IVF An Innovation-Driven Blessing for the Childless

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the premier monthly magazine on the enterprise of healthcare in asia & the middle east volume 13 / issue 12 / DECember 2018 / ` 100 / US $10 / ISSN 0973-8959

COVER STORY

IVF

An Innovation-Driven Blessing for the Childless

ealthcare

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december 2018 | Volume 13 | Issue 12

COVER STORY

IVF

An Innovation-Driven Blessing for the

Childless IVF Specialist Perspective

08

Spotlight: Delhi Gynaecologist Forum

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16

Dr Prassan Vij

Dr Sharda Jain

Senior Specialist & Head, Reproductive Medicine Unit, St. Stephen’s Hospital, New Delhi

Founder & Secretary General, Delhi Gynaecologist Forum (DGF)

technology Perspective

industry Perspective 20 Dr Minnie Bodhanwala

14 Dilip Patil

Managing Partner Trivector Biomed LLP

26 ABINAYA

Aosta Software Technologies India Limited

30 Dr Sonia Malik

Programme Director IVF Max Healthcare

guest article 22 Dr Gunjan Saxena

IVF Specialist Apollo Cradle

49 Corporate Updates 50 News Updates

CEO

Wadia Hospitals

28 Dr Abha Majumdar

Director and Head of IVF Sir Ganga Ram Hospital

48 Dr Aradhana Kalra

Consultant IVF QRG Central Hospital

conference report When Healthcare Leaders Mulled Finest Innovative Practices

31

Editorial IVF – A Synonym of Hope for the Childless IVF or the In-Vitro-Fertilisation is fast becoming a well-known term, especially among young couples in urban India. Understanding the impact of various lifestyle related challenges and other factors on internal health, there’s a growing understanding to try IVF for expanding one’s family.

Also, a lot of IVF centres have come up in different parts of the country, offering various options for the dejected couples in the present times due to innovative technologies. Due to rising number of infertility related issues among recently wedded couple, In-Vitro-Fertilisation has become a boon, giving a ray of hope to have their own biological child.

In this light, eHEALTH magazine in its latest issue has attempted to focus on IVF, which is emerging as a big option due to innovations, understanding and growing affordability of youth in urban India.

Through our cover story “IVF—An Innovation-Driven Blessing for the Childless”, we have tried to explore and explain the IVF as a concept, its need, the available options and what experts’ think of it. It highlights how despite faced with infertility there shouldn’t be hesitation to try it, away from social stigma.

We have also touched upon various aspects of Artificial Reproductive Technology (ART) and how India is making big stride on this novel reproductive technique.

In an article titled “Latest Trends of Assisted Reproductive Technology”, Dr Gunjan Saxena, IVF Specialist, Apollo Cradle, explains how Assisted Reproductive Technology (ART) has made immense strides since the first live birth following In-vitro-Fertilisation (IVF) in 1978.

The magazine also carries insightful interviews of experts who have shed light upon the IVF industry.

Dr Prassan Vij, Senior Specialist and Head, Reproductive Medicine Unit, St. Stephen’s Hospital, New Delhi, says there is a need to work and make IVF an essential part of healthcare, rather than a luxury treatment, where there is limited government support in drug pricing.

Dilip Patil, Managing Partner, Trivector Biomed LLP, says we are helping labs in quality control and monitoring important parameters like Co2, PH of the media, and temperature.

The magazine also carries a conference report of recently held “Elets Healthcare Innovation Summit” where top policymakers, international experts, and Industry experts deliberated on how to leverage latest innovative solutions to enhance patient care.

With such a wide variety of interesting special articles, interviews, stories and much more, we hope to evoke an invaluable feedback from our esteemed readers. Wishing you all a Happy and Healthy New Year!

Dr Ravi Gupta Founder Publisher and CEO, Elets Technomedia Pvt Ltd & Editor-in-Chief eHEALTH Magazine ravi.gupta@elets.in

cover story

IVF

An Innovation-Driven Blessing for the

Childless

Call it the effect of immense stress, modern lifestyle, late marriages or surging pollution, the problem of infertility seems to be badly gripping young couples in India. But thanks to In-Vitro-Fertilisation technique, popularly called IVF, a big hope today prevails for people, writes Sandeep Datta of Elets News Network (ENN).

I

nfertility is when a couple cannot conceive despite having regular unprotected sex. Though the reason could be anything from a range of disorders or lifestyle factors, fertility problems cannot be explained in around a third of cases.

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December 2018

The Bright Side Nearly three decades after the first test tube baby – Harsha -- was successfully delivered in India, the country’s IVF industry has been reportedly evolving up to global standards both in terms of quality and business growth.

With the proposed Assisted Reproductive Techniques (ART) Bill addressing many of the ethical issues related to IVF treatment, donor programmes and in tandem with Surrogacy Bill, IVF business is showing rapid growth in the country.

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The IVF market – The Scope By 2022, the country’s market for InVitro Fertilisation (IVF) is expected to grow to Rs 500 crore, as an increasing number of childless couples adopt artificial medical treatment to achieve blissful parenthood, a media report in a leading daily stated earlier this year.

As per UN estimates, India is expected to emerge as the most populated country in the world with nearly 150 crore people by 2024.

Clearly, while infertility is increasing among resource-rich people, the lower income groups could contribute more to the population explosion.

Growth of Infertility (Assisted Reproductive Technology) Centers Be it medical advances, medical reasons, or social factors, there is reportedly a fast growth in the country’s IVF market. a) While mentioning about medical reasons, late marriages, postponing child-bearing due to career / professional needs and financial reasons, lifestyle issues – alcohol / smoking / obesity can be classified as key factors making it difficult to conceive. b) Today, as far as “medical advancements” are concerned, more options are available and the access is getting better. Advanced treatments have made it possible to tackle more varieties of fertility problems. c) When it comes to “social reasons” infertility still remains a stigma, the need for a baby is very high. The patient awareness is increasing. With different celebrities accepting to have availed fertility treatments, social

By 2022, the country’s market for In-Vitro Fertilisation (IVF) is expected to grow to Rs 500 crore, as an increasing number of childless couples adopt artificial medical treatment to achieve blissful parenthood

cover story

The Big Challenge Of the many challenges, a key fact is that we do not have enough ART centres. We need more doctors who are trained well enough to carry out the complete IVF practise.

Surrogacy – A Hope for Childless Couples

acceptance of the IVF treatment will continue to consolidate.

Citing a study by Inito, a Bengaluru-based medical technology company creating the next-generation portable diagnostic devices, a media report stated earlier this year said that about 27.5 million couples are suffering from infertility and actively seeking children. Also, at least 10-15% of married couples are experiencing fertility issues,

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The rising rate of infertility among the well-off families is opening new opportunities for surrogate mothers.

These women come from lower income groups to earn a decent amount for their own naturalborn children.

In an interview with leading daily, Sarthak Bakshi, CEO, International Fertility Centre (IFC), a network of 10+ IVF clinics located in India and Nepal, shared: “On an average, we get 10 surrogacy proposals from such young women everyday, or nearly 4,000 per annum. We have them tested for medical fitness before they could become surrogate mothers. In return, these needy women get around Rs 5 lakh for renting their womb.”

Such money is deposited directly into these women’s bank accounts to enable them to plan in a better way for their kids’ future.

But surrogacy is not the only option as a medical treatment for childless couples to start their family.

A lot more methods exist to facilitate couples to become parents at a cost of about Rs 1.5 lakh to Rs 2 lakh per couple.

“The IVF market is growing at a CAGR of 28 per cent, and is expected to be around $775 million (Rs 495 crore) by 2022 in India,”

eHEALTH Magazine

december 2018

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cover story

the CEO of IFC added. To utilise the opportunities of this expanding market, IFC plans to set up 26 new fertility centres by 2020.

Denmark – Where IVF is a new norm of life Despite initial attempts to limit access to treatment, Denmark is today known for having the biggest proportion of babies born through assisted reproductive technology (ART) in the world.

