Bank Your Fertility

Fear of age-related sterility also drives demand. Dr. Mirudhubashini Govindarajan, who has been in this field since the mid-nineties and practises in Coimbatore, says that some years back, causes were neatly symmetrical: Male infertility, one-third; female infertility, one-third; other reasons, one-third. Now, she says, thanks to a combination of stress-prone lifestyles and external factors such as pollution, the male contribution to the equation has gone up to half.

Sperm banks are one part of Assisted Reproductive Technology (ART), which covers various methods to achieve pregnancy artificially. Like in vitro fertilisation (IVF), where fertilisation happens outside the female body. (“In vitro” is the Latin for “within the glass,” referring to the test tubes and culture dishes in a laboratory.) Dr. Aniruddha Malpani, who runs Malpani Infertility Clinic in Mumbai, says that advances in ICSI (Intra Cytoplasmic Sperm Injection, which improves the chances of fertilising an egg even with a low sperm count) technology, has pushed down demand for semen freezing in his own clinic.

For women, for whom it’s more important given ovarian depletion, things are more difficult and complicated, not to speak of, expensive (it costs about Rs. 1.5 lakh to extract and freeze eggs). It requires ovarian stimulation for eggs to develop and often involves an invasive procedure. Chances of eggs damage are high, and the success rate for fertilising preserved eggs is lower than for fresh eggs.

Dr. Malpani says he meets at least one patient every month who wants to freeze her eggs. But, put off by the complexity and cost, few take it forward. “There was this lady who got married quite early in her life. The marriage did not work out, and she got divorced. She is now 34 and runs her own business. She wants to get married, have children and raise a family. But given her bad experience in the past, she does not want to hurry things up. So, her next marriage could take place tomorrow or may be three or five years later. She wanted to preserve her eggs till such time.”

Dr. Priya Selvaraj, of GG Hospital in Chennai, says she actively discourages women who see egg freezing as a way to get pregnant later. “I tell them, you have to get your priorities right.”
Other practitioners share her view, but where the desire is medically driven, it is encouraged. Like with cancer patients; women who undergo chemotherapy risk becoming sterile. Ahead of treatment, they extract and freeze their eggs. Later, when they get healthy enough to bear a child, they have the option to use their own eggs.

Embryo freezing is a part of the IVF procedure. Patients may opt to have multiple eggs fertilised during IVF, but only one or two implanted in the uterus. The others aren’t discarded, but kept in the freezer. There’s a reason. Says Dr. Mirudhubashini: “Often, parents come back to us two or three years later for their second child. They don’t have to go through the whole process again. We use the
frozen embryo.”

It’s somewhere here that the question of ethics comes up. Pro-lifers, who believe that life starts at conception, look at this in the same way that they look at abortions. In their view, fertilising multiple eggs is like producing a dozen human beings when you want only one. And when you discard or freeze the rest, it is like killing or freezing a real person. Some Catholic countries have strict laws against IVF. But views even among traditionalists differ. In Judaism, for example, a baby is considered to come to life when it’s half way out of mother’s body.

“An embryo has the potential, but it is not a person. Not until it’s planted in a mother’s uterus,” says Dr Malpani. “As a citizen of India, you have the potential to become the prime minister. But, that doesn’t make you the prime minister”.

Doctors counsel, but leave the decision to patients. Some of them, Malpani says, go to doctors just for technical help. They know about the pros and cons of IVF and have thought it through. “A couple came to me. Both of them are successful in their careers. Their jobs take them around the world. They are healthy, and perfectly capable of producing babies. But they spend too little time together. They wanted to use ART. They did not want my counselling, only my technical skills.”

Technology continues to advance. Until a few years ago, we would not even have thought of the concept of ovarian grafting — banking ovaries by freezing them and resurrecting later — but today, it’s possible and practical. Banking eggs will continue to be harder than banking sperm, but for sure it will get easier and more effective than it is today.