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Technology, not the doctor, is key to success in IVF

Since the birth of the world’s first IVF baby in 1978 to a British mother with blocked fallopian tubes, millions of infertile couples worldwide have benefited from the amazing technology, fulfilling their dream of becoming parents.

IVF has become universally available in India too in recent years, with “IVF specialists” mushrooming in every city. However, few Indians realize that the success rate in IVF depends not so much on individual doctors (many of whom have acquired larger than life image) as on systems and technology. The credit for the vastly improved success rate in IVF over the last two decades largely lies not with the expertise of individual doctors, but with new breakthroughs in science.

The IVF procedure remains essentially the same since it was invented – extract egg cells from a woman, fertilise them outside her body and then implant into the womb. What has changed is medical devices which mimic much better the natural environment found inside fallopian tubes where fertilization takes place. This enables doctors to get better quality embryos than what was possible earlier, drastically increasing the chances of success.

The media in which embryos are produced has improved so much, the results have shot up to 45% today from just 20% a few years ago. The crude drugs used to develop eggs two decades ago have given place to much more effective ones with recombinant genetic technology to produce eggs of a much better quality. The success of an IVF expert today depends mostly on the use of latest technology, proper infrastructure, a group of supporting technicians and a state-of-the-art laboratory.

In India, the field of IVF is driven by individual doctors, many of whom have become very famous. However, in the rest of the world, things are much more instutionalized. Medical organizations excelling in IVF are known by their own names – Bourn Hall Clinic, Cambridge IVF, Mayo Clinic, Monash IVF. Hardly anyone knows or bothers which doctors work there. The institutions are bigger than individual staff, with proper systems and structures in place. This is how it should be, because while an individual can initiate something, it is only an organization that can sustain it and grow.

I therefore believe that the glorification of individual doctors, so commonplace in India, needs to stop, at least in IVF. While choosing an IVF expert, couples should learn to give more importance to the supporting team and infrastructure available at an IVF centre, because it is the technological ecosystem surrounding the doctor which actually delivers results. This is things happen in other parts of the world where the clinicians and scientists both are given equal prominence. The scientific side of IVF never gets any credit in India, while the clinical side – represented by the doctor – hogs all the limelight. This is an anomaly.

As technologies advance, IVF is going to become better, cheaper and simpler. In ten years from now, almost every gynaecologist will be able to practice IVF because they will no longer have to set up their own laboratory, the most critical part of IVF practice. There will be a central lab miles away and IVF could be done in any individual chamber by availing its service. In other words, the scientific part of IVF will be taken care of by a central laboratory, while doctors will solely focus on the clinical part. With this, more and more people will be able to avail of IVF at a cheaper cost.

The role of IVF has already gone much beyond helping infertile couples conceive and enable women to extend their fertile years. It has become an important tool for pre-selection of embryos to identify healthy ones free of any disease. This technology, called pre-implant genetic diagnosis, is particularly helpful for fertile people suffering from a genetic disorder who are wary to passing on their disease to their children. Embryo screening will greatly reduce the incidence of babies born with genetic defects, providing a major relief to parents and society as a whole.




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