As you visit any park in Denmark, it is likely that you may come across many of the children playing there born using IVF or donor sperm.

Denmark leads the world in the use of ART to build families - an estimated 10% of all births involve such techniques.

In Denmark, everyone is known to someone who may have gone through IVF and talking about it is no taboo.

Conversations at the school gates or even church frequently revolve around the origins of people’s children.

What’s Causing Infertility or Reduced Fertility in Daily Life?

Smoking - Studies have shown that

women who smoke take longer to conceive. Research has found the toxic chemicals in cigarettes can damage the lining of the fallopian tubes, which help transport the egg from the ovary to the womb.

Partners of men, who smoke, also have a reduced chance of conceiving as smoking can decrease the amount of sperm produced and their motility.

Drinking - Alcohol can reduce fertility in both men and women.

Among men, heavy drinking may affect sperm quality which can impact on chances of a successful pregnancy. It is not yet understood exactly how alcohol affects fertility but studies have shown drinking alcohol reduces the chances of a woman conceiving.

Body Weight – Being obese may also cause problems with conceiving. But in case you are very underweight it can be more difficult to conceive.

Being Stressed – Worry and tension can cause hormonal changes in the body, leading to fertility problems in the present times.

Timing Matters - An egg is fertilised when a man’s sperm meets the woman’s egg at about the time of

With different celebrities accepting to have availed fertility treatments, social acceptance of the IVF treatment will continue to consolidate

ovulation, which is when the egg is released from the ovaries. Women mostly ovulate once during each cycle, and the most likely time for conception is 14 days before the woman’s monthly period.

Age - Both men and women are most fertile when they are in their early 20s. While male fertility gradually declines from the age of 40, female fertility declines sharply once a woman turns 35.

Around one in three of the couples in which the woman is aged over 35, have fertility problems. It rises to two-third when she is over 40.

Hormonal disorders -- An underactive thyroid or a malfunctioning pituitary gland can cause fertility issues.

What Causes Infertility in Women?

The hormones oestrogen and progesterone control a woman’s monthly fertility cycle. An egg is released each month, as the hormone levels change. The egg then travels into the fallopian tubes which connect the ovaries to the womb, or uterus. This process is called ovulation, according to a BBC report.

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December 2018

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What Causes Infertility in Men? Male infertility is caused by abnormal semen (the fluid containing sperm that is released during sex).

Issues include: • Decreased sperm mobility making it harder for the sperm to reach the egg • Sperm with an abnormal shape, which makes it harder for them to move • A low sperm count or no sperm at all Damage to a man’s testicles can also affect the quality of sperm.

Damage can occur due to a range of problems including injury to the testicles, undescended testicles - when one or both testicles has not descended into the scrotum, infection such as mumps or gonorrhea, testicular cancer or due to surgery.

Experts Speak Health insurance can play a role in promotion of IVF segment in seeking medical treatment, says Dr Sonia Malik, Programme Director IVF, Max Healthcare, adding the health insurance will make things better for many but it will take time for people to accept health insurance per se.

“In tier two-three cities, there is lesser number of people having insurance coverage. Hopefully, this will improve with awareness.

Overall, the status of reproductive medicine in the country is improving. Regulation is need of the hour to streamline the whole process.”

Even though the success rate of IVF is 30 to 40 percent, it translates into a huge number. IVF technology is a boon for the couples who would not have been able to have their own biological children 30 years ago, she added.

cover story

In women, infertility is due to problems with ovulation in about one in three cases. Some issues prevent women from releasing any eggs, in other cases an egg is only released on some monthly cycles.

Ovulation problems can occur as a result of a number of conditions, such as polycystic ovary syndrome, thyroid problems or premature ovarian failure, which is when a woman’s ovaries stop working before the age of 40.

However, many other conditions can cause a woman to have problems with fertility. It may be difficult to become pregnant, for example, if the womb or fallopian tubes are damaged.

Another common cause of infertility is when small pieces of the womb lining are found outside the womb. This is called endometriosis and it affects around two million women in the UK.

Asked how India has evolved in terms of technology and innovations on reproductive and infertility treatment, Dr Minnie Bodhanwala, CEO, Wadia Hospitals, said reproductive and infertility treatment has grown by leaps and bounds in the last few years. India is among the leaders for ART with highest number of IVF cycles.

“In terms of technology, all modern and advanced equipments and innovations are available in India. There is an increasing trend with new IVF centres focusing on customer satisfaction and affordable cost. Access and awareness of IVF is also increasing and couples are now availing IVF services without any hesitancy.”

“New innovative models are also being developed with technology like cryo preservation for proactive family planning. In addition, preventive gene therapy is another evolving trend in terms of future of reproductive and infertility treatment. These days, more and more doctors are opting for courses in ART,” she said.

Dr Bodhanwala also said that IVF sector is still at nascent stage due to many factors like high cost, less awareness and lack of regulatory practices. “The trends are changing now and I believe with best practices, remaining challenges can be overcome.”

According to Dr Abha Majumdar, Director and Head of IVF, Sir Ganga Ram Hospital, who was part of the team responsible for the first IVF baby born in North India in 1991, out of 1.2 billion Indian population, almost 4.2 percent suffers from infertility. Approximately one percent of all infertile couples need IVF though only 0.05 percent has access to it.

“We are doing only one lakh cycles in a year whereas we need 93.3 lakh more cycles in a year. (Assessment by E&Y 2015). Therefore, the opportunity is huge. However, the gap between the one who needs IVF and those who can eventually have it, is also huge. This is not only due to financial constrains but also because of unavailability of the required technology in small towns and villages,” Dr Majumdar added.

According to Dr Prassan Vij Senior Specialist and Head, Reproductive Medicine Unit, St. Stephen’s Hospital, New Delhi, the future of reproductive medicine “looks bright”.

“We are getting the government interested in solving many issues pertaining to delivery of ‘Assisted Reproduction’ to the community.

Some stricter surveillance is also on the cards since the Indian Council of Medical Research has made many mandatory inclusions in labs providing IVF treatment. This, of course, is a good time for the patients to avail the benefits of this exciting science,” said Dr Vij.

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IVF Specialist Perspective

‘IVF Should Be Part of Essential Healthcare Treatment, Not a Luxury’ There is a need to work and make IVF an essential part of healthcare, rather than a luxury treatment, where there is limited government support in drug pricing, says Dr Prassan Vij, Senior Specialist and Head, Reproductive Medicine Unit, St. Stephen’s Hospital, New Delhi, in an interview with Souvik Goswami of Elets News Network (ENN).

Q

What drove you to choose reproductive medicine as area of specialisation?

During my post graduation days in 1996, IVF treatment was still in its nascence in India and a ‘part time’ commitment of doctors. Only a couple of specialised centers in the country had this facility. I wanted IVF to be available in every part of the country and take it to the people who could not afford the treatment.

So, with my laparoscopic expertise, which was again an expensive option then, and IVF training, I committed my services to St. Stephen’s Hospital which provides affordable IVF and laparoscopic surgery to the society.

IVF is cutting-edge technology and

we, in India, are the pioneers in the world to have so many IVF centers now. It is a logical conclusion of my 10-12 years of training at JIPMER Pondicherry and CMC Vellore.

Q

Is IVF an answer to the issues just mentioned by you? Why?

IVF is not just an answer rather it is the only option for many couples with poor tubal health, extremely low sperm counts, and unexplained infertility. Imagine helping a couple to have a pregnancy where the man has zero sperms! We dig out sperms from a Testicular Biopsy here and with a few sperms extricated we could fertilise the eggs of his wife in the

Dr Prassan Vij

Senior Specialist & Head, Reproductive Medicine Unit, St. Stephen’s Hospital, New Delhi

lab. We help such hopeless couples to have their own biological children...

Thank God, there’s IVF!

