Gynaecologist & Fertility Expert Dr Duru Shah Speaks About Assisted Reproduction Techniques

What’s remarkable about Dr Duru Shah is that despite her extremely busy schedule, she still makes time for things that bring a positive change to society and she was kind enough to give me time for an interview not once, but twice, thanks to our previous interview being erased due to a phone glitch! She sat through the interview for a second time and patiently answered all my questions again so that she could throw some light on an issue that many couples face; Infertility.

Dr Shah is no ordinary doctor, she has served as the President of the Federation of Obstetric and Gynaecological Societies of India (FOGSI), and also as Chairman of the Indian College of the Obs. Gyn. (ICOG). She is a member of FIGO’s Ethics Committee and has served as Past President of the Indian Menopause Society and the Mumbai Obstetric and Gynaecological Society (MOGS) and the past President of the Indian Society of Assisted Reproduction (ISAR) and a member of the Board of the International Menopause Society. 

She served on many National and International Committees like the “Technical Advisory Committee for Maternal Mortality of FOGSI” and the Ethics Committee of Majlis an NGO of lawyers, assisting survivors of sexual abuse. Dr Duru Shah is also the past Honorary Professor of Obstetrics and Gynaecology at the Grant Medical College and a Post Graduate guide for DNB. 

Dr Shah’s passion has always been to focus on Adolescent Reproductive and Sexual Health(ARSH).
Based on her experience, working on various programs such as Growing Up, Kishori and the
STAR program she has been able to bring centre stage the importance of ARSH and got it
included in the school curriculum through the MOHFW, Government of India.

She is currently focusing her attention on Gender Violence and Women’s Rights through her own NGO; The Women’s Empowerment Foundation. Dr Shah and her team have created a unique App
called Tooshytoask, for adolescents on reproduction and sexual health, which is currently
available in 5 languages, and free to download on both AppStore and Playstore. She is passionate about focusing on preventive health, especially in young girls and women as she believes they are the mothers of tomorrow. 

A recipient of many National and International Awards, like the Distinguished Merit Award for service towards women’s health which was awarded to her by FIGO at the World Congress in Rome, Italy in October 2012, making her the first and the only Indian to have ever received this prestigious award.

Besides that, she has been recently been awarded The Federation of Obstetric & Gynecological Societies of India Lifetime Achievement Award for Valuable Services and Lifelong Commitment rendered to FOGSI, the Midday Powerful Women 2022 for “Iconic Gynecologist & Fertility Expert”, the National Fertility Awards for ICON of the Year (OB-GYN, National) from ET Healthworld, and received the most prestigious Mahatma Award 2021 for Social Responsibilities and Gender Equality, among many others.

We could go on about her list of achievements as the list is endless! Let’s dive straight into the interesting and insightful conversation she had with BabyChakra regarding infertility and more.

You are a part of a groundbreaking campaign on gender violence issues, “Breaking the Silence on Violence and you are also involved with the Adolescent Empowerment program besides being brilliant in your profession. How do you manage time for all of it? 

I started this to make young girls aware. In 2001 we started visiting schools and talking to children in different schools around Mumbai. We then expanded and soon went to six cities teaching girls about puberty and menstruation via PPTs that we especially prepared for them. We spoke to children from class 5 to12 and these talks were received well and did well. 

We’ve been doing it for ten years and now we have 20-25 schools in every city. We have doctors who are specially trained by us, representing us. These doctors come to Mumbai and we train them. We also gave talks in colleges on things like contraception, HIV, etc., and every year we upgrade the content.

As far as managing my time, I think It’s all about time management; I wake up early in the morning depending on the work I have at hand. If I have more work, I may wake up as early as 4-5 am and finish my work by 7-7.30 am, then I have my breakfast, get ready for work and leave the house by around 9.30 am. When my daughters were younger, I would spend some time with them in the morning before they left for school, only then would I leave for work.

Earlier I used to visit the Wadia hospital as an honorary OB/GYN five days a week to train doctors and teach them how to do surgeries, and how to operate, I would spend four hours there and then go to the clinic and start my work there, or if there were surgeries to be done, I would do that in the afternoon and then go to the clinic at around 3-3.30 pm and work till about 7.30-8 pm sometimes even 9 pm or later.

