A woman’s reproduction potential is short-lived
Dr. Firuza Parikh
In many cultures, it is believed that storks bring babies. I would say, “You go get Firuza and babies will follow.”
Dr. Firuza Parikh is the Director of Assisted Reproduction and Genetics at the Jaslok Hospital and Research Centre. She has trained at KEM Hospital, Seth G.S. Medical College and Yale University School of Medicine, where she is currently an Associate Professor. She returned to India to set up and head the first IVF center in 1989. Within a year, the Jaslok centre was being hailed as an outstanding international centre. It began receiving patients from 40 different countries and from every state of India.
In 1999, Firuza delivered the 1,000th baby through assisted reproduction for an infertile couple, prompting renowned artist M. F. Husain to make a painting in her honour. In 2011, Firuza’s book The Complete Guide to Becoming Pregnant was published. Apart from spending time in her centre at Kashmir, Firuza helps economically deprived couples with infertility treatment. She has had several firsts to her credit including South East Asia’s first micro-manipulation baby in 1994 and first laser hatching pregnancy in 1999. More recently, she has introduced the technique of cumulus-aided embryo transfer. Let’s hear from Firuza about freezing for fertility, and pollution and its impact on fertility.
— R/Anne Vita Dani
Thank you, my dear friend Vita, President Nirav and Rotarians. I am going to touch upon two important subjects, which are going to be major issues if we don’t keep a tab on what is happening to the world today. I will talk about reproductive potential through freezing of eggs and the impact of pollution on the human body. \
A woman’s reproduction potential is short-lived when compared to a man. She is born with about half a million eggs, while a man can keep producing sperm till he dies. This in women is defined as the biological clock, which starts slowing down by the age of 37 and probably halts by the time she is 40. Isn’t that unfair, ladies?
However, in recent times there is a breakthrough called “egg freezing”. Over the last five to seven years, we have been able to freeze women’s eggs. The egg is the largest cell of the human body and has a lot of water in it. It was very difficult to freeze it in the past, but with emerging technology we have conquered this.
Today, women want to concentrate on careers and sometimes, having a baby takes a back seat. So if they want to postpone motherhood, it is possible to freeze their eggs at 30 and they can, perhaps, have a baby at 42.
But every woman cannot freeze her eggs — there are certain criteria and the doctor will look at things such as anti-müllerian hormones, ovarian reserve and follicle-stimulating hormone to determine whether the woman is a candidate for freezing her eggs. Even women who suffer from cancer or have a malignancy that will take time to be treated, look at this option. Ideally, a woman should be less than 38 years, with some biological markers, before coming forward for egg freezing. We would like her to be anxiety-free and avoid smoking and caffeine as far as possible for better harvest of eggs. Before starting the process of egg freezing, we need to give hormone injections to build up eggs in the ovary so that we get a good yield of eggs. We don’t look at harvesting just one or two eggs — we harvest more than 10 to 12. It’s an easier process today where time is stopped by removing all the water from the eggs and storing them in liquid nitrogen. Once we thaw the eggs in order to carry out the IVF procedure, 90% of these eggs will not be damaged. And after thawing the eggs, we go through a step-by-step procedure where an equilibrium is achieved between the thawed egg and the environment.
So are there side effects to this process? Rarely will women have an adverse reaction to hormones. She may complain of a little weight gain but that’s temporary. Besides, two or three eggs are not enough for freezing. If somebody is serious about freezing then we need to harvest at least 10 to 12 good eggs. Some may ask if pregnancy rates with frozen embryos are better than frozen eggs. Although the rate is lower, I am sure as technology improves we can achieve the same success rate. The younger the age at which you freeze, the better is the outcome.
Once the eggs are frozen, they don’t have a shelf life. They can be frozen for infinity. The cost including medication comes to two to two-and-a-half lakhs for the entire process.
Now coming to the topic of environment. There are pollutants in the atmosphere, which are endocrine disruptors, meaning they disrupt the endocrine system of men and women. We are exposed to these disruptors in all forms through the air we breathe as well as the water we drink and use for bathing. There is evidence today that certain chemicals will disrupt the endocrine systems of both men and women. One of the main ways in which the body communicates within itself is through hormones. Hormones, as you know, are present in different parts of our body such as the thyroid, testes, ovaries, adrenals and even in our brain. These master hormones coordinate with all the things in our body, including the reproductive system.