Q

In India, IVF treatment is still very costly, beyond the means of many. Should healthcare stakeholders like hospitals, insurance companies and others come forward to make IVF treatment affordable?

As a missionary hospital, we are doing a great job to keep the cost under control. Even a few government hospitals have started providing IVF treatment free of cost.

Though most of them do charge for the injections used for egg harvesting, it is still a great relief for the people who cannot afford treatment

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December 2018

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Q

What challenges exist in availing IVF treatment in India?

It is education on the patient’s part and sincerity on the doctor’s part. If the patient understands the importance of having the first child before the woman turns 35, almost 20 percent of the couples, seeking infertility treatment in the metros, won’t need any!

IVF centers across the metros should realise that every patient coming into the clinic is not an IVF patient because in many

patients the basic infertility treatment protocols can be fruitful prior to resorting to IVF. I have seen numerous normal healthy patients who actually had IVF within 6-12 months of their marriage.

Now, this is also a patient-driven demand sometimes, but the challenge is to educate and counsel the patients that even IVF is not 100 percent successful.

So, some patience on patient’s part and some counseling on the doctor’s behalf will make this a more understood branch of medicine.

Q

How do you foresee the future of reproductive medicine?

It looks bright. We are getting the government interested in solving many issues pertaining to delivery of ‘Assisted Reproduction’ to the community. Some stricter surveillance is also on the cards since the ICMR (Indian Council of Medical Research) has made many mandatory inclusions in labs providing IVF treatment. This, of course, is a good time for the patients to avail the benefits of this exciting science.

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IVF Specialist Perspective

at a private hospital. There is a need to work and make this an essential part of healthcare rather than a luxury treatment where there is limited government support in drug pricing.

Why don’t the insurance companies come forward to help?

Even though only 15% population is affected with infertility, I am sure if there will be an ‘Infertility Coverage’ that would be a great help. It will be great for the companies as well as for those few couples who eventually claim the infertility coverage.

The future of reproductive medicine looks bright. We are getting the government interested in solving many issues pertaining to delivery of ‘Assisted Reproduction’ to the community.

Some stricter surveillance is also on the cards since the ICMR has made many mandatory inclusions in labs providing IVF treatment. This of course, is a good time for the patients to avail the benefits of this exciting science

13

Technology Perspective 14

Trivector Biomed LLP – Empowering IVF in India since 1993!

Being a pioneering company in the field of Assisted Reproduction, Trivector has many firsts to its credit. Besides being the first company to establish IVF labs in India, Trivector also launched India’s first Fertility Training School (2005) and first International Sperm Bank (2008). Since last 25 years we have been helping IVF labs in quality control and maintenance of equipment, says Dilip Patil, Managing Partner, Trivector Biomed LLP, in conversation with Elets News Network (ENN).

Q

With over two decades of experience in the IVF sector, kindly throw some light on this technology. How have you contributed to this field?

IVF, popularly known as test tube baby, was at its nascent stage when Trivector was launched in 1993. There were less than 10 IVF centers then. We started providing all the services and products under one roof. We started IVF training school in India for the first time. We did it in collaboration with Copenhagen University of Denmark for first couple of years.

Many clinicians used to travel to Germany, Singapore, and Denmark and other countries abroad for getting trained on IVF techniques. We brought those specialists from Europe to India to train Indian doctors and embryologists. The Indian trainees started getting same level of training here in India. Hundreds of participants have been trained so far in Trivector Fertility School.

We realised a need to have quality sperm banking services in India and launched India’s first international sperm bank (Baby Quest Cryobank) in 2008. It has been supplying quality sperm samples to clinics and patients

December 2018

all over India as per their requirements.

Trivector was the first company which started providing readymade culture media, CO2 Incubators, Air filtration towers, Controlled rate freezers, IVF workstations, Micromanipulators, Lasers for Assisted Hatching, Polscope etc. along with technical support to the new and established IVF clinics all across India.

We made all the latest technologies immediately available for the Indian IVF community as they were launched elsewhere in the world.

Time-lapse incubation, which has gained currency recently, was launched first by us as in 2012. This special incubator allows embryos to be videographed and monitored continuously.

Experts keep a tab of how the embryos are growing without having their physical presence in the labs. Growth of embryos can be monitored remotely and appropriate decision can be taken.

Trivector has helped set-up hundreds IVF labs in India. We have been consulting the labs on quality control and troubleshooting. We are helping them in measuring and monitoring the parameters which are important e.g. CO2 gas concentration, pH of the media, and temperature of

Dilip Patil

Managing Partner, Trivector Biomed LLP

the lab equipment. We calibrate and validate the performance of critical equipment and provide preventive maintenance services.

It was a turning point in Trivector’s journey when we joined hands with one of our Danish principals in 2012 as JV partner and subsequently parted our ways in 2015 to explore new challenges and reinvent ourselves exclusively under our own Trivector brand. In addition to Human IVF, we decided to diversify into Hospital Acquired Infection control, Veterinary IVF and specialized Andrology products.

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Approximately one in six couples faces the problem of infertility. That translates to a couple of million couples who may need advanced infertility treatment in India. Even with more than 1,000 IVF centres across India, the number of ART cycles performed annually is not more than 2,00,000

Zymot Microfluidic based Sperm Selection Chips: Infertility attributed to Male factor is as rampant as Female factor. For Infertility treatment procedures, the sperm needs to be purified or washed to remove the debris and dead cells. To do so, the sperm are subjected to pipetting, mixing and vigorous centrifugation in the lab. These mechanical processes induce a reactive oxidative stress (ROS) and leads to DNA damage to the sperm. DNA damage is associated with failed fertilisation and/or possibly genetic defects in the offspring. To address this issue, we have launched Microfluidic-based sperm selection devices which are designed in Harvard Medical.

These devices which are also called ‘Lab-on-chip’, mimic the conditions of the female reproductive tract and allow the most healthy and motile sperms to reach the collection well, in a natural way, within 30 minutes. These champion sperms thus collected can be used for performing ICSI, IVF or IUI. There is no need of centrifugation, mixing or pipetting which avoids

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damage to the sperm and may lead to a healthier baby.

ColdStash Containers: With the advent of vitrification (rapid cooling) of reproductive cells, more and more labs are preserving the cells for future use. This obviously is leading to too many storage containers inside the IVF lab. In the space constrained labs in India, maintaining too many Liquid nitrogen containers has become a big issue. In association with Boston IVF, we have introduced a solution. We have specially designed containers in which you can store between two to five times more number of patients’ samples without sacrificing the lab space. This also saves on consumption of Liquid Nitrogen and the hassles associated with it.

Technology Perspective

Q

What technologies have been recently launched by you to improve clinical treatment in IVF segment?

In tune with our philosophy of offering new products to add value to improve IVF outcome, we have recently launched a few innovative products.

Novaerus Air Sterilisers: To grow healthy embryos in the lab which could lead to healthy babies, the air quality and the culture environment in the lab is of utmost importance.

Microbial contamination, particulates, volatile organic compounds (VOC), and chemical air contaminants (CAC) are the culprits which are detrimental for embryo quality and treatment outcome.

VOCs, CACs and particulates need to be removed and surfaces need to be disinfected by sterilization.

We have launched the most effective solution by way of a standalone Air Sterilizer which combines HEPA and Activated Carbon filtration with pathbreaking Plasma technology. This is the most effective and sustainable solution, (which is clinically tested by independent agencies like NASA) for the highest air quality which leads to better pregnancy rates and protect the IVF staff at the same time.

EmbryoSafe Disinfectants: We have also launched EmbryoSafe range of VOC free disinfectants for workbenches, surfaces, Incubators and floors which is based on Hypochlorous Acid which naturally occurs in the body as part of defence mechanism. These disinfectants work within five seconds and need no rinsing with sterile water. These products are MEA tested and CE marked.

EmbryoShield Gas line filter: We have also introduced a solution to improve the poor quality of gases entering into the culture Incubators from the cylinders. EmbryoShield, is a MEA tested unique inline gas filter with 0.1 micron HEPA/ULPA and activated carbon filtration.

