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Unable to conceive? Here's help

Fertility specialists treat people who are unable to reproduce. Ayesha Banerjee tells you all that you want to know about this profession - skills, insitutes and more.

education Updated: Apr 28, 2010 09:39 IST
Ayesha Banerjee

It’s a strange feeling. You meet someone who’s just starting to come to life as a four-cell embryo in a petri dish, and years later, when that someone’s grown into a bouncing five-year-old boy, you’re invited by his parents to be his godfather…

That’s why Dr Aniruddha Malpani, MD, who runs the Malpani Infertility Clinic in Mumbai with his wife, Anjali, loves what he does. Fertility specialists treat people who are unable to reproduce (men might have low sperm counts and other complications, women might have uterine problems, etc). “Being an in vitro fertilisation (IVF) specialist is one of the most rewarding careers possible, because you are changing the life of a family by helping them give birth to a deeply cherished child,” says Dr Malpani.

Dr Indira Hinduja, whose pioneering research in IVF (a basic procedure, where the sperm fertilises the egg ‘in vitro’ or outside the body and the embryo which is created is then transferred to the uterus) led to the birth of India’s first test-tube baby, Harsha Chawda, cannot forget that moment. “She (Harsha’s mother Mani) delivered on August 6, 1986… I can’t describe that moment. It’s like a film I see again and again. I remember when I was doing the Caesarean at 4.30 pm at Mumbai’s KEM (King Edward Memorial Hospital). The OT had high ceilings with ventilators. From below, we could see the cameras and the press photographers trying to catch the action. And then the baby cried... it was the most joyous moment of my life,” says Dr Hinduja

Dr Malpani was in medical college when the first test-tube baby was born. He found it “an exciting area and decided to specialise in it”. After completing his MD, he went abroad to get “real-life” training in IVF at a lab at the University of California, San Francisco and finished his clinical training at King’s College Hospital, London.

After MBBS, one needs an MD degree in obstetrics/ gynaecology. Then one needs to specialise in infertility. “Unfortunately, there are no training courses in India as yet, which is a shame. The tragedy is that young MD gynaecologists in India have no exposure to IVF at all — and most of them are forced to learn ‘on the job’,” says Dr Malpani. In the United States, however, there are reproductive medicine fellowships, which take three years to complete.

That said, one can benefit immensely from Dr Hinduja’s experience. Someone who began studies in a municipal school in Belgaum, Karnataka, the mother of IVF treatment in India powered her research purely through will power.

While studying for her MD at the KEM Hospital, she says she was intrigued by the literature on IVF that “flooded the library”. The Institute for Research in Reproduction was bang opposite the hospital, and “so I went over there to study and see what was happening,” she says. A lot of sweat and toil and never-say-die attitude saw Dr Hinduja, who now runs the Inkus IVF Centre in Mumbai, create history.

Fertility treatment can range from simple medication to operative laparoscopy. Advanced assisted reproductive techniques include IVF, or ICSI (intracytoplasmic sperm injection), etc (see ‘What’s it about’). Surrogacy is also becoming popular with couples, when their embryo is carried by another woman till birth.
The need for fertility specialists is very urgent because of the importance Indian society places on family building, and due to the social stigma that infertility still carries in our conservative society.

Says Dr Malpani, “Infertility affects about 15 per cent of all married couples, which means it is the commonest medical problem in the reproductive age group (20-45). Given the fact that India has over 1 billion people, a conservative estimate means that there are about 20 million infertile couples in India. Family planning and welfare should not just mean limiting family size — it should also mean helping infertile couples to have a baby. These are deeply desired and loved children – and will make ideal citizens for the future!”

What's it about?
Fertility specialists treat people who are unable to reproduce (men might have low sperm counts or other complications, while women might have blocked fallopian tubes or uterus problems). Treatment ranges from simple medication to operative laparoscopy (making small incisions in the abdomen and inserting a thin, fibre-optic tube with cameras — a laparoscope — to find the cause and treat it). Advanced assisted reproductive techniques include: IVF (in vitro fertilisation); ICSI (intracytoplasmic sperm injection: a single sperm is injected into the egg using a micromanipulator. An egg fertilised by a sperm is called an embryo); PGD (preimplantation genetic diagnosis — testing of chromosomes of the embryo, so that only healthy, normal embryos are transferred into the uterus); surrogacy (host uterus, where the embryos are transferred into the uterus of another woman, who carries the foetus for nine months till the child is born); and embryo adoption (an the infertile couple adopts embryos from another couple, and the wife gives birth to the baby)

