THE IVF COM­MANDO

Mum­bai Fer­til­ity Clinic & IVF Cen­tre

IVF India - - Mumbai, Maharastra -

When did you start Bom­bay Fer­til­ity Clinic & IVF Cen­tre? The clinic was es­tab­lished in 1994 with the sole aim of pro­vid­ing ap­pro­pri­ate cou­ple spe­cific ART ser­vices af­ter proper eval­u­a­tion and coun­sel­ing.

How did you choose this par­tic­u­lar branch of medicine? Since I was in the 8th stan­dard, I was pas­sion­ate about re­pro­duc­tive medicine. Also, once I en­rolled for my ob­stet­ric and gy­ne­co­log­i­cal post-grad­u­a­tion I was very sure that I would not be able to do abor­tions. For­tu­nately, I was ex­posed to the field of IVF at a very early stage of my ca­reer when I had the plea­sure of work­ing with the pi­o­neers of IVF in In­dia, namely Drs T C Anand Kumar and Dr Indira Hind­jua at the KEM hos­pi­tal and In­sti­tute for Re­search in Re­pro­duc­tion at Mum­bai. Un­der the guid­ance of th­ese doyens I was able to learn and mas­ter the skills of prac­tic­ing suc­cess­ful IVF.

How far do you think you have suc­ceeded in your en­deav­our? The clinic and my­self have been blessed to this end per­form­ing close to 2000 IVF & ICSI cy­cles an­nu­ally. The last one year alone re­sulted in close to 900 preg­nan­cies with more than a 1000 take home ba­bies from var­i­ous pro­ce­dures such as IVF, ICSI, IUI, Oocyte do­na­tion, Em­bryo do­na­tion and sur­ro­gacy. For the past three years we have been con­sis­tently main­tain­ing take home baby rates in the range of 40-50% per started cy­cle.

What was the sta­tus of ART cen­tres in In­dia when you started as com­pared to now? Of course, there were a very few cen­tres then (less than 50) when we em­barked on this fas­ci­nat­ing jour­ney. To­day we have close to 800 cen­tres prac­tic­ing in­fer­til­ity treat­ments and as per pop­u­la­tion stud­ies and statis­tics, still not enough for this huge coun­try.

What mo­ti­vates you in this field? The hap­pi­ness and smiles that just the an­nounce­ment of the pos­i­tive preg­nancy test brings to the cou­ple and their fam­ily are enough to keep me go­ing for sev­eral more life times. To my mind, this field is more sat­is­fy­ing than any other field in medicine. It would be apt to men­tion that cre­at­ing life (IVF spe­cial­ists) and sav­ing lives (car­diac sur­geons) are amongst the two most sat­is­fy­ing ca­reers that a doc­tor could se­lect. Ev­ery pos­i­tive preg­nancy test still brings the same joy to the en­tire team as our first IVF preg­nancy 18 years ago !

Is IVF dif­fi­cult to go through from a pa­tient’s per­spec­tive? To­day, IVF is highly sim­pli­fied com­pared to a few years ago. It en­tails just about 5 -6 vis­its over an en­tire month, fewer in­jec­tions ow­ing to more sim­pli­fied and safer pro­to­cols, higher suc­cess rates be­cause of state of the art equip­ments, dis­pos­ables and cul­ture me­dia. Also, our cen­tre pro­vides all fa­cil­i­ties for the pro­ce­dure un­der a sin­gle roof thereby sim­pli­fy­ing mat­ters greatly for the al­ready stressed cou­ple. The clinic has also in­cor­po­rated re­flex­ol­ogy and other ad­ju­vant ther­a­pies to help the cou­ple to im­prove their re­sponse and suc­cess rates. Fur­ther­more, stud­ies have es­tab­lished be­yond doubt that the pro­ce­dure is safe and ef­fec­tive with no long term con­cerns such as can­cer or other sys­temic side ef­fects which could af­fect the fu­ture life of the woman. Suc­cess rates in the range of 50% en­sure that the cou­ple achieves its goal within 2-3 at­tempts. Fur­ther­more, the easy avail­abil­ity of third party re­pro­duc­tion such as egg, sperm and em­bryo do­na­tion as well as sur­ro­gacy has rev­o­lu­tion­ized the field to en­sure that no cou­ple is de­prived of a child.