Q

How do you analyse the IVF market in terms of opportunity and challenges?

Approximately one in six couples faces the problem of infertility. That translates to a couple of million couples who may need advanced infertility treatment in India.

Even with more than 1,000 IVF centers across India, the number of ART cycles performed annually is not more than 2,00,000. More and more corporate chains are establishing multiple IVF centers and the competition amongst clinics is increasing. The gap between infertile population and actual treatments needs to be bridged.

The IVF market in India is growing about 18-20% annually since last few years. But due to few bottle necks and uncertain policy framework , there is a certain limitation foreseen to a growth of IVF in coming years. High cost of treatment, absence of insurance cover, uncertainty in the treatment outcome combined with lack of definitive regulations, are a few key factors which need to be addressed. Trivector as a leading company in IVF is trying to address some of these issues through its activities and awareness initiatives.

eHEALTH Magazine

december 2018

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Spotlight: Delhi Gynaecologist Forum

Delhi Gynaecologist Forum Boosting Quality Healthcare for Women Delhi Gynaecologist Forum (DGF) envisages better healthcare for all women and girl children by fostering public-private partnerships, pooling and sharing resources, creating a common platform for all stakeholders and family-based interventions with community involvement, says Dr Sharda Jain, Founder & Secretary General, Delhi Gynaecologist Forum (DGF), in conversation with Elets News Network (ENN).

Q

You have been a crusader against female foeticide, anaemia, save uterus campaign and many others. As an expert how do you analyse maternal healthcare in India?

We have come a long way as far as maternal healthcare in India is concerned. Still, we have a long way to go. The Millenium Development Goal of Decreasing Maternal Mortality is the only goal which we have achieved and this became possible because of good cooperation between the Central and State Governments. But it is also painful to observe that our maternal mortality or morbidity rate is higher than that of our neighbours: Sri Lanka, Bangladesh and even Pakistan. So, we, as a country, have to go a long way in terms of maternal health. As a Government recognised body, we are doing a lot of work in areas related to women health issues such as female foeticide and save uterus campaign.

Being a gynaecologist forum, we will keep doing this as it is our duty to take care of women’s health.

Q

Tell us a bit about Janani Suraksha Yojna, now a landmark initiative of Central Government.

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December 2018

Effective implementation of Janani Suraksha Yojana (JSY) has helped us in reducing the child delivery in places other than the hospitals up to a great extent. After the implementation of the scheme, around 90 percent of the delivery is done at Primary Health Centres (PHCs) which was only 20 percent earlier. It has boosted the maternal mortality up to a great extent. It is one of the best schemes by the Government that helped women to ensure good health.

Q

How is your organisation contributing to women’s health?

Delhi Gynaecologist Forum (DGF) is concentrating only in Delhi. For us, three areas are of top most priority.

First is the skilling of doctors, as lots of developments are going on across the globe in terms of healthcare.

The training in these skills is very costly outside the country and that’s why it should be available in India.

DGF is offering the best skills to gynaecologists. Along with different States of our country, doctors from neighbouring countries like Afghanistan and Bangladesh are also participating in these trainings.

Secondly, we do monthly

Dr Sharda Jain

Founder & Secretary General, Delhi Gynaecologist Forum (DGF)

meetings regarding requirements of our various teams in every nook and corner of Delhi. It helps us to provide healthcare services at the door-step.

Thirdly, we are focusing on “Saying No to Cervical Cancer”.

Cervical Cancer is responsible for more deaths than the deaths due to pregnancy related problems.

Majority of the people are unaware about it. So, we are trying to reduce the number of cancer patients by promoting HPV Vaccination. Due to our efforts, the Delhi Government is giving free vaccination at two centres in Delhi: Delhi State Cancer Hospital

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Q

How is IVF gaining importance these days and proving to be a boon to women having polycystic ovary syndrome (PCOS) and other pregnancy related issues?

Infertility is like an epidemic but all said and done it is for 15 percent of couples which comes under the infertile category. In India, having a child is a must for every couple. But infertility is only taught as a subject that too in the post graduate medical courses. So to work as an expert, one must have deeper knowledge.

As far as India is concerned, IVF centres are mushrooming but at the same time it is also required that one centre caters to the needs of 50

Effective implementation of Janani Suraksha Yojana (JSY) has helped us in reducing the child delivery in places other than the hospitals up to a great extent. After the implementation of the scheme, around 90 percent of the delivery is done at Primary Health Centres (PHCs) which was only 20 percent earlier

gynaecologists and it must be well equipped with latest technologies and instruments.

There are around one lakh IVF

Centres in India of which 60 percent are in metro cities and 40 percent are in tier-II cities. But it is a fact that 50 percent of these centres don’t have Intracytoplasmic Sperm Injection (ICSI) facilities which treats male infertility. It is very important for centres to have this facility as 50 percent of our patients are males.

In Australia, 10 percent of all the new born babies are through IVF and in UK 1-2 percent babies are born through it. Seeing this, India still has a long way to go.

Q

Given the burden of infertility, where does India stand when it comes to fertility treatments?

As far as Indian IVF market is concerned, it is going with the pace of demand. But the challenge is to find well trained workforce for managing IVF centres. It must be necessary for every gynaecologist to be well trained in this area. We are lacking in well-trained man power along with the nurses and technicians who are working in these centres. This is what Delhi Gynaecologist Forum is focusing on. In line with Prime Minister Narendra Modi’s vision of Skilling India, we are contributing to it by training the manpower in these skills.

Another challenge is that these centres are not in line with each other in terms of services they provide. Services at every two centres are different and it confuses the couples seeking treatment for infertility. It must be addressed.

Spotlight: Delhi Gynaecologist Forum

GTB Nagar and Janakpuri.

Another important aspect that we are focusing on is training doctors in identifying cancer at an early stage so that it can be treated and patients can be saved.

As far as maternal mortality is concerned, we are conducting workshops where we train gynaecologists to handle Life Threatening Emergencies. This helps in improving the skills of gyanecologists. We train doctors in a way that they can further train nurses and other support staff to help them in handling emergencies.

Q

Is a regulatory body highly needed to streamline unorganised Indian IVF sector?

As far as monitoring part is concerned, skilled doctors don’t need to be monitored whereas the unskilled ones really do. If we talk about the Indian Council

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Spotlight: Delhi Gynaecologist Forum

of Medical Research (ICMR) and Pre-Conception and PreNatal Diagnostic Techniques Act (PCPNDT), people from these authorities majorly focus on sex determination part. We need to focus more on technologies and facilities available at IVF treatment centres.

The lack of expert professionals in this sector is one of the reasons that the country is lagging behind in infertility treatment.

It is very important to check the quality standards adopted at IVF Centres on a regular basis by the Government bodies. The third party quality control checks are very expensive because of which only 10 percent of the IVF Centres choose to avail these checks for operating standards. Here comes the role of DGF, which helps IVF Centres to self regulate themselves on the basis of checklist prepared by it.

Q

Infertility is something which many people don’t want to talk. How do you view the role of awareness to keep myth and stigma surrounding infertility at bay?

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December 2018

In order to make people more aware about infertility, we have to engage the grassroot level workers like Auxiliary Nurse Midwifery (ANM) and Accredited Social Health Activist (ASHA)

Infertility is a kind of stigma for any couple and any such person wants to come out of it. People are now becoming aware of it not only in urban areas but also in rural areas. To make people more aware about infertility, we have to engage the grassroots-level workers like

Auxiliary Nurse Midwifery (ANM) and Accredited Social Health Activist (ASHA). Even the teachers in schools can help in spreading awareness about treatments related to infertility, as they also interact with good number of people on a daily basis.

It can be observed that hesitation among the people regarding infertility is gradually going away.

It is so as 7-8 years ago, people even after crossing the age of 45 or 50 won’t visit doctors for the cure.

