Nepalese women experience reproductive health issues such as menstrual disorders, infertility, and complications related to pregnancy. As Dr. Nutan Sharma stated, all are in play when we fail to recognize the symptoms of menstruation. Other lifestyle habits, such as smoking, diet, drinking, and stress in the workplace, can counter the advantages of reproductive health in Nepal.
Dr. Sharma has been treating infertile couples in Nepal for well over 20 years as a Senior IVF Consultant in Reproductive Medicine and Robotic and Laparoscopic Gynecologic Surgery. Although she is Indian by birth, Dr. Sharma dedicates her tireless attention to the development of reproductive health in Nepal and to bringing hope and treatment to those who need it.
She believes in education and in providing holistic knowledge to women experiencing pre-existing medical conditions and the effects of work-related issues and stress. Assisted reproduction and fertility options, specifically IVF, are suggested for women, regardless of their age. She also includes a holistic plan that encompasses family members, mental health, and personal hygiene to enhance reproductive health in Nepal.
Menstrual Health and Pain Management in Adolescence
Dr. Nutan Sharma emphasizes that teaching girls about menstruation needs to happen before the occurrence of the event, instead of after it happens. She explains that mothers in a traditional country like Nepal tend not to pass on this information. She shares her direct experience with her first menstrual cycle. She remembers seeing stains on her dress at school. This confused her until her mother explained that they were from menstruation. She appreciates her mother’s early lessons for teaching her the importance of menstruation.
From her, menstruation is sore, uncomfortable, and swollen. Hygiene is a huge concern for women. She recommended that women, on average, should be changing their pads every 4 to 5 hours. Dr. Sharma also cautioned about the risk of infection, as menstrual blood is a potential source of bacteria.
Rest, proper nutrition, and avoiding excessive stress are critical during the menstrual phase, Dr. Sharma emphasized. Women can minimize discomfort, self-repair that requires the involvement of another woman or physician, and the length of time to recovery by using these essential practices, along with proper care.
She states that menstrual pain medications like paracetamol should not cause any problems when you take a moderate dose. She commented that taking three tablets on the first two days is considered a safe dose.
Dr Sharma stated that cramping can be a sign of ovulation and healthy fertility. She emphasizes that if pain is severe and persistent, it may be a sign of another issue, like fibroids or adenomyosis, and suggests talking to a provider in these situations.
Dr. Nutan Sharma
Impact of Lifestyle Choices on Reproductive Health in Nepal:
Dr. Sharma says that menstrual pain at puberty is a normal experience representing fertility. She stressed that menstrual pain is preventable with lifestyle options such as minimal analgesics, rest, and self-care, emphasizing menstrual hygiene, primarily with girls.
She explains that family can provide pregnant women with immense physical and mental support, enabling them to lead a balanced life with good nutrition, sufficient rest, and a tension-free existence. Dr. Sharma also spoke about collaborative multidisciplinary management for chronically ill patients, such as diabetics and hypertensives, and also added that care should be centered not on the mother but on the child before birth.
She also advised regarding postnatal mental health conditions like postpartum depression, hormonal disturbances, mental stress, and the absence of family support. Dr. Sharma advocated for the provision of early psychiatric consultations and emotional support for mothers involving a collaborative care system of the husband, family, and health care providers.
Safety in Intimacy, High-Risk Pregnancy & Medication Use
According to Dr. Sharma, when a woman has risk factors for high-risk perinatal and obstetrics, there are numerous aspects to consider, including the age of the mother, experience of pregnancy loss, and pre-existing health concerns.
Most importantly, she highlighted that when we talk about routine monitoring and management of maternal care, we must ensure the safety not only of the mother but also of the fetus, explaining that chance histories from prior visits can help clinicians come to the next possible contact sooner to identify and create action plans to minimize complications.
Dr. Sharma discusses the evaluation of all physical and mental health histories, as well as the determinants of health, including lifestyle and environmental factors, before creating a personalized plan for conception.
She states that during pregnancy, the correct antibiotics and insulin must be prescribed. She recommends using safe antibiotics to treat infections and switching diabetic patients to insulin, especially those with gestational diabetes mellitus (GDM).
Causes of Diabetes, Ectopic Pregnancy, Vaginal Discharge Around Pregnancy, and Warning Signs
Dr. Sharma describes how health behaviors like smoking, nutrition, alcohol consumption, and work-related stress conditions in Nepal can harm reproductive health.
Dr. Sharma further states that pregnancy is a biological process with a variety of labor patterns, differing lengths of time in labor, and pain tolerance. She repeated that no two lives are the same and we cannot say any Pregnancy or Delivery is “Normal”, and part of patient care is defining the type of pregnancy based on fetal measures or gestation.
She explained that an ectopic pregnancy develops when a fertilized egg implants outside the uterus, typically in the fallopian tube. She also mentioned that part of reducing the risk of infection is recognizing and treating abnormal discharges associated with puberty and pregnancy.
