either from the moment or on the man. So both the partners are invited to come and have a chat with us to discuss because they have to be into this together because there is a lot of ups and downs and they both have to understand their contribution towards this whole baby making process. Dr. Partha,

[16:20] I just want to know now, see the buzzword, IVF. Everybody knows about that, but I think most don't know what it means. So in vitro fertilization, just tell me as a basic concept to imagine you're talking to a primary school student and you're explaining, you won't do that, I know, but you're explaining to a primary school student what IVF is. Start from the beginning. So IVF

[16:40] IVF stands for in vitro fertilization. Alright, so when we fertilize the cells of our body outside outside our body in the lab, it's called in vitro fertilization. When things happen inside our body, it is called in vivo fertilization. Alright, so that is why it's called IVF because we fertilize the cells outside is called IVF.

[17:00] of fertilization. So when we tell a couple that you have to start an IVF program that means we have found certain things in there where it could be difficult for them to conceive naturally. So that is why we have to take their eggs and sperms out of the body, make a baby outside, make an embryo.

[17:20] outside and then replace it back into the eutrass. So the whole process starts with an evaluation. Evaluation means doing a hormonal blood test for the lady and doing an ultrasound test for the lady and doing a sperm test for the man. Okay, so both are tested. Both are tested. Before you start. Once we have understood that everything, all the basic parameters are okay, then

[17:40] Then the woman starts some injections which are hormonal injections from her menstrual cycle day 2 after a baseline scan and some hormone test and these injections are continued for approximately 12 to 13 days. Every day one injection? Every day one injection or two injection based on the decision made by the treating physician.

[18:00] During this 12 to 13 days, she will be subjected for some scans and blood tests. After 12 to 13 days, once the follicles which is the egg bag are ready, then sorry again I will stop you. So, when you talk about follicles, these are egg bags that are ready in the ovary inside the ovary. So, this is called the ovary stimulation because

[18:20] Because hearing what we want to understand in IVF is that the common myths are that oh, you are doing an IVF, you are going to take all my eggs out. No, it is not like that. We are going to recruit the follicles which nature has given for that cycle. We are going to give injections to grow.

[18:40] those follicles and harvest those eggs out because if you do not then nature will grow only one follicle and the rest of the follicle will undergo a natural. We are not touching the reserves. We are not touching the reserves. The ovaries reserves are as it is. Yes. The five or ten follicles that come out every month utilizing only those. We grow those follicles and we see that you know the

[19:00] they grow to the optimum level that we want it to be and then we harvest it out. Harvest means? Harvest means collecting an egg out. Okay and this is done by a transvaginal approach under a short sedation or a general anesthesia so that you do not have any pain. It is a day procedure. It is a day care procedure wherein the total duration of stay in the clinic

[19:20] would be approximately 3 to 4 hours. And it is ultrasound guided? It is an ultrasound guided just like the way we do our scan exactly the same procedure but you will be sleeping for 30 minutes and we harvest your eggs out of the ovary. All of those, the 5 or 10? All the follicles which has grown, we harvest all the follicles out. Yes, this is a very common question which people

[19:40] ask us like how many eggs will you get? So all the follicles which has grown during that cycle we will harvest it out. It could be as less as 1 and it could be as much as 25 to 30 also. So the lesser means you have less number of eggs, the more means you have more number of eggs. So on the same day the husband will give the sperm and for

Common Causes of Infertility in Men and Women

[20:00] every good matured egg which is assessed in the laboratory, a sperm will be injected inside the egg and that is called ICSI, intracytoplasmic sperm injection. Is it on the same day? It's on the same day. Okay. It is on the same day of egg retrieval. And that's where your embryologist has to be? That's where our embryologist, that's an embryology lab thing our embryologists do it.

[20:20] it and once this sperm has been inseminated inside the egg. Let me sorry I am interrupting you just so that our viewers understand the intricacies of this. So you take out suggest for argument sake 10 eggs out and you feel that you assess them you feel 10 eggs are all healthy and they can be

[20:40] The sperms can be inoculated into them. Yeah, you would inoculate all 10. Yes. Yes with the sperm with the sperm So once one sperm for each egg, okay, and once we have inseminated These sperm inside the egg. This process is called intracytoplasmic sperm injection in short ICSI and this for this egg cell

[21:00] than kept inside the incubator. The next morning when we come in, we would like to check for fertilization. Now that is absolutely a natural process. We have no role in that, but we will be putting these eggs in the right environmental culture conditions for them to grow and sell divide. So we would be checking for fertilization and then we have the ability

[21:20] to grow and culture these embryos for five days in the lab. So a day five of our human life, it's called a blastocyst. Once the embryos have reached to the blastocyst stage, on that day, either we can take that embryo and put it back inside the uterus to achieve a pregnancy which is called a fresh embryo transplant.