But nowadays people around 30 or even less are visiting the doctors to treat their infertility problems. They are talking about Anti-Natal care, vaccination, post-natal care etc.

Another thing which is needed here is that the Government should also develop the infrastructure to spread awareness among people.

The collaboration between the Government and private players may ease in making more people aware about the same. Moreover, the facilities should be more standardised for treatment of male infertility, as it contributes 50 percent of all such cases.

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Industry Perspective 20

Horizon of Reproductive and Infertility Treatment Expanding: Dr Minnie Bodhanwala

Reproductive and infertility treatment has grown by leaps and bounds in last few years. We host Maharashtra’s first state-of-art Assisted Reproductive Technology (ART) centre in a public hospital setup, offering a wide range of treatments at an affordable cost, says Dr Minnie Bodhanwala, CEO, Wadia Hospitals, in an interview with Mukul Kumar Mishra of Elets News Network (ENN).

Q

You have been instrumental in bringing a transformation at Wadia Hospitals and been at the forefront of many innovative practices at the hospital, how has been this journey?

I am in the healthcare sector for 30 years. My journey started with dental practice. For me, practice was not limited to only treating patients but also guiding medical students as a teacher and mentor.

Time and again, I come across several instances where I would take operational roles along with the routine practice. One such opportunity was my association with Impact India Foundation for their “Hospital-onWheels” project to set up the first dental unit on the train.

It was a turning point in my life where I realised that I could reach to masses and create much more impact in the society as a healthcare professional. Hence, I got more inclined towards the management aspect of healthcare.

Besides, our country holds a plenty of talent, we need to manage healthcare delivery system in a better manner.

I pursued a Master of Health Administration (MHA) degree to contribute on healthcare management to cater people with better medical facilities.

I always make it a point in my

December 2018

management practice to visit the hospital patients every day and interact with them on how we could serve them better.

Q

What services are offered by the hospital in the area of cardiac care, endoscopic surgeries and endocrinology?

Established in 1928, the Bai Jerbai Wadia Hospital for Children (BJWHC) is India’s first and largest paediatric hospital.

We provide a wide range of over 35 paediatric specialities here. The department of cardiac sciences is a center of excellence at BJWHC and supported by a dedicated team of professionals who provide care at the cardiac ICU, cardiac OT and cardiac ward.

With early diagnosis and prompt management of cardiac ailments, the department saves lives of many children.

It provides superspeciality care to children with all kind of cardiac complications including congenital heart surgeries. The department caters to more than 5,000 patients on an annual basis who seek quality cardiac care.

The department is managed by a highly accomplished team and equipped with state-of-the-art equipment.

Then, Nowrosjee Wadia Maternity

Dr Minnie Bodhanwala CEO, Wadia Hospitals

Hospital, established in 1926, is exclusively dedicated to women and newborns and a pioneer in the field of Obstetrics and Gynaecology.

The hospital, a pioneer in the field of endoscopic surgeries, has a fully equipped endoscopic theatre.

All laparoscopic surgeries like hysterectomy and myomectomy are performed by our specialists.

Both of our hospitals have excellent departments for endocrinology as well thus catering to women and children with a complete array of diagnostic, treatment and consultations.

Q

Tell us about the reproductive and infertility clinic. What kind of services are provided to patients under such a clinic?

We proudly host Maharashtra’s first

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Q

How has India evolved in terms of technology and innovations on reproductive and infertility treatment?

Reproductive and infertility treatment has grown by leaps and bounds in the last few years. India is among

We offer a wide range of basic and advanced services at our IVF clinic including consultations and counselling, basic workup for infertile couple, Intra Uterine Insemination (self and donor), Saline Infusion Sonographies, Intracytoplasmic Sperm Injection (ICSI)

the leaders for ART with highest number of IVF cycles.

In terms of technology, all modern and advanced equipments and innovations are available in India.

There is an increasing trend with new IVF centres focusing on customer satisfaction and affordable cost.

Access and awareness to IVF is also increasing and couples are now availing IVF services without any hesitancy.

New innovative models are also being developed with technology like

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cryo preservation for proactive family planning.

In addition, preventive gene therapy is another evolving trend in terms of future of reproductive and infertility treatment. These days, more and more doctors are opting for courses in ART.

Q

IVF sector is still at nascent stage due to many factors like high cost, less awareness and lack of regulatory practices. What is your perception about it?

The trends are changing now and I believe with best practices, remaining challenges can be overcome. A stronger legislation will help to regulate most of these factors.

With tangible progress, we are one step ahead from the nascent stage due to increase in awareness level. Moreover, the Government is also looking forward to implement legislation in this field. I see more affordable centre like ours coming up across country.

Industry Perspective

state-of-the-art Assisted Reproductive Technology (ART) centre in a public hospital setup, offering a wide range of treatments at an affordable cost.

Established in 2016, the centre is managed by highly trained and experienced team. With quality care, we have helped many couples to attain parenthood.

We are the first IVF centre in India to receive an accreditation from Quality Assurance International (QAI).

We offer a wide range of basic and advanced services at our IVF clinic including consultations and counselling, basic workup for infertile couple, Intra Uterine Insemination (self and donor), Saline Infusion Sonographies, Intracytoplasmic Sperm Injection (ICSI), Intracytoplasmic Morphologically Selected Sperm Injection (IMSI), Blastocyst Culture, Male Infertility Management, Testicular Biopsies, Testicular Sperm Retrieval Techniques (TESA), and Percutaneous Epididymal Sperm Retrieval Techniques(PESA) etc.

Q

A section of experts opine the IVF sector is a bit unorganised.

What needs to be done to improve?

Centralised reporting will help in organising the IVF sector. Penetration of Health Insurance sector covering IVF will also encourage couples to avail the treatment.

Increasing awareness through government campaigns and programmes could also help in regulation and accessibility. Families need to understand that infertility is not linked to women alone. There could be some medical issue with male partner as well which can be treated to attain parenthood. IVF is a best option for such couples.

An accreditation like ours brings in more confidence and trust to people.

Such a policy wherein standards of care and quality are adopted by IVF centres will help in further organising this sector.

eHEALTH Magazine

december 2018

21

Guest article

Latest Trends of Assisted Reproductive Technology

A

ssisted Reproductive Technology (ART) has made immense strides since the first live birth following In-vitroFertilisation (IVF) in 1978. This multi-faceted improvement led to the optimisation of ovarian stimulation and a better assessment of embryo quality, giving rise to steady increase in live birth delivery rates.

The cumulative live birth rate after one oocyte retrieval cycle is considered the most accurate benchmark for ART success.

Empirical evidence shows that embryo evaluation based on morphology, morphokinetics, preimplantation genetic testing (PGT-A) or embryo metabolism, and microfluidics, all have the potential to rank embryos according to implantation potential.

We do not have high quality data showing the difference in ranking potential between these different methods to evaluate embryo quality.

However, much of ongoing studies are based on these. The aim is to improve live birth rate or cumulative birth rate for most recent developments in ART. IVF lab A perfect homeostasis is provided by in vivo micro environment during the course of blastocyst development. The same is mimicked in IVF lab.

Various commercial media companies recommend differing pH ranges, most within the range of 7.2–7.4.

Most don’t reveal the secret composition of media and fall short of robust research to indicate best media composition and incubation parameters.

Historically, CO2 set-points in incubators are adjusted to attempt to create the ideal media pH environment

22

DECember 2018

for any development stage of embryos.

CO2 adjustments are usually done by calibrating the pH of equilibrated media once a month or once a week.

There are many gadgets for pH measurement for IVF culture systems.

A bench top pH meter can be used for the routine pH measurement with proper calibration buffers.

However, it is essential to keep the certificate of analysis of the media being used. A new technology, SAFE Sens Trak Station, enables real time non-invasive pH monitoring within an incubator environment.

Use of this technology can reveal about incubator conditions which are not ideal for maintaining ideal pH levels. Use of RFID tags precludes the errors in the lab.

