Infertility is a multifactorial disease in which couples are unable to achieve pregnancy even after being sexually active despite using any contraception.
Since the birth of the world’s first ‘test tube baby’, Louise Brown, 40 years ago, 6 million babies have been conceived worldwide through Assisted Reproductive Techniques. The inception of in vitro fertilisation in India happened many years ago when the team working under the aegis of Institute of Research in Reproduction of the Indian Council of Medical Research (ICMR) and Kings Edward Memorial Hospital (K.E.M) in Mumbai.
Inspired by the success of Dr Patrick Steptoe and Dr Robert Edwards, the team started testing the therapeutic and surgical procedures initially on laboratory animals. Success in them was followed by extensive work for an attempt to successfully achieve IVF in humans with the permission of the Scientific Advisory Committee and Ethics Committee of both institutes. From August to December 1985, a number of cycles were taken up for IVF-ET. The team tried hard and learnt more and more from each of these failures. Each cycle of failure taught them what could be further improved in our methods and techniques.
The 23-year-old and married patient, Maniben's fallopian tubes were damaged due to tuberculous infection and subsequent surgery. Consolidating the lessons learnt from previous patients, the team followed the following procedure.
Ovaries of women contain millions of eggs since birth, and a number of eggs start growing in each menstrual, one egg matures in a single cycle and releases eggs (oocytes) for the purpose of fertilisation. For in-vitro fertilisation, the team needed that the ovaries should release more than one egg. Hence, the ovaries were stimulated by giving Oral medication namely, (Clomiphene citrate 100mg) from Day 3 to Day 7 of her menstrual cycle. The oral medication was supported by administering injection Human menopausal gonadotropin which was also given intramuscular daily from Day 5 to Day 10 of the cycle in a dose of 75 IU per day. The number and size of growing follicles were monitored by doing transabdominal sonography. The growth of these follicles suggested that multiple eggs were maturing in the ovary. They then correlated this with blood estradiol levels which are a hormone released by the growing follicles. An increase in the level of this hormone levels means that ovaries are responding to the treatment and the eggs were growing. In this manner, the team was able to see at least four growing follicles in each of the ovaries of the patient.
When the follicles were adequately grown, then Inj. Human Chorionic gonadotropin (hCG) 10,000 IU was administered to the patient on Day 13 to mature the egg within the follicle. This was in order to make the egg the ready for fertilization. Thirty-four hours after hCG, the eggs were retrieved. Using an abdominal approach, the ovaries were seen and a needle was inserted in each follicle to remove the fluid collected in the follicles. This fluid was screened under a microscope for the presence of oocytes/eggs. In this way, the team found five mature eggs and three immature eggs.
Simultaneously the semen of the husband was taken, washed and centrifuged. This helped to isolate the best and most rapidly motile sperm from the sample for fertilisation. The eggs that were retrieved were combined in a laboratory dish with her husband’s sperm. The eggs were seen After 24 hrs for penetration of sperm in the egg. After 48 hours and 72 hours for further growth i.e. 2-4 cell and 6-8 cells.
On November 30 1985, the team transferred the embryos into the patient Maniben’s uterus. On December 18, they did BhCG testing which indicated a positive pregnancy test and subsequently confirmed the pregnancy by redoing the BhCG test on 26 December 1985. Ultrasound was done on January 6, 1986, which showed a healthy growing pregnancy.
The first scientifically documented IVF baby Harsha was thus born on August 6, 1986, by Caesarean section in KEM hospital, Mumbai. Now Harsha herself is a mother to two children, a boy and a girl. The entire process of conception to the delivery has been documented in store with the Institute for Research in Reproduction now called NIRRH-National Institute for Research in Reproductive Health
Today, IVF is considered to be a mainstream medical treatment for infertility. In India alone, every year a significant number of babies are being born out of IVF. This has revolutionised the field of reproductive technology, providing hope, faith and a chance at parenthood to so many childless couples, having numerous causes including a malefactor, who struggle with various medical and social aspects of infertility.
Note: Dr Indira Hinduja is a Mumbai based leading gynaecologist, Obstetrician and Infertility specialist associated with P D Hinduja Hospital and INKUS Clinic.
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