[21:40] or we can freeze it back into the cryopreservus embryos for future use. And we also have the ability to do pre-implantation genetic screening of these embryos, means take five, six cells out of this embryo to check for the chromosomes to ensure that they are normal embryos. But that's not a norm. That's not something you do for embryos.

[22:00] It is not mandatory. We discussed this option with our clients, our patients and whoever has decided to do this genetic screening of the embryo, they would like to do that and at a later date when these embryos have reported as normal, they come back and put it back inside. No, but tell me one thing. You've fertilized 10 eggs and obviously you will not be

[22:20] putting 10 eggs into the uterus isn't it? No that I would like to go a little deep inside. Yeah it is not about it people are like okay you got 10 so I will have 10 embryos and 10 babies. No there is something called attrition rate. Yes. Alright attrition rate is like I start with 10 eggs probably seven or eight of them will fertilize. By the time it reaches to day

[22:40] 5 blastoses maybe I will have 4 or 5 of them and these 4 or 5 of them are good. But if you go a step ahead and do a genetic screening of this embryos maybe 2 or 3 will come back normal. So, see if we started with 10 but we ended up with only 2 or 3. Now those 2 or 3 probably could complete our family. So, you would ideally

[23:00] put one it is one at a time into the mother's womb into the mother freeze one yeah so how many number of embryos are you know biopsy they are all in the freezer for future use and when the time comes we always put one embryo at a time gone are the days when we used to put two or three no the nowadays we do not like to

[23:20] have twins or triplets one embryo at a time to give us one singleton pregnancy. But is it possible that accidentally someone can have twin or triplet pregnancy? Naturally yes. So naturally yes, but why people say that if you have undergone an IVF procedure the chances of IVF, sorry, twinning is much higher.

[23:40] Back back years. I was also a part of it when our scientific Program was not so great when I was I would say the advancements like, you know freezing and PGS program like pre-implantation genetic screening of the embryos so we used to make embryos and We don't know which embryo would give us a baby right? Yeah, they could be able

[24:00] abnormal also. So to increase the likelihood that you get a pregnancy, people used to put 3 embryos or 4 embryos or 2 embryos and the more number of embryos, the more higher order of pregnancy. So the chances of twin pregnancies and triplets was quite high. Now that we are selecting the embryos, when I say selecting means we have done the chromosome testing and

[24:20] And I know that this embryo, if it sticks to the uterus, it will be like you and me, healthy embryo. So we put one embryo at a time. But again, having said that, there are certain times when we put an embryo and after six weeks, we see two heartbeats. So that's called embryo splitting, but that is in nobody's hand. That's in nature's hand.

[24:40] That is where you get the, okay. So, yeah, I have had some few cases, you know, but and they are all good though it is a complicated one, but they are all good. Yeah. So fascinating, isn't it? This thing and so unpredictable at times, I guess. So, yeah. What is the timeline? So, if I am, you know, a mother is asking, I want to undergo IVF, what am I looking at?

Egg Freezing and Advanced Fertility Preservation Techniques

[25:00] before the embryo implantation is done. Is it a month? Is it 15 days? What's the time? So when we start an IVF program with injections from cycle day two, it takes us approximately two weeks to complete the process of egg collection, means the egg harvesting procedure, and making those embryos and freezing them. So approximately 15 to 16 days it takes.

