How IVF Has Evolved In The Society Today

By Dr. Surveen Ghumman Sindhu:

There has been a 50% jump in infertility in the last 30 years, with women delaying marriages and childbirth and focusing on their careers. There is also, an increase in conditions like polycystic ovarian disease and premature ovarian failure which contribute to increasing infertility. Sperm counts have gradually decreased over the years, male factor has now become responsible for 40% of cases, a rise from 25% earlier. Infertility incidence is 10%, but increases with age to 30 % in couples in their late thirties and early forties.

Why is male becoming increasingly responsible for infertility? The human male is known to have the worst sperm count of any mammalian species, possibly because the fragile location of these sperm production genes lies on the Y chromosome which has a very unstable structure because of the lack of “gene repair” that normally occurs when chromosomes recombine. Thus, the Y chromosome worsens with each succeeding generation. Effect of environmental toxins, unhealthy life styles and stress are also a contributing factor to the decrease in sperm counts.

Due to all the above reasons, there is an increase in use of assisted reproductive technologies and invitro fertilization (IVF). What was once considered a taboo treatment, is a common form of therapy today. Couples walking into infertility clinics ask about assisted methods of reproduction. This explains the rising number of infertility and IVF clinics and long queues outside them. Evaluations are done earlier than in years past, and the trend is, to treat more aggressively proceeding to IVF earlier, especially if the woman is older. Success rates of IVF fall after 35 years of age and are only 5% after the age of 42.

The other factor which has increased IVF being used is, introduction of newer technologies in this field leading to increased success rates and extension of treatment to those who earlier had only adoption as an alternative. Increasing sophistication of male infertility treatment allows men with low or zero sperm counts father children by surgically extracting a few sperms and injecting a single sperm into the egg under the microscope, in a laboratory, so that once fertilized, the eggs can be then placed into the woman’s womb a procedure known as Intracytoplasmic Sperm Injection (ICSI).

Cancer therapy is known to lead to premature menopause and freezing of eggs, or ovarian tissue before therapy is recommended for fertility preservation. If the woman wants to start a family at age 42, she can have her frozen ovary transplanted back. She will then be 30 years old again as far as her fertility is concerned and can go for assisted conception in the laboratory. Donors who are younger can donate eggs to an older woman who cannot produce eggs. Further fertilization and conception would take place in the laboratory. Surrogacy can be offered to a women who, does not have a functional uterus whereby after an embryo is formed in the laboratory it is placed in another woman’s womb who then bears the genetic child of the couple. Mythology goes back to the bible when Sarah and Abraham were unable to conceive, and Hagar, their slave became the surrogate by natural conception.

IVF is also indicated in couples, who have an inherited disease. In this case, the cells from the embryo formed in the laboratory are biopsied and only genetically normal embryos are used, a procedure called preimplantation genetic diagnosis. Thus, there is hope for carriers of sickle cell anemia, Down’s syndrome, cystic fibrosis, muscular dystrophy, and many other diseases. With these new techniques the success rates have improved over the years, although they are still dependent on the age of the woman.

The need today is to improve accessibility of this treatment and bring affordability into this sector. India, for its less fortunate population needs to evolve a low cost IVF programs so that these facilities of assisted conception in the laboratories can reach the masses. It is unfortunate, that for infertile couples who cannot access these facilities, a donor or surrogate comes in the form of a second wife, as even today, being able to carry on the family name is of paramount importance in India.