She recommended looking for things such as foul-smelling discharge, and discharge with burning or itching, color, etc., explaining that treatment and detection of uterine problems, including some forms of abnormal bleeding, pelvic pain, and abnormal discharges, is a large portion of reproductive health care.
Postpartum Sexual Health and the Importance of Valuing Daughters:
Dr. Sharma suggests waiting about six weeks post-delivery (if the uterus has healed and there is no bleeding). She pointed out that it may be helpful to focus on emotional and physical readiness over time and the risks of postpartum sexual intercourse. She also addresses the dangers of sexual intercourse early on. She recommends discussing those issues with a healthcare provider before progressing to sexual intercourse.
She stated that when looking at their infertility concerns, it might also be beneficial to have a progressive approach and also consider health issues related to pregnancy (diabetes, reproductive tract infections, and other health issues). She emphasizes making healthy lifestyle choices that would allow time to maximize the chances of conception and manage a healthy pregnancy.
She states that aside from fertility mandates, condoms are the safest method of contraception. She discusses unsafe abortions as well, suggesting we educate our children, especially women, regarding safe sex, which can reduce unintended pregnancy and mortality from unsafe abortions while spreading awareness regarding safe reproductive health in Nepal.
Dr. Sharma stated that this process can help establish healthy family systems while respecting family healthiness and the continuation of healthier communities. She suggested that independence for women stems from mutual respect and mutual care for one another, with the acceptance of parents and society. She stated that everyone has a responsibility to create this space for independence.
Comprehensive Overview of IVF: Understanding the Process
Dr. Sharma explains In Vitro Fertilization (IVF) as a complicated assisted reproductive technology for couples with infertility.
She explains in detail the process whereby doctors stimulate a woman’s ovaries to produce hormones to get many eggs to be released, which are then removed and kept in a lab with sperm to make embryos. The embryos will be the healthiest and returned to the uterus, where they can grow and develop into a pregnancy. She describes the process like natural fertilization, but happening outside the body.
She explains the IVF process consists mainly of five pivotal stages: ovarian stimulation, egg retrieval, fertilization, embryo transfer, and pregnancy testing plus follow-up care.
She also emphasizes that there can never be 100% guaranteed IVF success with advances in technology.
She states that implantation rates can be as high as 70%, but the “take-home baby” rate ranges from 50% to 60%, depending on factors such as the number of eggs fertilized and the health of the sperm.
Optimal Age for Conception and Egg Freezing Prevalence in Nepal:
Dr. Sharma suggests that the optimal age for a female to conceive or produce high-quality eggs is 21 to 29 years, as both egg quality and supply are at their peak at this stage. She explains that at the age of 30 and above, the reserve of eggs declines, which significantly increases the risk of infertility and pregnancy complications.
She explains how the egg-freezing procedure works. She states that first hormonal injections for 8-10 days are administered to induce ovary stimulation, followed by retrieval of eggs under anesthesia. Then, the eggs are frozen in liquid nitrogen (-196 °C) to preserve their cellular structure and maintain their integrity.
This method is one of the fertility preservation options, which involves freezing eggs at their youthful stage, allowing them to be fertilized later. Dr. Sharma further notes that egg freezing typically costs between 1.5 and 2 million Nepalese (NPR).
According to Dr. Sharma, the costs may seem high. Still, they are reasonable for the therapies involved, including ovarian stimulation, egg retrieval, and storage, which are comparable to the fees charged for similar services in many other countries.
Infertility Causes, Sperm Freezing Age & Preconception Care in Nepal:
According to Dr. Sharma, infertility can be caused by a variety of male and female variables, with 25% of cases linked to male factors such as sperm count or motility. She advocates for a comprehensive assessment of both partners to ensure effective treatment.
She also attempted to address patients’ concerns regarding IVF. She saw the emotional and social barriers faced by couples in treatment with IVF. She pointed out that the therapy brings happiness not only to the individual but also to their families and the wider society.
She emphasized the need for regular screening and routine checks every six months to one year to monitor reproductive health in Nepal, as well as for early identification of infections.
She confirmed that sperm freezing and donation are possible and are becoming more common practices, explaining that sperm banks in the far south and surrounding areas have done great with screening and freezing techniques and furthering reproductive health in Nepal.
She noted that IVF allows an alternative option for couples struggling with conceiving to be able to conceive a child.
Empowering Women Through Education, Holistic Care, and Advanced Reproductive Solutions
In examining the intricate lives of women and problems with reproductive health in Nepal, Dr. Sharma puts a high premium on education, lifestyle modifications, and holistic treatments sensitive to mental health, medical care, and family care.
In this video, Dr. Sharma discusses the significance of social support and the importance of learning about menstruation, lifestyle issues that affect fertility, and reproductive health in Nepal.
She emphasizes prioritizing female reproductive health in Nepal and general healthcare at the top of the list by focusing on making care more accessible and pushing for a gender equity framework.
