A Florence Nightingale for many infertile couples, Dr Indira Hinduja has several firsts to her credit. She produced the first test-tube baby in India, 'Harsha' on August 6, 1986, using the Gamete Intra Fallopian Transfer (GIFT) technique. She was the first woman to be presented the Dhanvantari award for pioneering work in treating infertile couples through new techniques in reproductive technology in October 2000. She has also received various awards such as the Bharat Nirman award, Young Indian award and Jagrutik Mahila Din award. Dr Hinduja is the only gynecologist and obstetrician in India to have been awarded a post doctorate in the field of Human In-vitro Fertilization (IVF) and Embryo Transfer from the Bombay University.

An excerpt from an interview with Dr Hinduja, who has successfully delivered 1244 test-tube babies in India till date.

Was taking up medicine a childhood ambition?

During my childhood I was unsure of what I wanted to do. I decided to take up medicine when I was in high school. Earlier, I wanted to be a musician. Medicine was decision that came after much thought.

Were you always inclined towards research and new creations?

During my MD, I came across articles in medical journals on In-vitro Fertilization (IVF) being conducted in the UK, Scotland and Australia. That reinforced my interest in the subject and led me to undertake a PhD in human in-vitro fertility.

At that time, I was an employed lecturer at KEM hospital, so all my research work was done after work hours. I did not go abroad for training. We had neither funds nor the required equipment, so we conducted our experiments by modifying everything according to the situation and availability. The biggest challenge, however, was the lack of equipment and knowledge.

We began with researching how the human egg looks -- taking out the egg, fertilising it outside the body, creating an environment for it, checking how long it could be kept outside the body, etc. First we experimented on mice, and later on hamsters. Eventually, when we were able to establish progress, we changed over to trial tests on humans. We achieved good embryos, but after transferring them to the human body, the pregnancy was not positive. After years of research, the 18th human experiment was successful.

How did you cope with the limited infrastructure and technology?

In the beginning, due to lack of knowledge, we did not really know what was missing and what was not, on the infrastructure front. As research progressed, we were able to identify our requirements. We went on buying equipment and improving on it. The basic instruments were available, but they were not sufficient. We had to alter them and upgrade them to suit our requirements. Even till today, in India we use imported equipment for IVF.

What is the procedure involved in IVF, its success rate and costs involved?

In this process, the egg is fertilised by sperm in a glass dish and the resulting embryo is inserted into the womb. Infertile couples, desperate to have a baby, have the option to use eggs or sperm other than their own. At times, the human embryos created in the test-tube have to be inserted in surrogate mothers, because their 'genetic mothers' for some reason could not become pregnant. To begin with, the success rate of IVF was 10 to 15 per cent. Now it is almost 45 per cent.

The treatment involves a cost of anywhere from Rs 50,000 to Rs 60,000, inclusive of medicines. As an expert, it is a doctor's duty to impart correct knowledge to innocent, unknowing patients and not to play on their vulnerability.

Why is IVF unaffordable to the Indian middle class?

Each of the hormonal injections used during the treatment is worth Rs 1200. Sometimes patients require 20 such injections. All the material, from the test tube to the needle, is imported, and embryo tested. We pay 40% import duty on them, hence the costs go up.

To be honest, I have not tried any of the locally made material. I am a little skeptical about it. If I am going to use the plastic material manufactured locally, I can never be sure that it is tissue toxic. I have to test the plastic tubes with the animal embryos, grow it and only then can I be sure that the plastic is usable. It becomes a little cumbersome. I do not think that the technology in India is lacking, but someone has to take the initiative.

What are the common reasons for infertility?

The main reasons (in men) are poor parameters of semen - less sperm count, low motility and poor morphology, which can be congenital or acquired. Diseases like mumps and tuberculosis, injuries, accidents, infections, very high fever, smoking, drinking, type of job, heat, exposure to chemicals or smoke, are some of the causes. The origin of the cause in women is blockage in the fallopian tube. Other problems are not planning intercourse at the right time, defective intercourse, psychological disturbances and improper procreation.

Most of the time, 50 per cent of the problem lies in the male and 50 per cent with the female. Even when the defect lies in the husband, the social stigma is borne by the wife who cannot or will not proclaim her normalcy. Artificial insemination is therefore carried out in great secrecy. On the other hand, donation of the egg is publicly proclaimed as the husband's manhood is not under a cloud.

There is no one cause and one treatment.

Do you support the concept of surrogate motherhood?

We hardly have any surrogate mothers in India. I would like to encourage this concept. I am really hoping that few women will come forward. Once the egg is fertilised by the sperm, it is inserted into the surrogate uterus. Once delivery has taken place, the surrogate mother has to hand over the baby to the genetic parent. I do not know what women are scared of, I think they are scared of society. Mostly surrogates are relatives, sisters, cousins, friends or aunts. Professional surrogates are very few.

Are your working on any particular research now?

I am most concerned about why the success rate in IVF is only 45 per cent. Where is the defect? What is the cause of basic low sperm count? Are there any genetics involved? How can it be corrected? What are the genetic problems that the woman carries to the egg? Presently, I have projects with 3 institutes - TIFR (Tata Institute for Fundamental Research), BARC (Bhabha Atomic Research Centre) and IRR (Institute for Research and Reproduction).

What are your goals and have they been realised?

My goal is never to reach 'just there.' I believe that there is no end to research. What disturbs me is that whenever new research is developed the benefits of the scientific development hardly reach the poor. The benefits of development and achievement in science should reach even the poor. Can we do that? This is really a disturbing point. Procreation is everybody's birth right. Unfortunately, the common man cannot take advantage of these techniques. My goal is to reach the common person and every village in India.

Given our population, is not adoption a better alternative?

Adoption is everyone's individual choice. Only 15 to 20 per cent of our population is infertile. Why should only infertile couples bear the entire burden of population control. What right do we have to tell them not go in for the treatment and adopt. When we cannot stop fertile couples from producing children, we have no right to deny infertile couples treatment. Population control is everyone's responsibility, not only that of the infertile.

Author: Anupama Vinayak