[25:20] Once we have gotten a report that the embryo is good and normal, then after the next cycle, very cycle, we can put it back inside or depends upon the logistics of the patient if they say that they want to come back after two months or three months. So, let's say between as early as one month, as late as two or three months. Just imagine, you know, now it's happening more often that we see mothers who are working

[25:40] career mothers who don't want to get pregnant this early because they have something strong going on in their family socially and so forth. They want to get pregnant in their late 30s but obviously there's a risk of infertility and other things and they want to freeze their eggs. Just tell us a little bit about that. So this is the game changer in our fertility practice nowadays because we

[26:00] have started understanding that the main problem of infertility is the eggs and the quality and the quantity that undergoes a lot of changes in a woman's lifetime. So when we diagnose the status of low over end reserve and that is diagnosed by doing

[26:20] scan to see how many follicles you can count. Now you might ask me what is a normal on a scan how many eggs do you see or we don't get to see but the number of follicles. So on a scan if I get to see 6, 7, 6, 7 follicles on either side which means 6 plus 6, 12, 7 plus 7, 14 follicles and when I do an AMH test which is anti-mulerian hormone

[26:40] test and if it shows more than 2 nanograms per ml then I would say that yes your over end reserve is good, you have good time but yes do not delay your process. But on scan if I see that the follicle numbers are less, less means 3, 4, 5, 6 only and when the AMH

[27:00] level comes less than 2 like 1.2, 0.8, 0.4, then we say that listen, your over end reserve is fast depleting, not many eggs are left, it's better you finish your program. So if the lady is married, we would encourage her to finish her fertility treatment either in the form of artificial insemination

[27:20] IVF program and complete the baby making process as soon as possible. If she does not want to get pregnant right now then we would say please do IVF, freeze your embryos, bank your embryos and then go back and do your whatever things you have to do in your life and then come back and replace these young embryos. If the lady is not married

[27:40] she does not have a partner, then she would be encouraged to do egg freezing and freeze these eggs for later use. The kind of job you do, I am sure you have had difficult conversations with families every day. And I know many of my friends and so forth who undergo this process by VF and they have failed multiple times. And that is not a good scenario to deal

[28:00] deal with? Do you involve counselors and psychologists in this whole process? And how do you personally deal with your patients when they have failed IVF? So as IVF practitioners, we don't the hat of a counselor ourselves. We get to speak a lot. You know, in our kind of practice, as you have told correctly, negatives are more than positives.

[28:20] We have to surround our conversation, trying to touch upon all those negative points and educating our patients and couples to make them decide an informed decision, whatever it is. But they also come with a lot of baggage, with a lot of stress. We also have a limitation.

[28:40] professional psychologists or counselors. So we do have educators and counselors in our clinic where in a neutral place, in a neutral environment, they have a chat one-to-one to know what is on the other side of this whole treatment process and it has really really helped our couples actually and it has

[29:00] Because it has made their journey very, very easy. So yes. And what is the solution for these families? So if they have undergone multiple IVF processes, maybe in one or two centers, which they keep exploring, I'm sure, and they fail. So short of adopting a child, what else can they do? Is there something else that they can explore? See.

[29:20] We cannot just write off anybody saying that oh you have done so many cycles so you cannot have a BB. No, till the time your ovaries show follicles means that you have the ability to make a good egg and every cycle is a new cycle with a new beginning with a new chapter with a new story. Just because

[29:40] your month of January you did not do well, that does not mean month of February and March you will not do well. You can really really do good. So, we need to persist. Also when somebody has failed in a centre elsewhere, we would like to know what all things has been done in the previous cycle and what all things we can do differently in the present one. And then hand

Genetic Testing and Screening in IVF

[30:00] holding and taking the patient forward. But again, yes, many times a lot of our couples have failed with us also. We have to admit that. That's when we have to have a very, very open discussion with the couple like exactly what they want out of it. There are a lot of other options in form of donor eggs and donor sperms or adoption.

[30:20] Or some people say that, okay, I have done it and I think this is it. We would not like to pursue anymore. But again, this hard talk has to be done and we do it and somewhere down the line there is a closure. I'm going to ask you, I think probably the most important question of our discussion today, which is

[30:40] is if a couple decides to have a baby, partners or married, whatever they may be, and they are trying for a baby, how long they should try before reaching out to you and saying, look, we've tried, we are not able to conceive? Yes. Very, very good question.

