Miracle babies on the rise

New Age
Xtra
October 13, 2006

Syed Tashfin Chowdhury tracks the rising popularity of test-tube babies in Dhaka, and reveals how the health ministry is oblivious of the numerous backyard fertility centres that are now cropping up throughout the capital

Even on the 16th anniversary of their marriage this year, Rokeya and her husband Matin, of Chittagong, were desperately looking for ways through which they could conceive a child. They had tried everything till now, but their options and their luck, it seemed, was running out. ‘We had attempted conventional treatment, alternative medicine, but failed everywhere,’ remembers Matin.

The Chittagong couple’s family and friends had stood by them through this long and painful ordeal. Some of Matin’s family blamed Rokeya for the problem but she was fortunate that Matin defended her through these allegations. ‘Some had suggested that we adopt a child,’ says Rokeya. Matin did not want this and so they continued looking for other alternatives.

With things looking bleak for the couple as they exhausted the last of their options, a friend advised them to try out ‘the test tube’ technology that has been growing in popularity in Dhaka over the past decade. ‘Matin refused at first as he had confused it with ‘surrogate pregnancies’ because of a spate of Hindi films that made the concept popular over the last few years,’ says Rokeya. But after a tumultuous two months of constant discussions and arguments, his misconception about test-tube babies was erased, and they decided to consult a Dhaka clinic that specialised in the technology.

After a number of sessions with the doctors concerned at one such infertility centre, the couple were convinced it was an option. Matin and Rokeya, encouraged by their family and friends, are finally about to conceive a ‘test-tube’ baby in a few months.

Matin and Rokeya, might have been an exceptionally progressive couple to be embracing this technology in the Dhaka of the nineties. Today, test-tube babies are becoming increasingly popular in the capital. According to media reports, around 479 test tube babies were born in the city from three infertility treatment centres since the year 2000.

Around 446 of these babies were born in three privately owned infertility treatment centres. These are the ‘Infertility Care and Research Centre’ (ICRC), ‘Harvest Infertility Care Limited (HICL) and Centre for Assisted Reproduction (CARe). The remaining 33 were born in a number of smaller clinics with the help of infertility treatment specialists.

Kaniz Tahmina and her husband, Ashraf Khan are a couple who successfully had their test-tube baby, a beautiful healthy daughter they named Simrin, on February 3, 2005.

‘We had our baby through HICL after numerous attempts both locally and abroad,’ says Kaniz, who has been married to Ashraf for over 15 years and like the Matins, was fast givng up hope for a child.

‘We had even flown to Bangkok, where the specialists were unsuccessful,’ says Kaniz.

She explains that they even considered about trying out in India in the future.

‘As the treatment requires immense mental strength and support, we wanted to be with our family,’ she explains. So they decided to try out the centres in Bangladesh first.

After visiting a number of clinics, the couple liked HICL’s facilities and method of treatment. ‘We were swept off our feet by their behaviour, especially. After a few days, we decided to try out their services,’ she remembers.

So, on April 2004, their treatment began and to their joy, they conceived on June 2004.

‘We waited for nine long months and our Simrin was born healthy in spite of our deepest fears,’ she says.

Dr Mustaque Ahmed, embryologist and managing director of HICL points out that Kaniz and Ashraf are one of the fortunate couples to have conceived successfully, within such a short time.

‘Since we opened our doors in March 2002, we have tackled 200 plus cases,’ he says.

He explains that only 39 per cent of these cases actually successfully conceived but not all ultimately managed to see a successful pregnancy. ‘Most of the pregnancies worked out well though,’ says Mustaque.

He further points out that most of the cases at his centre involve Intra Cyto-lasmic Sperm Injection (ICSI). ‘It is one of the most popular forms of treatment, alongside In-vitro fertilization (IVF), at battling infertility currently in the world,’ he explains.

According to Dr Rashida Begum, consultant gynaecologist, embryologist and specialist on the IVF treatment at ICRC, the male or female partner can bother suffer from infertility in a relationship, which can prevent them from having a child, even though it is predominantly the woman who is blamed for an inability to conceive in Bengali culture.

‘In 40 per cent of the cases, a couple’s infertility occurs due to male infertility factors and in 40 per cent cases, infertility is caused by female infertility factors,’ she says. The remaining 20 per cent cases occur because of problems that may exist with both partners.

She also explains that any partner in a relationship may be incapable of bearing a child due to a number of particular causes. The number of causes for male infertility exceeds the counterpart causes for female infertility, however, according to Rashida.

The male infertility factors include Oligospermia (which implies a low sperm count), Asthenospermia (which implies sperms may be sluggish), Azoospermia (due to absence of sperm in semen either due to lack of synthesis of sperm or blocks in the passage) and Teratospermia (due to an abnormal shape of the sperm).

For men, the other factors include Oligo-Astheno-Terato-Spermia (OATS), a combination of all the fertility complications.

‘Female infertility factors include Anovulation when ovulation fails to occur due to blocked or damaged fallopian tubes barring ovum and sperm from uniting, Fibroid uterus, Cervical hostility, Endometriosis and some unexplained reasons,’ says Rashida.

Most of these centres provide a full infertility diagnostic check up and counselling service, treatment of disorders causing infertility, treatment of ovulation induction with monitoring.

One of the most popular treatments at ICRC and throughout the world is the IVF, which involves fertilisation outside the body. The most common problem in the fallopian tubes cause the lack of unison between the sperm and the egg leading to infertility. IVF occurs ‘outside the body’ in a glass jar.

‘The Latin words “In Vitro” means “in a glass” and due to this reason, IVF babies were called “the test-tube baby”,’says Rashida. The IVF was first used to combat infertility in humans at Bourne Hall in Cambridge, London, in 1978.

