The Independent,
Ranjna Majumdar/ Mumbai

For 56-year-old S Singh from village Barddi near Patna it was a tough decision. Doctors declared that his sperm count was too low to impregnate his wife, while social pressures decreed that he and his wife produce a child soon. So without informing his family about the real reason of his trip and with many personal misgivings, he and his wife came to Mumbai and checked into a fertility clinic. Two months and three cycles later his wife was pregnant thanks to some donor sperm. While Singh was happy about the pregnancy, he was honest enough to admit his frustration at not being the biological father. "It is something that I will have to learn to forget," says he.

S Singh like millions of other Indian men suffers from testicular failure which means that there is no sperm present in their semen. Testicular failure attributed to undescended testes, physical trauma to the testes, to mumps and to several other inexplicable reasons, is the main reason that these men have to resort to donor sperm. However, research over the past few years has shown that despite the absence of sperm in their semen, these men do produce immature spermatozoa in their testes. This immature spermatozoa, if retrieved and injected into the egg, can achieve fertilization and normal development of the embryo. "The technique has revolutionised the whole field of assisted pregnancies," says Dr Anirudh Malpani, of the Malpani Infertility Clinic where the technique was introduced a week ago. The clinic has already reported 11 successful fertilizations so far thanks to this new medical procedure called ICSI (Intra Cytoplasmic Sperm Injection).

Under ICSI, sperm or their precursors, spermatids, are extracted directly from the testis. This is a minor surgical procedure which is done under local anaesthesia. The testicular tissue is then processed in the laboratory and sperm are recovered from these. One of these sperm is then injected into an egg, to achieve fertilisation. In the tests conducted so far fertilization rates in the range of 60 per cent have been achieved - which means that of 100 micro-injected eggs, 60 formed embryos after ICSI. The pregnancy rate in one ICSI cycle is absent 25 to 30 per cycle ie chances of an embryo so created after ICSI growing into a baby are about 25 to 30 per cent "which, says Malpani, "is the success rate in normal pregnancy."

Talking about the possibility of ICSI taking over as the preferred procedure over donor inseminations, Anirudh Malpani says, "Of course all couples would prefer ICSI rather than DI. But the problem here is of finances, each cycle costs about Rs 80,000 as opposed to Rs 50, 000 for DI." Couples like S Singh however are willing to bear the cost, says S Singh, "If my wife permitted I would like to go in far a second child using ICSI." It is a feeling echoed by many young couples looking to add their own bit of eternity to this world.

Authored by : Dr Aniruddha Malpani, MD and reviewed by Dr Anjali Malpani.

Open Video