The birth of Louise Brown in 1978 was the culmination of decades of scientific research in reproductive medicine. Since then, numerous breakthroughs in both clinical medicine and basic science have allowed an increasing number of infertile couples the chance to have a baby. Till date approximately 5 million babies have been born through assisted reproduction worldwide. Science has been criticized for several negative things but it has also definitely brought a lot of joy and happiness to mankind in every sense. Let us hear from Dato Dr Prashant Nadkarni of KL Fertility Centre on the progress of IVF technology in today’s world and how it is helping more and more people.
GetDoc: We know that KLFC has partnered with Monash IVF; what advantages would you say you have over other fertility centres in Malaysia, when it comes to technology?
Dr Prashant: There are probably about 3 or 4 very good fertility centres in this country which are comparable to international standards. But what happens when KL Fertility Centre partners with an international organisation is that we have continuous benchmarking. There are 14 IVF labs in our group, that’s close to 9,000 IVF cycles a year. To understand the enormity, you can go through our group website – every 2.5 hours, an IVF baby is born within our group – that’s about 10 babies a day!
Advantages of working in a big group include getting update and continuous news about the new revolutions in IVF technology. We have 120 doctors, and we have regular meetings, updates, scientific programmes, yearly conferences happening from time to time. Even our labs are all interlinked. We are at the front end of everything. I am not saying that other organisations are not well-equipped in this regard, they may be getting this information in some other way but since we are in a group, I consider it to be a significant advantage.
Secondly, bench marking. It is one of the most effective things fertility centres can do to improve our operations, results and boost our success rate. The bench marking – the audit and the processes that come with it, ensure that the output remains top-class.
Thirdly, systems. Similar to hospitals, systems are in place to maintain the same output – whichever doctor, embryologist, nurse – it is important to keep you going at the same pace throughout continuously. We have regular ongoing process and teaching to make sure our work is top notch.
Being part of the big group has its advantages – our processes are very robust – they are tested and designed well, they work for 8000 patients a year; it has helped us get our accreditation. All Singapore labs have this accreditation, so getting treatment here is same as getting the treatment done in Singapore and Australia. We keep patients up to date with the best in the world.
GetDoc: Can you tell us about the technological advancements in IVF field?
Dr Prashant: The big thing that has happened in recent years is that standard IVF has got much better than what it was before and it has kind of reached a plateau now. This is because we roughly know how to keep an embryo growing outside the human body. But pregnancy rates are not going up. That’s because of nature. In reality, women do not get pregnant every month, this happens only some months. This means that every month an embryo is formed, but it fails to implant. Then one good embryo is formed and that gets implanted and at that point, the woman is pregnant.
When we do IVF, instead of doing one every month, we collect 10 eggs and from there we hope to find the best embryo which gives patient a baby. Our way of choosing embryos up to now is only just by looking at it, and looking at the development of the embryo, not its genetics. The reason that embryos do not implant is because they are chromosomally not normal.
Now chromosome testing for embryos is available. It is called PGS, Pre-implantation Genetic Screening, is the process of removing a cell from an in vitro fertilization embryo for genetic testing before transferring the embryo to the uterus. The process involves removing a cell without harming the embryo or damaging the baby to test it for genetic condition or screening of chromosome. We can actually detect genetic problems such as Thalassemia using this method.
GetDoc: Can you tell us a bit more about chromosomal testing?
Dr Prashant: There are about 200 genetic diseases – cystic fibrosis, Thalassemia to name a couple. We can actually exclude that gene from the embryo and this is helpful in cases where there is a family history of say, breast cancer. Such diseases are removed from the blood line, you can say that in a way genetic diseases are being eradicated in this manner.
Advancing age leads to increased rates of chromosomally abnormal eggs. By testing the embryos, we are picking up the normal embryos, and only putting back the normal ones. This will give us better pregnancy rates.
