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When Delhi-based Deepika Katyal, 27, and Saurabh Singhal, 32, both working in the same multinational company, decided to get married, the first thing they did was to register themselves for a premarital testing procedure. They had good reason to do so: Katyal’s sister had had two miscarriages and the cause was said to be Rh incompatibility—her blood group was A-negative and her husband’s, O-positive. Katyal wanted to ensure her fiancé and she knew if there was some issue with their health compatibility.

“Tests showed that both were Rh-positive, making them compatible. The couple are now relaxed," says Uma Rani, senior consultant, obstetrics and gynaecology, Sri Balaji Action Medical Institute, Delhi.

The baby wish

Sandeep Talwar, IVF expert, Bourn Hall Clinic, Gurgaon, believes screening has become important today owing to changing lifestyles and late marriages, especially in urban India. “Proper screening can help doctors gauge the loopholes in a couple’s lifestyle and accordingly advise the changes needed to help them safeguard their fertility levels," she says.

She recalls a Gurgaon-based couple in a live-in relationship who came to him a few months back. Both were focused on their careers in the advertising sector, were heavy smokers, and wanted to delay having children till they got married. “They came to us to assess their fertility levels. We ran the battery of tests on them, counselled them about lifestyle changes and advised them to freeze their eggs/sperms so that if they were unable to conceive naturally at a later stage, they at least had the option of trying for a baby by IVF," says Dr Talwar.

Such screening can avoid future dilemmas and unpleasant situations. “Worries about progeny and fertility are most prominent," says S.S Vasan, consultant uro-andrologist and micro-surgeon, and chief executive officer of Manipal Ankur Andrology and Reproductive Services in Bangalore. He cites the case of a 32-year-old, Bangalore-based software engineer and his 28-year-old fiancée. When they decided to get married, the girl insisted on getting complete premarital fertility screening.

Her elder sister’s marriage had ended after seven years because she had not been able to conceive even after in-vitro fertilization (IVF), so she wanted to be sure they would be able to have a child. “They came to us in July and we advised semen analysis and screening for sexually transmitted diseases for him and a basal hormone profile to assess the ovarian reserve and ultrasound to assess the uterus and the ovaries for her. Everything was clear, and they will be getting married in the last week of December," says Dr Vasan.

Scanning for diseases

Dr Uma Rani recalls the case of an advertising professional who wanted to be tested before she got married—she had lost her younger brother to thalassaemia. While she was a thalassaemia minor, her fiancé, fortunately, was not, and that meant any child they had would not have thalassaemia.

Vimal Grover, senior consultant, gynaecology and obstetrics, Fortis La Femme, Delhi, says thalassaemia screening is important. “That is because when both partners are carriers of thalassaemia, the possibility of having a child with thalassaemia major is very high—and this situation can be avoided," she says. If both partners have thalassaemia, doctors advise them to avoid having children.

Kaushiki Dwivedee, lead consultant, gynaecology, Max Hospital, Gurgaon, says the number of people opting for premarital screening is increasingly steadily—it is, however, still not mandatory. “Today, we get an average of about 35-40 patients a month who come for basic counselling to undergo tests (see“What to get tested for"). Some ask for specific tests, some go by what the doctors advise during counselling," says Dr Talwar, “and I feel it is a good thing as these tests can help avoid unnecessary emotional stress and trauma at a later stage in life."

Dr Uma Rani agrees. “Screening before marriage helps in ensuring that both the individuals who are heading to start a life together are healthy and are aware about any issues that their partner or they face. Any abnormal health condition in one of the partners can endanger the health of the other partner and also of the offspring. Thus, it is better to be completely aware of each other’s health condition before marriage instead of facing problems afterwards," she says, adding that she strongly recommends these tests to all her patients of marriageable age.

“Screening tests for HIV, diabetes, asthma, allergies, Rh factor, thalassaemia and any known genetic condition in one partner should also be screened in the other so that they can be counselled accordingly," says Dr Dwivedee.

Unfortunately, in India there are no laws that mandate screening before marriage, and there is a social stigma attached to asking for such tests before a wedding. “In Australia, it is mandatory for couples to undergo premarital screening. The rule is now being implemented in the UK and China also. I hope India too implements it soon," says Dr Uma Rani.

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What to get tested for

Males: Complete haemogram (this test is indicative of various blood diseases and disorders like anaemia, sickle cell anaemia and thalassaemia), Rh blood group test, semen analysis, sexually transmissible diseases screening for HIV 1 and HIV 2, hepatitis B, hepatitis C and VDRL for syphilis testing, to identify morbid conditions like renal and hepatic disorders, renal function and liver function tests.

Females: Complete haemogram, Rh blood group test, basal hormone profile—FSH, LHS, Estradiol on Day 2 or 3 of the menstrual cycle, AMH (anti-mullerian hormone) to assess the ovaries, ultrasound to assess the uterus and ovaries, sexually transmissible diseases screening for HIV 1 and HIV 2, hepatitis B, hepatitis C and VDRL for syphilis testing, to identify morbid conditions like renal and hepatic disorders, renal function and liver function tests.

The costs of the package in hospitals vary from 4,000-12,000, depending on the tests suggested and opted for.

—S.S. Vasan, CEO, Manipal Ankur Andrology and Reproductive Services, Bangalore; and Kaushiki Dwivedee, lead consultant, gynaecology, Max Hospital, Gurgaon.

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