BORN IN A TEST TUBE My Own Child My Own Blood

Sumithra Sathyan | 01-July-2014

Millions of couples across the world fail to conceive. Some seek medical help and undergo years of treatment, some resign to their fate, while some others adopt children, yet “my own child, in its full meaning, is my own child, my own blood.” To realise that dream they are ready to go to any extent.

The birth of Louise Joy Brown, world’s first “test-tube” baby, in Britain on July 25, 1978 heralded a new era in medical history, giving hope to millions of women across the world who failed to conceive a child. It was Dr Patrick Steptoe, a gynaecologist at Oldham General Hospital, and Dr Robert Edwards, a physiologist at Cambridge University, inventors of the In Vitro Fertilisation technology, who made possible the dream come true for millions. At the same period, doctors in India also made great headway in developing In Vitro Fertilisation technology indigenously.

The second birth of a test-tube baby was in Calcutta(Kolkata), delivered by Dr Subhas Mukherjee. Named Durga, the child was born just 67 days after the birth of Louis Brown in the UK. Durga’s birth through IVF procedure opened up a floodgate of controversies, moral as well as ethical. The government refused to recognise Dr Subhas’s groundbreaking medical achievement. Out of frustration, he committed suicide in 1981. However, the government finally recognised his achievement in 2005, seven years after the births of Louis Brown and Durga. However, the birth of Harsha on August 6, 1986, in Mumbai’s KEM Hospital, delivered by Dr Indira Hinduja through IVF process has been considered the first scientifically documented test-tube baby in India. The number of babies conceived worldwide through In Vitro Fertilisation since then has been increasing day by day with millions of infertile couples benefiting from the treatment option.

Sumithra Sathyan, co-ordinating editor of Future Medicine talks to Dr Indira Hinduja, Dr Kamala Selvaraj, who delivered South India’s first test-tube baby, Dr Vijayalakshmi, who pioneered IVF treatment in Kerala and professor Dr Mohamed Ashraf, who has put smile on the faces of over 13,000 couples so far, about the past, present and future of this amazing medical invention.

She delivered the bundle of joy

Dr Indira Hinduja needs no introduction. She created history on August 6, 1986 by delivering Harsha, the first scientifically documented test-tube baby in India through In Vitro Fertilization method. Now this method has become widespread across India and so many children were born. She was 35 then and Harsha who lives in Mumbai is reaching 28 next month. Here, Dr Indira Hinduja talks to Sumithra Sathyan and shares her knowledge and experience in the IVF procedure

What is an In Vitro Fertilization (IVF) procedure?

IVF or test-tube baby is becoming household morals nowadays. But not so long ago, it was very mysterious and was supposed to be a very secretive and complicated procedure. People were hesitant to accept this procedure earlier. Now it has become a common option of treatment for a wide range of infertile couples.

Now the first test-tube baby delivered by you is about 28 years. Are you still in contac with her?

Yes, she is 28 years, beautiful and a charming personality. She shares all her joys and sorrows with me. We are in touch with each other on regular basis. At least once a week we talked to each other on phone.

How normal was the child when she was born?

I still remember she was 2.7 kg chubby baby doll at birth, absolutely healthy and she cried immediately after her birth.

Technology has improved a lot since the birth of the first test-tube baby. How easy is the IVF treatment now? And also, how costly is it now?

Technology has improved a lot, hence monitoring of the treatment has become easier. Initially blood tests were done but transvaginal sonography has made it more accurate and non-invasive method of monitoring the development of egg (oocyte). Previously it was done through laparoscopy but transvaginal route has made it easier and minimal invasive. Use of disposable material, associated procedures like surgical retrieval of sperms (TESA/PESA). Preimplantation Genetic Dignosis (PGD) tests when IVF done for genetic diseases really add on to the cost.

How many mothers you might have helped in fulfilling their dreams?

Many many women I have treated successfully, till now more than 10000.

Can you please tell about your experience about the birth of the first test-tube baby in India?

The birth of first scientifically documented test-tube baby was a dream come true for me. When she was born, she opened her eyes and looked at me, cried after birth for the first time and I forgot all the hurdles, difficulties that came on my ways once I saw her angeline face. Her birth was an important milestone not only in my life but also for many curious medical students in King Edward Memorial Hospital. She received a warm welcome by all. For her mother it was a boon. my other infertility couples took this as a ray of hope and for medical students it was a very important milestone that I could achieve.

Have you had an opportunity to meet Dr. Robert Edwards, who made possible in 1978 the birth of the first test-tube baby in the world?

