Vindana and parents share many happy b’days

Vindana, the Reproductive Health Centre that has passed many milestones, including its 101st baby being born on Friday, has advanced steadily in what it has to offer since its inception in 1998.

In a cosy home many miles from Colombo, while a family prepares to celebrate the sixth birthday of a little girl on July 1 with a "small party", in Colombo on Friday, a young mother experiences the joy of childbirth.

What is the link between the bubbly nearly-six girl and Friday's newborn……both are inextricably linked to Vindana, which helps "mimic nature". The six-year-old is Vindana's very first baby and the newborn the 101st. Both of them and all the others in between have been born through the process called in-vitro fertilization or in lay terms known as "test tube" babies.

A fine record within six years and though Vindana has the atmosphere of a family gathering in its waiting room than that of a clinic and the walls are plastered with photographs of smiling babies, some alone and two together, this Reproductive Health Centre has passed many milestones, including many firsts in the country, since its inception in 1998.

"She's a tall girl," says Prof. Harsha Seneviratne, smilingly recalling a visit paid by the couple who are the proud parents of the first Vindana baby, along with their daughter. Harking back to the centre's beginnings he says that although Sri Lanka was into in-vitro fertilization (IVF) technology with the expertise of foreign doctors, the technology was not being retained in the country.

"The need was to keep the technology within and when the time was right and our embryologist was confident that she could handle the process, we started it at Vindana," he says. The pregnancy and birth on July 1, 2002 of the first such baby were managed by a totally Sri Lankan team.

Commending Vindana for the loku sevaya (huge service) it is providing to couples who are desperate to have babies, the mother of the first baby tells The Sunday Times on the phone that her daughter is hari shok (very good). It was, in fact, the little girl, who quite confidently answered the phone and told her mother, "Ammata call ekak".

From the time the first baby was delivered through a caesarian operation, progress has been steady at Vindana and the hard work and dedication, along with the introduction of more modern equipment including the auto test-tube heater and the embryo-freezing facility have borne good results.

Vindana is now very much into freezing embryos, a "necessary investment" since it gives mothers more opportunities, without going over the process of aspiration (ova or eggs having to be extricated many times) to try again if the first cycle fails to produce a baby, Prof. Seneviratne explains in simple terms. "The embryos are also not wasted."

Sperm freezing and donation take place as also do egg donation and egg-sharing, The Sunday Times understands. Vindana has established a sperm bank and Prof. Seneviratne says that in sperm donation it is necessary for the donor's identity to be anonymous while in egg donation most often the recipients bring their own donors and there is a feeling of sisterhood between them.

It is also the same in the egg-sharing programme, he explains, stressing however that in all programmes, not only rigorous screening but also all guidelines including confidentiality and ethical principles are followed strictly.

The egg-donation or sharing programme benefits women who are unable to produce their own eggs due to premature menopause, cancer treatment as chemotherapy may have caused infertility or in the case of couples who may not wish to pass on known genetic diseases to their children.

Embryo-freezing has opened up a whole new world for infertile couples, says Prof. Seneviratne, commending the teamwork including the "pivotal" role played by embryologist Sumedha Wijeratne that has been the recipe of Vindana's success.

It was the team effort that won recognition for Vindana in the form of the National Science Award for 2005 for "excellence in multi-disciplinary team efforts in research and development in the area of Assisted Reproduction Technology" by the Ministry of Science and Technology. The Vindana team comprises clinicians Prof. Harsha Seneviratne, Dr. Athula Kaluarachchi and Dr. Sarath Wijemanne, embryologist Sumedha Wijeratne, IVF Coordinator Dr. Champa Nelson, Consultant Anaesthetist Dr. Manori Seneviratne, IVF Counsellor Dr. Kamini Alahakoon and the other staff.

The patients are also very much a part of our team, says Prof. Seneviratne while Dr. Kaluarachchi adds that all of them work for a cause."When we see the heartache of people longing for a baby, the main aim is to help them," says Dr. Kaluarachchi citing the example of a person who had lost both her ovaries to cancer. "Earlier, the only option for such a couple would be adoption but now through the egg-donation or sharing programme they can experience the joy of having a baby."

For embryologist Sumedha Wijeratne the long and lonely hours spent in a closed room, eye glued to a microscope are fully worth her while, when the process she has guided carefully results in an embryo yielding a healthy baby. The first few couples who had immense faith in us, even though at that time we didn't have any proof of our capability were the driving force, according to her.