Couples will be informed if no normal embryo can be found. We don’t want to add this torture to the already difficult IVF process – for the couple, for the relationship and the people around them.
GetDoc: Can you tell us about the advantages of such technological advancements?
Dr Prashant: The first big thing that has happened is that we are able to restore back the age. It may take you longer to get pregnant because you may need more IVF cycles but every time you put an embryo back, you have 70% chance of becoming pregnant and that’s huge for an older woman rather than a younger woman. By finding normal embryo through testing, we are able to give that woman same pregnancy rate as someone in her early 30.
Second, the technology has made increased pregnancy rates possible. At the moment the only thing holding it back is the cost. But like everything else, with time, it will surely become part of normal lives.
Third, we are able to eliminate diseases in our children – the most common one is Down’s syndrome. Down’s syndrome is a condition where there is an additional chromosome (21), once detected, it can be removed. That’s general success. Specifically speaking, we are able to eliminate familial disorders such as Thalassemia, Breast Cancer etc.
Fourth, the same technology is now being used to help people with miscarriages. There is a group of people that is not infertile, infertility means the inability to get pregnant. It is not the inability to deliver a child. There are women who do get pregnant but miscarry. We are able to use this technology to weed out embryos that are going to miscarry and only put back the normal embryos. So the miscarriage rate comes down. On doing the tests, we can tell with 95% degree of accuracy that they can have a baby. There is no difficulty in conceiving, the problem is miscarriage only. This can be a huge source of hope for those who have given up because of multiple miscarriages.
We can help people who have repeated IVF failures. We can also help people who are at a situation where age is a factor that is against them. Even people who are say 42 years of age can have a high pregnancy success rate. The chance of a live birth for a 42 year old is 8% but we are taking this up to 60% by putting back normal embryo. So IVF comes as a source of great hope for such people.
The technology of IVF has changed so much that you are now able to help a huge group of people who perhaps felt there was no further hope – the older woman, the woman who had miscarriages specifically and also the woman who had recurrent IVF failures, the woman who already had children with Thalassemia or Down Syndrome.
GetDoc: What do you think is going to come up in the future in terms of IVF technology?
Dr Prashant: Moving forward, we will be able to check the embryo for diseases, and transfer the embryo to uterus; this technology is not here yet but will be available soon. It covers diseases that are not essentially genetic, but those that have been in the family, say your grandfather had stroke or high blood pressure and this can be inherited. So you can check for that specific gene, eliminate it from the bloodline and create healthy babies. It is going revolutionise the way we are going to do IVF.
That I would say is the advantage of being a part of Monash IVF group. The babies that have been born are a result of all these advanced technology that we have today. Nowadays people are only putting back one single embryo so as to avoid the complications of twin pregnancies and associated risks such as early labour, handicap etc. all these problems are slowly disappearing.
GetDoc: Do you see such advancements causing people to misuse it? Like for example, if you have a healthy couple coming to you and say they want the genes tested and eliminate specific genes?
Dr Prashant: Doctors in general are aware of what they must do as part of their profession. In case someone does come with these ideas, we will surely talk to them and find out why they want this to be done. If there is no strong reasoning, surely we need not address that. Yes, there is a theoretical worry that people may misuse it. But in reality it doesn’t happen, especially in countries like Malaysia, it doesn’t. Our doctors are very ethical in this regard.
GetDoc: Do you have anything to say about people calling IVF unethical?
Dr Prashant: Well, those people raising these concerns are against making multiple embryos, freezing them and throwing them. We aren’t actually doing that. What we do is, we collect eggs, but we freeze them. We only inseminate 1 or 2 at a time, so creating 1 or 2 embryos at a time. We have a lot of people from different faiths and different walks of life who are our patients. The issue is about throwing the embryo away and since we aren’t doing that, there is no question of ethical issue.
That was a very informative session with Dato Dr Prashant. He has thrown light on how IVF can help different groups of women and it certainly paves way for bringing that tiny miracle into their lives.
This article was first published here.