It’s a remarkable thing — two people struggling to have a child start a family in a petri dish, implant the embryo in the mother-to-be, and have a baby. But many couples opting for IVF in India don’t know that success rates range from 30% to 35%.
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 techniques. But in the absence of regulation, clinics in India are still able to claim far higher success rates than they actually have, and the results of this can be devastating.
“As it is, there is the physiological stress of conception, and the harrowing wait,” says Dr Smita Deshpande, head of the department of psychiatry at Delhi’s Ram Manohar Lohia hospital. “The trauma of conception failure can be immense. And because a lot of couples are led to believe there is a 50% chance of success, disappointing outcomes can lead to anxiety and depression.”
A 34-year-old art teacher from Gurugram says she suffered an ‘emotional breakdown’ after each of her two failed IVF cycles. She was 32 when she and her husband decided to start a family.
A year later, she still hadn’t conceived. “But I wasn’t too worried because I had friends who had conceived in their 30s and it had taken time. I had also been on medication for my irregular menstrual cycle, so I knew it wouldn’t be easy,” she says.
Then tests revealed a block in one fallopian tube, and the couple decided to opt for IVF. “The doctor had told us we had a 50% chance. We were hopeful and fairly confident of success, because I was young. But the implantation didn’t work, and I was devastated.”
Two months later, they decided to try again. “This time, my test showed that I was pregnant and we were overjoyed. We told our friends and family. But the first ultrasound scan showed the embryo had implanted in my fallopian tube, so I was advised to terminate the pregnancy. It was the worst day of my life,” she says.
A biopsy of her uterine lining revealed that she had tuberculosis. “Finally we knew the reason.” After her TB had been cured, she did a third cycle of IVF and conceived in January. “This time, we were very cautious. We told our parents only after the first ultrasound scan was done.”
With each IVF cycle costing between Rs 60,000 and Rs 2 lakh, the financial loss compounds the trauma and distress. “More often than not, women either blame themselves or are criticised for not doing things right,” says Dr Deshpande.
Are private clinics and hospitals misrepresenting data and overselling IVF? The simple answer is that many of them do. “There is no centralised data, so clinics can claim whatever they want,” says Dr Hrishikesh Pai, who heads the IVF Centre at Mumbai’s Lilavati Hospital and Research Centre.
The success rate of an IVF cycle varies greatly as it depends on many factors, but it ranges between 30% and 35% at AIIMS, says Dr Alka Kriplani, head of obstetrics and gynaecology at the All India Institute of Medical Sciences, India’s premiere hospital and research institute in New Delhi. “During a good run, it’s 40%,” she adds.
The outcomes at AIIMS are comparable with most developing nations, the chances of conception being highest for women under 35.
According to the US Centers for Disease Control and Prevention, IVF cycles resulted in live births in 38.3% of women under 35, with the number falling to 32% for women aged 35 to 37. The success rate fell to 23.1% for those aged 38 to 40, and to 10.4% in women over 40.
In the UK, IVF is successful in 29% of women under 35, 23% of women aged 35 to 37, 15% of women aged 38 to 39, 9% of 40- to 42-year-olds, and 2% of women over 44.
Private clinics in India claim success rates that are two to 20 times higher. At the Go IVF Surrogacy Centre in west Delhi, for example, the claim on its website is a 70% to 80% success rate for women under 35, and a 40% to 50% chance for women over 40.
‘According to research, it has been found that the success rate is increasing in every age group as the techniques are refined and doctors become more experienced,’ the website states. Doctors at the clinic did not take calls.
- The world’s first test tube baby, Louise Brown (right), was born in the UK in July 1978. She is now 39, married and a mother of two.
- Louise’s sister, Natalie, was also conceived via IVF, four years after her. By then, she was already the world’s 40th IVF baby.
- Since 1978, an estimated 8 million ‘test tube’ babies have been born worldwide, according to data for 2017 compiled by the International Committee Monitoring Assisted Reproductive Technologies (ICMART), an international non-profit organisation.
- The WHO estimates that there are between 120 and 160 million couples struggling with infertility worldwide.
- Some governments now offer free IVF treatments to boost their population. In France, for instance, married heterosexual couples diagnosed with infertility are allowed four free IVF cycles for women under 45.
- India too has a subsidised IVF programme, but only for the tiny Parsi community, which is in danger of extinction.
Off the books
The Indian Council of Medical Research (ICMR) has National Guidelines for Accreditation, Supervision and Regulation of ART Clinics in India, but these are, in effect, suggestions. They are not legally enforceable, and can be ignored without peril.
“There is a need for a centralised registry to record and standardise IVF data across the country. Without that, clinics can promise patients anything and if the IVF cycle fails, tell patients that they are one of the ‘few’ failures,” says Dr Nutan Aggarwal, former professor of obstetrics and gynaecology at AIIMS.
The draft Assisted Reproductive Technology (Regulation) Bill of 2017 would regulate and supervise ART clinics to prevent misuse and ensure safe and ethical practices, but it hasn’t been enacted.
“The law will ensure that all clinics submit their data to a central registry, just as is done in the UK. People seeking IVF can access this data and choose a centre based on its success rate and clinical outcomes,” said Dr Pai.
As a start, the ICMR has set up a National Registry of ART Clinics and Banks in India to establish a database of facilities, but enrolment does not indicate registration or accreditation with the ICMR. “Anyone claiming the contrary in publicity material or any other form can be prosecuted,” said a health ministry official who did not want to be named.
Close to 400 centres are enrolled for now, of an estimated 1,500 to 2,000 centres across the country. “The estimate is really a very rough one, because there are new IVF clinics opening all the time,” says Dr Pai.
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- Sperm and eggs from skin: In a lab procedure known as IVG (in vitro gametogenesis), scientists have been able to create sperm and egg cells using skin tissue. This could benefit people who are infertile, or are rendered infertile by treatments such as radiation and chemotherapy. But the technology faces battles over its legal and ethical status and potential for misuse.
Infertility, defined by World Health Organisation (WHO) as a “failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse,” affects more than 10% of women aged 15 to 49 worldwide. This estimate is based on women who have tried unsuccessfully and have remained in a stable relationship for five years or more.
The infertility burden in men is unknown, according to the WHO, but studies show a significant fall in sperm count, motility and morphology or structure after the age of 35 in India.
Many centres say their higher than normal success rates are because of their use of newer technologies, such as Intracytoplasmic Sperm Injection (where sperm is injected into the egg to improve the chances of fertilisation) and assisted hatching (where an incision is made on the shell outside the embryo to increase chances of implantation in the uterus). “Even with the use of the new techniques, the outcome does not vary greatly unless it is male-factor infertility,” says Dr Pai.
What has been shown to improve the chances of success is freezing eggs before the woman is 35, for use when she is ready to start a family. “Not only are a younger woman’s eggs healthier, it has also been observed that in case of frozen eggs the chances of implantation are better,” says Dr Suneeta Mittal, director of obstetrics and gynaecology at Fortis Memorial Research Institute, Gurugram.
Despite the anxiety and gut-wrenching sadness of her two failed cycles, the Gurugram teacher is happy she chose IVF. “It worked for us and offers a good chance to millions of others who want children,” says the mother-to-be. “It was far, far harder than I had expected, I wasn’t prepared for the heartbreaks. But trust me, the baby makes it all worthwhile.”