Dr Duru Shah, Scientific Director of Gynaecworld and Gynaecworld Assisted Fertility Centre and a Consultant to the Breach Candy Hospital, Jaslok Hospital, Mumbai, talks to Shahid Akhter, ENN, about the struggle and solutions faced by the infertile couples
How have aids such as ovulation kit helped/harmed the modern couple?
The ovulation kit is a very useful method which helps couples to time ovulation and plan a pregnancy. The kit has made it easier for infertile couples to plan a pregnancy in the comfort of their homes, without any invasion from doctors and clinic staff, especially in women with irregular periods, as it helps them to time their ovulation. The kit detects the rise in the luetinising hormone in the body which is responsible for the final maturation of the egg and its release leading to ovulation. In this busy world, where men and women are both struggling to build their careers are so stressed that they have no time for sex. Getting pregnancy in such couples is not spontaneous, but dictated by the kit which tells them today is the right day.
Please tell us something about the embryology lab at your centre.
The embryology lab is the heart of any ART Centre. It is a state-of-the-art laboratory with well-equipped Laminar Air Flow, the latest incubators, ICSI Manipulators, culture media, Laser Assisted Hatching machines, freezers for embryos, sperms and eggs for future use with a high level of quality control. The embryology lab is converted into a space like the womb of a mother–adjusted at the same temperature, clean environment, humidity and atmosphere of the womb, so that the sperms, eggs and embryos thrive and give positive results.
What is the success rate of IVF at your centre, and your USP?
IVF success rate will always be a variable. It depends on the age of the woman you are treating. Besides that, there may have various other complications. The average success rate is approximately 30 percent per embryo transfer. But, if we select the couples based on the age of the woman, the pregnancy rates go as high as 47 percent per embryo transfer in women below 30 years of age, and go lower as the age advances. On the other hand, when we use donors egg in older women, the pregnancy rate rises to 53 percent per embryo transfer. In women, where we have used donors egg and surrogacy, it goes up to 65 percent per embryo transfer. So, success rates vary from situation to situation with the womens age being the most important factor.
How do the cost and services of IVF in India compete with other competitive markets?
In India, the cost per IVF cycle is approximately 25 percent of the cost in Western countries, even though most of the culture media and consumables such as petri dishes, etc., are imported with a heavy import duty being levied. The cheap labour and the cost of medical expertise help to make it more affordable here. Our USP is that we offer all services under one roof so that patients do not have to travel all over the city for all the services needed. Every couples treatment is customized, and individualized care is given to every couple. We do not believe in having assembly lines.
Can you think of any government initiative that can make IVF more cost effective?
IVF is totally unaffordable by the lower socio-economic strata of society because of its high cost. The government can definitely assist by setting up their own IVF services at government hospitals. It can collaborate with private IVF centres for treatment at subsidized rates, and also manage basic infertility in rural areas. The Government of India has been aware of this, and has initiated a process to address the issue of infertility management, which does not exist, at all, in the rural areas. I have been a part of this process during the development of the basic guidelines by the ICMR.
What they need to do is to bring infertility under the purview of the insurance companies so that more people can afford IVF treatment.
“Globally, IVF seems to have become the first choice, especially in women as they get older”
What is the biggest challenge facing the surrogacy industry in India today?
India became the capital of surrogacy in the last few years mainly because of the high-end services available in India with proven results and English speaking doctors. Because of its high monetary value, many businesses which came into being went into extremes, and started creating babies for trafficking. The Government of India, however, clamped down on them, and created guidelines which made it possible for couples who truly needed surrogacy to avail themselves of this facility. Visa rules for international clients were tightened, and a lot of documentation came into existence. This has put off a large number of potential international clients from coming to India due to these bureaucratic difficulties.
The entire business of international surrogacy has now moved to Thailand and Mexico, away from India.
Please dwell upon some of the most revolutionary reproductive therapies that can aid in curing infertility.
The most revolutionary reproductive therapies that can aid in curing infertility are: Intracytoplasmic sperm injection (ICSI) for those men in whom not even a single sperm is obtained through the semen. In such men, the sperm is aspirated from the testes directly, and used for ICSI. Besides, there are times when women from other countries or cities can live in Mumbai for their treatment, and husbands can freeze their sperms and leave. The frozen sperms can then be utilized for the next few cycles whilst the woman is in Mumbai. She can still get pregnant with his sperm, even though he is away.
How do you commence the treatment of unexplained infertility?
It involves a lot of psychological counselling as the cause of infertility is not known. Unexplained infertility is a situation wherein the doctor is unable to determine the cause of infertility even after all the relevant investigations are done. We induce ovulation in patients with ovulation inducing agents and perform Intrauterine insemination (IUI) — a procedure where husbands semen is deposited within the uterus). After three to four attempts, if this process also fails, then IVF is the best option.
How do you resolve the chances of multiple births?
Multiple pregnancy is an important complication of IVF. Careful stimulation of the ovaries after proper patient selection and single embryo transfer can help to reduce the multiple pregnancy rates. Most of the IVF centres transfer three embryos at a time, so that the chance of pregnancy increases, because it is well known that only one out of three embryos is usually normal, and will lead to a pregnancy. However, sometimes all three are normal, and we end up with triplets. Hence, today, in order to reduce the chance of multiple births, we grow the embryos to Day 5 in our labs, and they represent the best of the lot of embryos. And a single of those Day 5 ones is transferred, hopefully leading to a single pregnancy.