Microfluidics: The future is for Microfluidics. From semen preparation to separate the motile healthy sperm, the technique is very useful and may provide sperm with high motility, normal morphology and with least DNA damage in comparison to simple wash and density gradient centrifugation (Schulte et al., 2007).

Lab-on-a-chip: Lately, labon-a-chip (LOC) has proven to be a useful tool for enhancing non-invasive assisted reproductive technology (ART).

Surrogates to Anti-Mullerian Hormone (AMH) The oocyte-secreted growth factors, growth differentiation factor-9 (GDF9) and bone morphogenetic protein-15 (BMP15) are regulators of folliculogenesis, oocyte quality and fertility. It can be measured using immunoassays. They may have a role as predictors of fertility potential.

Dr Gunjan Saxena

IVF Specialist, Apollo Cradle

Latest drugs and protocols DRUGS 1. Corifollitropin, a long acting Gonadotropin: One injection on day-two is enough for eight days. It might require two or three additional daily gonadotropin injection, with comparable results.

2. Recovelle: Follitropin delta has finished the phase III trial for individualised dosing based on AMH levels and body weight. The results are comparable to other gonadotropins.

3. Kisspeptin: Kisspeptin was first discovered in 1996 as a metastasis inhibitor. It is used as an ovulation trigger due to its efficacy in achieving pregnancy rates compared to human chorionic gonadotropin (HCG) and gonadotropin-releasing hormone agonist (GnRH agonist).

Also, it is safe for patients who are at high risk of developing ovarian hyperstimulation syndrome (OHSS).

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Shorter protocols Time constrain associated with emergency fertility preservation has led to • Dual stimulation • Random-start at any point in the cycle, for cancer patients Strategies for poor responders Pre treatment with transdermal testosterone was associated with an increase in clinical pregnancy [rate difference (RD): +15%, 95% CI: +3% to +26%] and live birth rates (RD: +11%, 95% CI: +0.3% to +22%) among poor responders undergoing ovarian stimulation for IVF. In conclusion, transdermal testosterone pre treatment seems to increase clinical pregnancy and live birth rates among poor responders undergoing ovarian stimulation for IVF. There is ongoing research to improve thin endometrium but there is no effective easy solution yet.

Field-effect transistor (FET) with pinch of salt There has been a see-saw approach

over time i. e all fresh, then FET followed by fresh/ FET transfer. The available evidence from randomised controlled trials (RCTs) and systematic reviews and meta-analyses indicates that overall live birth rates (LBR) were significantly higher after FET as compared to fresh ET in the hyperresponders [HR], with significantly lower risk for OHSS in both groups.

However, in HR, FET were associated with a higher risk for pre-eclampsia.

Therapeutic options Anti-oxidant therapy Cochrane Review by Showell et al (2013) gives no benefit for anti-oxidant therapy in improving clinical pregnancy or live birth. However, Coenzyme Q10, resveratrol and alpha-lipoic acid have been proving beneficial in terms of reducing aneuploidy rate, delaying oocyte reserve depletion, improving mitochondrial activity and reducing intracellular oxidative stress.

There is a need to target the drug delivery and action.

Therapeutic options of treating mitochondrial dysfunction by three parent approach Modern mitochondrial therapies – Mitochondrial replacement therapy is useful to two group of patients – one to patients with mitochondrial

The cumulative live birth rate after one oocyte retrieval cycle is considered the most accurate benchmark for ART success. Empirical evidence shows that embryo evaluation based on morphology, morphokinetics, pre implantation genetic testing (PGT-A), all have the potential to rank embryos according to implantation potential

guest article

Latest Protocols: Stair Step Protocols: Stair Step protocols with both Clomiphene and letrozole are being used. The technique takes less time for ovulation keeping pregnancy rate low.

diseases to prevent the inheritance of the same in the progeny and patients with poor oocyte and embryo quality with previous failed IVF cycles at an attempt to improve oocyte/embryo competence and achieve pregnancy.

Meiotic spindle transfer, pronuclei transfer, cytoplasm transfer from donor oocyte and autologous germline mitochondrial energy transfer (AUGMENT) are the techniques in our armamentarium to boost oocyte/ embryo mitochondrial endowment.

The use of these techniques is still at experimental stage and shrouded with ethical and political challenges as well.

At the same time, Time LAPSE, DNA fragmentation test and PGT-A are gaining acceptance for indicated cases. But these are also adding to the cost of IVF cycles.

(Disclaimer: The writer is Dr Gunjan Saxena, IVF Specialist, Apollo Cradle. Views expressed are a personal opinion.)

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Technology Perspective 26

mHealth Playing a Key Role in Patient Monitoring

H

ealthy relationship with physician/nurse and the patient is what every patient would look forward to. To make this happen, an effective patient monitoring system has to be in place. Patient monitoring is hence gaining traction and has been made easier with the proliferating technology trends. Today, most of the doctors are IT savvy and demanding to have a user-friendly system. Not just the doctors, even the patients and support staff of hospitals are looking for everything in a mobile device – be it services, games or apps.

According to the survey of Statista 2018, the percentage of internet usage from mobile phones has grown to 52.2 percent in 2018 while it was just 10.7 percent in year 2012. It clearly indicates that people now prefer using internet from their mobiles rather than personal computer.

With these revolutions in place, the healthcare industry is also trying to match the pace of change to avoid being left behind. Therefore, in a healthcare environment too, it is important that the IT systems which are going to be deployed should be mobile ready, both for clinical administrators and patients.

In this regard, a Hospital Information Management System (HIMS) plays a vital role in supporting the hospital to provide a quality healthcare to its patients.

Aosta as an IT services company has an exclusive focus on offering Enterprise IT Solutions to the healthcare industry. Our flagship

December 2018

product - BackBone HIMS is a classic product conceived by doctors and architected by software professionals.

With over 25 modules, it fits every functional dimension of the hospital.

With the system being cloud ready and mobile compatible, it has become user friendly for both the hospital end users and the patients.

Apart from the mobile ready HIMS, Aosta also offers specialised modules and mobile apps for enhancing the patient care across various verticals as given below :For clinicians • EMR: A very impactful tool for the doctors to monitor patient’s health and provide consultation from anywhere. Being web based and device compatible, it can be used as a Computer on Wheel (COW) if Wi-Fi is enabled. With provisions

ABINAYA

Aosta Software Technologies India Limited

like template based notes entry and a quick list of patients/orders/drugs, it effectively reduces the time taken for patient consultation process. It helps the doctors to view the status of the ordered tests and results of completed tests while ensuring that there is no manual intervention in posting of results. The doctor gets

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Aosta also provides consulting and managed services to its clients in growth markets like Africa and Far East. We have established our presence in these markets by providing creative solutions using Telemedicine. We have partnered with a Micro Insurance firm in Kenya to set up our EMR with Telemedicine in cloud to cater to a cluster of clinics in Nairobi and nearby countries.

enabling the doctor to look into all information about the patient on a single screen. It helps patients to track a doctor’s availability, book appointment, create their own credentials to view all their clinical information and medical records from their own space. The doctors can use their credentials to view the waiting list of patients. Choosing a patient opens up the medical record of the patient with the window for video chat. While the doctor does the online examination on the patient, he can also raise online orders for lab, diagnostic orders and medications, record the treatment plan with primary diagnosis, monitor the previous investigation order’s result, make template based notes entry and do many more tasks.

For management • Mobile Dashboard: BackBone’s Mobile Dashboard is a management tool to track the real time performance of various branches of a hospital across various verticals

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Technology Perspective

notified on any abnormalities in the patient’s report which thereby enhances the patient care.

• eOrders: It’s mobile app for ward in-charges to monitor the real time health trends of patient. With provisions like ordering of various services from a single window, online viewing of results, colour code indicators for patient’s special needs, etc., it aims to improve the patient-nurse relationship.

