Tuesday, September 09, 2008
Simplifying IVF to make it affordable and available in India
This is the technique of intravaginal culture, invented by Dr Claude Ranoux.
15% of all married couples are infertile which means that infertility is the commonest medical problem amongst young adults. Infertility is a major social stigma in India , which causes enormous personal distress. The good news is that medical technology, in the form of IVF offers effective treatment for infertility today.
The major problem is that IVF is expensive and unaffordable, which means that it is out of reach for most Indians. Not only is its availability restricted to the larger cities; it costs a bomb, so most Indian infertile couples cannot avail of this technology.
This is because Indian IVF clinics have copied the West and have not attempted to adapt IVF technology for Indian conditions. This is a challenge – and a major opportunity !
We need to simplify IVF to make it affordable and available. We need to adapt and tailor IVF for Indian conditions. We need local innovations which address the following facts:
There are many more patients, but most of them have limited paying ability
Indian patients are usually much younger ( because they get married at a younger age)
There are few doctors; and infrastructure is poor, which means it is difficult to maintain sophisticated medical equipment ( even the electric supply is unreliable !)
Most IVF clinics in small towns have low success rates because they cannot maintain sophisticated machines
We have introduced the technique of IVC – Intra-vial culture, for the first time in India. This is a proven technique, which was invented in France by Dr Ranoux over 20 years ago. We have achieved the first IVC pregnancies in India recently.
IVC versus IVF.
The principles of both remain the same – that we fertilise the egg outside the human body, to make an embryo, which is then transferred into the uterus. Regular IVF needs a sophisticated IVF laboratory. The heart of the IVF lab is the CO2 incubator – an expensive , imported equipment ( which costs about Rs 5-7 lakhs) which keeps the embryos at the right temperature and pH outside the human body.
In IVC, instead of using a CO2 incubator, we incubate the eggs and sperm in a simple sterile cryovial , manufactured in India, which costs only Rs 3 . This is filled with culture medium; the eggs and sperm are placed in this; it is sealed; and then kept in an indigenous “hot block” ( which costs only Rs 15000) which keeps at 37 C.
This vial can also be placed in the vagina, so the woman acts as a "human
After 48 hours, once fertilization has occurred in the vial and the embryo formed, the embryos are transferred into the uterus.
Reduces capital expenditure – no need for CO2 incubator. No need for a complex imported machine/ gas supply
Uses simple, indigenous equipment
Cost to start IVC clinic – less than Rs 3 lakhs
Can be done by any gynecologist who does IUI !
Can afford to do IVC for Rs 20000 per cycle
Simple and cheaper to perform
The trade-off is that IVC has a lower pregnancy rate. However , the cost effectiveness is as good, as the cost per baby would be the same
Our goal is to simplify IVF so that it is available to infertile couples who could never dream of this treatment otherwise, because of financial constraints.
We want to now introduce it in medical colleges , where it should form part of the basic training for gynecologists studying for their MD degree .It can easily be introduced into government city hospitals and district hospitals
IVC and IVF are complementary procedures; and each have their role to play, especially in developing countries like India. While the success rate per cycle with IVC is lower than with standard IVF, the cost per baby would be much less; and the cumulative pregnancy rate would be the same.
I feel we need to offer a wide range of options to infertile patients, depending upon their budget; age; medical problem; location; and local facilities, so that they can select what works best for them.
at 10:14 PM