Yes I met Dr. Edward. I found him very much open to discussion and down to earth person. I also visited his lab and had an opportunity not only to have coffee but dinner as well in the company of my Ph.D. guide Dr. Anand Kumar and my friend Dr. Kusum Zaveri. I could meet him for scientific discussions and casual discussions as well when he invited us to visit his farm house.

Was your treatment different from Dr.Edwards?

The basic protocols which I have followed for my earlier cases were similar, techniques were similar but nowadays the advancement and sophistication have made it much easier than before. Nowadays we are getting back-up facilities which we did not have earlier.

Have you ever felt what you were doing was unethical as some people were accusing at the time of the birth of the first test-tube baby?

The technique was performed in animals first then tried in women. Before enrolling the women for treatment the work was reviewed by scientific advisory committee of IRR ( Institute for Research in Reproductive Health) now known as NIRRH ,Indian Council of Medical Research (ICMR) and KEM hospital. Ethics committee and ICMR in collaboration with ethics committee of KEM hospital gave me the permission to start the treatment in women. Hence there is no question of doing unethical work.

Mothers’ own doctor

Apart from being a pioneer in In Vitro Fertilisation treatment in southern India, Dr Kamala Selvaraj has many firsts in her career. In 1992, for the first time in India she made a surrogate baby possible. In 2008, she delivered the first frozen egg baby. These are only a few. Thanks to her, thousands of couples in India and abroad are living happily with children of their own. In an interview, Dr Kamala shares her experience and expertise in IVF treatment with Future Medicine

When was “your” first test tube baby born?

On August 1, 1990 at 11am. How can I forget that day? My patient Ponna was admitted to the hospital with full nine months before the delivery date. Her cesarean date was fixed as we had planned. We had informed the Madras Doordarshan the previous day since it was to be the ‘first South Indian test-tube baby’. Logeshwari was compere and she insisted that the cameraman should be inside the theatre to video tape the baby coming out. I was terribly nervous. I just left everything to God and proceeded with the cesarean .The operation went on smoothly and I could not see the baby clearly since my eyes were blinded with tears.

Looking back at your first experience, how do you feel about it now?

I feel great. Now I have reached a stage where I never look back but look ahead for a bright future for thousands of couples longing for a child. I have learnt to live my days completely and well with sweet memories of my achievements and forget the grievances. I thank Lord Vinayaka and my hard work for now I get a great success rate throughout the year.

What is the immediate response of patients to your suggestion to go for IVF?

Luckily, my patients are supportive and cooperative. They trusted me and were also willing to do anything I suggested. They knew that I would never do any harm to them.

Approximately how many IVF treatment cases you might have handled so far?

Plenty. With a fully equipped state-of-the-art IVF laboratory, GG Hospital successfully serves every year about 2000 to 2300 childless couples from India and abroad.

I am sure you may have vivid memories about your first IVF treatment. Would you please share some of them with our readers?

Sure, the memories about my first IVF are still afresh. I remember my patient Ponna. I could not have had a better patient than Ponna herself. She was so obedient. She did not step out of her room for the first 28 weeks. She did not even stir out of her bed for the first 12 weeks of her pregnancy. Her level of tolerance was just amazing. It was more like she was nurturing my baby inside her than her own. In the 7th month, they celebrated the ‘Vallikappu’ in a grand style next door at my parents’ house. Her cesarean was fixed for August 1, 1990 at 11 am.

When the time came to part with the baby, I clung to the baby and held it close to my heart and refused to give the baby to her parents and cried. Poona and Ramamurthy were shocked and hurt. They felt very bad for me and said, “Madam, you keep the baby and we will be the foster parents.” On hearing this, I felt so ashamed of myself and gave the baby immediately to them. My first test tube baby, Kamala Ratnam, named after Ramamurthy’s mother and me, calls me up from Sundrapandiapuram, her native place, on all auspicious days and talks to me for 3 to 5 minutes and also sings to me in her sweet voice.

What are the procedures for IVF? How many days the patient has to stay in the hospital?

In Vitro Fertilisation as the name implies, is a process where the egg and sperm are fertilised outside the woman’s body, in a culture dish under controlled laboratory conditions. After 2-5 days of incubation in specially gassed incubators, the resulting embryo (2 cells – blastocyst) is transferred into the uterine cavity with the hope to implant and grow into a healthy baby. As stated earlier, we use our own media for IVF. We make sure the couple attends a counseling class prior to this programme in order to understand the basic techniques involved, risks, cost and outcomes. Every patient’s treatment and stimulation protocol are individualised since the problems vary from couple to couple.