[31:00] If you are less than 35 years of age and you have been trying since 1 year un-protected intercourse, but it has not resulted in a successful outcome, you should visit your nearest physician, fertility physician or gynecologist for a check, a wellness

[31:20] check. Let me stop you there. Unprotected intercourse, is there a frequency? Is it like once a month, once a week or there's no? Yeah, so unprotected intercourse means starting from if you have a normal regular cycles of let's say 28-day cycle menstrual cycle length, then starting from day 10 every alternate days up until day

[31:40] 2022. So that is the unsafe period of a menstrual cycle. So it has been shown that having frequent sex during that time can increase the chances of successful fertility outcome or pregnancy outcome. So if somebody has been having this practice and they have not been able to achieve pregnancy, they

[32:00] should visit the doctor and check if everything is okay or not. But if the woman's age is 35 years and more, it reduces to 6 months. But again having said that, we need to change these definitions. As for atelite doctors, we cannot just say that you have to go back. No.

[32:20] If the couple who is even young, even 28 years old and they have not been able to achieve after six months of trying, I think it's better to go and visit your doctor to say that if we are having absolutely the right thing at the right place and why we are not able to reach to the other side, is there anything wrong?

[32:40] So doing a little bit of checks here and there is always beneficial. I mean, you've been doing IVF for nearly 20 years. In every medical field there are innovations, there are new technologies coming in. What has changed in IVF in the last 20 years? Yes. What has changed is the ability to

[33:00] freeze the cryopres of the eggs and the embryos. What we say is the vitrification process that we do in our lab. Initially it was not there. We could not keep this egg stored or the embryo stored for future use. Nowadays we can freeze the eggs and the embryos and as per the

[33:20] United Arab Emirates Law, we can freeze them for five years and to be renewed again if the couple wants to freeze it for long. I'm sure there's very strong regulations around it, isn't it? Yes. With consents and all that. We have all these things in place and it has to be done, you know, as per the regulation that we follow. So that's one of the major

[33:40] innovation. What about in scans and those kind of things? So when we talk about the advancements, the next advancements is about the pre-implantation genetic screening of the embryos. Gone are the days where we make an embryo and in the name of God you say okay I hope everything will be fine and you will surely get pregnant and the patient

[34:00] doesn't get pregnant or if she gets pregnant at third month we say that you know you end up with a Down syndrome or any other abnormalities you know where the pregnancy has to be terminated. Nowadays with the advent of pre-implantation genetic screening wherein we check the chromosome status of that embryo, we are able to rule out the normal for the abnormal

[34:20] We replace only the normal embryos back and because of that we have increased our success rate from as low as 25-30% to as high as 70 to 80% per embryo transferred. But again that's again a debate in the whole fertility world to do or not to do is the question. Because in my

[34:40] My field, as a neurologist, I see a lot of genetics, children coming to me with genetic problems and all that, autism, for example. And I always tell parents, look, we have to differentiate between multifactorial genetic problems as opposed to single gene problems. And in IVF, you might have tested for single gene disorders, but autism cannot be tested antenately or before, you know, as a PGD process, isn't it?

Emotional, Psychological, and Financial Aspects of IVF

[35:00] Correct me if I'm wrong. So we have to understand two things. One is the genetic disorders, the single gene disorders that we have like cystic fibrosis, the thalassemias and all these other things, Huntington's disease and the others are the chromosomes like the commonest chromosomal errors would be down syndromes, or Turner syndromes. So we

[35:20] test the chromosomes means that on a history taking if you have not presented to me with any kind of familial genetic problem that is running in your families then I take for granted that there is no genetic problem in your family. But can I do the chromosomal test and ensure that the embryo which we have is a 46xx or a 46xy? Absolutely.

[35:40] absolutely normal like you and me, then those are the tests we can do and replace the normal embryo. So if somebody says that yes doctor, I do have a family history of you know, muscular dystrophy or cystic fibrosis or telesim or something, then we would like to specifically screen for the genetic defect and try

[36:00] to ensure that this embryo either is normal means it does not carry that gene or probably it could be a carrier like your parents. And that's the embryo that we would replace it and when we replace that normal embryo, we cut that genetic you know that transmission of to the next generation. So I tell my patients when they come with say autism for

[36:20] They've gone through an IVF process and the trial eventually has a diagnosis of IVF and they asked me could this have been picked up before the embryos were implanted and I tell them no it's not. This is a multi-factorial, multi-genetic issue, it's a polygenic issue and it cannot be found out. So I had patients who frequently, in fact last week also, I had who said that

[36:40] that I would like to do an idea about can you rule out the autism and autism is polygenic. It's like a multifactorial environmental kind of a thing, you know, which we have not been able to pinpoint the exact genetic clokae or defect. So we cannot rule out autism in this regard. No, I agree.

