VOICES PUSHPESH PANT G PARTHASARATHY RAVI SHANKAR ANAND NEELAKANTAN SHINIE ANTONY SADHGURU JAGGI VASUDEV BUFFET MAGAZINE PEOPLE WELLNESS BOOKS FOOD ART & CULTURE ENTERTAINMENT NEW DELHI SEPTEMBER 30 2018 SUNDAY PAGES 12 eat Gr he T ace yR ab B IL INFERT ITY les are g lifesty angin s and ch ndia. tion ples in I omplica c eir y of cou Medical aking th g fertilit n es are m impacti hnologi -art tec e true. te-of-the am com Sta od dre arentho p timated Of the es n 60-80 m coeupflresinfertility ring om suff ar, every ye are in globally 5-20 mn etween 1 —ICMR b ne. India alo and 44 (20 percent increase estimated between 2010 and 2020), who typically display lower fertility rates. This shifting demographic trend coupled with rising contraceptive use is likely to scale up infertility rates in India. Age has an important part to play in conception. “The child bearing capacity of a woman begins to diminish significantly at 32. Once she reaches 35, the decline accelerates, and by 45, her fertility quotient has fallen by half. The female body is more vulnerable to pregnancy risks and birth complications at a later age. The sperm quality of men begins to decrease after 40. Even sperm mobility a , sperm’s ability to reach an egg and fertilise, diminishes. Hence, the number of IVF trials involving men over 40 is higher,” explains Dr Archana Dhawan Bajaj, who runs Nurture IVF Clinic in Delhi. 10-15% couplecsor ied le of marir , of which femay fa t a 0%. Infertilit rise in Ind 5 e rly ects nea rtility aff Infe n th s for 40ctors is o account o male fa . ble t attributa utes 30-40% tit and cons ia is still nt in Ind treatme Infertility fordable to nearly naf . mostly u pulation of the po Only 1% Tech to Rescue 80% s in e couple of infertil ent. k treatm India see -44 ge of 20 ductive a ewed epro is sk n in the r of wome 020). The growth 10 and 2020), rtion 2 ropo 20 e in the p etween 2010 and imated between e is a ris db est Ther estimate ars (20% ars (14% e aged 30-44 ye ity rates. ye fertil thos towards lly display lower a t has the who typic nt marke me IVF treat by l to grow t potentia treatmen rriers to ed. IVF stimated An e as ba ss ely addre ogressiv ted to increase are pr e estima cycles ar timated 1,00,000 ed es 0 associat from an ently to 2,60,00 sses are somal lo n urr mo cycles c 020, driven by a rtile with chro ies in the 2 fe lit cycles by the number of in abnorma in . increase eking treatment report embryo. g e s st & Youn couples urce: Ern 60% % all IVF y 20 of c pregnan So Rising Burden M By SHILLPI A SINGH r and Mrs Swamy have lived for most of the 12 years of their blissfully wedded life. Not so blissful it turns out to be, for each time Mrs Swamy’s pregnancy wouldn’t last more than six-seven weeks. The Swamys tried for a baby seven times using a process called Intrauterine Insemination (IUI), which entails placing a sperm inside the uterus to facilitate fertilisation. They also tried in-vitro fertilisation (IVF) in the UK and India; another process in which the egg is combined with sperm outside the body Mrs Swamy failed to get pregnant. . The Swamys, now based in Australia, then flew to hometown Chennai to meet Dr Geetha Haripriya at Prashanth Fertility Research Centre. She started a fresh round of investigations that revealed aneuploidies (presence of an abnormal number of chromosomes in the foetus) in Mrs Swamy’s case. She had no family history of chromosomal abnormalities and the doctor attributed her age as a contributing factor to her condition. Dr Haripriya recommended intracytoplasmic sperm injection (ICSI) to enable fertilisation and subsequently preimplantation genetic screening (PGS) for the embryos. In the next IVF cycle, 11 embryos were screened using PGS at MedGenome Labs in Bengaluru. The report recommended the best embryos for transfer to Mrs Swamy’s womb with happy results and the stork visited them in May . Forty years ago to this week, the first IVF baby was born in India. On October 3, 1978, Dr Subhash Mukhopadhyay and his team in Calcutta had delivered happiness to the lives of a childless couple in the adorable form of Durga, brought into the world using the revolutionary method. Dr Mukhopadhyay a pioneer in the , world of fertility research, had created history because Durga is only the second IVF baby in the world. Infertility is spreading at an alarming pace in India, especially in metros. It is estimated that of the 60-80 million infertile couples that are yearly recorded across the globe, between 15-20 million are in India. Doctors say the stigma of barrenness is curable and infertility is like any other medical condition. Dr Keshav Malhotra of Rainbow IVF, Agra, cites the case of a patient with a history of recurrent IVF failure. He used two of the latest technologies—embryoscope and PGS—to generate a pregnancy . Embryoscope provides digital images of the embryos every 20 minutes through unprecedented details of early embryonic development that help select the best ones for transfer. IVF is a process of pain and gain with a hefty price tag. It involves the use of advanced medical