Clock Work
Dr Malpani’s day would look somewhat like this:
9 am: Walk into office, check appointments diary, check on staff
10 am: Receptionist buzzes in first patient. Most of the work is clinical and involves consultations, check on a couple of patients, do ultrasound scans to monitor the growth of eggs
1.30 pm: Break for lunch
2.30 pm: See patients again, do some counselling, do egg collections; and embryo transfers
5.30 pm: Finish managerial work, which includes supervising the nursing staff
6 pm: Supervise the work of the embryologist in the IVF lab
7 pm: Leave office
7.30 pm: Spend time with family at home, catch up with friends, watch TV
9.30 pm: Dinner
11 pm: Since reproductive tourism has become such a hot area, spend a lot of time answering emails and running website, www.ivfindia.com

The Payoff
Doctors who are entrepreneurs and have their own their own IVF clinics can earn more than Rs 2 lakh a month. A superspecialist in a government hospital can earn about Rs 50,000 a month; and someone in a private hospital can earn about Rs 1 lakh a month upwards

Skills
. Good at handling IVF, other procedures, able to carefully manage egg-collection and preservation techniques
. Able to handle an immense amount of learning related to fertility treatment
. Great communication skills to help the couple understand everything about the treatment
. Good counselling skills as breaking the news to a woman that she can’t have children can be the toughest of tasks

How do i get there?
You have to take up science at the plus-two level and then sit for the All-India Pre-Medical/Dental Entrance Exam conducted by the CBSE, or entrance exams of other colleges/universities such as the All India Institute of Medical Sciences or Jawaharlal Nehru Medical College (Aligarh Muslim University), etc. for the MBBS course. Then, you need a postgraduate MD degree in obstetrics and gynaecology and then specialise in infertility treatment. Unfortunately, there are no training courses in India as yet. In the US, there are reproductive medicine fellowships, which take three years to complete

Institutes & urls
IVF is not offered as a specialised programme in India. After an MD degree in obstetrics and gynaecology, you can do a training programme from:
. UK (Oxford University)
www.ox.ac.uk
. USA (Jones Institute)
www.jonesinstitute.org
. Australia (Melbourne University and Monash University )
www.unimelb.edu.au
www.monash.edu.au

Pros & cons
.

You create life


.

You bring hope and happiness to people who can’t have children


.

Everyone cannot get pregnant. To break the news to some couples can be a tough task


.

If you are running a clinic, you get to make a lot of money

Slate & chalk & TEST-tube babies

The pioneer in IVF treatment talks about how she made history

Please tell us something about your background - what led you to medical science?
When I was a little girl I wanted to be a nurse and later, while growing up, I changed my mind and wanted to become a doctor. Till Class VI, I went to a municipal school in Belgaum, Karnataka where my family had moved from Pakistan. We are Bhaiband Sindhis, who used to be quite affluent and somewhat orthodox. My family thought education was essential so they ensured I studied. When I shifted to a private school, I was quite thrilled to be using the pen and notebook instead of the slate and chalk we used in the municipal school. I was a good student. Then, my family moved to Mumbai. Getting admission to a medical college was not difficult for me. I just told my brother, “bhaiya, let’s go get the applications”. Nobody in the family was aware of this, and when I got admitted everyone was very happy. My father went to the sari shop and asked them to give him the best sari, telling them ‘my daughter has got admitted to medical college’. I still have that saree preserved.

When did you realise you wanted to be a gynaecologist?
After I got my MBBS, I had very clear goals in mind. I knew I had to study further and kept asking people about new fields. First, I wanted to go for paediatrics but as time went by I realised gynaecology interested me more. Medical studies were not difficult at all. I had a single-point objective. I wanted to score the highest marks. It was during this time that I went to KEM College and found the library flooded with literature on the new IVF treatment. The more I read the more interested I was.

Was the research work difficult?
When we started, yes. I read up on the literature first, then learnt to handle the eggs, experimenting on animals first. We had to get permission from the Ethics Committee of the Institute for Research in Reproduction I was associated with to conduct experiments. The eggs were collected from female patients came in for sterilisation. Our experiments failed 17 times. Success happened at the 18th attempt — a strange coincidence because my birthday happens to be on December 18. We also didn’t have proper equipment. There was one small incubator from Baba Adam’s time and you had to keep calling the technician to repair it. Once he went for a movie and I had to go to the movie hall miles away from work and get him back because I was afraid the embryos would get destroyed.

I used to often sleep at the lab to ensure everything was in order. The women we collected the eggs from were all volunteers, including Mani Chawda, Harsha’s mother.

Once the lady I had to collect the eggs from said she hadn’t been taking the prescribed medication as she had no money. I rummaged in my bag and gave her everything I had – about Rs 200 — for the medication and walked home (miles away) as I didn’t have money for the bus tickets. Then Mani Chawda came to me. She had been unable to conceive and wanted a baby badly. She was the successful 18th attempt. Her pregnancy was confirmed on December 18, my birthday.

Dr Indira Hinduja, fertility specialist Interviewed by Ayesha Banerjee