Dr. Sandhya & Dr. O.P. Singh

Infertility is a global health issue affecting approximately 8-10% of couples. It is a multi-dimensional problem with social, economic and cultural implication and defined as the inability to achieve pregnancy after one year of unprotected intercourse. It may arise from genetic abnormalities, infections or environmental agents, delayed child bearing behavior and certain diseases. Among them endometrosis, estrogen dependent disorder causes 25-40% infertility in women and occur wide range of women fro pre-menarche to post- menopause and diagnosis have been made in women ranging from 12-80 years of age. It is defined as presence of an endometrial tissue outside the uterine cavity having multifaceted pathology. Its pathology involve various factors like genetic predisposition, menstrual and reproductive factors, life style factors such as smoking ,exercise and consumption of alcohol and caffeine. About a third of the time, infertility can be traced to the woman.

Many infertile women in developing countries consider that, without children their lives are without hope. Our culture demands that for a woman to be socially accepted, she should have at least one biological child. Primary treatment involves removal or reduction of ectopic endometrial implants, restoration of normal anatomy, and hindrance of disease and alleviation of symptoms. Besides this, ART (Assisted Reproductive Technology), laproscopic surgery have been also used for management of endometrosis.

The high-tech reproductive technologies have associated psychological and ethical issues that must be addressed by the infertile couple. Infertility counseling and support services are the well organized  psycho-social approach to infertility. Psychosocial issues should be discussed by physician with the couples in every visit. Information material about the centre, procedural information, booklets or educational videos is provided. Presence at support groups will build up coping abilities. Psychotherapy and psychosocial counseling are effective in minimizing negative outcome, clarifying life goals, context for support, advice and guidance will help live more satisfied and resource fully. (British council of Association of Infertility Counseling, 1999)The list of various counseling techniques are: Ventilation, explanation, reassurance, diversion by physical and mental activities, recreation, Yoga, improve problem solving skill, encourage health defense mechanism, suggestions, reinforcement, change of attitude and life style.

If treatment has been unsuccessful, couples are faced with the decision to either continue treatments or make other choices. Choices include adaptation and child free. All of these options are difficult decisions. The early intervention and meeting with a specialist, infertile person will find answers and be able to realize your dream of having a child.

Dr. Sandhya is a Sr. Resident, Dept. of Prasuti & Strirog, Institute of Medical Sciences, Banaras Hindu University and Ex consultant, MGM Hospital, Mumbai.

Dr. O.P. Singh is the Asst. Professor (Occupational Therpay/ Physiotherapy),Dept. of Orthopaedics, IMS,BHU