[37:00] Absolutely. And I think as a young couple, when obviously we've gone through that process a long time ago, but as young couples, they come to me, they're pretty hesitant to reach out to an IVF specialist, isn't it? I mean, it's inherent that this is not natural. Should I go to a specialist and talk about this? There's a lot of taboo attached to it. There's a lot of stigma.

[37:20] stigma attached to it in many parts of the world. How do you kind of overcome this? So I've been into this practice for the past 19-20 years and I have seen the highs and the lows, the good and the bad and practicing and doing my medical part in Dubai where I get to see

[37:40] Good demography of patients that comes to me and I've seen one thing, you know There are categories of people who are very shy to talk about IVF or if they have gotten pregnant with an IVF They want to tell the whole world that it is a natural baby natural conception and then I have clients who would like to flaunt it and they

[38:00] really say that it is because of IVF that I got a baby. Both extremes you mean? Both extremes and they would like to talk about it. They even invite me to come and do a talking that you know how IVF has changed their life. So we do understand with the kind of background and the society we come from these kind of reservations will be there. We do not want to get into it but we want to tell

[38:20] One thing that as per the World Health Organization criteria, infertility has been diagnosed as a disease of the reproductive system, which means that if you are not able to have a child, that is the symptom. If I have a pain in my tummy, the doctor will say that you have appendicitis and you need to remove your appendix.

[38:40] But not having a child is a silent symptom which your body is presenting. You said it's 15%. It's as good as migraine for example. Every other person has a migraine. Yeah. You would never feel shy of saying to someone, I've got migraine. That's right. But when it comes to because people take it on them that you know they have the some deficiency. Deficiency that they're not able to budge.

[39:00] it is not like this nowadays. Please I would say take advantage of science and technology to your advantage and complete your family because if you do not take advantage of science and technology today, tomorrow it cannot help you because as I said before in the beginning of my talk, it is age dependent. We are at the mercy of the eggs because once these eggs are

[39:20] become aged, they cannot produce a good life out of it. The other issue that couples would have is, for example, eventually they do decide, okay, I need to go ahead and get IVF done or speak to a specialist. Financial constraints is a big thing, isn't it? It's not cheap. It's a pretty expensive process without having even close to 100% outcome rates.

[39:40] Someone might tell you, okay, you have a 50% chance of getting pregnant after an IVF process, but you are still buying something that gives you a 50% chance of an outcome. How do you overcome this? And do you deal with insurances? Does insurance help with this at all? Just tell me a little bit about that side of things. So yes, money is important.

Future Innovations and Scientific Advances in Fertility Treatments

[40:00] Especially if we don't have it. Yes, I do understand. Fertility treatment is quite expensive and unfortunately, insurances, they shy away from us. They don't like us. They don't cover fertility treatment. So when a couple comes to us, we do not want

[40:20] to think about finances or money. When a couple comes to share the story with us about their problem, we as physicians first of all, we have to talk to them as a human to understand the problem they are going through and then make a plan for them. The plan that if you do this kind of a treatment

[40:40] You surely will have a successful fertility outcome. It could be in the form of IVF, it could be in the form of artificial insemination or it could be as simple as going home and trying naturally with some tablets and medications. So this decision making is absolutely pure and scientific, not biased on any kind of money. Today if I

[41:00] take a decision saying that okay this costs this much and you have to do then it becomes very biased. So first and foremost we show our patients that this is what you need to do. If you think you can do it, you can do it with us. If you think money is an important thing or insurance is not covered, you please go back to your own country and do it and tell your doctor that this is the way I need to go ahead in my full

[41:20] treatment and get a baby home. So we do have these conversations in our clinic. We also put our patients to our financial counselors to address these needs. If somebody needs help, we go out of our way to help them out. But again, yes, the decision is made by the couples themselves. They know themselves well.

[41:40] they have to do because if it is really really hard for them and they are not able to afford it, they should go back to their own country where they come from if it is easily affordable there. But they should not delay this process in the name of money. Any success story that just stands out for you in your 20 years of

[42:00] I know you do this daily, I understand, but something that stands out that you can think, oh wow, this had happened to me five years ago or something like that. Yeah, I mean, there are quite a few actually. I don't know which one to tell. There has been success stories of infertility after this was a couple who had around 10, 12 years of married life.

