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God’s gift, Delivered on order

The incidence of infertility is much more prevalent than what we would like to believe. Up to one in six couples have difficulties in conceiving and many seek medical advice and treatment. But bells of joy are ringing in the life of many such couples, thanks to increasing awareness about Assisted Reproductive Technologies, says Ratan Mani Lal Procreation is the greatest, most amazing gift of nature. Whether or not one believes in rival theories about origin of life, the arrival of a new-born is always a moment of pure joy.

Great civilizations and great creations are the result of the urge to leave the best for posterity. And posterity is what most humans are engaged in creating. Human reproduction is a complex science of union of chromosomes but it all begins with a union of two individuals of opposite sex with that specific purpose – procreation. Our huge population might suggest otherwise but the fact remains that reproduction still remains one of the most serious problems faced by our people. For those who are physically and physiologically normal, having a biological offspring of their own is just about as natural as any other activity but for those who face difficulty in having a child of their own, the disappointment and trauma are unimaginable.
But thanks to new, emerging techniques in human biology – particularly reproductive biology – it is now possible for all those unhappy couples to get a little bundle of joy they can call their own child. Practices of assisted reproductive technologies (ART) have brought about a much-needed revolution in human biology that has helped bring in happiness to hundreds of thousands of households around the world, but also helped the society get over the unfortunate stigma associated with childlessness.
The subject has been taboo in the media and entertainment industry with the 2001 film Filhaal (starring Tabu, Sushmita Sen and Sanjay Suri) being the only serious attempt to focus attention on the issue. However, a string of recent events have not only brought the subject of assisted reproduction out into the open for public discussion, but also revealed the extent of the problem of infertility.

Common problem

Infertility affects approximately 13-14% of reproductive-aged couples. It is defined as the inability to conceive after one year of properly timed, unprotected intercourse. This definition is based on the cumulative probability of pregnancy.
If a woman in the reproductive age group and her partner have been trying to have a baby for at least one year without success, there are many tests, which can be done to find out the reasons why. If the cause of your infertility has not been investigated previously, the clinic will carry out the necessary tests. These tests may include an analysis of the man's semen and the conditions of the woman's uterus, fallopian tubes and cervical mucus. While some patients will need only advice others may need drug therapy or surgery. But some may need counselling to go in for assisted reproductive techniques. The possible treatments of infertility include drug therapy; surgery to improve blocked or damages fallopian tubes; intra-uterine insemination using the husband's sperm; insemination using donor sperm if the husband or partner has no sperm or very poor perm or risks passing on an inherited disease, in-vitro fertilization (IVF); egg donation with IVF; embryo donation and a few other techniques.
An increasing number of women aged above 35 years, especially professionals and upwardly mobile, are now reported to be opting for having children through IVF technique. Newspaper reports suggest that late marriages, career priorities and finance are the key reasons for this trend. Figures at the National Registry of Assisted Reproduction in India (Nari), which maintains records of all in-vitro fertilisation (IVF) procedures in India, reveal that the number of women seeking test-tube babies has more than doubled since 2005. Doctors say that nearly 60% of patients above 40 have difficulty in conceiving naturally. The delay in opting for pregnancy can be attributed to various reasons such as late marriage, career priorities and financial security. And due to awareness of procedures like IVF, women in their late 30s wanting a baby are more open to approaching doctors. In Mumbai, the Lilavati Hospital IVF Centre does 500-600 IVF procedures annually, of which more than 50% are for women over 35. Most of these women are in the middle class, upper middle class, and high society, including many career women trying to beat the biological clock.