You will be surprised to know that endocrine disruptors are present in plastic toys, cosmetics, cigarettes, pesticides and packaging materials. We have started seeing abnormalities in children and problems in women and men. We are all aware of the high increase in cases of breast, ovarian and prostate cancer. The rates are spiralling. There is also a rise in the number of diabetic patients. In fact, India is the diabetic capital of the world — one out of every six Indians is diabetic.
It is, thus, essential to avoid using plastic bottles because these disruptors leak out of plastics. It’s better to use the traditional matka or glass bottles. The epoxy resins, which are used to coat metal, can cause issues too.
All of this can have an effect on early menopause in women and testicular cancer in men. We find phthalates in perfumes, soaps, shampoos and lotions. We are heading for trouble because we are not respecting our environment. Wastes from industrial pollutants are dangerous because they bio-accumulate. It’s not as if they are there today and if we get rid of them, they will not be there tomorrow. They accumulate in the fat present in our body. It affects the food chain and generations to come.
So how does it affect human beings? We see that women who come for IVF have less fertilisation of eggs, poorer implantations and smaller volumes of eggs. Many women get menopause early. We have seen a decline in the sperm quality and quantity of men. This has also been reported by the WHO. There is an increase in testicular cancer. There are children born with abnormalities. All these are the effects of endocrine disruptors.
The critical development of most of us is after the egg is fertilised and that is a very delicate stage in our lives, when lots of hormones and protein changes occur in the body of the woman and the baby. So we are now going to undertake a study where we will look at this fluid which surrounds the eggs. We will look at the blood and the seminal plasma of men to see whether these endocrine disruptors are present in the amount that we think they are. We are going to choose two sets of couples or two sets of patients, one from the rural atmosphere and one from the urban and see if there is a difference in the endocrine receptors or disruptors in their body. We will select women who are showing early menopause or early aging of their eggs because we are seeing bigger and bigger incidents of this in our practice. We will also target men who seem to have falling sperm counts or falling sperm parameters. We will then compare them with fertile egg donors and sperm donors to see whether there is a difference in the hormone profile as well as the endocrine disruptor profile in these two groups of patients. Then we will be able to present this data perhaps to our government to make everybody aware that we have to look after the future generations. I thank you for your support and patient hearing because we need to protect our future generations.
Some excerpts from the Q&A session:
Q. Is egg freezing better than oocyte freezing?
Dr. Firuza:
Oocyte freezing is the scientific word for egg freezing, so it’s the same. When you inject the sperm and make the embryo, that becomes embryo freezing. In placenta freezing, we extract the stemcells from the umbilical cord. These can be later cultured and they have multiple advantages. They are believed to have a biological insurance not only for the child but also for siblings. To cite an example, if a sibling has thalassemia and if their human leukocyte antigen (certain genes in the chromosomes) matches that of his/her newborn sibling then the baby can become a donor by giving good quality genes to the sibling. So we don’t freeze the entire placenta — we freeze parts of the placenta.
Q: Are you sure that the baby after 20 years will be normal? And are we talking about genetically modified human beings in the future?
Dr. Firuza:
When IVF started, everybody was scared. They felt we were manipulating the sperm and eggs and going against nature. Most studies have shown that IVF or embryo freezing does not cause problems. But a study done in Sweden showed that with IVF, some children have higher incidents of retinoblastoma, a tumour inside the retina of the eye. Although the chromosome numbers don’t change, the DNA is re-positioned in this process. Any technology has to be looked at carefully. In egg freezing, when we recover the eggs, we look at the basic DNA and go ahead when we do not find any damage on the DNA. That does not mean that we are 100% sure that it is a safe procedure. Only time will tell.
Q: How do you ensure the security of the frozen eggs and embryos?
Dr. Firuza:
Special precaution and care is taken when it comes to storing the eggs, sperm or embryos. There is a coding system given. Everything is coded, it is banded and there is no scope for mistake. Whenever anything is frozen or if any sample is used, there will be always be two people from my team who will counter check. So far, we haven’t given birth where there has been a mix-up!
Q: If you freeze the eggs when the lady is 35 and if she is pregnant at 45, will she be biologically ready to have a child in every other respect?
Dr. Firuza:
As a woman ages, there will be certain changes such as changes in her heart, her endocrine system. But if she remains healthy and her uterus is strong, it is possible. We can manipulate the uterus by giving hormones to make it as good as a 20-year-
old uterus.