IVF or in vitro fertilisation is a process by which the eggs or the oocytes of the woman are fertilised by the sperm of male partner outside the human body in a laboratory. Though commonly called a test tube baby, the eggs are actually fertilised in a small dish, says Dr Shivani Sachdev Gour, SCI IVF International Hospital, in conversation with Elets News Network (ENN).

Q Give us an overview of SCI IVF International, which caters to people by providing state of the art technologies.

SCI IVF and Healthcare was started in 2009 and since then it has conducted over 13,000 IVF procedures. It has helped thousands of couples and single individuals in India and over 55 countries of the world to become parents.

We provide state of the art technology and offer individualised protocols for fertility treatment. Our staff is very sensitive to the needs of our patients and we provide service with care and compassion which is highly appreciated in the numerous thank you notes that we have received.

Q Tell us about your services i.e IVF/ICSI and other infertility treatment. How do these work?

IVF or in vitro fertilisation is a process by which the eggs or the oocytes of the woman are fertilised by the sperm of male partner outside the human body in a laboratory. Though it is commonly called a test tube baby, the eggs are actually fertilised in a small dish.

Originally this process of fertilisation takes place in the fallopian tube of a woman. This is called in vivo fertilisation. After fertilisation, an embryo is formed which grows for four days in the fallopian tube and then it is transported through fallopian tube into the uterus or the womb where it grows into full-term baby in nine months.

In IVF, this process takes place in a small dish outside the human body and embryos are transferred directly into the womb or the uterus thus bypassing the fallopian tube. Its important to know that not all embryos grow into a child. Some stop developing at an early stage and the pregnancy does not continue and this is one of the major reasons why multiple embryos are transferred into the uterus in the IVF process.

The services that we provide include testing for ovarian reserve and sperm function; DNA fragmentation studies; sonosalpingography; follicular monitoring; testing for immune factors in infertility; IUI; IVF; ICSI; PICSI; Embryo biopsy and Pre-implantation genetic screening or PGS/ PGD; Laser assisted hatching; Spindle view technology for imaging the egg; Egg freezing; embryo freezing; sperm freezing; vitrification; Donor gametes and Surrogacy.

Q What is Clinical embryology? Shed some light over Laser Assisted Hatching, a technique which improves pregnancy rates.

An embryologist is the person who works in the laboratory to handle the gametes — the sperm and the egg. The work involves testing the gametes for fertility. Embryologist does the actual fertilisation of the egg by the sperm by IVF or ICSI technique. Sperm preparation by various techniques like swim up and density gradient; doing sperm function tests when indicated and testing the sperm for vitality are a part of the process. Cryopreservation of the eggs, sperm and embryos and maintaining records, quality control and quality assessment in the laboratory are also a major part of their work profile.

Clinical embryology involves a further specialisation in which the individual also meets and consults with the patients instead of only working in the laboratory. Exploring various treatment options with them and walking them through what is actually involved in the treatment process.

Q IVF technique is boon for childless couples and single parents.  What are the factors which drive IVF market in India?

India has a large number of couples who require assistance to conceive.  According to the ICMR Publication, approximately 1.8 million couples in the country need infertility treatment. The ICMR study puts the incidence of infertility in India at approximately 4 % which is lower than approx 10 % seen in Western countries.

Today, at approx 1.2 to 1.5 lakh IVF cycles a year, India performs only approx 90 cycles per million population compared with 3,000 per million population in Israel, 1,500 in Australia, 500 in the US and 220 in Egypt.

Varying reports put the Assisted Reproductive Technology (ART) market in India to be worth at $1 billion (Rs 5,000 crore) in the next 1-2 years and predicted to cross Rs 10,000 crore mark by 2018.

In 2012, global IVF market had a value of $9.3 billion which is projected to cross $21.6 billion by the end of 2020.

A worldwide decline in sperm parameters, late marriages and delayed pregnancy, decline in egg quality are the major determinants affecting pregnancy.

In addition, environmental factors like pollution, pesticide use, mobile phone use or stress may play a role contributing to rising rates of infertility.

Along with this, increasing availability of advanced fertility treatment and third party reproduction like donated gametes and surrogacy offer more options to couples unable to conceive by other means such a conventional IVF.

Increased availability with even smaller towns and semi-rural areas having new fertility centres, plus scientific advances leading to a range of treatment options to treat infertility are readily available in India.

These include medications for ovulation induction, endoscopic surgery to correct or minimise anatomical and medical conditions, and the assisted reproductive technologies, including IUI, IVF, ICSI (intra cytoplasmic sperm injection) and many more.

India has foreign trained highly skilled doctors to provide best IVF treatment. Here, fertility treatments are available at very competitive prices and that is why many more people visit the country to access the facility.

Patient awareness camps that are being regularly conducted by corporate and medical institutes along with success story of celebrities have given acceptance to this modern technique and have raised its profile. Medical tourism in the country for fertility treatment is also rising.

Q Lifestyle induced disorders, such as obesity and smoking are the main reasons for the high infertility rates among women. What are your suggestions to them?

It has been shown in numerous studies that obesity and smoking have a close relationship with infertility. In certain conditions like polycystic ovarian syndrome or PCOS even a 5 per cent reduction in weight can help some women to rectify the underlying hormonal disorder and restore ovulation which help the woman conceive naturally without any medication.

Obesity has been found to be associated with infertility via many mechanisms including an increased risk of ovulatory disorders; oxidative stress; increase in miscarriage rates. Obesity in men has been linked to reduced sperm quality and oligoasthenoteratospermia; erectile dysfunction and reduced fertility.

Smoking has been found to be directly toxic to the gametes; both the eggs and sperm and has been linked to premature ageing of the eggs or premature menopause and reduction in quality of the sperm and its motility. It increases the risk of miscarriage. Both men and women are strongly advised to give up smoking for the sake of their family.

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