Dhanavantari Award for Dr Indira Hinduja
1244 Test tube babies!
Florence Nightingale for many infertile couples, Dr Indira Hinduja
has several firsts to her credit. She produced the first test-tube
baby in India, 'Harsha' on August 6, 1986, using the Gamete Intra
Fallopian Transfer (GIFT) technique. She was the first woman to
be presented the Dhanvantari award for pioneering work in treating
infertile couples through new techniques in reproductive technology
in October 2000. She has also received various awards such as the
Bharat Nirman award, Young Indian award and Jagrutik Mahila Din
award. Dr Hinduja is the only gynecologist and obstetrician in India
to have been awarded a post doctorate in the field of Human In-vitro
Fertilization (IVF) and Embryo Transfer from the Bombay University.
An excerpt from an interview with Dr Hinduja, who has successfully
delivered 1244 test-tube babies in India till date.
Was taking up medicine a childhood ambition?
During my childhood I was unsure of what I wanted to do. I decided
to take up medicine when I was in high school. Earlier, I wanted
to be a musician. Medicine was decision that came after much thought.
you always inclined towards research and new creations?
During my MD, I came across articles in medical journals on In-vitro
Fertilization (IVF) being conducted in the UK, Scotland and Australia.
That reinforced my interest in the subject and led me to undertake
a PhD in human in-vitro fertility.
At that time, I was an employed lecturer at KEM hospital, so all
my research work was done after work hours. I did not go abroad
for training. We had neither funds nor the required equipment, so
we conducted our experiments by modifying everything according to
the situation and availability. The biggest challenge, however,
was the lack of equipment and knowledge.
We began with researching how the human egg looks -- taking out
the egg, fertilising it outside the body, creating an environment
for it, checking how long it could be kept outside the body, etc.
First we experimented on mice, and later on hamsters. Eventually,
when we were able to establish progress, we changed over to trial
tests on humans. We achieved good embryos, but after transferring
them to the human body, the pregnancy was not positive. After years
of research, the 18th human experiment was successful.
How did you cope with the limited infrastructure and technology?
In the beginning, due to lack of knowledge, we did not really
know what was missing and what was not, on the infrastructure front.
As research progressed, we were able to identify our requirements.
We went on buying equipment and improving on it. The basic instruments
were available, but they were not sufficient. We had to alter them
and upgrade them to suit our requirements. Even till today, in India
we use imported equipment for IVF.
What is the procedure involved in IVF, its success rate and
In this process, the egg is fertilised by sperm in a glass dish
and the resulting embryo is inserted into the womb. Infertile couples,
desperate to have a baby, have the option to use eggs or sperm other
than their own. At times, the human embryos created in the test-tube
have to be inserted in surrogate mothers, because their 'genetic
mothers' for some reason could not become pregnant. To begin with,
the success rate of IVF was 10 to 15 per cent. Now it is almost
45 per cent.
The treatment involves a cost of anywhere from Rs 50,000 to Rs
60,000, inclusive of medicines. As an expert, it is a doctor's duty
to impart correct knowledge to innocent, unknowing patients and
not to play on their vulnerability.
Why is IVF unaffordable to the Indian middle class?
Each of the hormonal injections used during the treatment is worth
Rs 1200. Sometimes patients require 20 such injections. All the
material, from the test tube to the needle, is imported, and embryo
tested. We pay 40% import duty on them, hence the costs go up.
To be honest, I have not tried any of the locally made material.
I am a little skeptical about it. If I am going to use the plastic
material manufactured locally, I can never be sure that it is tissue
toxic. I have to test the plastic tubes with the animal embryos,
grow it and only then can I be sure that the plastic is usable.
It becomes a little cumbersome. I do not think that the technology
in India is lacking, but someone has to take the initiative.
are the common reasons for infertility?
The main reasons (in men) are poor parameters of semen - less sperm
count, low motility and poor morphology, which can be congenital
or acquired. Diseases like mumps and tuberculosis, injuries, accidents,
infections, very high fever, smoking, drinking, type of job, heat,
exposure to chemicals or smoke, are some of the causes. The origin
of the cause in women is blockage in the fallopian tube. Other problems
are not planning intercourse at the right time, defective intercourse,
psychological disturbances and improper procreation.
Most of the time, 50 per cent of the problem lies in the male and
50 per cent with the female. Even when the defect lies in the husband,
the social stigma is borne by the wife who cannot or will not proclaim
her normalcy. Artificial insemination is therefore carried out in
great secrecy. On the other hand, donation of the egg is publicly
proclaimed as the husband's manhood is not under a cloud.
There is no one cause and one treatment.
Do you support the concept of surrogate motherhood?
We hardly have any surrogate mothers in India. I would like to
encourage this concept. I am really hoping that few women will come
forward. Once the egg is fertilised by the sperm, it is inserted
into the surrogate uterus. Once delivery has taken place, the surrogate
mother has to hand over the baby to the genetic parent. I do not
know what women are scared of, I think they are scared of society.
Mostly surrogates are relatives, sisters, cousins, friends or aunts.
Professional surrogates are very few.
Are your working on any particular research now?
I am most concerned about why the success rate in IVF is only 45
per cent. Where is the defect? What is the cause of basic low sperm
count? Are there any genetics involved? How can it be corrected?
What are the genetic problems that the woman carries to the egg?
Presently, I have projects with 3 institutes - TIFR (Tata Institute
for Fundamental Research), BARC (Bhabha Atomic Research Centre)
and IRR (Institute for Research and Reproduction).
What are your goals and have they been realised?
My goal is never to reach 'just there.' I believe that there is
no end to research. What disturbs me is that whenever new research
is developed the benefits of the scientific development hardly reach
the poor. The benefits of development and achievement in science
should reach even the poor. Can we do that? This is really a disturbing
point. Procreation is everybody's birth right. Unfortunately, the
common man cannot take advantage of these techniques. My goal is
to reach the common person and every village in India.
Given our population, is not adoption a better alternative?
Adoption is everyone's individual choice. Only 15 to 20 per cent
of our population is infertile. Why should only infertile couples
bear the entire burden of population control. What right do we have
to tell them not go in for the treatment and adopt. When we cannot
stop fertile couples from producing children, we have no right to
deny infertile couples treatment. Population control is everyone's
responsibility, not only that of the infertile.