Thirty-two years after Robert G Edwards delivered the first test tube baby of the world, he was awarded the Nobel Prize, which can mean only one thing: assisted pregnancies are here to stay. Active! gets you the latest developments in infertility treatments with an expert rating on each
Thirty-two years after Robert G Edwards delivered the first test tube baby of the world, he was awarded the Nobel Prize, which can mean only one thing: assisted pregnancies are here to stay. Active! gets you the latest developments in infertility treatments with an expert rating on each
British biologist Robert G Edwards was awarded the noble prize in Physiology of Medicine last week, for his efforts in the development of In vitro Fertilisation (IVF), which has become a milestone in the development of modern medicine. His efforts, which began in the 1950s were finally crowned with success on 25 July, 1978, when the world's first "test tube baby" Louis Brown was born.
Approximately four million individuals have so far been born through IVF since then and many of them are now adults and some have already become parents. India's first successful in-vitro fertilization to produce "Durga" (Kanupriya Agarwal), also the second test tube baby in the world, was performed by Dr Subhash Mukhopadhyay in 1978, just three months after Edward's success.
Durga's birth was caught in ethical and moral controversies with the West Bengal government. Facing social ostracization, bureaucratic negligence and refusal of the Indian government to allow him to attend international conferences, the physician committed suicide in 1981.
Eight years after the birth of Durga, India's second Test-tube baby Harsha Chawda was born at the hands of gynaecologist Indira Hinduja at KEM Hospital, Mumbai, in 1986. Harsha's birth opened up the much-sought opportunity for treating couples incapable of natural reproduction.
In India more couples are now open to going for other assisted reproductive techniques (ART). And IVF (process by which egg cells are fertilised by sperm outside the body) is an established therapy throughout the world.
Rise in artificial fertilization
The ICMR (Indian Council for Medical Research) estimates that more than 10 per cent of couples in India face infertility and for many of them, this is a great disappointment and causes lifelong psychological trauma.
Infertility specialist Dr Nandita Palshetkar who practises with the DY Patil and Lilavati Hospital confirms that the rate for couples going in for assisted pregnancies to deal with infertility has gone up in India due to the changing social dynamics. "Today couples delay child bearing because of career or financial reason. Late marriage is also seen to be a new trend today, which again delays child bearing. Some couples want to wait for five years or more before having a child so that they can get to know each other better," she says.
Technological advancements
The advancement in the field of artificial infertility is also encouraging more couples to go in for unconventional methods. Presently, there are more than 400 IVF clinics in India that even treat those coming from abroad due to the comparatively lower costs and, in some cases, for Indian donor eggs. Results of assisted pregnancies have gone up due to advanced techniques like ICSI, IMSI, IVM, Assisted Hatching and Metabolomics. More and more infertile couples are also turning to IVF.
Hospitals have been striving to launch the latest technologies in the field of reproductive medicine. This year Lilavati Hospital, Mumbai, became the first in Asia and fifth in the world to have installed the technology "ViaMetrics", which assesses embryos with respect to their viability and implantation potential.
Psychological and social impact
Dr Palshetkar explains that IVF is a result-oriented method and long-term studies have shown that artificially fertilized babies are healthy, but certain issues might arise. "It is the most result oriented among all methods but cost is high. There is also a risk of multiple pregnancies and overstimulation," she says.
Many couples require more than one cycle to be successful which will take the cost even higher. "Surrogating, egg and embryo donation also as a method is a little difficult to accept in India and is usually resorted to as a last option. Couples are apprehensive about how they would be viewed by the society and about the psychological impact on the child as well," she adds.
Maximising conceiving
Gynaecologist Dr Rishma Pai suggests that when routine methods fail to achieve pregnancy in two years' time one can resort to ART. She says that certain precautions and steps need to be taken to maximise conceiving. "Do not delay the first pregnancy beyond 35 as ovarian reserve starts reducing. Baseline investigation for female fertility, sonography, a blood test called AMH in women can easily predict their ovarian reserve. Do the baseline fertility investigation for male like semen analysis and sperm abnormality," says Pai.
Thyroid and prolactin abnormality should be ruled out by doing tests and one must avoid smoking and alcohol as it reduces sperm count and motility. "One must not waste important reproductive age in doing more than 3-6 cycles of IUI depending on the age of women. They should quickly move to In vitro fertilization," says Pai.
Do surrogate babies need more TLC?
Surrogate children and test tube babies need to be brought up with a lot of nurturing and care. They have to be told when they are young in a children's language about how they were born so that the baby doesn't hear about he or she being different from friends, neighbours and relatives. Else, it can cause confusion in the child.
I had a case of a foreigner couple living in Mumbai who had an Indian baby from a surrogate mother. He developed a lot of complexes because he was very dark and felt he was very different from his parents. I had counselled the parents to make the kid understand why he was different. A sense of attachment has to be instilled from the day the baby comes into this world.
Options for couples seeking help getting pregnant
Options available to couples in India to help deal with infertility and their success rate in women not more than 35 years of age. Stated below are approximate costs per cycle but the charges vary from hospital to hospital.
Ovulation induction with letroz with IUI (Intra Uterine Insemination) and Ovulation induction with letroz plus gonadotropin with IUI (Intra Uterine Insemination)
In this process 'Washed sperm' (spermatozoa) which have been removed from most other components of the seminal fluids, are injected directly into a woman's uterus.
Success percentage-8-10%
Rating: 1/5
Cost: Rs 5-10,000
Ovulation induction with gonadotropin only with IUI (Intra Uterine Insemination)
Success percentage: 15-20%
Rating: 3/5
Cost of injections per cycle: Rs 5,000-10,000
IVF (In Vitro Fertilisation) / ICSI (Intracytoplasmic sperm injection)
A process specially used for male infertility, Invitro involves a process by which egg cells are fertilised by sperm outside the body. In ICSI, each egg is injected with one sperm using a special machine called the micromanipulator.
Success percentage: 50-60%
Rating: 4/5
Cost per cycle: Rs 70,000 to Rs 1,00,000 ICSI: Rs 15-20,000
Egg donation, embryo donation, and surrogacy
Success percentage: 60% to 70%
Rating: 4/5
Cost for egg and embryo donation: Rs 1,00,000- Rs 2,00,000
Celeb couples who have opted for assisted pregnancies
Jennifer lopez and marc anthony
Although never confirmed, Jennifer Lopez allegedly conceived her baby via IVF after trying for 3 years.
Courteney cox and david arquette
After several miscarriages and battle with infertility, David and Courteney Cox-Arquette had a healthy, baby girl, Coco.
Sarah jessica parker and MattheW broderick
Sarah Jessica Parker and husband Matthew Broderick had twins via surrogacy last year. (Pics/AFP)
celine dion and Rene Angelil
Celine Dion is slated to give birth to twin baby boys in November, a product of the 6th IVF and other treatments.
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