Friday, October 5, 2018

Dr. Rajesh Koradia and Dr. Dipti Koradia in conversation with Rashida Mukadam

MIRA hospital & IVF center which has been assisting great number of couples achieve parenthood since 1992, with utmost care, transparency and empathy.They are the pioneers of IVF in Mumbai and also the facilitators of the 1st IVF baby in the Mirabhayandar region.

For many couples, conception moves from the bedroom to the laboratory. In the future, 30% of the babies may be conceived using IVF. Today, in vitro fertilization (IVF) is practically a household word. But not so long ago, it was a mysterious procedure for infertility that produced what were then known as "test-tube babies." Unlike the simpler process of artificial insemination -- in which sperm is placed in the uterus and conception happens otherwise normally -- IVF involves combining eggs and sperm outside the body in a laboratory.

India has one of the largest and fastest growing private health sectors in the world and is one of the most established and popular destinations for fertility treatment. MIRA Hospital & IVF Center was conceived by Dr. Rajesh Koradia and Dr. Dipti Koradia, with the endeavor of providing state of the art mother & child care facilities to the patients in Mumbai. Safe Motherhood is the guiding force and thought behind every step of MIRA hospital with about 30 Years of expertise in the field of Maternity, Gynecology and Infertility.

MIRA Hospital & IVF Center was conceived by Dr. Rajesh Koradia and Dr. Dipti Koradia, with the endeavor of providing state of the art mother & child care facilities to the patients in Mumbai. Safe Motherhood is the guiding force and thought behind every step of MIRA hospital with about 30 Years of expertise in the field of Maternity, Gynecology and Infertility. MIRA hospital has been assisting great number of couples achieve parenting since 1992, with utmost care, transparency and empathy.They are the pioneers of IVF in Mumbai and also the facilitators of the 1st IVF baby in the Mirabhayandar region.

1)Would like to start with an basic question about IVF as when a couple realise an need to go under this process  ( Natural period of conceive failed ) and what age limit. 

Dr. Rajesh Koradia
Considering apparently normal couples, if 100 couples are trying for conception, then 50% of the couples conceive within 3 months, another 25% conceive within next 6 months, another 10% conceive within next 3 months. So at the end of the year, 85% of the couples conceive and 15% fail. If these 15% couples try for one more year, half of them (7%) may conceive. Hence at the end of 2 years 7% of the couples may fail to conceive, in spite of everything being apparently normal. I am saying “apparently normal” because the sonography report is normal, husband’s semem report is normal and the couples are having regular intercourse (3 times a week or at least covering the high fertility days). So somehow, the highest natural fecundity rate (the rate of potential for reproduction) is approximately 20%. So if young couples fail to conceive after one year of unprotected intercourse, they should start the investigation. If someone who is more than 35 years old and is not able to conceive even after 6 months of trying, they should immediately start the investigation and consult an IVF center. Also, in a case where husband’s semen report is abnormal or the wife has an irregular/delayed menstrual cycle, the couple should start the investigation. So in short natural time period for conceiving in young couples (below 35 years) is one year and above 35 years is six months.

2)How do a couple make sure about the doctor or the institution is right for getting the  IVF done as not getting duped. 

There are a lot of marketing gimmicks going on in the IVF industry and many IVF centers try to inflate their success figure. Many centers do unethical practices by sharing gametes, embryos without the patient’s knowledge. If somebody does these kind of unethical practices, the success rates can be high. As per the industrial average standards, the success rate so far is approximately 40% out of which 3-4% may get aborted and hence the take home baby rate is approximately 35%. Now, any center offering this success rate is absolutely fine. Apart from the success rate, the journey from the beginning of the  investigation to the treatment to the final delivery is a very long process just like a roller-coaster ride with many ups and downs and hence its not only the success rate to decide the right center, but also how the doctor is cooperating, attitude of the doctor whether he is too commercial or has a sympathetic attitude, the staff of the hospital, the infrastructure, the vicinity should be considered. If at all somebody doubts the success rate that the center is offering, they can always ask for testimonials and authentic datasheets of the lab, and ideally no center should mind showing their potential patients the factual sheets for the success rates.

3)What's the cost factor for getting the right procedure for IVF, an middle class or the lower class can afford to pay. 

Dr. Dipti Koradia
Once upon a time, the cost for IVF treatments were very high because there were not many centers offering infertility treatments. Probably because the authentic way of doing IVF was not happening. Now a days, IVF protocols are pretty transparent and since we have internet these days, almost any doctor who wants to get into the depth of IVF can easily go ahead and practice in the best possible way and hence more and more specialists are coming up and more IVF centers are coming into existence due to which the cost has gone down tremendously because of the competition probably. The major cost in IVF as far as the patient is concerned is the drug. Apart from that, embryologists, anaesthesia and clinical charges are the other expenses involved. Other running costs to the IVF Centre are the maintenance of the IVF Lab, air quality, cleanliness, etc according to the required standard.  The IVF cost the western countries is 6-8 times higher than that it is in India. However the patients there do not mind because it's covered by the insurance. Unfortunately in India, the IVF treatment expenses are not covered by insurance and hence the cost definitely matters. Now, running cost to the center completely depends on how meticulously a center maintains all the protocols. As far as the injections are concerned, they are of different quality, different brands and different prices and hence there are a lot of variations. There are only a couple of companies which are believed to be highly reliable but the cost of their injections are also very high and in India if we start using those injections, then the cost of IVF treatments would increase tremendously and secondly if we recommend our patients to use these expensive injections, their expectations also increases and they would want to see fast results and in case the injection fails to work, the the patients get disappointed. So the best is to use the injections with reasonable costs without compromising the results and that is what we do at MIRA hospital and IVF center. We test injections from different brands and lock up on the ones we find effective and result driven and hence it is possible for us to offer IVF treatments at the lowest possible cost in India. We have our own labs and doctors/embryologists and hence our operational cost is relatively less as compared to other centers and we pass on this benefit to our patients.