In high places

Celebrity endorsement of ART may be a recent happening in India, but in the west, it has always been a subject that captured public imagination. A host of celebrities have admitted without hesitation about their reasons for turning to surrogacy. Hollywood actress Jennifer Lopez is reported to have gone in for assisted reproductive technology at the age of 38. Other Hollywood celebrities included Emma Thompson, Courtney Cox and Celine Dion.
A recent example is that of Hollywood actress Elizabeth Banks (recent film Man on a Ledge) has a ten-month-old son through surrogacy and combines work as an actress with her new role as a mother.
Back home, assisted reproduction has become much talked-about because of a series of developments. First it was the birth of a child to film director Farah Khan who had been very open about the IVF procedure she chose to have a child. "I wanted to have children at a particular time and I had to choose IVF for it,“ she has said on record. In December 2011, actor Aamir Khan announced the birth of a baby boy through surrogacy. His wife Kiran had a serious problem because of which she had had problems in child birth. She had been advised IVF with the help of a surrogate, and this led to the accomplishment of having a son for her and Aamir. In the letter that Aamir and wife Kiran released to the media they thanked miracles of science and read: "This baby is especially dear to us because he was born to us after a long wait and some difficulty.“ It added that because of some complications, "we were advised to have a baby through IVF-surrogacy, and we feel very grateful to the Almighty that all has gone well.“ They underwent treatment with Dr Firuza Parikh, who heads Jaslok Hospital’s IVF department.
The medical fraternity believes that Aamir’s step will change the public perception about IVF. Dr Indira Hinduja, who is officially credited with India’s first test-tube baby born in KEM Hospital 25 years ago, said, "Aamir Khan is a top star and people may now no longer mind undergoing a surrogacy treatment and talking about it.“ Hopefully, this will take away the stigma attached to IVF in general and surrogacy in particular, and more and more couples aspiring for parenthood will use surrogates to help them complete their family. IVF specialists hope that more and more couples shed their fears and come forward to fulfil their hopes of parenthood.
Since Khan’s announcement, Mumbai’s fertility clinics have been flooded with queries. Experts are also hopeful that this will help shed some myths around the procedure. The couple has attracted wide applause from the film fraternity. "By not hiding the fact that they have used a surrogate, Aamir becomes a role model,“ says Prahlad Kakkar. "When an icon like Aamir opts for surrogacy and talks about such a medical procedure openly, it helps remove taboos associated with it,“ says filmmaker Mahesh Bhatt.
"Thanks to Aamir, couples will be able to discuss such things more openly now,“ says actor Raveena Tandon. Another actress Minissha Lamba feels that IVF is a boon for women who don’t want to give up their careers. However, some experts point out that if surrogacy gains popularity then it may become more acceptable as a method of family building and many other infertile couples will follow blindly therefore misusing or overusing this technique. Due to lack of a proper law on surrogacy, the process remains a grey area. Presently, guidelines formulated by the Indian Council of Medical Research (ICMR) in 2005 are used for surrogacy cases.

Vicky’s donation

The latest development to clear the air about ART was the film Vicky Donor recently. The film, starring newcomers Ayushmann Khurrana and Yami Gautam, not only regaled family audiences, but also went on to popularize sperm donation to the extent that young boys are now calling up fertility clinics to see how they can donate sperm and make a quick buck. Film actor John Abraham, who made his foray into production with Vicky Donor says infertility "is a serious concern, which needs to be addressed.“ Sperm donation is the easiest and least troublesome of ART but it can be used only when the male partner is infertile or for same-sex couples. But it is wrong to believe that any man can rush to a fertility clinic to donate sperm. There are many tests the prospective donors have to undergo before they can donate sperm. These include sperm analysis tests to check sperm motility, count, volume, the donor has to aged between 21 and 45, not suffer from HIV, hepatitis B and C, hypertension, diabetes, STDs and genetic disorders. The blood group and Rh status of the individual also needs to be noted. The tests are thorough and need to cover everything including height, weight, age, skin and eye colour, family medical history etc. A little background check including educational qualification and profession also takes place.
Due to lack of stringent adherence to laws, fertility centres are known to approach donors directly although this is illegal. In addition, there are various websites, which allow everyone to put up their information including intending parents, sperm donors, surrogate mothers and egg donor. These websites function without the need for any regulation - couples who want a child can state their preferences and they can approach the donor after checking out his profile. Sperm donation laws vary all over the world, for example a single woman in India is allowed ART but it is illegal in various countries, so interested couples might travel to India where it is legal.
Films –in India and elsewhere – have always played a crucial role in spreading awareness about social issues and problems. Right since the days when socialist and pro-left portrayals were the toast of the nation, to depiction of hitherto taboo subjects, films and television have helped in forming of public opinions. Hopefully, ART will be more widely acceptable now.