I also run an urban slum-based NGO “Kishori” which is an Adolescent Empowerment program in Dharavi,  the largest slum in Asia. Here we educate and empower young girls in Dharavi to become financially independent and independent by teaching them things like English and Computers. We train them in self-defence so they can defend themselves against sexual and domestic abuse. These girls are also assisted in finding employment.

I have a digital app; Too Shy To Ask, which is a reproductive and sexual help digital app in five regional languages. It helps young girls with information on reproduction and sexual education. It has all the information about whatever young girls are too shy to ask about otherwise.

I have also authored a book called Pregnancy and You, which has all the information to-be-parents need to know.

What is the most commonly used assisted reproduction technique? 

The most common is of course IVF (In Vitro Fertilisation), but we first try treating them with routine treatment procedures. We give ovary-inducing drugs, check hormonal disorders if any, and check the male and the female. We make sure everything is corrected like if they have diabetes, hypothyroidism, etc. we correct all their hormonal disorders, make sure their ovaries are fine, and the tubes are okay. 

We try for around 3 – 4 months and then if we feel that it is getting difficult for them to conceive, we only go ahead with IVF. Some cases come to us when they are at an older age around 37- 39 years old, then they don’t waste their time with routine treatments but go for IVF straightaway.

What are the different artificial reproductive technologies?

Besides IVF the other artificial reproductive technologies are ICSI(Intracytoplasmic sperm injection) PESA(Percutaneous Epididymal Sperm Aspiration) where, and TESA(Testicular sperm aspiration), surrogacy, egg donation.

We have some patients who hardly have any sperms or eggs, so we use a different technique, in that case, called ICSI, where we take one sperm, and one egg and artificially fertilise it. If there is a woman who hardly has any eggs left in her ovaries, or the eggs are not of good quality, we use donor eggs in such a case, Same goes for the husband, if the sperm is not good enough we use donor sperm. We first try with their eggs or sperm, but if it doesn’t work we have to use a donor egg or sperm.

However, before we do the process we explain everything to them and take their permission. If they agree, they have to sign a consent, since the DNA will change when we use a donor. 

Then there is surrogacy. Some women have a damaged uterus or are born without one, she might have had TB in the uterus, etc., or a medical problem like a severe liver disorder, a heart disease, or a history of cancer, and cannot carry a pregnancy but wants to carry her baby with her genes, that’s when they go for surrogacy. 

That way they don’t have to bear the brunt of the pregnancy but the baby will still have her genes. These are the instances where surrogacy is used and it is very helpful for women who have medical problems and cannot carry a pregnancy.

Though there is a uterine transplant available and children have been born from that, it is very tedious and has so many problems attached to it, that not many clinics do it. I feel surrogacy is a better option.

How effective is assisted reproductive technology?

There is never 100 per cent surety. Sometimes even after repeatedly trying, there is never a 100 per cent surety that a patient will get pregnant, therefore we always counsel the person, and give them an idea before we proceed. A lot of the times when these pregnancies are not successful, we do advise them to adopt, some have taken the advice and are happy, but some want their genes, and also since adopting a child is not an easy process.

Are there any risks associated with IVF? What should couples who want to consider IVF keep in mind

Not risky, chances of risk are very rare. If the centre treating you is careful, the chances of complications are very low. Having said that, yes, it is taxing sometimes, taxing in terms of time, money, and emotions. These are some of the reasons people sometimes get stressed, so we always like to counsel our patients and keep them in the loop.

We explain everything in detail to them before they go ahead. Women who opt for IVF need to keep these in mind for the process:

• There will be investigations to know if they are okay.
• There are about 10 to 12 injections that they need to take. 
• They will be monitored by ultrasound.
• They have to undergo some hormone tests and might have to undergo anaesthesia to get their eggs out. 
• They have to have time because there will be multiple clinic visits so they need to plan their time and schedule accordingly. We organise their schedule in such a way that they are not stressed about it.
• They have to be mentally prepared.

What is your advice to couples who want to have a baby via assisted reproduction? 

When you are going to a fertility clinic you must understand the ethos of that clinic. Select what you are comfortable with and not go by what you see, hear or read.

Remember any clinic that gives you a 100% guarantee, you must know that clinic is fibbing! In short, make sure you choose the right clinic.

How would you describe your association with Baby Chakra?

I think it’s been a good association and you guys are doing a great job.

Image Source: Dr Duru Shah