Lahore: Fertility issues mean big business in Pakistan. Fertility centers have been set up in all major cities and they are doing thriving business, thanks to no official regulatory checks.
The idea that a man is supposed to procreate is paying. And to gain immortality one has to pass one’s genes by having children, but, unfortunately, this doesn’t always work because of various reasons, particularly biological. At this point, these fertility centers tread their foot to make impossible possible. Flamboyant ads having pictures of beautiful babies with doctors and quacks offering help to issueless couples adorn dailies and magazines. Some take a step forward and run ads on electronic media with the help of local cable operators.
Besides these state-of-the-art setups, there is a murky world of amulet givers and faith healers who promise one a guaranteed male progeny. These so-called healers generate revenues for dailies by giving them regular ads. They are frequented by couples having monetary issues and those who cannot afford these un-Islamic fertility treatments, as they call it. For some couples, results are horrendous when they submit to the will of the so-called healers.
The first IVF facility in Pakistan was set up in the mid 1980s by Dr Rashid Latif Khan in Lahore. He was the one who delivered Pakistan’s first test tube baby in 1989.
Offering hope, the number of IVF centers is increasing so do the patients who want to opt for In-Vitro Fertilisation (IVF) treatment. Though there is no official database of test tube babies in Pakistan, estimates suggest some 5,000 babies were born through IVF in the country.
Prof Dr Saqib Siddiq, a topnotch obstetrician, gynecologist, pioneer infertility specialist, IVF, ICSI consultant and member of the team that delivered the first test tube baby in Pakistan who runs a state-of the art Saqib Fertility and IVF Clinic at Mid City Hospital, told News Lens Pakistan that fertility centers are giving a ray of hope to issueless couples. He says awareness about fertility treatment is growing and misgivings about IVF treatment are waning. This, he said, can be judged from the number of patients visiting these centers. Still there is a lot to be done.
He says there are two things that need to be understood when one talks about fertility issues and awareness about them in Pakistan. There are two categories of people —- first who know fertility treatment is available and second those who know about treatment but are stuck in morality and religious debates. People in the second category strongly believe that infertility treatments are un-Islamic. They refuse to budge an inch from their beliefs and are not ready to listen to any argument in his regard.
“Illiteracy, lack of education about Islamic edicts and rural backgrounds are major barriers to the people thinking negative about fertility treatment. Role of religious scholars to create awareness among these people is vital. They are the people who control destiny of their children when it comes to fertility treatment. Couples visit us with the desire but they are forbidden by family elders or parents from undergoing fertility treatment. Some disobey them, some submit to their will. It’s still a taboo that has to be broken.”
Raising an important point, Prof Saqib says test tube baby is actually a misnomer and it was derived from the 19th century novel The Brave New World written by Aldous Huxley. In the novel, he talks about a baby raised for nine months in a tube and delivered to biological parents after birth. The part that sperm and eggs of the couple were taken and unionized in a plate is relevant to the IVF. But raising a child in a tube for nine-month cycle is not possible though attempts have been made in the modern world but failed.
He says the concept of IVF is widely misunderstood in Pakistan. He said In Vitro Fertilisation (IVF) is an assisted reproductive technology (ART) that helps women become conceive. He says the procedure, in simple words, involves fertilising an egg outside the body in a laboratory dish and then implanting it in a woman’s uterus. The rest is in the Almighty’s hands.
Prof Saqib says the biggest misgiving in the mind of people opposing the fertility treatment is the paternal issue. The question of mixing up does not arise because there is no system of sperm donation and surrogacy. This needs to be understood. Couples do visit looking for alternatives but that is not possible in Pakistan for being un-Islamic.
About gender selection, he says: “We do that for couples having three or four daughters. We have ethics and norms. We don’t do it for couples who just want first male child.”
Replying to a question, he says there is so far no official check on fertility centers. The government is contemplating to bring these centers under supervision. He says for a mega city like Lahore, there has to be at least 50 fertility centers. Since the infrastructure is so costly, there are only five centers working in Lahore. These centers work under able supervision and have state-of-the-art facilities and expertise.
Prof Saqib, who is also Scientific Committee chairman of the IVF Society of Pakistan, claims IVF is cheaper in Pakistan than other countries. One can get it done for one third the price that in Dubai. The US and UK are too expensive. In Pakistan, cost of IVF treatment is around Rs300,000 which is still out of the reach of many middle and lower middle class couples.
Talking to News Lens Pakistan, Gynecologist Dr Ayesha Khan says Islam is a progressive religion and in the early 1980s, Egypt’s Al Azhar University had issued a fatwa stating that IVF could be used by infertile couples who were legally married.
“What we practice here is completely Islamic. There is no third person involved and eggs and sperm from married couples are used for fertilisation. The concepts of IVF surrogacy, in which another woman offers her uterus for pregnancy, and egg donation, however, are considered un-Islamic and are banned in Muslim countries.”
Agreeing with the notion that fertility centers are doing a roaring business, she says the number of these centers is growing which is heartening but a matter of concern too because there is no official mechanism to check the veracity of the claims of these fertility centers.
Ruling out misgivings about IVF, she says lack of education and awareness makes IVF controversial in Pakistan. She says the biggest concern is shown about mixing up of sperm and eggs of a third party which holds no ground, as there is no donor system in the country.
The Council of Islamic Ideology has allowed test tube babies under certain conditions. Furthermore, it maintains that gender selection is not prohibited in Islam and it can be done within the limits of Shariah.
CII member and Pakistan Ulema Council chairman Hafiz Tahir Ashrafi explains that IVF is permissible if the sperm and eggs belong to a married couple.
“It’s an innovation and if it is done within the parameters set by Islam, its fine.”
He says that surrogacy and donation, where another woman’s womb/eggs or another man’s sperm is used, is not at all permissible.
Talking about the option of gender selection, he says that although the CII is not against it, the move must be discouraged.
“In our society, girls are looked down upon and if this selective trend is allowed, it is not a good omen. The logic that IVF gender selection is not like abortion is pointless. In our society, no one wants a female child and if the concept of gender selection due to IVF gets hold, it won’t do much for our girls.”
He urges the medical community to think morally and ethically and not make financial gains the sole prerogative.
In a report issued by the International Committee for Monitoring Assisted Reproductive Technologies (ICMART) in 2012, five million babies were born around the world after IVF and other assisted reproductive treatments. However, the report also noted that “major barriers to access are economic and societal in some situations.”
Taking to News Lens Pakistan, Sana, a housewife who underwent IVF treatment in one of reputed centers in Lahore, says she couldn’t conceive in her maiden IVF attempt. She says she had other procedures in different centers prior to IVF that too remained unsuccessful. She says she doesn’t blame anybody but thinks she might have conceived had she been to the UK or US.
An expat, Maryum, has a different experience to share with the News Lens Pakistan. She says she was unable to conceive after five years of marriage. Tests and treatments she underwent abroad were very expensive and she started to look for low-cost options. She finally decided to head to Pakistan as IVF is cheaper here. The country has given me a child and in a way restored my ‘identity’ as a creator.”
Despite her successful treatment, she says she prefers to keep a mum about the subject of infertility at family events in Pakistan. She says that IVF is still considered a taboo and says that she and her husband have decided to stay quiet on this front.
“My mother-in-law would often make fun of a relative’s children who were conceived after IVF treatment.
According to a research paper ‘Risk Factors for Secondary Infertility among Women in Pakistan’, the prevalence of primary (where a couple never had a child) and secondary infertility (inability to conceive for one year after having conceived at least once before) is nearly five per cent and 18 percent, respectively, while the global average hovers around 10–15 percent..