December 1, 2021
Kakoli Ghosh Dastidar speaks on The Assisted Reproductive Technology (Regulation) Bill, 2020
FULL TRANSCRIPT
Thank you, Sir. Our country has for long awaited the legislation on assisted reproductive technology (ART) because nearly 60 million people of adult age in this country suffer from infertility, and are therefore unable to bear a child after one year of unprotected coitus. That is, nearly 30 million couples. So it is laudable that the Honourable Minister and the Government have brought this bill, though the Surrogacy Bill was like (putting) the cart before the horse, which was brought here before. Surrogacy cannot take place unless in vitro fertilization takes place. So we brought the cart, now we’re bringing the horse.
Now, what I would like to phrase is that the measure excluding single parents, transgenders and LGBT couples should be done away with, in this day and age. They also have a right to become parents. Extracorporeal fertilization—that is what ART is—that is, fertilization outside the human body, has been compared to man’s landing on the Moon. It is so specific, so sensitive, super-specialised. People who have been working on it for thirty-forty years know they’ve devoted their lives to make babies happen. Extracorporeal fertilization means taking the gamete out from the woman, the oocyte, and her male partner, the sperm, and mimicking completely the conditions which exist inside us as human beings, which, in physiological terms is known as ‘milieu interieur’. We mimic this situation outside in the laboratory, in the computer, which has oxygen, carbon dioxide, humidity as we have in our bodies, and form the baby outside. This is a very very difficult task. But we can say with pride that we in India had a scientist who was contemporaneous with Professor Robert Edwards and Patrick Steptoe of Bourn Hall Clinic, Cambridge. They gave the Nobel Prize to Edwards but our own scientist Professor Subhas Mukherjee was not given it. He was also contemporaneous with Dr Alan Trounson of Australia and Howard Jones of the United States. And he was a Bengali, for which I am proud. But he committed suicide because the then Left Front Government ridiculed him as it did not believe that he could do what he did. I have a very sensitive feeling towards him. I want to humbly say that I am a student of physiology. After his death, his work was taken up by one of his colleagues and another student. Dr Baidyanath Chakrabarty and Dr Sudarshan Ghosh Dastidar, respectively, who carried forward his work and reported the first successful IVF pregnancy from Asia at the third World Congress in Helsinki, Finland in 1984.
And before we go deep into the Bill, from my side, I would like to elaborate a little bit on the procedure because it has great significance to this Bill. As an Honourable Member said, hyperstimulation might take place, wherein hyperstimulation is the killer disease. It is not taught in Gynaecology. Sometimes a laboratory, an IVF laboratory, is mixed up with a pathological laboratory. But they have nothing in common. A pathologist knows nothing about IVF, has never handled the gamete. An ovum is a hundred times smaller than a strand of hair. It can only be seen under a microscope. A sperm is much smaller than that. When IVF takes place, that is, in vitro fertilization, these two are mixed in a petri dish—though these are called test-tube babies, they don’t use test tubes but petri dishes and the media—and put it in the incubator for the baby to happen on their own.
There is an advancement to this known as intra-cytoplasmic sperm injection, in which, if the male factor, which is the sperm, is very slow or very less in number, hair-thin pipettes are used in an equipment called the micromanipulator to crush the tail of the sperm and inject it into the ovum to make the baby. This method is much superior to ART, much ahead of in vitro fertilization. To master this technique of catching the tail of the sperm by using joysticks through robotic movement and putting it in the ovum, doctors are spending a lot of time.
Here, in this Bill, when we are talking about the national board or the state board, we are not mentioning who is going to be the member. With due respect to the officers who are going to be members of the board, I would like to say that if they have no knowledge about the equipment and the techniques, about the child, how would they catch an erring clinic which is cheating patients by doing AID and telling them that it is doing ICSI? Now, what is the difference between them? AID means artificial insemination by donor, that is, the donor’s sperm, which is a very easy technique. A woman who is ovulating comes to you saying that her husband has very less sperm. A clinic which knows about it will say that it will use the husband’s sperm,—sometimes even use a further technique called TESA to take out a single sperm from the testes of the man by cutting the testes—and thus give the woman’s baby her own husband’s genetic material. But if a clinic cheats, it will take the sperm from a sperm bank or from somebody else, and just put it in during her ovulation. If a doctor wants to cheat, he can do this, but if the administrators in the board do not know anything about the science, the board will not be able to catch the cheater. So, this is completely wrong, erroneous and, don’t mind my words, please, but some foolish person has coined the terms of the board, with respect to the administrator. This is not done. A national board cannot be formed like this.
See, Bengal had a role in the Renaissance, though music, through art, through culture. Bengal has come up again, because our chief minister, the Honourable Mamata Banerjee has had a state government hospital of West Bengal tie up with a faciltiy for a state-of-the-art centre of excellence on ART. Poor patients will get free IVF done there. So if the Government wants to control IVF in order to stop patients from being cheated, it must start such centres in the government sector. Some private-sector clinics have been cheating patients, I will only mention the name of the state and not the name of the person because I don’t want to highlight her. In Gujarat, there is a lady who owned nearly an entire village, and who used to go to the poor women, provide them food for one year, take their ova and make them surrogate mothers, and cheat them. I don’t want to name her, the government knows about it. I am sure the government knows. I don’t want to mention the name, and it is not the state which is erring, it is the doctor who is erring. There are doctors who want to err and cheat patients. Therefore, these kinds of national boards and state boards are completely erroneous as, unless the doctor or the members of the board know about surrogacy, they would not be able to catch a cheater.
