Giv­ing Hope to Hope

MEET DR. SO­NIA MA­LIK

IVF India - - New Delhi/gurgaon/panipat -

When did you start Southend IVF? Southend IVF was started in the year 2001.

How did you choose this par­tic­u­lar branch of medicine? As a stu­dent of medicine in the early '70's, I no­ticed that there was very lit­tle to of­fer th­ese un­for­tu­nate cou­ples in the form of treat­ment. So, I started work­ing with what­ever lit­tle we had and grad­u­ally kept learn­ing as I treated more and more cou­ples who went through the pain of child­less­ness. Even­tu­ally I was able to start a cen­tre where I could of­fer all the lat­est tech­nol­ogy and medicine to them.

How far do you think you have suc­ceeded in your en­deav­our? I have over the years had the op­por­tu­nity to treat many in­fer­tile cou­ples and bring hap­pi­ness to them. I have man­aged to do what I had planned through eth­i­cal ev­i­dence based prac­tice.

What was the sta­tus of ART cen­tre’s in In­dia when you started as com­pared to now? ART was avail­able to only a very few when I ini­tially started this cen­tre. How­ever, cen­tres have now mush­roomed all over the coun­try. Many are un­able to main­tain the stan­dards of space, equip­ment and man­power re­quire­ment. On the other side of the spec­trum there are also state of the art IVF cen­tres which have come up and have lent a com­mer­cial an­gle to this field due to heavy in­vest­ments made in in­fra­struc­ture. Re­cently, im­por­tance of guide­lines for ART cen­tres is be­ing stressed on. Once the reg­u­la­tions come into force, the sit­u­a­tion may be­come more uni­form.

What mo­ti­vates you in this field? The fact that I have been given the op­por­tu­nity to pro­vide child­less cou­ples with the boon of par­ent­hood is a big mo­ti­va­tion.

Is IVF dif­fi­cult to go through from a pa­tient’s per­spec­tive? Yes, it is a dif­fi­cult pro­ce­dure, not in terms of in­con­ve­nience of the pro- ce­dure but in terms of the stress, costs and fail­ure rates the pa­tient may have to en­counter. As a pro­ce­dure, it is fairly sim­ple. The ovaries are stim­u­lated to pro­duce ex­cess amounts of eggs which are re­trieved by ul­tra­sound guided as­pi­ra­tion, a short pro­ce­dure done un­der gen­eral anes­the­sia. Once the oocytes are as­pi­rated they are fer­til­ized in a petri-dish with sperms and de­vel­oped to 8 cell stage. Af­ter this the em­bryo is de­posited in the uterus through a catheter. This pro­ce­dure is a sim­ple one which does not re­quire anaes­the­sia.

What is good pa­tient care? Good pa­tient care in­volves treat­ing the pa­tient both in body and mind. It must fol­low ev­i­dence based guide­lines. To this, ones own ex­pe­ri­ence must be in­cluded to take the right de­ci­sions. To coun­sel pa­tients about var­i­ous treat­ment op­tions their suc­cess and fail­ure rates is a must.

What is the kind of care a pa­tient can ex­pect at Southend IVF? We at Southend be­lieve that an IVF pro­ce­dure in­volves not only reach­ing the tar­get of mak­ing a baby but along the route tak­ing care of the stress which the pa­tient un­der­goes both be­cause of the pro­ce­dure and the in­fer­til­ity she has. It is im­por­tant to coun­sel th­ese pa­tients many of whom suf­fer from poor self es­teem. Also as the suc­cess of IVF has lim­i­ta­tions, coun­sel­ing pa­tients in case of a fail­ure is im­por­tant. We also be­lieve in pro­vid­ing treat­ment which is ev­i­dence based and sci­en­tif­i­cally ac­cepted. We also from time to time bring in the re­cent de­vel­op­ments in pro­to­cols and equip­ment in the field of as­sisted re­pro­duc­tive tech­nolo­gies which is a fast chang­ing field. In our lab­o­ra­tory we be­lieve in qual­ity con­trol with all our pro­ce­dures. We main­tain a qual­ity man­ual and all meth­ods used are by stan­dard op­er­at­ing pro­ce­dures of in­ter­na­tional stan­dards. We be­lieve in trans­parency and our re­sults are clearly dis­played and ex­plained to all our pa­tients.

Med­i­cal Re­search has taken great strides in the last three decades and there has been a re­mark­able change in the tech­nol­ogy that is used. Should pa­tients be re­as­sured by th­ese de­vel­op­ments? Yes. As the tech­nol­ogy has im­proved the suc­cess rates have gone up. Ear­lier where we faced blocks, tech­nol­ogy has cleared the path.