[42:20] And they have been to doctors and the doctors kept on doing some tests and kept on doing the sperm test and the blood test and saying that, okay, keep on taking the hormones. Your menstrual cycles will be regular. And five years became eight years and eight years became temporary.

[42:40] So when they came up to me, they were referred to me by one of my ex-patients. So I started talking purely about fertility treatment and not about regularizing the menstrual cycles. And the couple was quite surprised. They're like, everybody kept on treating my menstrual cycles and your

[43:00] never ever spoke to me about my menstrual cycles and you are like after like fertility treatment and I said yeah just see what happens because if you keep on treating the menstrual cycles you know your fertility could be you know never be addressed but if you treat the fertility automatically your menstrual cycles also will be taken care of. So we did a splinter

[43:20] simple cycle of artificial insemination and she had two follicles and she got pregnant and when she got pregnant there were two heartbeats and she ended up with a baby boy and a baby girl which I didn't lie because I don't like to have you know give a higher order you know because it's a complication but it ended up you know sometimes an artificial insemination you cannot contain

[43:40] control those things. And then she came back saying that if I were with those doctors, they would have kept treating my menstrual cycle. My 35 years would have been 38 and 40 and then I would have no chances. But you flipped that whole thing into doing a pro-fertility treatment. What I needed at that time, you did it and automatically everything was in place.

[44:00] So these are the few few things which keeps us motivated as the right word out of all the odds and there are other cases also where we have clients at 41-42 years of age and they are trying IVF and they end up getting genetic

[44:20] abnormal embryos where we are not able to replace and after second or third time when we get a beautiful normal embryo when we have replaced it just turns out and sticks out there. So yes and also about genetic mutations. We have had cases where we had real real their first child was abnormal because of genetic mutation and when

[44:40] We have done IVF program with PGTM. PGTM means the monogenic disorder, single gene disorders treating that. We have completely cut that genetic transmission of abnormal gene going past the generation. So these are the few good things which happens in IVF practice.

Final Thoughts, Success Stories, and Message to Couples

[45:00] We have a segment on these podcasts, it's called Myths in Specialities and I'm going to throw some myths at you and you have to bust them. So the first one is infotility is rare, it happens to only a few people. Infotility is very common, it happens to most of us.

[45:20] It is not a female problem, it is a combined problem. And it could be a male problem as well, isn't it? Yes, it could be. And smoking an alcohol does not affect fertility at all. Smoking an alcohol does affect fertility if taken in excess, but again having said that, having

[45:40] Once in a while, a good happy moment is not a bad thing. Like women, men don't have a ticking biological clock. Initially it was said to be yes, but now no. What has changed now? We are trying to tell the men that if you are young, please get things done first.

[46:00] don't wait for the moment of 40 plus years because your sperms also gets old and a lot of DNA changes happens to the old sperms. If I have had easy first pregnancy, it's likely that my next pregnancy also will be the same. Studies have found that the second pregnancy is more difficult than the first pregnancy. Even the chance of conceiving? Yes. So that

[46:20] clarifies it. Fertility is entirely genetic. Fertility is entirely not genetic. Okay. There are many more factors. There are many other factors. Yes, involved. Genetics is also probably I would say one of the major ones, but not the only one. Okay. I'm sure you've come across this in India as well in your practice.

[46:40] that people eat to make them more fertile. Tell me some examples that you've come across with your patients that your elderly tell you, okay, have more of this, less of this and you will be more fertile than you. Yeah, it's not about back in India but here also I see patients, all throughout their journey they were absolutely having the normal food and all

[47:00] But the moment they get positive pregnancy test and everything changes. Morning the lady will start eating a lot of nuts and one full glass of milk even though she does not like it and so on so forth. So yes, nuts and all are good but just taking at the time of pregnancy does not change the criteria. Taking

[47:20] lot of coconut water doesn't change the baby's growth and well-being and all. Some of these practices might be harmful as well, isn't it? Too much of anything is harmful. Life should be in moderation. Nothing of too much excess or too less. Whatever you have been doing, whatever you did yesterday, you do it today and so on and so forth.

[47:40] Dr. Parthav, we are going to move to our last segment now, which is the personal segment. We will be talking to you about you. No more IVF, no more fertility. So what do you do outside your clinical work? I mean, you are a doctor, been in Dubai for now 16, 17 years. I think Dubai has changed miraculously over the last two decades.

