An old article about Test-tube baby

Nepali ‘test-tube baby’ could become a reality

By Suvecha Pant

KATHMANDU, July 9: 2002 

What can be termed as a breakthrough in science and technology in Nepal, "test-tube" baby production is underway for couples who are without children or who have not had one for a long time.
A treatment centre at Putalisadak, Kathmandu, which for over eight years has been helping treat infertile males and females, from Sunday has begun the initial stages of producing test-tube babies for couples without children. Already two childless women are beginning the initial tests.
"This is good news for the fifteen percent of the population in Nepal who are childless" said Dr. Uma Shrivastava, working at the Infertility Research Centre. She further added that equipment required for the production of test tubes had been brought and the research to produce the first test-tube baby in Nepal was underway.
So, how are test-tube babies produced? "In Vitro Fertilisation (IVF) or test-tube babies are the basic assisted reproduction technique in which fertilisation occurs in vitro (literally in glass)," explained Shrivastav. She further added that the man’s sperm and the woman’s egg are combined in a laboratory dish, and after fertilisation, the resulting embryo is then transferred to the woman’s uterus.
"The five basic steps in an IVF treatment cycle are superovulation (stimulating the development of more than one egg in a cycle), egg retrieval, fertilisation, embryo culture, and embryo transfer," said Shrivastav adding that the stimulation period would begin by August.
"IVF will benefit Nepali couples that are not able to conceive for various reasons and presently have to travel to India spending hundreds of thousands of rupees," said the doctor who is also a masters degree holder from the University of London in Reproductive Endocrinology. "Although some of these couples have given birth to children, there are still many women who have had to return without conceiving."
Therefore, at a cheaper price than India, the centre plans to provide the same services of IVF. However, IVF is not a foolproof solution, warns Shrivastav. "IVF does increase the chances of conceiving as it is assisted reproduction in which the doctor lends a helping hand to the natural process, and the success rate is around 20 per cent."
Inspite of this, for those parents who are without children, even this success rate brings some sense of hope.
Although very common in developed nations, both the lack of highly trained doctors in Nepal and the expense of producing test-tube babies have restricted its use.
Travelling back in history, the first test-tube baby was born in England only 20 years ago. This birth through in vitro fertilisation revolutionised medical treatments for infertility, making it possible for thousands of women to conceive.
On the other hand, the birth of the first test-tube baby caused an international sensation, with some critics denouncing conception outside the body as immoral.


Published article on The Kathmandu Post, July 09, 2002

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An interesting case with Genetic disorder

Mrs. N.  Bajiko 30 yrs. married for 5 years came to Infertility centre with secondary infertility in 2009. She complained of three abortions at 7-8 weeks gestation, two of them were curetted & one of which was ruptured ectopic right sided, for which she had undergone laparotomy.

Karyotyping of the abortus tissue showed Trisomy 20 (47 XX) (tested in Delhi).

Her blood PCR for MTB showed negative.

She had undergone treatment of danazol for six months for unknown reason.

Her menstrual history had normal cycle 35-36days with average flow for 3-4 days.  On examination, Wt = 70 kg BP = 120/80mmHg.

Laboratory investigation:

Semen analysis - Sperm count 200 mln/ml with 80% motility & 70% morphology

HSG showed both fallopian tubes patent

Hormone profile (D2) at Infertility centre

FSH = 6.5                  

LH = 2.3           

E₂ = 120

PRI = 3.9

TSH = 10.9

Both ova & sperm could have role in recurrent abortion. Therefore, ovulation was induced with clomiphene form D4-D8.  When 2 follicles reached 18-20mm on transvaginal ultrasound, 10,000IU HCG was injected for complete development of follicles & maturation of ova which was followed by Intrauterine insemination(IUI) recovered conception.

Hypothyroidism was treated with 50mg thyroxin even during conception. She was also supplemented with Didrogesterone, Folic acid 10gm, vitamin B-complex till 12 weeks gestation, iron, calcium, prophylactic Anti-TORCH treatment with Rovamycin 3mIU till 20 weeks.

All routine tests at 20 weeks gestation including RBS were within normal limits.

She had severe itching at 28 weeks gestation which was treated with calamine lotion as her liver functions were normal. An early labor sign at 31 weeks were treated with isoxsuprine & salbutamol.

At 38 weeks, when placental maturity was assessed by scanning, an elective Caesarean section was planned & a beautiful baby girl was delivered. As the girl has completed 2 years, she came again for second trial for fertility & has conceived with just progesterone supplement & folic acid. Her pregnancy is at 20 weeks & the scan shows normally growing fetus.

Was this a case of genetic abnormality? If yes what cured her defective gene?

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