Kindly look at our success rates to know about the monthly variation of results. Once the female partner has been adequately prepared (down regulation of endogenous hormones and stimulated to produce multiple follicles), she is taken up for oocyte (egg) pick up under short acting anesthesia. If there is no risk of hyperstimulation wherein an ovarian enlargement is evident and greater numbers of oocytes are aspirated, the patient can go home the same evening. On the same day as the oocytes pick up, the husband’s sperms are collected and after pre incubation for 2-3 hours, the oocytes are inseminated with pre-prepared sperms of the husband. The inseminated oocytes are observed 16-18 hours later for the evidence of fertilisation. We normally transfer the embryos on day 2, since our results are consistent but in those cases that are indicated we do day 3 to day 5 transfers.

Trusted Image

Dr Vijayalakshmi, trained and experienced in India and abroad in the treatment of infertility problems, has pioneered IVF treatment in Kerala. Her Vijaya Fertility IVF and Endoscopy Centre in Cochin is a much sought-after centre for IVF treatment. SHE shares her expertise and experience in this field with Future Medicine

How effective is IVF treatment?

There are many factors which decide the success in assisted reproductive technology (ART) treatment. Proper selection of patients for particular procedure plays a major role in success rate. Listening to the patients with patience, explaining their problem to them and advise the necessary investigation and go through the results of investigation carefully and chose the proper programme for that particular couple are all important.

Even after all investigations, surprises will occur sometimes during the course of treatment which should be explained to the patients and if necessary, cancel the ART cycle. What I mean is that if a woman does not respond to ovulatory drugs or is a poor responder, her endometrium may not develop well or a missed Hydrosalpinx may start draining into the uterine cavity. These are some of the factors for failure from female aspect. A tense male may not produce semen on the day of his wife’s ovum pick up. In most of the clinics, this problem is overcome by prior freezing of semen sample.

You helped so many couples realise their wish for a child through IVF treatment. While looking back how do you feel about the achievement?

The lessons I have learned about ART procedure, the outcome, the mood swings of female patients, the happiness of the couple who get positive results and the emotional outburst of patients who failed in getting pregnant taught me lessons in counseling patients before taking them for ART. I explain the cost very clearly and the cause of failure and success in ART, and am very alert not to paint a rosy picture about the outcome. In each stage, I tell the patient what may be her success rate. Over the years, I have learned to be very attentive to these patients and spend more time with them, listening to them which ultimately resulted in seeing a few patients per day.

What are the procedures the patients have to undergo before IVFtreatment and how long it will take?

There are certain basic investigations that the couple has to undergo. The husband should undergo a routine semen analysis after three days of abstinence. The wife has to undergo a base line pelvic scan to rule out any tumour in the uterus or ovaries and on the second day of periods, certain blood hormone estimation to know about the ovarian reserve and to rule out any other endocrine pathology. It will take just one day to complete the investigation.

The Unsung Hero

Dr Subhas Mukherjee is an unsung hero, who discovered the easiest and most successful way of producing a test-tube baby. In fact, he was the first Asian to discover such a process but never got his recognition during his lifetime. However, in 2002, after 21 years of his death, ICMR (India Council of Medical Research) recognised his work for the first time

Dr Subhas Mukherjee along with Sunit Mukherji, a cryobiologist, and Gynaecologist Dr. Saroj Kanti Bhattacharya, worked on a method of in-vitro fertilisation that was used successfully on patients with damaged fallopian tubes. On 3rd October 1978, the team announced the birth of the world’s second test tube baby, in Calcutta. The announcement came 67 days after the birth of the first test-tube baby in England. Unlike his counterparts in England, Mukherjee had used gonadotropins for ovarian stimulation, transvaginal colpotomy to harvest oocytes and cryopreservation of the human embryo.

To verify his claims, the government set up a committee that denounced his achievements. Mukherjee was even denied leave to write up a detailed report of his results and later to attend a meeting in Japan to discuss his work. As a final act of humiliation, he was transferred to Institute of Ophthalmology as professor of electrophysiology. The insult may have been unbearable for Dr. Mukherjee as he committed suicide in 1981.

In 1997 Mukherjee’s papers and handwritten notes on his technique were assessed by T. C. Anand Kumar - former director of the Institute of Research in Reproduction, Mumbai. Dr. Kumar, who had played a key role in the birth of another test-tube baby in 1986, not only freed Dr. Mukherjee from charges of fraud but also wrote extensively about his pioneering feat.

Ironically Mukherjee’s method of combining in-vitro fertilisation and cryopreservation of human embryos is the currently preferred technique of medically assisted reproduction. Today, more than 3 million test tube babies worldwide see the lights of day from Dr. Subhas Mukherjee’s discovered method.

Dr. Subhas Mukherjee is today respected and remembered as someone who invented the most efficient process for the birth of test tube babies. In Sao Paulo, during the eve of 30 years completion of IVF, Brazilian Medical Society recognised and honoured him for his incredible achievements.

Remarkable achievements