If IVF treatment is publicly funded at least partially, or covered under proper health insurance schemes, it could become more affordable. Then much of the anxiety of the women to get pregnant in the first cycle would perhaps not be there, and doctors would be more willing to go about it within ethical boundaries.
It didn't feel as if they were talking about human life at all. Dr Jatin P Shah, the rising superstar of a chain of fertility centers in five cities, explained in excruciating detail how he injects potassium chloride straight into the baby's heart. "It can be seen clearly on ultrasound. But I still like to wait for an anesthesiologist to confirm that the heart has really stopped beating," Dr Shah said.
His audience: the delegates to the World Congress of Practical Infertility Management held in September 1999. The subject: "fetal reduction", that is killing off unborn babies, just eight to ten weeks old in the mother's womb.
The entire gathering of over 400 delegates from all over India, Singapore, Australia, Britain, Germany, Belgium and France listened with rapt attention, as he expounded on the "single needle technique" which Dr Shah uses in his fertility centers in Mumbai, Pune, Kochi, Agra, Madurai, and Erode.
He is not the only one. So does Dr Mehroo Hansotia, the president of the Federation of Obstetric and Gynecological Societies of India (FOGSI) which was one of the main organizers of the conference. She however prefers to use two needles - one to "fix" the baby, so that it cannot slip away! And most of her colleagues who practice the modern approach to "Assisted Reproduction Technology" agree that "we have to accept the idea of fetal reduction."
But they never talk about the fact that by the time the doctors carry out their macabre task, the unborn baby has already assumed a nearly human shape, and the development of most organs has progressed to a considerable extent.
The basic structure of the brain, the liver, the heart and the skin is there - in the third month, that is eight to twelve weeks of gestation, even hair begins to appear on the baby's head. And then it is killed.
What is harder to accept is that these unfortunate beings are the creation of the IVF specialists themselves! When a lady comes for treatment of infertility, and agrees to undergo In Vitro Fertilization (IVF), she is under tremendous mental and social pressure to become pregnant. Some of this pressure is transferred to the doctors, who then organize the fertilization to take place in a laboratory.
Once that is done, the incipient human being has to be put back in the woman's uterus, usually within 48 hours, for the fetus to grow in the course of the next 40 weeks. Though the process appears quite simple, it fails in four out of five attempts, because of a variety of reasons that are beyond the control of the doctors. Then the only course is to try again the next month, and each such attempt could cost the patient up to Rs 40,000, which many feel they cannot afford.
The doctors therefore put back at least three and sometimes four or even five embryos into the patient's uterus, expecting that at least one will grow to a full-term baby. The trouble starts when three or more get attached to the uterus wall and soon begin jostling for space and blood supply. If nothing is done, all three might continue to grow till they are delivered prematurely, dangerously underweight and vulnerable. Triplets born to Indian women almost always require a lot of care in a sophisticated intensive care unit. The mother's health is also at risk; she may have a stormy labor with abnormally high blood pressure and a host of other problems.
Yet most IVF specialists in the west frown upon this solution to the problem of plenty (of babies). "We don't do fetal reduction at all," said Professor Robert Norman of the University of Adelaide, when this writer met him in Mumbai recently. Instead they put back only one embryo or a maximum of two and make sure that the lady delivers a healthy baby. According to Professor Norman, the need for fetal abortions indicates that the specialists in India are not confident enough about the efficacy of their procedures.
Belgian professor Paul Devroey has another suggestion. If IVF treatment is publicly funded at least partially, or covered under proper health insurance schemes, it could become more affordable. Then much of the anxiety of the women to get pregnant in the first cycle would perhaps not be there, and doctors would be more willing to go about it within ethical boundaries.