Since it opened in August last year, the infertility clinic at the national referral hospital in Thimphu has seen more than 140 cases.

The clinic currently provides ovulation induction (OI) and intrauterine insemination (IUI) fertility treatments.

Gynecologist Dr Ugyen Tshomo said OI is a fertility treatment that uses medications to cause or regulate ovulation to increase the chances of conception. The IUI fertility treatment involves placing sperm inside a uterus to facilitate fertilisation.

Dr Ugyen Tshomo said IUI is done when a male has mild fertility problems like low sperm count and unexplained infertility. “Unexplained infertility occurs when a woman is not conceiving even though all is normal with the couple. Each woman is treated with medicines at least four times.”

In case of women with blocked fallopian tubes or abnormal tubes, or when the male has inadequate numbers of sperm, the couple are advised to go abroad for In Vitro Fertilisation (IVF) or the test tube baby programme. IVF is the process of fertilisation by extracting eggs, retrieving a sperm sample, and manually combining an egg and sperm in a laboratory dish and kept in an incubator overnight.

The next day, Dr Ugyen Tshomo said most of the eggs would be fertilised. All fertilised and good quality eggs are kept in an incubator to become a blastocyst (embryo).

“Two of these embryos are transferred to the mother’s uterus,” Dr Ugyen Tshomo said. “The rest of the eggs are frozen and kept for future use.”

Dr Ugyen Tshomo said currently Bhutan doesn’t have the capacity and logistics to provide IVF treatment. “But we should have the service established so that we can provide the treatment to those couples who require it.”

Today, only few couples that can afford the treatment go abroad to avail IVF.

“While waiting to establish the service here in the country, we have proposed to the National Assembly to allow us to finance the referral of those couples that genuinely require help,” she said.

Each treatment cost about Nu 150,000. “Initial cost is high but subsequent treatment cost will be less,” she added. For instance, if the two eggs that were placed in the woman’s womb are not successful, then the stored fertilised eggs would be used.”

She said the cost for the second treatment will be less because it only requires preparing the mother’s uterus lining to receive the baby.

Another fertility treatment called Intracytoplasmic sperm injection (ICSI) is for men with low sperm count. In this process, the sperms are taken out from testes, made rich and injected in the mother’s eggs.

Dr Ugyen Tshomo said Bhutan has started to show a decline in population growth rate. “We are a small population and we need to address infertility seriously.”

She said one in every six couple is infertile. If there are 100,000 married couples, about 15 percent of them are infertile.

Since last August, the clinic had 68 patients that underwent OI treatment while 81 patients received IUI treatment.

Dr Ugyen Tshomo said infertility cases are prevalent in both men and women. Infertility cases are generally divided as ovulation where women are not producing eggs; tubal meaning the fallopian tubes are blocked and males meaning the sperms are not produced.

“We also divide it as primary infertility and secondary infertility,” she added.

Primary infertility refers to those who never had children and secondary infertility refers to those who have a child but are unable to produce a second child. “We have many secondary infertility cases,” she said.

Women’s age is one factor that matters when it comes to infertility. Dr Ugyen Tshomo said that after 30 years of age, women’s fertility drops and after 35, it becomes difficult to treat.

Excessive smoking, diabetes and obesity are other health problems that affect fertility. Patients suffering from polycystic ovarian disease (PCOD) are common in women who are overweight. They don’t ovulate and menstruate once in a few months. “We do have such patients who are treated by giving medicines to ovulate,” she said.

Dechen Tshomo