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.