Interview

Every woman enjoys the right to give birth

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“Infertility treatment can be very demanding and can create a great deal of physical, emotional and psychological stress for a couple.Over 1500 IVF babies born in Milann and this includes South Indias First Baby through Laser Assisted Hatching”

Regulated and standardised IVF centers are the need of the hour today. ICMR has set national guidelines to regulate ART. These are simply guideliens. Dr Kamini A Rao, Medical Director, Milann, shares her experience

How does the lifestyle impact fertility?
Lifestyle is one of the greatest problems facing society today. The deleterious effects of an unhealthy lifestyle affects not only the capacity to reproduce but also increases the risk of chronic health diseases. Factors that are causing so much concern today are – Choices of excessive smoking, drinking alcohol or a caffeine overload, fast paced, hectic work schedules, junk food leading to increase in weight, career demands leading to postponement of the decision to have a baby, erratic sex life and such like are turning out to be the bane of fertility professionals. A report conducted by the International Institute of Population Sciences shows that infertility is growing at an alarming pace, especially in the cities. – upto 13 percent of ever-married women aged 15-49 years were childless in 1981 (rural 13.4 percent and urban 11.3 percent) which increased to 16 percent in 2001 (rural 15.6 percent and urban 16.1 percent). Over half of married women aged 15-19 years were childless in 1981, which increased to 70 percent in 2001.  In women, hectic lifestyle and job stress contribute to conception problems. A very common cause is polycystic ovary disease (PCOD), a condition characterised by excess production of hormones and lack of ovulation. There are others as well such as genital tuberculosis (a chief factor in rural India) fallopian tube defects, endometriosis, a condition characterised by abnormal growth in the womans reproductive system, multiple partners and STDs that may permanently destroy the womans reproductive system, obesity, use of certain medication, and smoking and alcohol consumption.

Does great advances in sperm and egg preservation techniques mean an increase in number of babies?

While the concept of a designer baby does seem exciting, it is not just the scientific parts that need refining. The current techniques of genetic modification introduce genes at random places in the genome. Many genes have more than one effect. The effect we intend may be accompanied  others of which we become aware only later as well as the fact that it may be more than one gene that is responsible for a particular trait. In addition is the all important moral and ethical distinction between treating or preventing disease and enhancing traits? Some think that we should pass different moral judgments on enhancement from those we pass on therapy. They say that while therapy is justifiable, enhancement is not. Having said all this, there have been several instances reported of how a child was conceived to save its sibling suffering from a near fatal disorder.

How does the cost of IVF in India compare with that of US and Europe?
The average cost of an IVF cycle in the US is USD12,400 (varying between 12000 to 15000$ depending upon individual clinics) according to the American Society of Reproductive Medicine. In the UK, the cost varies between £1,000 to £10,000+. In India, the average cost of an ivf cycle varies between 1.25 to 2 lakhs INR depending upon individual clinics. This compares very favourably with the IVF done in the West where the average cost per cycle will be over 5 lakh INR. The costs will obviously be about 25 percent – 50 percent more if surrogates or donor gametes are used. India has proven to be a very popular destination for meditourism for this purpose.
Each country has its own IVF laws and protocol. How about India?
 The problem of infertility is very real affecting upto 10 “ 15 percent of the reproductive age groups today. With changing lifestyles, this will continue to increase. Regulated and standardised IVF centres are the need of the hour today. Indian Council of Medical Research (ICMR) has set national guidelines to regulate ART but these are still simply guidelines. However in 2012, the Government has, for the first time in the history of infertility treatment in India, finalised a draft law. The draft law prohibits In Vitro Fertilisation (IVF) clinics from advertising for surrogates on behalf of infertile couples and seeks to create Assisted Reproductive Technology (ART) Banks to do the advertising for commissioning parents. These banks will screen surrogate mothers and donated sperms and oocytes for infections while ART clinics will simply offer ART services. The Bill allows only 21 to 35-yearolds to be surrogate mothers and says no woman would act as a surrogate for more than five successful live births in her life, including those of her own children. The Bill guarantees legal protection to parents, surrogate mothers and children and mandates legally enforceable agreements between the stakeholders. Any violation would be a cognisable offence punishable with imprisonment and fine.

Does the long term use of drugs used in IVF impact the health of mother or child?
With regards to the long term safety of these medications, the relationship between fertility drugs and epithelial ovarian cancer is controversial, and causality has yet to be proven. How  ever some studies have shown a small increase in the risk of borderline ovarian tumours. Indeed, a working knowledge of the many adverse effects associated with these medications is essential to any physician prescribing ovulation induction agents, in order to ensure maximum patient safety, compliance and understanding. As regards breast cancer studies are again controversial. Some reports indicate that although the drugs seem to reduce breast cancer risk in young women, the risk goes up when they get pregnant. The study found that women who took the drugs and did not get pregnant had a slightly lower risk of developing breast cancer before age 50. Those who took the drugs and reporteda pregnancy lasting 10 weeks or more had a slightly increased risk, but that risk was little different than the risk of women who never took fertility drugs at all. Whatever studies show the increased risk also state that the increase is extremely small. The coming years and more research will hopefully give us more insight.

Most of the sophisticated techniques and technologies that are used  oday may  impact the childs life as he or she grows?
Thousands of babies have been born  all over the world today who have been conceived by ivf. In the general population  around 2.5 percent of babies are born with some form of birth defect,  while in IVF this may rise to around 3.5 percent. It must be stressed that  the majority of babies born through IVF are healthy. While this small increase  in the risk of birth defects and  learning disabilities have been identified, IVF babies continue to be some of  the most wanted and treasured children on the planet. Couples are counseled  regarding these facts before  they embark on their journey through an IVF cycle.   

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