Silicon Valley has largely been a bellwether for more than just bleeding-edge technology. It is an incubator and early adopter of cultural trends that spring from the liberal-minded millenials who descend in droves on the Bay Area. It’s no surprise then that some of its most prolific companies including Facebook, Apple and Google now offer women employees, in addition to a litany of other benefits, the chance to freeze their eggs if they wish to pursue their career and delay pregnancy. When In Vitro Fertilization (IVF) which originated in the early eighties goes from a need-based therapy to treat infertility to a lifestyle choice, it’s safe to say that we’ve reached an inflection point in IVF becoming a topic that isn’t considered taboo any longer at the dinner table.
Daddy’s Digest recently spoke with Dr. Hrishikesh Pai, a leading IVF specialist from India who says that medical tourism to the country for fertility issues is on the rise.
India has been able to keep the costs down to a fraction of what they are abroad due to the sheer number of people from the country availing of IVF – Dr. Pai says that there are 30 million people who require IVF in India, of which around 3-4 million can afford to get treated every year. “In the US, it costs $15,000-$20,000 while here in India we do it for $3,000-$4,000. In Dubai, for example, it is roughly double that of India.”
Pai, whose home base is Lilavati Hospital in Mumbai, also practices at seven other centres across the country. He says that his clinics in Mumbai and Delhi routinely see patients from the Middle East, Russia and Africa.
In 1990, Dr. Pai learnt the tricks of the trade as a research fellow at the Royal Women’s Hospital in Melbourne Australia. At the time, that department was headed by Dr. Ian Johnston, the man responsible for Australia’s first IVF pregnancy and the third such baby globally.
When Pai returned to India in 1991, he was one of less than ten doctors who could offer IVF treatments in India. He’s witnessed first-hand the rapid advancements that the field has made within the country which now has the world’s second largest population. “In 1991, the success in pregnancy rates [via IVF] was 5 – 10 per cent. Now, it’s around 40 – 50 per cent per attempt. In three attempts, around 90 per cent of patients will achieve pregnancy today.”
There are key advancements to the field that has led to an incredible growth trajectory for successful IVF pregnancies. “In 1992, there was a technological breakthrough called the Intracytoplasmic Sperm Injection (ICSI) wherein you can take a sperm and inject it into the egg. We had another breakthrough in the technique of freezing embryos in 2007, a technique for which I was trained in Tokyo. Before the introduction of that technique, if we froze 10 embryos, five would die in the thawing process. Now with the vitrification process, nearly 100 per cent survive the freezing process, which is why through one cycle of IVF you can have multiple embryo transfers. We’ve frozen nearly 20,000 embryos through this process since 2007,” he says.
The new vitrification process introduced around a decade ago was the start of IVF going mainstream. It gave rise to a class of patients beyond the need-based ones, for example a woman about to undergo chemotherapy who’d like to freeze her eggs to achieve pregnancy later, to a ‘lifestyle-choice’ oriented client – a woman who wished to freeze her eggs because she didn’t want a break in her career momentum. The latter category received a celebrity boost when in 2007 a former Miss World, Diana Hayden, came to Dr. Pai to freeze her eggs. Two years ago, she used those eggs to have a baby and is now expecting twins.
New technologies
“The vitrification process of 2007 gave rise to the egg freezing technology. If they did IVF by using their own eggs at 40, they would have a 10 per cent chance of pregnancy. But if they use the frozen eggs that they stored at 35, then their chances of pregnancy would go up to 30-40 per cent.” He adds that the lifestyle-choice segment of patients is still relatively small as compared to the need-based patients. “Last year, out of 3,000 cycles we had 150 cases that were freezing out of a lifestyle choice – to delay for reasons of career growth – while the others were there for reasons of infertility.”
It is important to remember that IVF treatment isn’t primarily women-centric. In fact, Dr. Pai says that of the patients that he treats, 40 per cent are male infertility cases which can be detected by a semen test, 40 per cent are female infertility cases which can be gauged by an Anti-Mullerian Hormone test, 10 per cent are because both are infertile and 10 per cent are unexplained infertility wherein all the tests come out positive and yet the couple is infertile. There are major advancements in treatment options for men too within the scope of IVF. “When we are doing Intracytoplasmic Sperm Injection (ICSI) we magnify the sperm 200 times and inject the egg with the sperm. But around five years ago, we had a breakthrough in technology with Intracytoplasmic morphologically selected sperm injection (IMSI) that allowed us to magnify the sperm 6,000 times.”
Pai has previously been on the board of international bodies like the International Federation of Fertility Societies (IFFS) and was also the former President of the Indian Association of Gynaecological Endoscopists, besides being the current Vice President of the Indian Society for Assisted Reproduction (ISAR) which is a national body of all gynaecologists dealing with the treatment of infertile couples. He says that he’s treated over 20,000 patients since he began in 1991 and says that India has roughly a quarter of all the world’s IVF treatment centres. In some cases, Dr. Pai argues, India is even ahead of Western markets. “I’ve bought a new spindle check machine a few months ago that hadn’t yet been introduced in America. In Japan, he says, there are already a hundred of these machines installed. But outside of Japan, ours was the first country to get it.”
Psychological issues

Men often come saddled with problems like erectile dysfunction that could do more with psychological issues rather than physiological ones. In those cases, Dr. Pai refers them to specialists, who with “good therapy and a backup with medicine like Viagra” often achieve pregnancy naturally. A new law being introduced in India, will also require all patients to go to independent counsellors to balance their expectations and prepare them for the possible outcomes before they begin IVF treatment.

There are ethical dilemmas that Dr. Pai says IVF practitioners are confronted with also. One of them, for example, is the Preimplantation Genetic Screening (PGS) technique. “It can be misused as a way for sexing (selecting gender), but the actual use is to take a biopsy of the embryo so that we can analyse all the 46 chromosomes and all the genes on the chromosomes by a technique known as next-gen sequencing.”

However, the future of IVF looks bright. Dr. Pai currently uses the PGS technique for certain categories of patients like those with repeated IVF failures, or a past history of thalassemia, abnormal children or Sickle-Cell Anemia.  A friend of his in China though who does 10,000 – 14,000 cycles a year is testing all embryos. “The future will be to routinely test all embryos and conduct PGS on every embryo. There’s a new technique called CRISPR technique which is currently at the research stage too and would allow us to go one step further and correct the embryos after screening it. Over the next 20 years, it will help IVF success rates to grow to nearly 100 per cent pregnancy rates.”
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