Bioengineered baby

The world changed in 1969 with the lunar landing, but another revolution followed in 1978 — the birth of the first test-tube baby. After struggling to conceive, UK couple Lesley and John Brown turned to physiologist Robert Edwards, who fertilised Lesley’s egg with John’s sperm in a petri dish. Embryologist Jean Purdy monitored the embryo, and Dr Patrick Steptoe later implanted it in Lesley’s womb. On July 25, 1978, she gave birth to Louise Brown, the first baby born through in-vitro fertilisation (IVF), offering hope to millions.

Just a few months later, in Kolkata, Dr Subhash Mukherjee pioneered a similar technique, making India a silent but significant player in assisted reproduction.

Infertility: The global & local picture

According to the World Health Organisation, one in six people of reproductive age globally experience infertility. In men, this may stem from issues such as ejaculation problems, low sperm count, or abnormalities in sperm shape or movement. In women, infertility can result from disorders affecting the ovaries, fallopian tubes, uterus, or endocrine system.

India has about 27.5 million individuals facing infertility. Fertility rates have dropped below the replacement level (2 births per woman) in 17 of the country’s 29 states and union territories. Dr Keshav Malhotra, Vice Chairman of Embryology at the Indian Society of Assisted Reproduction (ISAR), attributes this trend largely to reduced fertility rather than personal choice. India’s current fertility rate stands at 2.01 (2022).

Impact of changing lifestyles

Dr Prakrutha S, an IVF expert, points to a range of modern lifestyle factors contributing to infertility: postponing pregnancy, work stress, poor diet, alcohol, lack of exercise, smoking, and obesity. In rural areas, infections like tuberculosis that affect the fallopian tubes are common. Meanwhile, conditions such as Polycystic Ovary Syndrome (PCOS) show a higher prevalence among Indian women.

The ART of science

Thanks to advances in Assisted Reproductive Techniques (ART), personalised fertility treatments are increasingly common. Dr Kamini Rao, a pioneer in assisted reproduction in India, has observed IVF success rates rise from just 5% in the early years to as high as 60% today.

Among the landmark procedures is Intra-Cytoplasmic Sperm Injection (ICSI), where a single healthy sperm is injected directly into an egg. While effective, Dr Kamini Rao cautions that ICSI is not a complete solution, as implantation failure still poses a challenge.

What is ICSI?

ICSI involves a multi-step process:

• Daily hormone injections for 10–12 days to stimulate egg development
• Egg retrieval via a fine needle
• Manual injection of a healthy sperm into a mature egg
• Embryo culture for up to six days
• Selection of the best embryo for implantation

Engineering reproduction

Merging mechanical engineering and reproductive biology, Dr Santosh Bhargav and Dr Ramnath Babu, both PhDs from IISc Bengaluru, founded SpOvum Technologies. Their innovation: RoboICSI, a robotic hand that gently holds an egg — the body’s largest cell — and injects it with a single sperm, one of the smallest. This precision reduces cell damage and measures the egg’s mechanical properties, improving IVF outcomes. “Most IVF decisions are experience-driven,” says Dr Babu. “But we believe a first-principles engineering approach can help improve consistency and success.”

Their automation system also collects lab data to detect anomalies and improve embryo culture conditions. A real-time embryo imaging tool is in the works to enhance embryo selection.

AI in the IVF lab

Dr Keshav Malhotra notes that while Artificial Intelligence cannot replace skilled embryologists, it plays a growing role in standardising outcomes. AI tools help analyse gametes and embryos, assisting in the selection process — a form of augmented intelligence.

Other innovations include consumables tagged with unique IDs to prevent lab mix-ups and microfluidic devices that help select the best sperm using the unique physics of fluids at a microscale.

Understanding implantation

At the National Institute for Research in Reproductive Health (NIRRCH), ICMR scientist Dr Deepak Modi studies why some embryos fail to implant. His research shows that successful implantation depends on uterine cells transitioning from epithelial to mesenchymal form — a transformation triggered by the embryo itself. Mild inflammation in the uterus is also critical, and blocking it may lead to failure.

Working with Dr Abhishek Sengupta of Amity University, Dr Modi has developed an AI tool that predicts IVF outcomes in men with Y chromosome microdeletions — a rare but important advancement.

Epigenetics & embryo health

At IISc Bengaluru, Dr Srimonta Gayen of the Department of Developmental Biology and Genetics studies how epigenetics — chemical changes that regulate gene activity — affect embryo development in IVF.

He warns that lab conditions can influence the embryo’s epigenome, possibly affecting immunity, metabolism, and even life span. “We still don’t fully understand the long-term health of IVF-conceived children,” he says.

Dr Gayen is also investigating a disturbing trend: male embryos have higher survival rates during IVF, a concern in India where sex imbalance remains an issue.

Still growing, still learning

Since that historic Tuesday night in 1978 when Louise Brown was born, over 12 million IVF babies have been born worldwide. Today, scientists, doctors, and engineers continue to push the boundaries of reproductive science, blending AI, robotics, and biology to make parenthood a reality for millions.

(The author is a consultant haemato-oncologist with a special interest in stem cell transplantation at Royal Wolverhampton NHS Trust, UK. He can be reached at [e-mail].)