Opinion Nascent stage

Doctors also know that it may well lead to multiple pregnancy,like in the case of Bhateri Devi who gave birth to premature triplets. When I met her at the hospital where the children were kept in the incubator,Bhateri was dragging her feet to the room to feed them. The family had taken a loan for the expensive IVF treatment,but it did not go easy. One of the babies died.

Given the high rates of infant mortality in India and the lack of facilities in hospitals to take care of premature babies,multiple pregnancies are often a risk. Multiple pregnancy at an advanced age especially so. Medical insurance doesn’t cover IVF treatment in India because the sector claims it is not a disease. However,to make success out of their claims,clinics have adopted the practice of transferring more embryos to increase the chances of pregnancy. But what they have often failed to acknowledge or even communicate to the couples going for IVF treatment is the risk of multiple pregnancy.

While European countries are moving to single-embryo transfer in young women,in India,guidelines allow for the transfer of three embryos. Now,the Indian Society of Assisted Reproduction,a body of IVF specialists in the country,is meeting in March to discuss recommendations for limiting the number of embryo transfers to two,besides restricting the age for IVF treatment in women,and regulating the clinics that have mushroomed all over the country. The recommendations on embryo transfer will be submitted to the ICMR.

In the UK,doctors can place a maximum of two embryos in order to reduce the risk of multiple births. Unlike in European countries,in the US and India,in the absence of any laws regulating IVF treatment,clinics go for multiple-embryo transfer not just in young women but also older women in order to boost their success rate. In the US,reports suggest there have been up to six embryo transfers for older women.

One argument in favour of multiple-embryo transfer is that IVF is still in a nascent stage and since the technology is not perfect,it is difficult to predict which embryo will become a baby and so transferring more than one will lead to a better success rate.

But Bhateri Devi’s case is hardly ideal. Twice the doctors had transferred two embryos to Bhateri Devi,and both were unsuccessful. The third time the IVF specialists at the National Fertility Clinic in Hisar transferred three embryos and all of them fertilised,leading to a medical emergency,where the mother had to be on the ventilator on the night of the labour and then in the ICU. But the delivery was a success — and that seemed to be all that mattered.

“We only have ICMR guidelines. We need a proper law to regulate such things,” says Dr Jaideep Malhotra,an Agra-based IVF specialist. “Without the law,the guidelines are not of much consequence. We have submitted some of our recommendations for the bill on IVF and we are hoping we will soon have a law on this.”

Another specialist said limiting the number of embryo transfers would mean better health for the mother and the child,given the issues that plague our healthcare system and the high cost of the treatment. “I think we should go for two-embryo transfer. That’s the best bet as multiple pregnancy can lead to many complications,” he said.

Therefore,if a law is in the pipeline as the reports say,it must also evaluate the risk of multiple pregnancy and the tendency to transfer multiple embryos in women regardless of their age ,and limit the number of transfers to two in one cycle in order to rule out emotional,financial,and physical strain.

chinki.sinha@expressindia.com