OASIS collaborates globally to tailor treatments for Indian patients: Dr. Durga G Rao

Beyond Treatment: OASIS Fertility’s Comprehensive Approach to Reproductive Health

Dr.Durga G. Rao, Co-Founder and Medical Director at Oasis Fertility, is a distinguished pioneer in reproductive medicine and minimally invasive surgery. With over 18 years of experience across the UK and Canada, she has significantly advanced the field of In vitro Maturation and Fertility Preservation. Dr.Durga’s work at McGill University and Oasis Fertility has set new standards in Assisted Reproductive Technologies(ART), enhancing patient care and success rates.

Educated at Andhra University with further qualifications from the Royal College of Obstetricians and Gynaecologists (MRCOG) in the UK, and a Fellowship from McGill, her contributions have shaped global fertility practices. Since returning to India in 2009, Dr.Durga’s mission has been to expand access to cutting-edge fertility treatments, transforming the lives of countless families. In this exclusive interview with Rashmi Kumari of NSH, she discussed many issues including advancements in IVF, patient care strategies, and fertility research.

Dr.Durga, how does Oasis Fertility stay up-to-date on the latest advancements in the field of fertility treatments?

The team we have at OASIS has been assembled with a lot of thought, and we take academics very seriously. In the sense that, all the consultants employed at OASIS Fertility have undergone proper fertility training and fellowships before joining Oasis. We then further their knowledge and training. This is very important because this field is quite nascent, only about 45 years old, as the first baby was born in the mid-70s.

Being this young in the field, there’s a lot that has happened over the last few decades that has brought us to the point where the success rates have actually doubled in the last decade to two decades.

There’s a lot that has gone into the innovations in fertility to reach this stage. It’s not just about understanding human physiology, the endocrines, how the ovaries work, how the sperm works. Gaining more knowledge about these has enabled us to modify the hormones to our benefit, to gather more eggs so that we create more embryos, which can lead to better fertility and success rates.

For instance, the first child, Louise Brown, was born with just one egg. Right now, we are at a stage where we are extracting anything from 8 to 10 eggs and above if the woman is young and has a good result. Things have dramatically changed, and that change has happened because of a lot of research, knowledge sharing, and understanding about human physiology. All of this has led us to this point.

In addition to that, it’s also about the interest that a lot of gynecologists are showing in the field nowadays, and rightly so, because fertility is increasing. Previously, about 10% of the people who visited the clinic had fertility problems. Currently, with any gynecologist, at least 30% of the patients are for fertility.

Can you elaborate on how the changing fertility rates in India impact the broader socioeconomic structure, especially in light of the country’s demographic shifts?

In a country like ours, though people would say that we are the most populated nation in the world, why are we still thinking about fertility? Now, this is where it’s very important to understand, you need to have a fertility rate of at least 2.1. That’s the basic. So that way, your population is well balanced. You have a good younger generation, middle-aged generation, and an older generation. It’s the work that the younger generation and the middle-aged people do that takes care of the economy of the country and that’s what helps in the pensions for the older age.

For this balance to happen economically, you need to have the right amount of people in the right age category. And if the fertility rate is not 2.1 and it gets lower, what tends to happen is it gets skewed. You have more older generation than the younger generation. Who’s going to do the work? How is the economy going to improve? How are innovations and how is the country going to go forward in all directions? That cannot be possible.

So in our country, what is actually happening is, except for about 4 or 5 states in the whole of India, everybody else is lesser than this 2.1. So even though right now we don’t see a major change, if this continues, the next generation will be severely affected. As you know, a lot of young people are delaying marriage, even if they do get married, they’re delaying having children, so all of this is actually causing such a huge problem in terms of the fertility in the country.

How are you addressing the gap in fertility education among young women, particularly regarding the concept of the biological clock and the potential of egg freezing as a viable option for planning future pregnancies?

A lot of awareness is required in this aspect and women have to be told. Initially, or rather in schools, the education was such that the girls were told how to avoid pregnancies.

A lot of information and education was going about contraception, which is very good. I think that’s how we have managed to stem teenage pregnancies, illegal abortions, complications, and septic abortions. Healthcare has improved significantly because of this education. But now we also have to swing to the other end of the pendulum and discuss with the younger generation in schools and colleges about how fertility is age-related. Women don’t seem to understand that there is a certain biological clock, and we have to be aware of it. We are not saying that everybody should conceive before they hit 30, no.

But right now, the technology is such that, coming to the question that you had about the latest advances. So now we are educating our gynecologists, our colleagues, our other fraternity, and even the generation in terms of social media and other things is that women have the possibility of actually vitrifying and freezing their eggs so that they can choose to have children at a later age. Because when you are in your late 20s or early 30s, the quality of the eggs that you have is much better than what it would be in your mid-30s or late 30s, isn’t it?

So getting to that stage and then wanting to have a child but having difficulty conceiving is not a very pleasant position to be in. So we advise that if you are planning to have children in the late future and not currently, then look at this concept of freezing your eggs so that they won’t have difficulty later on as you are growing older, you will still have a genetically normal child. Less chance of miscarriage, more healthy child. So once you are emotionally and financially capable, that would be the right time for you to have a child, that’s fine. But look at all of these precautions before.

Can you describe the specific strategies your clinic employs to enhance male fertility, particularly in light of the rising challenges posed by environmental and lifestyle factors?

