Assisted Reproductive Techniques (Part-I)

(This is a guest post by Indu Ravishankar. Indu is a MBBS from Kasturba Medical College, Manipal. This is the first of a two part article)

INTRODUCTION

To introduce the concept of In vitro Fertilization, or the broader category of Assisted Reproductive techniques that it falls under, there is no better place to start from, than Hindu mythology. The progress of science depends on the rich imagination that the human mind is capable of, and even with an inadequate technology to translate a seemingly absurd and improbable idea into reality, there is no limit to the creativity and fantasy of the mind. In fact, that is where all original ideas are born. Necessity is the mother of all invention, and man as a resourceful being, it is only time that
stands in his way of immediate achievement. In mythology, every birth is a miracle. It is
not humanly possible for a woman to give birth to a hundred sons. Nor is it possible for
a woman to remain a virgin after conception/birth. We can dismiss all that as part of a vivid imagination involved in the narration of the birth of some extraordinary person, mostly God himself in a reincarnated form. However, at the rate we are progressing, most of these stories increasingly appear probable. Did our ancestors have immense foresight? For, the more I think of it, it seems to me, that we are converting those ‘stories’ into real ones!

There is one story that is particularly interesting, to this topic. It is the story of the birth of
Satyavati, the mother of Sage Vyasa, the great seer who composed the Mahabharata, and
who later went on to wed Bheeshma’s father-Shantanu.

It is said that, there was once a Kshatriya king named Uparichara. Being an enthusiastic
hunter, he dismisses the advances of his wife, when she is in her fertile period, and
instead goes hunting. Upon missing his mark repeatedly, he realizes how aroused he is. So,
he ejaculates on to a banyan leaf, folds it, and sends it to his wife through a falcon. The falcon, due to unforeseen circumstances drops the leaf into a river, whereupon it is swallowed by a fish, who is actually a nymph cursed by a Rishi.
Needless to say, a fisherman catches the fish one day, who finds twins inside the belly of the fish, upon cutting it. The fisherman returns one of the twins to the king, and requests to keep the girl, whom he raises as Satyavati, thus also explaining why she always smelt like a fish. This is an interesting, and rather amusing
mythological rendition of artificial reproduction
and surrogacy.

HISTORY

This year’s Nobel Prize in Medicine has been awarded to Dr Robert G Edwards, for
translating this fantasy into a practical reality. The very first IVF baby, Louise Brown was born in July 1978. There have been many advances in ART, both, from the treatment point of view, as well as laws pertaining to the use of the same. The advent of the same has opened a Pandora’s Box of medical ethics, and various legalities surrounding the issue. The technology to create life outside the human body has completely revolutionized obstetrical treatment, giving hope and joy to thousands of couples. It has come so far indeed, that, now we are looking at a ‘fertility tourism’ industry in many
countries.

ASSISTED REPRODUCTIVE TECHNIQUES

ART is broadly defined as ‘all treatments and procedures that involve the in vitro handling
of sperm or oocyte or embryo for the purpose of achieving a pregnancy’. In vitro fertilization is but a part of it. Other popular methods include GIFT (Gamete Intrafallopian transfer), ZIFT (Zygote Intrafallopian transfer), ICSI (Intracytoplasmic Sperm Injection), and IUI (Intrauterine Insemination). Surrogacy, where another woman unrelated to the biological father and mother, carries the pregnancy to term also falls under the same category. I shall not discuss the technical details of any of the above procedures as each of them, individually are a topic in itself.

The main motivation for ART is infertility, which is defined as a failure to achieve spontaneous conception, following unprotected intercourse, for atleast one year. Infertility per say could be due to male factors, or female, or both, each of them contributing equally to the total incidence of infertility. The type of ART that a couple receive is dictated by the primary cause for their infertility, the availability of appropriate
technology and the expense of the same.

A CDC report demonstrating the trends of ART and its success over the years-

http://www.cdc.gov/art/ART2007/PDF/COMPLETE_2007_ART.pdf

The major ‘side effect’ of ART is the problem of multiple pregnancy. During implantation,
multiple embryos are selected, to increase the chances of at least one of them being carried
to term. Others are the specific effects of the drugs used for purposes of Ovulation Induction and other relevant procedures.

UPSIDE

The obvious advantage of ART is that it offers another chance to infertile couples who are very keen on continuing their genetic line. It is infact, one of the greatest achievements of science that life can be created outside the human body, in a tiny petri dish. I cannot imagine the adrenaline rush that Dr Robert Edwards would have had, when he created an actual living embryo for the first time!

Another section of the population who largely benefit from this advance are homosexuals.
By the process of Artificial insemination from donors, they are able to bear children. The
same goes for single mothers, thus fulfilling their desires and roles in and as a family.

In cases of individuals suffering from various cancers, who receive treatment in the form of radiation, with their gonads at risk of exposure, oocyte and sperm retrieval and their storage in egg and sperm banks, offer a good chance of a later pregnancy for these individuals, minimizing much of their emotional trauma at
losing fertility.