The part about the registry is good. Clinics should be registered. Clinics should be accountable. Clinics should be putting in their data. How many oocytes were retrieved? One Honourable Member was talking about hyperstimulation. Each woman ovulates once a month during her reproductive age. But when we are doing artificial insemination, we are giving them injections depending upon her hormonal status and so many eggs might be produced. The eggs might be so many, which is called hyperstimulation, that there would be collection of fluid in the third space. She might get fluid collected in her abdomen, that is, ascites, and fluid may even get collected in her thorax, a condition called hydrothorax, and she might die. So you have to know when to stop the stimulation using injection and to stop that, every day, a qualified doctor, who has been working on the subject for 25, 30, 40 years, must see the results of the rising blood E2 level. Unless the board is qualified enough, they will not be able to catch it.
How do you see how many eggs are coming out? You can’t see from the outside. So we do a transvaginal ultrasound daily, and a doppler ultrasound daily to measure the blood flow. We measure the size of the follicles daily. So one doctor has to sit though day and night to measuring the follicles every day in the woman in order to ensure that she does not die. This is a very humbling moment for me. I am the country’s first transvaginal ultrasonologist. I started my work in 1980 or 1981, I have forgotten, it’s more than 40 years. So unless you know how many eggs are coming out, you cannot caution her and she might then die. You have to stop the medicines, stop the injections, take out the follicles and let her live. So, unless a qualified person is there in the board this cannot happen. The Bill says nothing about a qualified person.
We cannot have so many boards, one here, one there and everywhere. We don’t have so many qualified people in this country. There are only a few qualified people, who have been working for the last 25, 30, 40 years. So you can have one board and have centralised reporting for who is doing what. Many clinics have been treating women, and many women have lost their lives. Many women have lost their properties trying to get a baby because everyone wants a baby after marriage, and nowadays, the young people, before marriage. We have to keep up to the times. If they are of the right age, why can’t we give them the benefit of becoming parents? We should be able to because science is there.
And the other erroneous term here is ‘bank’. It’s not State Bank of Calcutta or State Bank of Delhi. We are talking about a ‘gamete bank’, from where we can get the gametes. As far as men are concerned, it is very easy. Men know how they can take a sample out, which is then then treated at the bank and stored. But for women, they have to be stimulated with injections, the follicular material has to be done through a transvaginal ultrasound, the serial rise of the estradiol level has to be measured, like I said when talking about the patients, and then through the vagina, the retrieval of ovum has to be done. So how do you do these in an ovum bank without qualified people?
Who trains the qualified people? As far as I know, even till date, we don’t have any ART degree here in the country. Gynaecologists are not ART specialists, let me tell you, not even me, I’m sorry. In gynaecology, there is only one chapter about ART. Even Williams has only one chapter, maybe. Gynaecologists per se are not infertility specialists. Infertility specialists are those who work with the gamete, who have been doing it for 20 years and who know the subject from the beginning. So, who forms the board and who monitors the bank? And, you are also talking about the gamete bank and zygote bank, that is, the embryo bank. To form the embryo you need an IVF lab. So, unless there is a properly government-monitored IVF laboratory with serious, sincere doctors, experienced doctors, how do you form the gamete, like I told you? Take the oocyte from the woman who has had transvaginal ultrasound, take the sperm from the man if it is a masturbated specimen, or if it is not, that is, if he doesn’t have semen outside, cut the testis to extract it, though TESA or PESA; and then you put them together, make the baby, and finally put the embryo in the bank. So you need a laboratory, and the bank and the laboratory need to be in the same place; because if the bank is somewhere and the laboratory is somewhere else, then you make the eggs here, the baby (embroyo) here, and then you carry it to the bank. But it would die on the way as the baby is smaller than a strand of your hair.
So, this Bill today, I think it also goes to support the corporates. There are corporates, we know, I don’t want to name them here, who have come to India, and who are mostly international corporates. The Bill will support them because the international corporates will be using foolhardy, gullible patients, tell them that they will get them a donor, take money from them but won’t give them, be it a donor, a surrogate or even a sperm sample. So this Bill will support the corporates, not the poor people of the country, my 60 million brothers and sisters who are looking for a child, for whom this Bill has been brought today and for which I am so grateful to the Minister.
So the Honourable Minister should give a thought to the things that I have spoken about and change the Bill completely. It has to go for scrutiny. The board has to be manned by people who know the subject, the bank must be completely abolished unless it is associated with an IVF laboratory and it has to be manned by people who know the subject, and are not pathologists. I’m not trying to demean pathologists. If a pathologist has been working on IVF for 30 years, welcome, if an honourable gynaecologist has been working on IVF for 30 years, welcome; otherwise not. Every gynaecologist is not an IVF specialist, because IVF and ART are subjects which are not taught in our MBBS or MD curricula. You have to give a thought to all these things before you pass the Bill.
Thank you so much, Sir.