What are the most im­por­tant changes in tech­nol­ogy in the last few years? Tech­nol­ogy has changed in the form of drugs, pro­to­cols, pro­ce­dures and equip­ment. In many cases we are mov­ing to milder and low cost stim­u­la­tion pro­to­cols. Re­cent ad­vances in equip­ment have brought in the em­bryoscope which is an in­cu­ba­tor which vi­su­al­izes the de­vel­op­ment of the em­bryo as it is di­vid­ing and cap­tures their im­ages as they are de­vel­op­ing. This al­lows check­ing em­bryos with­out dis­turb­ing the cul­ture en­vi­ron­ments. Be­sides this new tech­nique known as IMSI al­lows us to see sperms at a very high mag­ni­fi­ca­tion and en­ables us to choose the sperm which is mor­pho­log­i­cally nor­mal. A mor­pho­log­i­cally nor­mal sperm is usu­ally ge­net­i­cally com­pe­tent also and gives bet­ter preg­nancy rates. Preim­plan­ta­tion ge­netic di­ag­no­sis is a re­cent de­vel­op­ment where a sin­gle blas­tomere is as­pi­rated and sent for ge­netic anal­y­sis to en­sure that the em­bryo trans­ferred is ge­net­i­cally nor­mal. This is in­di­cated in case the par­ents have a ge­netic dis­ease or in re­cur­rent abor­tions and im­plan­ta­tion fail­ures. As far as em­bryo trans­fers are con­cerned we are now mov­ing to only 1-2 em­bryos be­ing trans­ferred. In freez­ing tech­niques for preser­va­tion of em­bryos, a rapid freez­ing tech­nique has come in called vit­ri­fi­ca­tion which al­lows bet­ter cryosur­vival and preg­nancy rates.

Do you be­lieve the suc­cess rate would im­prove in view of such changes? Yes. As stated em­bryoscope, IMSI and vit­ri­fi­ca­tion im­prove preg­nancy rates. Be­sides that mild stim-

ula­tion pro­to­cols and sin­gle em­bryo trans­fer pre­vent hy­per­stim­u­la­tion and mul­ti­ple preg­nan­cies.

What is the big­gest hur­dle of mak­ing ART avail­able for the masses? The cost of the tech­nol­ogy makes it in­ac­ces­si­ble for the masses. The drugs are also very ex­pen­sive. Also there is limited trained man­power in this field. The need is evo­lu­tion of a low cost pro­gram.

Do you think the govern­ment should help in­fer­tile cou­ples? Def­i­nitely. In­fer­til­ity is a dis­ease and must be treated like all other dis­eases. The govern­ment must take re­spon­si­bil­ity in pro­vid­ing ser­vices to all in­fer­tile cou­ples who un­dergo great amount of stress due to dif­fi­culty in ac­cess­ing treat­ment.

What spe­cial fa­cil­i­ties do you of­fer pa­tients seek­ing ART pro­ce­dures at Southend IVF? We may not be of­fer­ing them any­thing dif­fer­ent from other cen­tres in terms of tech­nol­ogy but we are cer­tainly dif­fer­ent in our ap­proach to pa­tients. We un­der­stand that an in­fer­til­ity cen­tre can­not prom­ise 100% re­sults in ART, but our ap­proach is to pro­vide in­fer­til­ity so­lu­tions to each and ev­ery cou­ple who vis­its us. A cheer­ful team and con­fi­dence in our guid­ing prin­ci­ples makes us a very pos­i­tive cen­tre for in­fer­til­ity treat­ment! There are no signs of neg­a­tiv­ity in our en­vi­ron­ment! Our pa­tients who again come back to us af­ter failed cy­cles are a re­flec­tion of con­fi­dence and sat­is­fac­tion in our mode of treat­ment. We try to help pa­tients choose the right treat­ment for them and help them with other op­tions if they fail.

What is your vi­sion for Southend IVF? A group known for its clin­i­cal ex­cel­lence, eth­i­cal prac­tice and com­pas­sion­ate ap­proach to pa­tients.

Af­ter help­ing so many distressed cou­ples, how do you un­wind to take on an­other chal­leng­ing day? Ev­ery pro­fes­sional must learn to switch off once he/she leaves work or else the per­for­mance for the next day is af­fected. My lit­tle dog Google helps me do so! A wel­come wag, a jump on me and his spe­cial bark for me are enough to make me for­get work and re­lax.

Dr Jy­oti Ku­mari MBBS, MS Dr Meenakshi Dua MBBS, MS Dr So­nia Ma­lik DGO, MD, FICOG, FIAMS Dr Van­dana Bha­tia MD(Gy­nae)

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