06 Jan 2017
10 min read
1657 words
Dr Uma Shrivastava, reproductive endocrinologist and infertility specialist at Infertility Centre Nepal (ICN), derives immense pleasure from giving people hope

When did you first start thinking about getting into the medical field?

My father used to tell me that ever since I was six years old I used to say that I wanted to be a doctor. However, because I came from a lower-middle class family background, we all knew it would be difficult for me to become a doctor. We lived in a joint family, and there were 12 other kids who had to be taken care of.

What were you like as a child?
I was very observant of my surroundings and receptive to the people in them. Growing up, I wanted to study in St Mary’s High School, as a lot of my friends studied there, but since my father couldn’t afford the fees, I went to a local school. My school work was always important to me, so I made sure that my grades were where they needed to be. Making the best of one’s situation is something we all need to learn, and in my case, it was instilled at an early age.

So how did the path to a medical profession open up for you?
As I said, the prospect of a self-funded medical course wasn’t an option for me, so I would constantly go to ministries, looking for scholarship opportunities. I’ve lost count of the number of forms that I filled during the time when I was doing my intermediates and bachelors. My life took a turn for the better when the late ex-Prime Minister Tanka Prasad Acharya, who was also our neighbour, suggested my name for a government-funded Russian scholarship for international students. Of course, I had my own reservations regarding the communist regime, and for someone who hadn’t even ventured beyond the Nepal-India border, moving to a new country was a daunting experience. Looking back, I’m grateful for Acharya’s counselling because my academic setbacks were starting to get to me. I ended up learning a lot in Russia—not just about the medical profession, but also lessons in how to adapt to challenging circumstances.

This came after you already had to deal with earlier rejections.
When I turned 21, I was almost done with my MSc, and seeing all my friends in their chosen academic field used to leave me frustrated, and I consciously started avoiding my friends. A flickering ray of hope came in the form of a scholarship in Iran, but my father vetoed that because he was worried about my security. And I remember getting very irritated at my situation. I got really depressed during my bachelors and that started affecting my grades. It didn’t exactly help my case when my cousins would satirically comment that all I did was roam around ministries, and said that I had become an expert in filling application forms. I think the struggle phase of my life made me a stronger person and hardened my resolve to fight for my dreams.

What made you decide to focus on fertility and reproductive health?
After I returned home, I started working at the newly started Teaching Hospital’s Department of Gynaecology and Obstetrics (OB/GYN). During my work, I realised that we didn’t have any proper counselling and treatment facilities for infertile couples. We used to merely conduct X-rays of fallopian tubes, maybe a basic sperm analysis, and suggest some Ayurvedic treatments—there was no provision for hormone tests. Also, there has always been this tendency to blame the woman for failed conceptions even if it was the husband who might be sterile, and that really bothered me. As destiny would have it, in 1990, I got the chance to do my post-graduate in the UK on reproductive endocrinology. It was a great learning experience as I got to work in various hospitals in London and got to learn about various hormonal conditions that affect fertility in males and females.

After specialising in hormonal treatment, you started working in Nepal.
I was working 18 hours a day during my post-graduate days, and when I resumed my job at the Teaching Hospital, I felt like I had gone back in time. I had been exposed to medical possibilities that could help infertile couples, and here I was idling around, doing nothing with my newly acquired knowledge. I must say that phase was the lowest I have ever felt in my life. Eventually, I resigned from my post and started Reproductive Health Care Centre in Putalisadak with two of my friends. I felt really liberated that I was doing something I had actually been trained to do.
How did your family react to your decision to quit your job?
I think everyone was shocked, especially my husband, that I was willingly parting with a stable job and steady paycheck. See, I could have either just stayed at Teaching Hospital as a lecturer in Physiology or gone with my instincts and done something with my knowledge: and I’m grateful I chose the latter. I remember how for a few days my husband was really miffed with me, but eventually he came to terms with my decision and till this day has been very supportive of my work. It's never easy being a mother trying to juggle a full-time job with a family life, and having the support of your other half is imperative if you are to succeed.

What kind of struggles did you face while running your own clinic?
When my founding partners got transferred, I was left to run the centre by myself. I decided to start afresh and changed the name of the clinic to Nisantaan Kendra, Infertility Centre Nepal (ICN), and that name raised so many eyebrows. Even the landlady of the building where I was running my clinic asked me to look for alternative names. There were times when we barely had two or three patients in a week. It was only after the success in IUI, intrauterine insemination—a fertility procedure for men—that my practice slowly started picking up pace. Finally, my work started getting recognised by people, and I was also awarded by RONAST with the Scientist Award in 1998.

What has given you the most satisfaction at work?
In the last 14 years, ICN has helped more than 200 couples give birth to children through IVF; the treatment still remains, and should be, the last resort for infertile couples who have tried every other option to conceive. Before starting IVF in Nepal, infertile couples would be referred to India, but since there are many people here who couldn’t afford to spend more than Rs 100,000, we decided to start our own complete IVF facility. We set a minimum cost of Rs 70,000 and started treating couples who couldn’t conceive naturally. The initial days were full of failures; lest you forget, the nature of the treatment is such that the failure rate far outweighs the success rate. And the treatment takes its toll on a woman as she’s going under a lot of hormonal treatment. I still don’t encourage IVF treatment to couples before trying other means of conception. As far as possible, we use conservative treatments to make couples fertile—such treatments account for 85 per cent of our patients.

Are you satisfied with the way IVF facilities are run?
It’s indeed sad that many people think that IVF treatment is the sure-fire way of conceiving, for which our infertility specialists are also to be partly blamed. In fact, although ours is an infertility centre, we help couples recognise their problem and help them find other ways to have children. We counsel them thoroughly before they opt for fertility treatment. One should keep in mind that the hormonal treatment is tough on the body and mind, so the doctors need to be very careful about suggesting the treatment to patients. That is one of the reasons why the state has to regulate some rules to ensure that nothing is off the mark.

What factors should someone consider when choosing a fertility specialist?
You definitely need to do your homework and find a centre with a high rate of producing successful pregnancies. Once you’ve identified programmes with higher success rates, you’ll want to interview at the centres and get a feeling for how they care for their patients. It’s very important that you feel comfortable with the doctors and staff. We make sure that everyone who visits our clinic first goes through intensive counselling before it can be decided whether the procedure is needed.