`IVF treatment should be advocated only after thorough screening’

Dr Ken McElreavey, head of reproduction, fertility and populations unit, Institut Pasteur, Paris, which specialises in research into genetic causes of infertility was recently in India to lecture in various cities. Speaking to Soumya Viswanathan during his recent visit to Mumbai, he stressed on the importance of research in genetic causes of infertility.

How important is genetic research in infertility for India?
Research is important to understand the underlying genetic causes of infertility. In India, with the in vitro fertilisation (IVF) clinics flourishing, the thrust is clearly only on treatment and very little is being done to establish the cause. If we identify the causes, we can prevent failure of IVF pregnancies. Prognosis for each individual then, would be different and management of patient can change. Success of IVF could be subsequently increased.

Can you elaborate on how establishing genetic causes of infertility will help?
Couples who cannot have children are not screened for problems. Instead, they are directly started on treatment. In such cases, still-borns, recurrent abortions, etc., will continue. Only when you know the changes in chromosomes, can you prevent these.
Screening the couple for genetic patterns is essential because genetic tests can change the prognosis of treatment. Assisted Reproduction Technology (ART) can be more successful and a lot of money can be saved. For example, in recurrent abortions, rearrangement of chromosomes could be the cause of failed pregnancy. If analysis is done, doctors could select embryos for implantation or see that foetus receives part of the chromosome. We can prevent a lot of trauma and unsuccessful IVFs.

What could be the causes of infertility?
I am not sure what it could be in India but there could be environmental causes like pollution, causing genetic mutations. In terms of pure genetics, 10 per cent of couples who seek treatment have rearrangement of chromosomes. In Europe, 5 per cent of all births is by way of ART. Sperm count has decreased by 2 per cent in Paris and 2.6 per cent in UK. You can calculate the decrease in sperm count after 20 years mathematically and see how many more couples will need ART.

Are the couples screened for problems in Europe?
In Europe, if a couple is undergoing IVF related treatment, there is analysis of chromosome at general level, karyolytic and specific mutation. In many countries, this is obligatory. Genetic aspect is large, nearly, 60-70 per cent. But the problem is not sufficiently evaluated here.

What are the latest research projects undertaken at Institut Pasteur?
We are doing research on population genetics. We are trying to understand cases where we don’t know the molecular cause and therefore analyse the entire population. We take all men with infertility, define Y chromosome they have, compare with Y chromosome of general population and find the difference. Research is relatively easy to do. But nobody is motivated to do research. People must understand that the underlying causes will become more important to investigate with more couples going for ART.