FM JANUARY 2019 - digital edition

initially on laboratory animals. Success in
animals was followed by extensive work
for an attempt to achieve the same in
humans. From August to December 1985,
a number of cycles were taken up for IVF-
ET. Each cycle of failure taught us what
could be further improved in our methods
and techniques. The patient, Maniben, was
then 23 years old and married, and whose
fallopian tubes had been damaged due
to a tuberculous infection and subsequent
surgery. Consolidating the lessons that we
learnt from previous patients, we used the
following procedure.
Ovaries of women contain millions of
eggs since birth, and a number of eggs start
growing in each menstrual [cycle], one egg
matures in a single cycle and releases eggs
(oocytes) for the purpose of fertilisation.
For in-vitro fertilisation, we 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 the
menstrual cycle. The oral medication was
supported by administering an injection of
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 the
growing follicles was monitored by doing
transabdominal sonography. The growth of
these follicles suggested that multiple eggs
were maturing in the ovary. We correlated
this with levels of blood oestradiol, a
hormone released by growing follicles.
An increase in the level of this hormone
means that ovaries are responding to
treatment and the eggs are growing. In this
manner, we were able to see at least four
growing follicles in each of the ovaries of
the patient.
When the follicles were adequately
grown, an injection of 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 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 microscope
for the presence of oocytes / eggs. In this way, we found 5
mature eggs and 3 immature eggs.
Simultaneously, the semen of the husband was taken,
washed and centrifuged. This helped us 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 it and it was
checked after 48 hours and 72 hours for further growth, i.e.,
2-4 cells and 6-8 cells. Shortly, (on November 30, 1985), we
transferred the embryos into the patient Maniben’s uterus. On
December 18, we 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.
Have you ever wondered why none attempted this
before you in India even as the world’s first test tube baby
was born in 1978?
I think there were many reasons, including the lack of
infrastructure and a focused effort from the larger institutions,
as well as the controversies surrounding artificial reproduction
in humans. We all remember the strong opposition and the
uproar against artificial reproductive techniques and IVF in
1978 from key religious bodies like the Vatican Church and
some Muslim organizations.
What about the other ART breakthroughs that came your
way after IVF?
The later projects, such as the first case of GIFT in 1988
and the first case of egg donation in 1990, enabled the
use of somebody else’s egg in women whose ovaries can’t
produce eggs for natural fertilisation. In the case of GIFT, the
egg and the sperm are inserted in the fallopian tube of the
mother before fertilisation. Whereas, under the egg donation,
a woman’s ovaries are stimulated to produce multiple mature
eggs, which are then harvested and donated, usually for the
purpose of assisted or third-party reproduction. These eggs
may also be frozen for later use or for in vitro fertilisation.
There are apprehensions, even among gynaecologists,
about defective or multiple pregnancy in IVF and future
health issues in ART children. Any comments?
Such fears are baseless. In IVF, there are rare possibilities of
pregnancy happening in the tube, which you cannot prevent,
because the embryo that is inserted into the uterus may
migrate into the fallopian tube. This happens in the natural
process as well, and it has nothing to do with IVF in particular.
In order to ensure the success rate in ART, we put in multiple
eggs, where chances of multiple pregnancy are more. But
mostly, the patients do accept it or rather they wanted it.
The concerns about future health issues in both ART as well
as natural pregnancy are mostly addressed by the latest
38 / FUTURE MEDICINE / JANUARY 2019