Couples who have waited years to have children are stuck in limbo as the virus outbreak raises questions about infection threat to both mother and child
Pic/ISTOCK
Last month, the Human Fertilisation and Embryology Authority (HFEA), which regulates Britain's fertility industry, ordered private and the National Health Service (NHS) clinics to stop treating patients who are in the middle of an in-vitro fertilization (IVF) cycle. All new treatments had also been banned. Experts believed that this decision would prevent the birth of at least 20,000 babies if the policy were to stay in place for 12 months. But on May 1, the fertility regulator did a U-turn, lifting the suspension of fertility services, provided they were taking safety precautions for both doctors and patients.
The conundrum is more or less the same in Mumbai. Much before the Janata Curfew was imposed by Prime Minister Narendra Modi on March 22, a few fertility clinics in Mumbai had already shuttered. Dr Firuza Parikh, director, Assisted Reproduction and Genetics at Jaslok Hospital and Research Centre, says, "A week before the nationwide lockdown, Jaslok shut its fertility clinic for two reasons. We wanted to ensure the safety of our patients since we did not know what course the infection was going to take in Mumbai or Maharashtra. Second, we thought the government needs hospitals and healthcare workers to tend to COVID patients. We didn't want to sap resources including anaesthesia medicines, medical talent, etc., which could otherwise have been used to contain the spread of Coronavirus. We decided to pass on all the resources from our inventory to the ICU. The supply chain of PPEs had not started then, so this felt like the right thing to do."
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Dr Firuza Parikh
Jaslok's fertility centre had around 40 patients who were in the middle of their IVF cycles at that point. Dr Parikh says we can no longer view the world from an individual standpoint. "It has to be about 'us'. I personally made calls to all our patients to explain the reason behind the decision. While a majority of them agreed with us, some women who had come down from the US and wanted to do multiple cycles of IVF at our centre, weren't pleased," she adds.
Dr Parikh explained the dangers. During the Zika virus outbreak, several newborns ended up being infected as their mothers were in the first trimester when they contracted the virus.
While there is no mandate from the Centre or the state government on the closure of fertility centres, it was a decision taken unanimously by most gynaecologists in the city. NOVA IVF fertility centres in Chembur and Andheri, too, shut down when the lockdown was imposed. Around 75 IVF cycles were underway at NOVA at that time. Dr Ritu Hinduja, consultant fertility specialist, NOVA, explains, "We didn't know if we were equipped to deal with patients during the pandemic. But before we closed, whatever injectable cycles were ongoing, we completed those, created embryos and cryopreserved them within a week."
Dr Ritu Hinduja
If embryos are cryopreserved, they can be transferred into the patient's womb at a suitable time. Once the eggs are frozen, the couples need not worry, Dr Hinduja adds. But what about those who had to leave the cycle in the stimulation phase? "They have to restart the IVF procedure when the world opens up. But we tried to finish ongoing cycles as we knew it would be mentally harrowing for patients. Some couples wait for years to have this procedure.
So while this is not a typical emergency service, it is indeed an emergency for some desperate couples."
Shweta and Sailesh Kumar may have to wait even longer. The Kumars have been undergoing IVF treatment under Dr Hinduja's supervision. "We have been married for four years. Last year, my wife was diagnosed with systemic lupus erythematosus (SLE), an autoimmune disease." In this condition, the immune system of the body mistakenly attacks healthy tissue. It can affect the skin, joints, kidneys, brain and other organs. "Our rheumatologist advised us to freeze her eggs as the treatment for SLE could have an effect on them." Just before the lockdown, Shweta's condition improved and her rheumatologist gave her a fitness certificate to go ahead with the pregnancy. "We decided to do the transfer of embryos but due to the lockdown, the procedure has been put on hold," Sailesh says.
The couple's case is unique. Since Shweta is a high risk patient, doctors advised her against venturing out for IVF treatment during the pandemic. They have staggered her transfer, because she has co-morbidity.
At both Jaslok and NOVA, doctors are ensuring that tele-consultations are available to patients to allay their fears. Dr Parikh says, "It's important for them to know when we will start OPDs again. About 50 per cent of our patients come from outside Mumbai, and about 10 per cent are from outside India. So, unless travel restrictions are lifted, we cannot help them."
Dr Prakash Trivedi
Dr Prakash Trivedi, well-known gynaecologist and president of the Indian Society For Assisted Reproduction (ISAR), facilitated a meeting of stakeholders last week to discuss the issue. "We recommended that couples who are not showing any COVID symptoms, have tested negative and are keen on IVF, could be treated. But necessary precautions need to be taken, both by doctors and patients. Since we don't know if the patient can contract the virus during IVF, we will only allow transfer of embryos. But this will be done after offering thorough counselling to the couples. We have also recommended that the embryos of patients undergoing IVF post-COVID be separated from the ones done before in different jars. This is to ensure safety of all patients," he shares.
According to him, there are close to 3,000 fertility centres across India, of which most have voluntarily decided to close temporarily. While Jaslok and NOVA are aiming to open up their OPDs for embryo transfers, they are yet to decide on whether to take on a new patient to start a fresh IVF cycle.
How does IVF work?
Ovulation Stimulation: During the stimulation phase of an IVF cycle, female patients are administered hormones for a period of 12 days.
Egg retrieval: Patient is put under mild sedation and the eggs are collected.
Sperm retrieval: Male partner is asked to produce a semen sample. The specimen is washed, and those that display maximum motility are selected.
FertiliSing the eggs: Retrieved eggs are fertilised with sperm. The eggs are regularly monitored to confirm the fertilization.
Embryo transfer into uterus: Embryologists monitor the embryo’s growth and viability to determine whether a transfer should be done.
After Transfer: Two weeks after retrieval, a pregnancy blood test is performed. If this test is positive, the patient is considered four weeks pregnant.
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