techniques and “For any IVF specialist, success is about bringing a baby home. I do a thorough initial consultation: understanding the couple’s journey, analysing the case and setting realistic expectations. Ultimately, I can then provide personalised care.” Dr Narmada Katakam, Medical Director, Genesis Fertility & Laparoscopy Centre, Hyderabad procedures on women with abnormalities of reproductive organs or genetic complications. But it is easier said than done. “For any IVF specialist, success is about bringing a baby home. It is done first by increasing the pregnancy rate and secondly by reducing the miscarriage rate. I start with a thorough initial consultation to understand the couple’s journey Only then can I provide . personalised care and choose the perfect treatment,” says Dr Narmada Katakam, Medical Director, Genesis Fertility & Laparoscopy Centre, Hyderabad. The myths around infertility treatments are legion. Some of them are outright ignorance: infertility is a female problem; women of all ages can become pregnant through IVF; IVF results in multiple babies and herbal supplement is enough to give a woman kids, are just some of them. Breaking the popular misconception that IVF has a low success rate, Dr Aniruddha Malpani of Malpani Infertility Clinic in Mumbai, says, “It’s an effective option if done properly and millions of , babies have been born the world over with IVF. And they are healthy and normal.” A latest Ernst & Young (E&Y) report records high prevalence of infertility affecting nearly 10-15 percent of married couples in India, of which women account for 40-50 percent. Infertility attributable to male factors is on the rise and constitutes 30-40 percent of the segment. “Factors such as poly-cystic ovarian syndrome, blocked or damaged fallopian tubes, the ovarian tissue disorder (endometriosis), low sperm quality and quantity , lifestyle changes, stress and marrying late contribute to infertility In the past two . decades, there has been considerable progress. However, IVF does not have a 100 percent success rate,” says Dr Haripriya. Only 1 percent of infertile couples in India seek treatment, says the E&Y report. It highlights the rise in the population of women in reproductive age (20-44). This proportion could go up by 14 percent between 2010 and 2020. The climb is skewed towards women aged between 30 The fertility treatment landscape has drastically improved over the years. The services at a fertility centre range from the simplest that involves IUI to the most advanced ones such as IVF, IMSI (intracytoplasmic morphologically selected sperm injection), ICSI (intra-cytoplasmic sperm injection) and PICSI (a new method of sperm selection for ICSI). Today any IVF specialist is lucky to possess the latest techniques to combat the disadvantage of advanced maternal age, prevent unnecessary transfer of embryos, prevent and reduce implantation failure and give quick results. Dr Jayesh Amin, Director, Wings Hospital, Ahmedabad, who has been on the fertility treatment scene for over a decade and a half, says, “It is the age of personalised embryo transfer using pre-implantation genetic tests (PGT) that include screening/ diagnosis (PGS/PGD) and endometrial receptivity array (ERA). This coupled with Day 5 embryo transfer has upped the success rate.” Explaining the finer details of the two techniques, he says in the PGT method, a few cells from the embryo are analysed to determine the chromosomal number for mutations. The result allows the clinician to selectively transfer embryos which have a normal chromosome number and are free from disease-causing mutations. PGT is the best cutting-edge mechanism available today to gauge the defect in the genetic material of an embryo. Of 100 women who fail to conceive through IVF, 75 percent have defects in the genetic material of their embryos. However, 25 percent cases are implantationrelated, Dr Amin claims. He has a two-point advisory: It is necessary to discover any defects in uterine lining, or endometrial receptivity . Personalised timing of implantation called the window of implantation (WOI) should be carefully calibrated since it could differ from person to person. “We conducted the biopsy of the uterine lining of a patient to figure out her personalised timing of implantation, which turned out to be 87+3 hours. turn to page 2 “A lot depends on one’s thought process, and chance only favours a prepared mind. If one’s mind is open, and programmed to fill with positive thoughts to visualise success, there’s no way that IVF cycle will not succeed. It does.” Dr Archana Agarwal, Medical Director, Mannat Fertility, Bengaluru
Express Publications (Madurai) Limited publishes the prestigious English language newspaper The New Indian Express from 21 centres in Tamil Nadu, Karnataka, Andhra Pradesh, Kerala and Orissa.
Express Publications (Madurai) Ltd. also publishes the Tamil daily Dinamani, Cinema Express (Tamil) and Malayalam Vaarika (Malayalam). Through a sister company, Kannada Prabha Publications Ltd., it publishes the Kannada daily Kannada Prabha.