Why has Conception Moved To The Laboratory?
– The Era of ‘A child Against All Odds’
Dr Surveen Ghumman Sindhu MD (Obst & Gyne), FICOG
Director
MAX IVF & Reproductive Medicine, Department of Gynecology
MAX Superspeciality Hospitals, Panchsheel, Saket, Vaishali & Patparganj.
The first reference to the test tube baby as an answer for infertility goes back to the time of Mahabharata. Gandhari was unable to hold a child in her womb and following the advice of a wise sage, 101 clay pots were impregnated with fetuses that finally burst open to produce 100 Kauravas and a daughter. Test tube baby or Invitro fertilization (IVF) is a laboratory procedure whereby a woman’s eggs are surgically extracted to be fertilized by the partner’s sperms in a petridish under optimum laboratory conditions and the resulting embryo (early stage baby) is deposited in the woman’s womb.
In the last three decades, with acute change in lifestyle, accompanied by delayed marriages and childbirth, there has been a corresponding increase in infertility by 50% in urban India. In men, a stressful lifestyle, has manifested with decreased sperm counts.
Why is the male becoming increasingly responsible for infertility? The human male is known to have the poorest sperm count of any mammalian species, with the exception of the gorilla, possibly because of the fragile location of these sperm production genes on the Y chromosome which, deteriorates with each succeeding generation, as it is unable repair itself. Well, maybe the reason why it takes 50 million sperms to fertilize one egg is that, the male ego just doesn’t like asking for direction despite this deterioration!
Since IVF is the solution to many of these problems, conception has moved from the house to the laboratory. Introduction of new technologies in this field have introduced options for those who, earlier had only adoption as an alternative. In males, with low or zero sperm counts, sperms can be surgically extracted for laboratory conception. Older women who are unable to produce their own eggs can take eggs from donor agency. Cancer therapy, which leads to premature menopause, requires prior fertility preservation by freezing of eggs, or ovarian tissue, to be used at a later date.
Ethical Issues
There are couples who come into IVF clinics with the demand that their traveling jobs allow them no time for natural conception! Here lies an ethical question – Is the petridish in the laboratory the answer? If they do not have time to conceive a child, will they have time to do justice to their role as parents and is the IVF specialist justified in playing God and facilitating conception of babies to such parent? IVF for such indications is to be denied.
India’s Unmet Need
Today, India bears nearly one fourth of the global burden of infertility hosting nearly 30 million infertile couples, out of which only 40,000 are able to access this treatment, as it still remains costly. The need today is, to bring affordability into this sector for the masses by indigenous manufacture of drugs and laboratory disposables. It is unfortunate, that for childless 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.
Through my practice over the years, I have witnessed a growing awareness and acceptance of IVF treatment as an option for childless couples. The increasing references to the subject in mainstream cinema have contributed to ensuring that the treatment is no longer alien.
Vicky Donor and changing perceptions
The movie, Vicky Donor has changed perceptions about infertility. Couples walking into infertility clinics ask about assisted methods of reproduction. They are willing for prompt evaluation and aggressive treatment, proceeding to IVF earlier. However, the number of children conceived through Vicky’s donation was far beyond those allowed by Indian guidelines. Limiting number of donations from one person is essential, to prevent the birth of numerous siblings from a single donor who are unaware of their genetic relation. One would not want to meet their look alike at malls and restaurants in the years to come!
Positive contribution of Bollywood to surrogacy
Recently, Bollywood stars, have gone public with details on their very personal and sensitive matter of surrogacy, and have rendered a great service to numerous childless couples in India by removing the taboo from this procedure. Their declaration of gratitude to this medical advancement has brought respect for a surrogate, as she is not perceived to be just selling her womb, but is helping someone build a new family with a baby that remains genetically the couples.
The Grandmother’s Acceptance
Recently a grandmother posted the ultrasound of her grandchild at 10 weeks with the comment – My grandbaby aka the ‘lab brat’. …..And, there is also the grandmother who knits cardigans for her grandchild thinking that the child will need it, as it is conceived from a frozen embryo! Acceptance of laboratory conception is happening.
With multiple choices offered in IVF one needs to take correct decisions. So don’t put all your eggs in one basket. Use some, and freeze some for later, now that laboratory conception has come of age and gives you options!