Subha (not her real name), 35, had been married for over 10 years, but was still childless. Doctors attributed this condition to her husband's low sperm count. Her craving for motherhood drove her to three infertility clinics in Kolkata, West Bengal, where she underwent several insemination sessions. Sadly what she conceived was not a new life, but the germ of death -- HIV
subha (not her real name), 35, had been married for over 10 years, but was still childless. Doctors attributed this condition to her husband's low sperm count. Her craving for motherhood drove her to three infertility clinics in Kolkata, West Bengal, where she underwent several insemination sessions. Sadly what she conceived was not a new life, but the germ of death -- hiv. Today, she is the 15th victim in the world -- and probably the first in Asia -- to contract aids through artificial insemination.
Subha is currently undergoing treatment at Kolkata's School of Tropical Medicine (stm). According to doctors at stm, the aids virus entered her body through one of the sperm donors' infected semen. This could have happened at any of the three clinics in the city in which she had undergone six artificial insemination sessions. "Between 1997 and 2002, sperms from donors were implanted in her ovary at these infertility clinics. But she failed to conceive. It was then that the couple approached a non-governmental organisation (ngo) for adoption. The ngo recommended hiv and Hepatitis-b tests. In August 2002, Elisa tests conducted on the couple showed that Subha was hiv-positive while her husband was negative," reveals Dhrubo Neogi, head of stm's virology department.
Neogi suspects that one of the three clinics (he refuses to divulge their names), in all probability, did not screen the male donor for hiv properly (see box: Highly vulnerable). "The probability that the woman contracted the hiv virus from any other source has been ruled out, because neither had she undergone blood transfusion nor did she belong to the high-risk group," points out Neogi. "Moreover, we cross-checked all her medical reports (before she went in for artificial insemination) and found them to be negative." She has been declared hiv positive on the basis of three tests -- Elisa, western blot and polymerase chain reaction, adds Neogi.
The case was first reported in the Indian Journal of Pathology and Microbiology in January 2003 and was only recently revealed to the media. Kolkata-based infertility expert Baidyanath Chakraborty feels more investigations are necessary before the blame can be pinned on the clinics.
Sperm banks are required to test the blood of a donor and 'cryofreeze' (preserving the semen in extremely low temperature) the sperm for six months, after which it should be tested again. As it takes at least three months for the aids antibodies to develop, the donor should be tested again after six months during which the semen is preserved. "All body fluids should be tested before being transplanted. We have asked the state aids control agency to look into the matter," says a senior official of the National aids Control Organisation (naco), the nodal body for monitoring the disease in the country.
As per the National hiv Testing Policy, a clinic can follow any of the three strategies specified by naco. The first pertains to the donor being tested only once with a very sensitive kit. The second involves a repeat test where a symptom surfaces or there is suspicion about the person being hiv positive. Under the third strategy, if the individual is asymptomatic but in the high-risk group, the test is conducted thrice. Those considered susceptible to the disease include truck drivers, drug addicts and sex workers.
At present, there are no regulations in the country for keeping tabs on clinics conducting artificial insemination. The draft guidelines for Assisted Reproductive Technology (atr) clinics, issued by the Indian Council for Medical Research (icmr) in September 2002, recommend carrying out artificial insemination using only frozen donor semen. It should have been quarantined and its donors tested twice for hiv/aids, hepatitis and syphilis.
It is difficult to control these clinics, as even their numbers are unknown. Since no special equipment is needed for it, anyone can conduct the procedure. "Roughly 10 per cent of males in the reproductive age group are infertile. In such cases artificial insemination can prove useful for the couples," says Anoop Gupta, infertility specialist, Delhi ivf and Fertility Research Centre.
In the meantime, West Bengal's health department has said that the fertility clinics would be investigated to check if they are following the stipulated process of storing the sperm. According to C R Maiti, state director of medical education, artificial reproduction clinics in the city were registered as ordinary clinics till now. "Henceforth, they will have to be re-registered as 'artificial reproduction clinics'. We admit to glaring lapses in the system," adds Maiti candidly.
With inputs from Vibha Varshney in New Delhi
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