Explaining that in the "natural fertilization" procedure (conventional IVF technique) the egg is allowed to select the best sperm as happens naturally, Ms. Wijeratne said problems such as both the sperms or eggs having infections may crop up. She, however, has developed techniques to overcome these and in the past two years the infection rate has been zero. "Every step of the way, we are cautious," she adds.

Team work, sticking to protocols, keeping meticulous records, informing the Sri Lanka Medical Council of their work and following worldwide accepted regulations and guidelines on ethics have all been contributory factors to their 35-40% success, says Prof. Seneviratne, looking ahead at the challenges in a changing field. "There is a need to get into gene technology but we need new investment and space."

All those are behind-the-scenes worries for the Vindana team but for couples such as the parents of the 101st baby the only reality is the inexplicable joy of parenthood. As embryologist Ms. Wijeratne peers into the microscope and sees not just an embryo but a baby who will be born some day, the vision has become a reality for the mother of the 101st baby. Married for nearly five years, there were no signs of a baby, but now a little bundle lies beside her. Mother, father and baby, their world is complete.

The treatment of infertility has three levels.

Basic management or Level 1 – Both the husband and the wife are checked for the basic requirements of reproduction to ascertain whether he is producing good quality semen samples and she is ovulating satisfactorily. The reproductive tubes of both are also checked as the sperm and eggs should be able to travel easily while her womb should be normal to maintain a pregnancy. If a problem is detected at this stage, then the couple moves onto supportive techniques or Level 2.

Supportive techniques or Level 2 – The wife is given medications to stimulate maturation of the eggs while good quality sperms of the husband are separated from the seminal fluid through seminal processing. The separated sperms are then deposited in the uterus (womb) of the wife at the correct time using a fine tube, in a delicate procedure called Intra Uterine Insemination (IUI).

The couple moves to Level 3 or high-tech assistance only if the fallopian tubes are blocked, if there is very poor semen quality or when other measures have failed to result in a pregnancy.

High-tech assistance or Level 3 (Assisted Reproductive Technique-ART)– The services include IVF, ICSI, embryo freezing, egg donation, egg sharing and surrogacy.

In-vitro Fertilization (IVF) – Using medication, a number of eggs are grown in the wife and then taken out of her body and allowed to fertilize with the sperms of her husband in a petri dish (not in a test tube). Once the eggs and the sperms fuse (fertilize), the resulting embryos, the tiniest stage of a baby, are placed in the uterus.

Intra Cytoplasmic Injections (ICSI) – This differs from routine IVF at fertilization as only one sperm is selected and injected into the egg. This technique is used when the number of sperms in the semen is very low when sperm is retrieved from the male reproductive tract or if there is a fertilization failure in an earlier IVF cycle.

Embryo freezing – When a large number of embryos are produced in one cycle, the surplus is stored under special conditions, to be deposited in the wife's womb at a later date.

Egg donation – When the wife is not producing eggs or the eggs produced are of very poor quality, eggs obtained from a consenting healthy fertile female are used for fertilization with the sperm from the husband. The resulting embryos are deposited in the womb of the wife. Although the wife's eggs are not used, she nurtures the pregnancy.

Egg sharing – If a wife of a couple who requires IVF treatment is able to produce a large number of eggs in a cycle, she (donor) could share her eggs with another couple whose wife is unable to produce eggs (recipient). The shared portion of eggs belonging to donor and recipient is fertilized by the sperm from the respective husbands and the embryos are placed in the uterus of the respective donor and the recipient. Their identity remains confidential.

In an egg-sharing programme the cost of the whole IVF treatment cycle of the couple consenting to donate eggs will be borne by the recipient couple. Therefore, this is a tremendous help to needy couples with young (<35 years) female partners who require this treatment for the management of their infertility problem. All precautions are taken to ensure that these donors are protected from exploitation.

Surrogacy – If the wife does not have a healthy womb to carry a pregnancy, embryos grown from the eggs she produces in her ovaries and fertilized with sperms from her husband are deposited in the womb of another woman who has consented to carry the pregnancy for the infertile couple.

Sperm donation – If the husband is unable to produce a semen sample with adequate good quality sperm, a sample of sperm donated by another male from the sperm bank, could be deposited in the wife's womb, allowing a pregnancy to occur. Confidentiality regarding identity is maintained at all times.

Testicular Sperm Aspiration (TESA) technique – Sometimes men produce sperm in the testes but fail to ejaculate them due to blockages in the male tubes through which they normally pass to the exterior. Under a painless technique the sperm may be obtained directly from the testes or the male tubes and used to fertilize the egg using the ICSI procedure.