[48:00] do you do when you get out of your clinic and want to spend some time with the family of course but beyond that? It's now you might see me struggling with answers because it is so difficult to answer about yourself but it is so easy to talk about your you know the thing which you are passionate about and that is fertility and medicine and all. So yes

[48:20] At the end of the day, I love to go back to family back home. I am very very very much a family oriented guy, not so much of an outside guy. But yes, again, as I said at the beginning, I have a little finesse or little

[48:40] things to do things differently. So I don't know my people at home say that you know I have very good hands at cooking. So I can make some fine dishes, fine dining at home. You know Bengali food? No no no no no no I'm very poor. What is that? International international

[49:00] you know, thanks to Instagram and all, you know, I copy a lot. So take a lot of, you know, ideas from there and try to, you know, have a nice chilled food at home. The kids love it. Everybody loves it at home. So are you going to retire here in Dubai? Life has been good so far. It's been very kind.

[49:20] I don't see changing my present scenario in the near future. I'll continue working and if it takes me to the age of 65-70 years plus of course I'm going to be here. So if that means that I'm going to stop working here then yes I would retire here and would love to stay in this country.

[49:40] What have you planned for it? Like all of us we have like in the UK, you have pensions, you have this and that. What's your relationship with money to support you later on in life? Have you given it a thought? Because this is the question that all doctors discuss on a drink or when you're meeting a party or whatever, but they never open up in public like this. But you can choose not to answer that question.

[50:00] But I'm discussing as a friend as a relationship with money has been very awkward with my this thing. Me and money I think we go opposite sides. Frankly speaking, I was never after money.

[50:20] I never took up anything just because it was heavily paid or highly paid or whatever it is, whatever I got, I got it based on what I needed to work as and what I was passionate about. I did not equate that with how much I should get and whatever I got, I knew that it would suffice my needs.

[50:40] that's how I started. But you will need like if you get out of your job and you're going to stay in Dubai you need some kind of a backup isn't it? Absolutely. So to continue with my thing what I was trying to say is if your work is good and if you think you're passionate about your work money automatically will follow you right. It will follow you. So that is one thing so far so good.

[51:00] So now I think all of us at whatever situation we are, we are in a safe place. I think we have enough to take care of the needs of our kids. That is the topmost priority as of now. So yes, for the education for the kids, yes, it's all there.

[51:20] for her own retirement life, whatever we have, I think whatever we have would be happy with that. I do not have something that you should have this much and I don't think so. Maybe I'm wrong in that. If you have to create one thing in the next 10 years, create one thing in the next

[51:40] 10 years. I would, I don't know how to answer this question but probably I would put all my, as of now put all my effort or resource or whatever it is for the best education for my children. Children, okay. As of now that's a topmost priority for me. Give them the best. Once they are big and they leave and they

[52:00] go back for their higher studies and all. I think that's done and then we can take care of ourselves. Do you play golf? I do not. No. Okay. I would love to, but I do not play golf. Great. Dr. Parsa, we have come to the end of it now. Thank you so much for this. It's been fantastic and I have learned a lot from it from our one hour session, but I'm

[52:20] sure the viewers have learned even more, especially people who are not into medical field. And these questions are not asked simply because they don't get a chance to ask this to anyone. And I hope this particular session and this podcast would have reached out to many people and help them make the right decision moving forward. Yes, thank you so much for having me here today. Infertility, fertility, whatever

[52:40] you name it, this is there out there in the community, in the society. Many people are not able to talk about it because of fear of being judged. Many people are not able to avail it because of finances and many people don't even know about it. And it

[53:00] It is our duty to talk about it in this kind of forums to address the importance of doing things at the right time. And again, I am coming back to the same thing. If you in fertility practice, we have seen one thing good. If you have done things at an early stage, you are in the positive group.

[53:20] The more you wait, you will be more dragged to the negative group. So this conversation really, really helps to enlighten our people in the community about the right things, not the right things. Whether should I freeze my eggs? Whether should I do IVF to do it now, to do it later, to freeze the embryos now, to do the transfer later? These are the small, small things which I think you can

[53:40] And always discuss with your early adopter. Thank you so much. Pleasure.

[54:00] you