ICRC also uses alternative technologies and the centre has been successful with 60 pregnancies out of 139 couples in 171 cycles with each cycle being the number of attempts.

‘Overall, we consider ourselves as improving in this particular field of expertise and are hopeful that our numbers will increase in the next few years,’ she assures.

ICRC is particularly proud of their first test-tube baby, Aynee Atiar born on September 9, 2005 to Leena, who is a TV actress. ‘My husband and I have been married without a child for over 15 years,’ says Leena.

She explains that she sought ICRC’s help after she heard of it from a friend. ‘I already knew about the procedures from my friends and some relatives residing abroad,’ she says. The couple attempted the treatment, which according to them was quite easy and efficient.

‘We conceived within two months of the treatment,’ she says. Little Aynee is a healthy 21 month-old girl, according to her mother.

Although these centres are doing well, the ‘test-tube baby’ methods were first introduced in Bangladesh by Dr Parveen Fatema of CARe and a renowned assisted reproduction specialist.

She explains that most clinics and centres employing Assisted Reproduction Technology (ART) claim to have 50-60 per cent success rate but this is not true.

‘Actually the success rate is no more than 30-35 per cent,’ she says. Already at CARe, Dr Parveen claims to have handled 250 pregnancies both in IVF and ICSI methods, not all of which were successful.

‘While IVF remedies female infertility, the ICSI technology is primarily for the treatment of male infertility’ she says. In case of ICSI, sperm samples is provided by the husband in the form of semen or acquired through operation. Individual mature sperm from this acquired semen is injected into the egg, which is collected the same way as with the IVF procedure.

She points out that ICSI is an extreme solution to the childlessness problem and should be tried only when all other alternatives have been exhausted. A number of health journals in the West have, however, criticised the ICSI procedure as being the reason for birth defects.

‘Most babies that have been born through these procedures, have been normal,’ claims Rashida, when asked about the criticisms. Kaniz and Leena both say they have healthy babies. ‘She does get the occasional fever and seasonal diseases but nothing out of the ordinary has occurred to her till date,’ says Kaniz about her daughter Simrin.

The price of treatments at these centres, are rather high and vary considerably when compared to each other. HICL charges Tk 2,60,000 for their treatments while CARe charges anywhere between Tk 1,70,000 to 2,20,000 for each attempt. ICRC, on the other hand, charges Tk 1,30,000 to 1,70,000 for their technology.

‘The prices are rather reasonable if one considers the kind of technology that we use, the trained doctors and specialists, the time we dedicate behind the treatments and all other factors,’ says Dr Parveen Fatema.

Rashida also points out that the services being provided are very inexpensive compared to the same technologies being provided in the Western countries. ‘Undergoing these treatments in the USA would cost a couple around $16,000 to 18,000 while it will cost around Tk 4 to 5 lakhs in Bangkok or India,’ she claims.

The inexpensive rate is attracting childless couples from neighbouring countries and abroad, according to the authorities at these centres. ‘Most of my patients reside in USA, Canada, Italy, Saudi Arabia and other countries of the world,’ says Rashida.

Parveen claims to have most of her successful patients in these countries and Japan, Singapore and some countries of Europe. Mustaque Ahmed provided similar information.

But the success of these centres is now attracting copy-cat clinics funded and run by unscrupulous gynaecologists and embryologists, she claims. ‘Most of these clinics are still experimenting. Given the time and proper funds, these clinics may also rise in the near future,’ says Rashida.

Although successful patients are all praise for these infertility centres, the risk associated with these services are immense and most countries have monitoring authorities that strictly regulate the business of test-tube babies, so that desperate patients are not cheated over and over by the centres.

In Bangladesh, office of Health Services is completely unaware of the activities of these centres. When asked about the existence of these centres, a senior official of the Hospitals department of Directorate General of Health under the health ministry claimed, ‘most of these centres are just glorified consultancies providing services on a makeshift basis. They are using the reputation of a few gynaecologists, embryologists and others to cheat patients.’

It was found that except for the top three centres, the Hospital division of Health services are unaware of the names, locations and activities of smaller clinics.

When asked the reason for this, Dr Shahadat Hossain, Director General Health Services cited a ludicrous reason for their inaction against the smaller

clinics.

According to him, the smaller, unlicensed clinics are offering this technology secretly, and do not operate as full fledged hospitals so are beyond the ambit of his regulation. ‘Specialists can always perform in an in-door environment and such treatment does not require a license or approval. However, the complicated treatment and operation of patients in an outdoor environment does require proper approval from the Health Services.’

Rashida, who has a number of degrees from the UK as a gynaecologist, points out that only the most eligible and skilled doctors can treat patients suffering from infertility.

On the other hand, Mustaque says, ‘We are trying to set a standard through our work. But the standards and security of patients will not be ensured if the Health Services do not monitor these treatments properly.’ A specialist from one of these centres claims that the office of Health Services are not carrying out these responsibilities properly.

‘This is a baseless allegation. We are doing our best and are aware of the activities of most of these infertility treatment centres. We will be extremely grateful

if citizens concerned come forward

to inform us about the clinics and

centres which are carrying out these treatments with approval,’ says Shahadat Hossain.

But despite all the allegations, these centres have aided couples in materialising a dream they thought would never come true. ‘It’s like a whole new life, after the birth of my child. Earlier, I had given up hope of ever becoming a father,’ says Shaheen Akhter, father of 20-month-old Anjara, who was conceived through test-tube technology.

Similar reactions were expressed by other successful parents. ‘This is a great treatment most appropriate for those who cannot conceive,’ says Leena.

As Matin and Rokeya save up for their treatment, it is a cinch that the population of test-tube babies will continue to increase consistently as each successful couple emerges from these infertility centres.

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