• eMAR: BackBone eMAR is available as a standalone mobile app and also as a part of eOrders. It speeds up the prescribing process and reduces the prescription errors to a large extent. The physician as well as the nurse can keep a track of prescribed and consumed medicines along with their dosage details. It makes refilling of medications as easy as the click of a mouse. It provides real-time monitoring of duplicate drug orders, missed medications, next schedule for the medication and many more. eMAR hence helps in improving patient care and workflow efficiency by supporting the six rights of medication administration: right patient, right drug, right dose, right route, right time and right documentation.

• Telemedicine: BackBone Telemedicine is a platform to connect the patient and the doctor.

With a simple and user friendly layout, it is packed with rich features

from a single screen. Being a cloud based, multi-tenant and device compatible application, it enables the user to get real time information anywhere, anytime on the move. It covers the metrics across various departments like billing, lab, diagnostic, pharmacy, inventory, OT, etc. with two level drill down. By monitoring the metrics across various departments, the management can thereby improve their patient monitoring. It is available as HTML5 application as well as a mobile app.

For patients • Patient Portal: It is an electronic vault of patient information on the cloud, which can be easily accessed by the patients anywhere anytime. A user friendly platform for patients to access their health records and to improve communication with doctors and other experts at the hospital where they are being treated. With entire family’s health records under one credential, the patients can exploit the app for booking appointments with doctors, tracking their ordered services and viewing their complete test reports, accessing bills and their previous visits, etc. Along with these provisions, the app also notifies the patients on their next follow up visit and enables the virtual consultation between the patient and doctor.

Available as HTML5 application as well as a mobile app.

Apart from m-Health, other technologies like AI, IOT, machine learning, wearables and remote healthcare are now playing a key role in digital transformation of healthcare ecosystem enabling a better patient care.

(Disclaimer: The writer is Abinaya of Aosta Software Technologies India Limited. Views expressed are a personal opinion.)

eHEALTH Magazine

december 2018

27

Industry Perspective 28

‘Sophisticated Labs and High-End Technology Ensure IVF Success Rate’ Out of over a billion people in India almost 4.2 percent suffer from infertility, creating a huge opportunity in the IVF sector. Affordability, awareness, and self regulation are important areas which need to be worked upon to streamline the sector, says Dr Abha Majumdar, Director and Head of IVF, Sir Ganga Ram Hospital, in conversation with Elets News Network (ENN).

Q

You were a part of the team responsible for the first IVF baby born in north India in 1991. Tell us about the experience how you made it possible at a time when reproductive treatment was at its nascent stage?

I joined Sir Ganga Ram Hospital as a junior consultant in February, 1987. Since I was interested in treating infertility, I started looking after the free infertility OPD on Thursdays. This clinic then provided only basic treatment for infertility i.e Ovulation Induction, Postcoital Test, and Intrauterine Insemination (IUI).

The birth of India’s first scientifically documented IVF baby occurred in 1986 with the efforts of Prof T C Anand Kumar and Indira Hinduja in Mumbai. Two years later, in 1989, we felt the need to take infertility treatment to a higher level in northern India. It was the foresight of Dr S K Bhandari who was the head of the Obstetrics and Gynecology Department that we started to develop this part of infertility management.

We made a team of three, Dr M Kochhar, a gynecologist; Dr Raj Gaur, a senior retired scientist (PHD in genetics) from AIIMS and myself.

Initially, I went once to Dr Sadhna

December 2018

Desai’s IVF (In-Vitro-Fertilisation) centre in Mumbai to see ultrasound guided egg pickup.

Dr Gaur herself used to make culture media by mixing various salts together. Ultrasound monitoring system was developed with the help of Dr Deepak Chawla, the in-house ultrasonologist of Sir Ganga Ram Hospital. We used to procure gonadotropins as well as gonadotropin-releasing hormone agonist (GnRH agonist) from SukhSagar chemist in Mumbai due to unavailability of same in Delhi.

Fertility and Sterility, and Human Reproduction were two eminent journals in this field which used to publish research papers on this very topic every two months. We took help of these journals at every stage.

In fact, these became our ‘Gurus’ in terms of learning IVF protocols.

This is how we started our IVF journey and had our first success with the birth of baby Garva on 21 September, 1991.

Another huge challenge at that time was to convince patients to get IVF done because the procedure was new to them as well as to us.

However, since then we have been rolling forward towards better technology, protocol and results.

Dr Abha Majumdar

Director and Head of IVF, Sir Ganga Ram Hospital

From a modest number of 26 cases in the first year of its inception, the center now provides IVF to more than 1,500 couples annually. With the incorporation of latest technologies and rigorous persistence with quality control, the center has achieved high success rates, comparable with international standards.

Q

How do you analyse Indian reproduction treatment market in terms of huge opportunity it offers? How does it fare in comparison to global standards?

Out of 1.2 billion Indian population, almost 4.2 percent suffers from infertility. Approximately one

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Industry Perspective

percent of all infertile couples need IVF though only 0.05 percent has access to it.

In our country, we are doing approximately one lakh cycles in a year whereas we need around 93.3 lakh more cycles in a year. (Assessment by E&Y 2015). Therefore, the opportunity for IVF is huge.

However, the gap between the one who needs IVF and those who can eventually have it, is also huge. This is not only due to financial constrains but also because of unavailability of the required technology in small towns and villages.

New centers keep mushrooming in the metro cities i.e few colonies or a single road has as many as 8 to 10 centres. The cost of establishing these centres is high as most equipment needs to be imported from various countries.

Q

It is being believed that 75 percent success of IVF depends on the technologicallyequipped labs. What kind of technology the hospital banks upon to improve the treatment outcome?

It is true that IVF success rate depends on the lab. Most of the standard equipment is available to all these IVF clinics. However, quality control and quality assurance are major lacuna in our system.

To improve things on this

A registry or central data bank is needed which would not only minimise abuse of technology but also prevent any complications to patients who opt for IVF

area, well-qualified and trained embryologists are required to monitor the functioning of these laboratories.

Otherwise, the treatment outcome becomes ineffective.

All these centers should have in-house embryologist to take care of quality maintenance in order to improve the treatment outcome.

Q

The IVF industry has a lot of areas for improvements i.e. self-regulation, accreditation and formation of a registry or a data bank of IVF centers. How do you analyse the statement?

It is not only the IVF industry which would improve by self-

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regulation but also it is the requirement of every sphere of work in our country without which accreditation alone may be of no use.

A registry or central data bank is needed which would not only minimise abuse of technology but also prevent any complications to patients who opt for IVF.

Q

As per the data, around five percent of the needy people in India actually reach an IVF specialist. How do you see role of awareness, affordability, and insurance factor?

India needs to have IVF centers in every nook and corner of the country, not to be concentrated in metro cities only. There is a huge deficit or lack of awareness among people about the benefits of IVF technology. Moreover, affordability is also a major factor which makes many a couples averse to seek the treatment.

In our country where per capita income is less than 1.1 lakh per year as per 2018 census, the costly treatment puts huge financial burden upon couples. In the wake of these facts, insurance plan would be very beneficial for couples who can’t afford the treatment. But, the difficult task is how real beneficiaries would be identified so that they would be given insurance assistance.

eHEALTH Magazine

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Technology Perspective 30

‘IVF Technology a Boon for Childless Couples’ IVF technology has given a ray of hope to childless couples enabling them to have their own biological child. With cutting-edge equipment and dedicated lab personnel, the technology ensures better clinical results, says Dr Sonia Malik, Programme Director IVF, Max Healthcare, in an interview with Elets News Network (ENN).

Q

How is reproductive medicine proving to be a boon for the couples who long for their own biological child?

The development of this branch of medicine has led to more awareness about infertility issues, better diagnosis, and treatment. Even though the success rate of IVF is 30 to 40 percent, it translates into a huge number. IVF technology is a boon for the couples who would not have been able to have their own biological children 30 years ago.