Well, now another advancement is, we are very ahead in terms of research. So we have a lot of papers and publications that come from our institute because everything that we do is evidence-based. And like I said, because this is such a new thing, a lot of information is still required. Now one aspect is sperm selection. Now sperms, as you know, are in millions.

So, how do you select that one particular sperm that is likely to lead to a pregnancy, a healthy child, when you have millions to choose from? We devise ways in which we are able to understand the different methods of sperm selection, how we can pick the right quality sperm to improve embryo quality, reduce miscarriages, and have a healthier child. A lot of our focus is also on male infertility. Previously, we used to say 30% of infertility was because of the man. But currently, due to lifestyle, environment, pollution, and habits like smoking, alcohol, binge drinking, drugs, and others, the quality of the sperm is also falling.

What tends to happen is that male infertility is increasing and people don’t realize that. There are a lot of contaminants in all the foods that we are eating, the water we drink, everything is plastic. All of these are actually called endocrine disruptors and these actually change the endocrine environment in the human body and that has impacted male infertility quite a lot.

We take great pains and we have a dedicated male fertility clinic as well where men are seen for their problems. It’s not as if the woman comes, we do IVF and they cancel it and go. No, we actually provide what is required for the male as well. We do a complete evaluation. We see how best we can improve their lifestyle. It’s not just about having a child. It is about the rest of their lives also being healthy.

So we give them the right kind of dietary advice, tell them about all the contaminants and pollutants that they should avoid and how to have a more healthy lifestyle, educate them about smoking, alcohol and all the effects. And even though everybody is sedentary now, you have a lot of gyms, but how many of them are actually… People pay the subscriptions, but how many of them actually go and utilize the services. So, all of this education is very important as well. So we help in that as well.

How do you address male infertility?

We have a specialized clinic for male infertility, AndroLife. In this clinic, all our patients are seen by qualified andrologists in a program we’ve named AndroLife. We’re committed to helping the community by involving both males and females in the process, providing them with the necessary psychological comfort, advice, and support.

Another significant aspect for us is our lab. This is where most of the technical work is carried out. We are very clear about our transparency in how we want to proceed. We understand that this is a sensitive and emotional journey for our patients. We ensure that patients do not have to worry about mix-ups or losses, providing them with the confidence they need.

We use various methods to achieve this, including an electronic witness system. This reassures patients that things are progressing well in the lab. We also use the latest equipment, which helps us achieve the best success rates.

Could you elaborate on the advanced reproductive techniques and technologies, such as blastocyst transfers and pre-genetic counseling, that OASCIS Fertility employs to improve IVF outcomes and ensure genetic health in offspring?

We are pioneers in terms of blastocyst transfers. We’ve been practicing this for years, even though others are just now catching on. We also offer pre-genetic counseling and PGT variant, a step up from IVF. This helps in selecting an embryo that is genetically complete and normal, leading to a healthy child without any abnormalities.

For people who have genetic problems in their families, we can eliminate that disease from their lineage, ensuring a disease-free next generation. We’ve been doing this for the last 10 years. We were the first to start in the state and in the south of India.

We are capable of performing all the advances that are possible anywhere in the world. In fact, we offer certain treatments like In Vitro Maturation (IVM).

This was a project I undertook during my fellowship in Canada 20 years ago. We have imparted this knowledge at Oasis, the only clinic in India that performs In Vitro Maturation (IVM) using the latest methodology. This is possible because we are in collaboration with the University of Brussels in Belgium, who initiated this project. We are currently working on a project involving IVM, which is beneficial for fertility preservation.

There are two aspects to this. Firstly, people diagnosed with cancer often undergo treatments like surgery or chemotherapy, which can cause their eggs to shrink, leading to premature menopause. This can prevent them from having children later in life. To address this, we perform a procedure called IVM. Without administering a lot of medications that might impact their malignancy, we extract the eggs, mature them outside in the lab, and then freeze the mature oocytes. This technology is not currently being used by anyone else in India.

We have already treated about 50 patients using this method and plan to publish our data. This is one of the new things we are doing. We also focus on prevention aspects. For instance, we have managed to control breast cancers to some extent through monitoring mammograms, breast screening, cervical screening for cervical cancer, and so on.

Can you discuss how lifestyle factors influence fertility and the specific educational initiatives OASIS Fertility is implementing to address these issues within the unique context of the Indian population?

We trying preventative actions even to reduce infertility. Infertility has a lifestyle implication which needs to be addressed and patients needed to be educated about change in diet and sleep, exercise and work life balance. A campaign from government, gynecologist society and media intervention is required to spread the message to common people to increase awareness about the detrimental effects of our lifestyle on fertility.

We are striving to provide information that can help people change their lifestyles, not just in terms of fertility, but in general. We believe that healthier parents will have healthier children, and we are keen on disseminating this information as we move forward.

This field is continuously advancing, and we contribute to research and science. We also collaborate with different countries because the Indian population is unique. What works for women in Europe or the US may not necessarily work for Indian women due to differences in genetic structure, environment, and genes. Our response to treatments and our success rates could be very different.

Unless we study our population and understand what works for us, we cannot bring about changes in our society. Our aim is to have a healthier, more prosperous India. India is one of the most populated countries and is economically sound. We want to contribute to making this nation healthier and further its progress. This is our commitment and our mission. We are dedicated to this cause and will continue to work towards it.