What is your idea of good pa­tient care? The first meet­ing is the most im­por­tant when it is es­sen­tial to screen all pre­vi­ous records, ask for valid ad­di­tional tests such as the AMH for ovar­ian re­serve, do an ul- tra­sound scan and then dis­cuss all pos­si­ble op­tions with the cou­ple. Sen­si­tiv­ity and com­pas­sion are of ut­most im­por­tant in ad­vis­ing op­tions and dis­cussing all pros and cons with the cou­ple. It is im­por­tant to hear them out and not be in a hurry to just dis­pose them of as just one more case. There­after, cy­cle man­age­ment should be in­di­vid­u­al­ized and tai­lored to suit the pa­tient’s needs to en­sure that they go through the pro­ce­dure as smoothly and with­out com­pli­ca­tions as pos­si­ble. Pro­to­cols should be se­lected and de­signed to avoid com­pli­ca­tions such as ovar­ian hy­per­stim­u­la­tion and mul­ti­ple preg­nancy. Com­mu­ni­ca­tion with the main doc­tor or sec­re­tary or IVF nurse through­out the pro­ce­dure is of vi­tal im­por­tance to es­tab­lish­ing a firm rap­port with the cou­ple. Also, post-fail­ure coun­sel­ing and sup­port to the cou­ple goes a long way in help­ing them have a good ex­pe­ri­ence of the treat­ment.

What is the kind of care a pa­tient can ex­pect at Bom­bay Fer­til­ity Clinic & IVF Cen­tre ? As high­lighted ear­lier, a very pa­tient hear­ing and eval­u­a­tion at the first visit, con­stant en­cour­age­ment and coun­sel­ing by the sec­re­tariat, nurses and as­sis­tant doc­tors, min­i­mal in­jec­tions by way of in­di­vid­u­al­ized pro­to­col se­lec­tion, per­sonal at­ten­dance by the main doc­tor at all steps of treat­ment and a sen­si­tive and hu­mane ap­proach in case of fail­ure are the land­marks of our cen­ter. Also, min­i­mal vis­its and wait­ing hours and easy ac­ces­si­bil­ity and com­mu­ni­ca­tion with the main doc­tor and an­cil­lary staff are very im­por­tant at our clinic

What are your mem­o­ries of the first IVF Baby you helped con­ceive? She was a lovely child born to Mrs P Mani of Ban­ga­lore and hap­pened to be our 14th IVF pa­tient in those days. I still have a copy of the let­ter she wrote to me and the en­tire team ex­press­ing how un­til that day her 14 years of mar­ried life had con­sisted of vis­its only to doc­tors

and tem­ples all over the coun­try. The emo­tional and sen­ti­men­tal side of not hav­ing a child were deeply ex­pressed in that let­ter and till this date is a mo­ti­vat­ing fac­tor for us when­ever we are con­fronted with a new in­fer­til­ity pa­tient.

You have seen the birth of thou­sands of IVF ba­bies so far. Can you share a few mem­o­rable cases? We had a pa­tient who pre­sented at the age of 51 with a his­tory of a tragic loss of her only daugh­ter in a ve­hic­u­lar ac­ci­dent. Think­ing that we would refuse treat­ment in view of her age she told us that she was 41. We tried IVF re­peat­edly for her but with no re­sult. Fi­nally af­ter the 5th cy­cle I ad­vised her to go for adop­tion but she in­sisted that she had full faith in the cen­ter and that we should try one more time. Lo and be­hold, she con­ceived in the 6th cy­cle and is now the proud mother of a 15 year old daugh­ter. We have dealt with in­nu­mer­able pa­tients who have lost their chil­dren to ac­ci­dents and nat­u­ral dis­as­ters and by IVF we have man­aged to give most of them a new hope to live for. We also re­mem­ber pa­tients of pre­ma­ture menopause be­com­ing mothers with the advent of oocyte do­na­tion and nu­mer­ous pa­tients of zero sperm counts who could have their own bi­o­log­i­cal chil­dren thanks to tes­tic­u­lar biopsy and ICSI. Of par­tic­u­lar good mem­ory was the case of a gy­ne­col­o­gist (her­self ) who was born with­out a uterus. We could do a la­paro­scopic egg re­trieval for her and af­ter IVF trans­ferred the em­bryos to a sur­ro­gate mother who sub­se­quently de­liv­ered a lovely daugh­ter for her.

Med­i­cal re­search has taken great strides in the last three decades and there has been a tremen­dous and re­mark­able change in the tech­nol­ogy that is used. Should pa­tients be re­as­sured by th­ese de­vel­op­ments? The field of As­sisted Re­pro­duc­tive Tech­nolo­gies has wit­nessed a rev­o­lu­tion over the past three decades.

Dr Jatin P Shah has the unique dis­tinc­tion of be­ing able to per­form all IVF tasks in­clud­ing ul­tra­sonog­ra­phy, oocyte re­trieval surgery, IVF em­bry­ol­ogy and em­bryo trans­fer sin­gle hand­edly. His abil­ity to trou­ble shoot for prob­lems in IVF & ICSI pro­grams in dif­fer­ent lab­o­ra­to­ries has earned him the nick­name of "IVF Com­mando".

