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Aparna
Pallavi writes on infertility expert Dr Meena Chimote’s
research to make in vitro fertilisation cost-effective
A man from rural Chhattisgarh walked into Dr Meena Chimote's fertility clinic, Vaunshdhara, in Nagpur, Maharashtra, with a strange problem. He had married four women—all sisters. "None of them has given me a child," he complained. When, after examination, the man was told that he suffered from azoospermia, a condition in which a man's semen has no sperms, he fainted in shock. In another incident when Dr Chimote informed a patient about the cost of a cycle of in vitro fertilisation (IVF) for his wife — Rs 50,000 — he exclaimed in dismay: "For that much money I can get married again." Infertility expert Dr Chimote (50) is witness to such extreme reactions on a regular basis. She, along with her IVF team, has counselled and treated scores of childless couples ever since she set up her clinic. "The pressure on Indian women, whether urban or rural, to bear a child continues to be intense," she says. In rural areas, rejection of a childless woman by her marital family, and polygamy for the sake of a child are rampant practices. In urban areas, women continue to be subjected to intense cruelty if they fail to bear a child. The high cost of infertility treatment enhances the predicament. It is this realisation that prompted the doctor to research ways to make IVF treatment cost-effective. Exhaustive research bore fruit recently, when Dr Chimote received international recognition for her work on the effect of anti-mullerian hormone (AMH) on a woman's fertility. The results of this research, which, claims Dr Chimote, can not only dramatically reduce the cost of IVF but also provide estimations that would help avoid several related complications, were presented at the European Society for Human Reproduction and Embryology (ESHRE) conference in Lyons, France. Dr Chimote's paper was one of the 150 papers selected out of thousands to be presented at the conference.
Given the ongoing trend of late marriages owing to career pressures, the loss is even higher. So, by the time a woman seeks infertility treatment, which is on an average five years or so post-marriage, half of her ova are already gone. This, according to Dr Chimote, is the biggest reason why infertility problems are on the rise. The problem is exacerbated by stress, unhealthy food and lifestyle habits, which cause women to gain weight around the waist. This causes poly-cystic ovarian syndrome (PCOS)—in which ovaries release several ova per cycle but none mature. These factors increase the rate of ova stock depletion and cases of premature menopause. Infertility treatment, now an established sub-specialty in medicine, requires that the doctor treating a woman should have a clear idea of a woman's ovarian functioning and her ova stock, or the antral follicle count (AFC). Many biological markers have been developed by researchers to calculate AFC, like follicle stimulating hormone (FSH), estradiol (E2) and transvaginal sonography. But none are accurate. Dr Chimote focused her work on the anti-mullerian Hormone (AMH) marker, known to be the most accurate till date. While work has been done on AMH earlier, Dr Chimote's contribution lies in pinpointing the exact time at which an AMH test should be conducted — the first day of the menstrual cycle, or day zero. An AMH estimation taken on day zero, she reveals, is useful in all cases of infertility in women, as it gives the most exact estimate of AFC, and also valuable information regarding conditions like PCOS. This information is crucial not just to infertility treatment but also in predicting health hazards like diabetes, cardiovascular problems and cancer. From the financial point of view, Dr Chimote's technique is of great help to women going in for IVF. She explains that the expensive IVF procedure involves the stimulation of a woman's ovaries to produce a large number of ova, extracted to be mated with sperms. The resultant embryo is implanted into the uterus. One cycle of ovarian stimulation costs between Rs 70,000 and Rs 1 lakh. When an ovarian stimulation is carried out on the basis of imprecise information on AFC, the failure rate of stimulation circles is high, and both the cost and the frustration of the patient and her family mount as a result, says Dr Chimote. But with day zero estimation, it is possible to not just estimate AFC but also predict whether conditions at the time of a given cycle are favourable for conception. Hence, the cost of repeated cycles is saved. Another advantage for women lacking the required reserve of ova is that they can be advised to go straight for egg donation, so that the cost of IVF is further reduced — to about Rs 35,000. Apart from this, the chances of a woman's ovaries giving an exaggerated response by producing several times the required number of ova can also be ascertained by this technique. Exaggerated response is a serious medical condition that can even be fatal. In the last two years since her research began, Dr Chimote has used her technology to test more than 400 patients. This, as well as peer reviews carried out previous to the Lyons conference, have put the stamp of authenticity on her work. Dr Chimote feels that more than technology it is awareness that is required in the field of infertility. Unfortunately, there is a low level of awareness about infertility management amongst medical professionals, too. Adds the doctor: "Most couples that arrive at infertility clinics do so after they have tried every option, including quacks and over-the-counter medication. By this time, several years have passed and the couple has aged and lost much money." — WFS
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The scientific basis of
Dr Chimote's research — that helps identify the favourable time for
conception as per a woman's menstrual cycle — is quite simple. Every
woman is born with around 350 to 400 premature ova in her ovary, which
start maturing at the onset of menarche between 13 and 15 years. With
every menstrual cycle, a woman loses one, sometimes two, of these ova.
If she gets married 10 years from the onset of menarche (age 23 to 25
years), her stock of ova is already diminished by around 135-140.