Definite future for human IVF

The bumpy ride to the birth of the first test tube baby may be over, but ethical issues remain

Had they met, the pioneering scientists would have found to their utter dismay how most of these doctors cash in on in-vitro fertilisation – a boon to many childless couples – purely for commercial gains, ignoring its larger societal implications.

Complaints from parents of children born through the IVF route are uncommon because of the emotional trauma of infertility. Prescriptions are a rarity in most of the clinics and many doctors double up as counsellors – with little time to spare – even though the clinics are supposed to have trained counsellors. Nobody explains to the hapless couples that unlike most other medical techniques, the success rate of assisted reproductive technology (ART) is poor. The doctors cash in on the desire of childless married couples to have a child.

The government, as a regulator, has done little over the years. Infertility was never been an issue for the government, trying to stabilise the population. The Indian Council of Medical Research developed  guidelines in 2002 that, after eight years, is before Parliament waiting to become law. Once the bill is passed, it would be legally mandatory for IVF clinics to maintain a standard and take care of at least some of the grey areas.

Negative publicity

“IVF has received lots of negative publicity. The onus lies with the doctors. They have to decide which patients stand better chances of conceiving. They should not make tall claims so that the patient does not feel disheartened in case of failure to carry through a pregnancy. Every step has to be explained and the patient counselled. Most of the clinics don't follow ethical practices,” said V S Venkatesh, president of Bourne Hall Clinic's India operations.

But that was not the way, Bourne Hall Clinic's founder Edwards and Steptoe looked at IVF when they developed the technique in the 1970s. Bourne Hall was the first IVF clinic set up by the duo in early 1980s, soon after the world’s first IVF baby Louise Brown was born in 1978. The techniques developed over three decades at National Institute of Medical Research in London and at Cambridge University were perfected at Bourne Hall in the 1980s from where it spread.

Edwards realised at the outset that IVF research would inevitably raise important ethical concerns that had to be addressed. He and his lawyer David Sharpe initiated the ethical debates. An ethics committee for IVF was created at Bourne Hall.

“Mukherjee too had such strong sense of ethics, which is completely missing in the modern crop of doctors that use IVF as a money making tool,” said Sunit Mukherjee, a Kolkata-based embryologist who collaborated with Mukherjee and is a custodian of his documents after his suicide.

In fact, as Bourne Hall plans its first two clinics in Kochi and Gurgaon next year, what Venkatesh claims will distinguish Bourne Hall's first two clinics outside the UK from other Indian centres is a strong focus on ethics and improving the quality of delivery in terms of technology. Most Indian clinics pay little attention to quality. Some of these issues may be addressed if the law is passed and enforced.

Controlling the quality of air inside the IVF centre, for instance, is very important to avoid  contamination. Also there should be witnesses to ensure no sample is mixed up. Many such issues are being addressed in the proposed legislation, which will help establish a standard operating procedure and a national ART registry.

Cost too remains an issue with IVF. With each cycle (trial) costing between Rs 1 to 1.5 lakh, doctors advise minimum three cycles to have the best results – a flat expenditure of Rs 3 to 4.5 lakh for a procedure which has only 40 per cent chance of success at best.

Low end options like intrauterine insemination (IUI) is relatively cheaper, but the success rate is only 20 per cent. And there is no insurance cover at all even though the infertility treatment market in India is estimated to generate Rs 25,000 crore, which too must have escalated.

Medical insurance of infertility remains a tricky issue. More than five years ago, the union health ministry set up an expert panel to look into the issues. But that group failed to make progress because of opposition from the insurance sector, which felt it would be difficult to fix the cutoff age of  infertile couples. “Some support like the cost of drugs should come from insurance. But nobody pushed it,” Venkatesh said.

Only two govt clinics

IVF clinics at government hospitals could have been an alternative. But only two government hospitals – All India Institute of Medical Sciences in Delhi and the Queen Mary unit of KGMC, Lucknow, offer IVF treatment, besides the Army Research and Referral Hospital in Delhi. But little information on the facilities are available.

Second time lucky mother

Three years of marriage and repeated failed attempts later, Archana, 25 (name changed to protect identity),  and her husband went for a check up, where it was found that her husband was infertile (sperms absent during ejaculation). The news was devastating but the couple was not disheartened. They decided to go in for IVF treatment.

“She was undergoing the IVF treatment for the first time. In the first round we extracted good number of eggs. We also performed a biopsy of the testicular tissue on the husband. From this tissue we collected sperms, which were just enough to be injected into some eggs,” said Dr Sulochana Gunasheela, well known Bangalore-based gynaecologist and obstetrician. Rest of the eggs were vitrified, a process where eggs undergo rapid freezing.

While some eggs got fertilised, the doctors could not implant it immediately as they felt Archana could develop Ovarian Hyper Stimulation Syndrome leading to complications. So they waited for two months for her ovaries to normalise. When the embryos were implanted, she failed to conceive. Although disappointed, Archana agreed to try again. Another biopsy was done on the husband to retrieve sperms. These were injected into the vitrified eggs. This time, the procedure was successful and she conceived.

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