4). Also a bigger problem lies in interior where patients are still not aware about the advance of medical can help them, how is the medical fraternity trying to reach in this area.

A lot of IVF centers these days are arranging free infertility check up camps in the interior areas to increase the awareness. Also if these areas have bare minimum facilities of doing sonography and some doctors in the nearby vicinity who can inject the patients and share the reports with us over mail/whatsapp, a Distant IVF program can be run, where in the patients would have to visit the clinic only twice, once for the ovum/egg pick up and then for the embryo transfer. So even if the patients are in the interior and even if we include their travel expenditure, our basic cost of IVF is so low which makes it sustainable and the patients get the best results.

5) How many chances does a woman have to go through   the process of IVF if they're first one is unsuccessful? 

Our recorded success rate is 55%. So we can consider that a patient should conceive in 2 cycles at our center. Generally at 35% success rate, a patient should conceive within 2 or 3 cycles. Maximum chances of conception in the first and second cycle. If a patient does not conceive in 3-4 cycles, then we probably need to think about seeking the help of an egg donor/sperm donor.  

6) In this stressful life what precautionary  measures  can be taken to prevent infertility? 

Stress is the most important factor affecting infertility. It affects the brain (hypothalamus) which is the control center for the hormonal system of reproductive organs. Another factors involve obesity, lifestyle, lack of exercise, junk food, addiction to, too much of tea/coffee, alcohol, smoking cigarettes, hookah, marijuana which hampers the fertility of male as well as female. Hence by keeping a regular check on these factors, one can improve the fertility.

7)The acceptance  of being infertile  and going for the IVF process do need convincing because  people  always  have this what will people  say at the back of their mind?

Different people have different nature. Some of the people are shy to disclose that they are facing some challenges in conception and hence they do not want to share it with anybody. There are also people who conceive with the help of IVF but refuse to disclose the same because there are different reasons/logic behind it. Like for example some think that if their family members or close ones get to know that they have conceived using IVF treatment, then they might think that the baby is not their own, the donor is different, facing the relatives on failure of cycle and lot of other thoughts might crawl up their minds. In our case, most of the couples we come across tries to know who is at fault, is it the husband or the wife? Approximately 40% of the cases, wife is responsible, 20%-30% of the cases husband is responsible and remaining can be overlapping where both husband and the wife is responsible. So in short, we can say that 50% cases, the male is responsible in some or the other way for infertility. However, in the current social scenario very few males accept that they could be responsible for infertility and hence a lot of times they are hesitant towards investigation, they hesitate to accompany their wife for the treatment which gives more stress and trouble to the wife and the compliance of the treatment is not maintained just because of the non-cooperative nature of the husband.

8)Can you shed some  light on the myths that people have about  IVF
a) It's for young and rich?

Partially true, because IVF is most successful when done at a younger age and least successful at an older age if the couple wants to conceive using their own eggs. Coming to rich people, they probably have a mindset and a time target for everything (career, marriage, conception, etc) and would not want to waste time trying other reasonable non IVF treatments. Also they know that IVF is the best available and the most successful treatment for infertility and hence directly opt for IVF without thinking about the monetary bit and I think there is absolutely nothing wrong in it if they have got such requirement.   
b)It has a 100%   success  rate?

100% success rate is purely a myth. After trying for 4,5,6 cycles, approximately 5% of the patients remain childless. So for the 95% there is some or the other solution like seeking help of a sperm/egg donor, surrogacy, but still nothing works on the remaining 5% of the patients and they remain childless.

c) Baby's  are born with defects and malformation? 

This is absolutely wrong! It is very well established that IVF babies are as normal as the other babies. There is an increased number of malformed babies in IVF due to the increased age factor, various other disorders affecting infertility (like endometriosis, diabetes etc.) present in the couple undergoing IVF treatment. Keeping these factors aside, the number of malformed babies in IVF and natural fertilization is absolutely the same.

d) IVF is not safe?

It is true that the injections used in the process of IVF might rarely cause side effects but theses side effects are temporary and does no harm in the long run. In some cases, health hazards happen if the IVF stimulation is not done properly. For example, the most dreaded complication is ovarian hyperstimulation syndrome which was a major killer in the IVF patients once upon a time. However, currently since all the protocols are in place and there is a proper understanding of the dosing and use of antagonist, these complications are very rare. So as far as the mortality is concerned, it is zero.

9)There is a lot of hype around the IVF process can you shed some  light  on this?

What happens is that companies keep innovating and manufacturing different equipment. To sell these equipment,  they keep marketing with a great hype in the results with aim of changing way of doing IVF. Two great examples in this is 1. the time lapse incubator where in the morphologically best embryo is selected and 2.  IMSI where in the sperm is magnified and selected sperm cells are injected. There are advantages of these techniques in very selective patients. People who buy these machines hype about the results after using these machines but statistically speaking or by looking at the evidence none of these are helpful in common population. It has to be used in very selective & specific patients. It is definitely useful but only in a selective population and these procedures incur additional cost to the patients.

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