To­day, prac­ti­cally ev­ery child­less cou­ple and also cou­ples with re­cur­rent mis­car­riages can hope for suc­cess with the wide range of treat­ment op­tions avail­able to them. We have wit­nessed the be­gin­ning of IVF con­quer­ing all forms of fe­male fac­tor in­fer­til­ity and ICSI do­ing the same for al­most all forms of male fac­tor in­fer­til­ity. Fur­ther­more with the advent of IMSI, we are able to se­lect the mor­pho­log­i­cally most healthy sperm for ICSI and with the Em­bryoscope would be able to se­lect the most vi­able em­bryo for trans­fer (thereby re­duc­ing mul­ti­ple preg­nancy rates). Fur­ther­more, re­fine­ments in egg and em­bryo freez­ing tech­niques gives hope to many a can­cer pa­tient who can pre­serve his or her fer­til­ity with th­ese tech­niques be­fore em­bark­ing on chemo or ra­dio­ther­apy (which is likely to de­stroy fer­til­ity for­ever).

What are the most im­por­tant changes in tech­nol­ogy in the last few years? The avail­abil­ity of drugs with con­sis­tent qual­ity man­u­fac­tured by the re­com­bi­nant tech­nol­ogy (for ovar­ian stim­u­la­tion), ready to use cul­ture me­dia with per­fect in­gre­di­ents for em­bryo cul­ture and op­ti­mized lab ware such as in­cu­ba­tors, egg re­trieval nee­dles and em­bryo trans­fer catheters have made sure that ev­ery suc­cess­ful unit has an op­ti­mal on­go­ing preg­nancy and live birth rate.

Do you be­lieve the suc­cess rate would im­prove in view of such changes? In­di­vid­u­al­ized drug pro­to­cols, se­lec­tion of the most ap­pro­pri­ate ART method, per­fect cy­cle co-or­di­na­tion and mon­i­tor­ing, em­pha­sis on safety and qual­ity con­trol would surely en­hance suc­cess rates.

What are the big­gest hur­dles of mak­ing ART avail­able for the masses?

“We have dealt with in­nu­mer­able pa­tients who nat­u­ral dis­as­ters and by IVF we have man­aged par­tic­u­lar good mem­ory was the case of a gyne could do a la­paro­scopic egg re­trieval for her & sur­ro­gate mother who sub­se­quently de­liv­ered

have lost their chil­dren to ac­ci­dents and to give most of them a new hope to live for. Of col­o­gist who was born with­out a uterus. We af­ter IVF trans­ferred the em­bryos to a a lovely daugh­ter for her.”

Lack of in­sur­ance cover and cost of treat­ment is still the big­gest hur­dle in mak­ing th­ese tech­niques avail­able to one and all. For­tu­nately, the costs in In­dia are still the low­est com­pared to prac­ti­cally ev­ery other coun­try in the world which makes it at­trac­tive for most of the mid­dle class and a lot of in­ter­na­tional pa­tients too.

Do you think the govern­ment should help in­fer­tile cou­ples? Govern­ment could surely play an im­por­tant role by im­ple­ment­ing the Guide­lines for ART as Law at the ear­li­est to pre­vent mis­use of th­ese tech­niques. Also, sub­si­dies on im­ports of con­sum­ables and cul­ture me­dia as well as drugs could surely help to re­duce the cost of treat­ment. More­over, fa­cil­i­ties for IVF should also be in­cor­po­rated in govern­ment and mu­nic­i­pal in­sti­tutes to re­duce the costs even fur­ther and let ev­ery In­dian have ac­cess to th­ese won­der­ful tech­niques.

What spe­cial fa­cil­i­ties do you of­fer pa­tients seek­ing ART pro­ce­dures at Bom­bay Fer­til­ity Clinic & IVF Cen­tre? In­di­vid­u­al­ized care, su­per sec­re­tariat and coun­sel­ing fa­cil­i­ties, all fa­cil­i­ties un­der one roof, con­stant upgra­da­tion of equip­ment and tech­nol­ogy, staff up­dates and train­ing in the best fa­cil­i­ties in the world on a con­stant ba­sis, ad­ju­vant treat­ments such as re­flex­ol­ogy, pa­tient sup­port groups and post fail­ure coun­sel­ing and sup­port are some of our spe­cial­i­ties.

Af­ter help­ing so many distressed cou­ples, how do you un­wind to take on an­other chal­leng­ing day? An hour of in­tense ex­er­cise at the gym fol­lowed by some good mu­sic, the oc­ca­sional movie and meet­ing friends both from within and out­side the fra­ter­nity helps me chill out be­fore em­bark­ing on a new day of treat­ing distressed pa­tients.

Dr. Jatin Shah MD.DGO Mrs Nina Shah AD­MIN­IS­TRA­TOR

Dr. Ja n Shah with wife Nina & son Dharam

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