Q

Tell us about latest trends and practices in reproductive medicine segment. How is Max Healthcare contributing in IVF segment?

Initially, reproductive medicine was initiated to help infertile couples.

However, as we delved more into the intricacies of reproduction, we developed a better understanding of the process. It can now be extended to anyone who desires help.

For instance, today women can reproduce whenever they decide to and that is because of fertility preservation facility. This is called social egg freezing.

The same can also be offered to cancer patients. Similarly, we can now detect any faults in the embryos before we transfer them. This is called pre-implantation genetic screening.

Embryos can also be implanted in the uterus by laser hatching.

All these cutting-edge technologies are available at our center.

December 2018

Q

Shed some light on how does whole process of IVF take place in the lab. Tell us about the role of diagnostic equipment in whole process.

The IVF lab should be looked at with sanctity because it is here that we are creating life. It is very important to have excellent and dedicated lab personnel (called embryologist).

The eggs that are taken out from the body of the woman are mixed with the sperms of the man (called IVF) or injected into each egg (called Intra cytoplasmic sperm injection or ICSI). An embryo forms after fusion of sperm and egg.

These embryos are then transferred back into the uterus of the woman. It is therefore of utmost importance to maintain strict vigilance and ensure quality within the lab. If there are any lapses at any stages, it may lead to formation of bad embryos or no embryo at all.

Cutting-edge equipment can not only diagnose, but also help to give better results and minimise errors in a lab.

Our lab observes strict quality control by having both internal and external audits. We are NABH accredited and observe international standards in all our protocols and use latest technology for doing so.

Q

In India, the percentage of people availing IVF treatment is still very low. What could be the possible reasons for the same like costly treatment and lack of legal framework?

Dr Sonia Malik

Programme Director IVF, Max Healthcare

This is also because of lack of availability of such services in small towns and cities. According to unpublished data from ICMR, India has around 900 registered IVF clinics across country. But unfortunately maximum (80 percent) are in the metros. Hence services and appropriate treatments are not available to all.

Q

How do you see the role of health insurance in IVF segment? Will the insurance coverage help couple to seek the medical treatment?

Health insurance will make things better for many but it will take time for people to accept health insurance per se.

In tier two-three cities, there is lesser number of people having insurance coverage. Hopefully, this will improve with awareness.

Overall, the status of reproductive medicine in the country is improving.

Regulation is need of the hour to streamline the whole process.

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CONFERENCE report

Sheena Chhabra from World Bank; Moe Kyaw Aung, Ambassador, Myanmar; J Goburdhun, GOSK, High Commissioner, Mauritius, and Dr Ravi Gupta, Founder Publisher, CEO & Editor-In-Chief, Elets Technomedia Pvt Ltd, during inauguration of Elets Healthcare Innovation Summit in New Delhi

When Healthcare Leaders Mulled Finest Innovative Practices T

o leverage innovative healthcare practices enabling people to avail quality and affordable healthcare facilities, Elets Healthcare Innovation Summit was organised recently in New Delhi.

Organised by Elets Technomedia, the Summit confluenced top policymakers, international experts and industry leaders to deliberate upon innovative practices, conducive policies and reaching out to people living on the last-mile with healthcare services, its challenges and opportunities.

The discussions also involved significance of technology and modern-day innovative solutions for healthcare.

Inaugurated by Moe Kyaw Aung, Ambassador, Republic of the Union of Myanmar, in the presence of Erik af Hallstrom, Deputy Head of Mission, Embassy of Finland, New Delhi; and J Goburdhun, GOSK, High Commissioner of the Republic of Mauritius, New Delhi, the conference witnessed one of the finest congregations of top luminaries of the healthcare world.

Other important dignitaries included Sheena Chhabra, Senior Health Specialist, Health, Nutrition and Population Global Practice, World Bank; Dr Madhu Raikwar, Director, Central Bureau of Health Intelligence, Ministry of Health and Family Welfare, Government of India and Dr Ashok Seth, Chairman, Fortis Escorts Heart Institute, were also present at the Innovation Summit, held recently.

On the occasion, healthcare experts shed light on trending innovative practices across globe and how that can be leveraged to improve healthcare delivery system in India.

Various enlightening discussion sessions including ‘Healthcare Innovation: The Road Ahead’, ‘Emerging Global Innovations and Technology Interventions in Healthcare’, ‘Changing Dynamics of Hospital Management and Healthcare Delivery’, and ‘Emerging Trends in Hospital Management and Administration’ were organised at the conference.

A special issue of eHealth Magazine, which has been highlighting the role of ICT in healthcare ecosystem for about 15 years, was also unveiled on the occasion by eminent dignitaries. Also, industry leaders, diagnostic equipment manufacturers, and healthcare service providers were felicitated with Healthcare Excellence Awards for their extraordinary contribution in healthcare world.

Here is a glimpse of the Healthcare Innovation Summit:

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Moe Kyaw Aung

J Goburdhun

Ambassador Republic of the Union of Myanmar, New Delhi

GOSK, High Commissioner Republic of Mauritius, New Delhi

"Ministry of Health, Myanmar is providing preventive, curative and rehabilitating healthcare to the people of the country.

Myanmar is making much needed effort in healthcare sector.

As demand for private healthcare facilities is on the rise, it has been identified as a priority sector for investment. An MoU has been signed between India and Myanmar to cooperate in healthcare sector i.e providing training to healthcare professionals, assistance in human resource development and hospital management."

"Healthcare is an important sector where one gets chance to serve humanity. The Ministry of Health all over the world has done a commendable job to eliminate communicable diseases.

But we have collectively failed to provide real preventive healthcare facilities. Throughout the world we have an epidemic problem of non-communicable diseases like cancer, diabetes and heart related ailment. To create a healthy world, community participation is the need of the hour."

Erik af Hallstrom

Shekhar Agrawal

"Health and well-being in Finland is not an issue of individual or families but the responsibility of public sector and obligation of the State. In Finland, the State guarantees everyone access to health, education and livelihood. Rich, poor and the middle-class everyone uses public health. In Finland, we have public health stations which are open to all citizens and residents. Primary healthcare services are provided by Municipal Health Centers and specialised services are provided by district hospitals."

"All the innovations need to get implemented at the grassroots level. As a telecom service provider, we back up such kind of innovations with robust IT and software. Vodafone Idea limited has become the largest telecom provider in the country having robust operating model, digital initiative and full-fledged trained staff. We are the largest backbone of our country in terms of telecom distribution and connectivity with highest capacity."

Senior Vice President Vodafone India

Deputy Head of Mission, Embassy of Finland, New Delhi

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inaugural session Ayushman Bharat: The Game Changer for Building New Healthcare Ecosystem in India

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CONFERENCE report

Dr Ashok Seth

Chairman Fortis Escorts Heart Institute

"Over the last 30 years, many innovative practices have been introduced in interventional cardiology. India created world’s first thinnest bio absorbable stent. We came up with Transcatheter Aortic Valve Replacement (TAVR). One of the first such cases in the world happened to take place in 2004 at Escorts Heart Institute. We change the valve in cath lab through the non-surgical procedure of TAVR. Now, around 1,50,000 people have undergone Transcatheter Aortic Valve Implantation (TAVI) worldwide."

Dr Madhu Raikwar

Director, Central Bureau of Health Intelligence Ministry of Health and Family Welfare Government of India

"We are committed to ensure an accountable, accessible and affordable healthcare for every citizen of India. The National Health Resource repository is a building block for Ayushman Bharat. We have a vision to create a robust standarised and secured Information Technology enabled repository of healthcare establishment. NHR is first of its kind census of public and private healthcare establishments."

Sheena Chhabra

Senior Health Specialist, Health, Nutrition and Population Global Practice, World Bank

"Ayushman Bharat rests on two pillars, one relates to comprehensive primary healthcare and other to social protection through health insurance. Even though India has made remarkable progress in healthcare delivery, it needs to work upon many healthcare parameters. Hospitalisation rate is three times higher among the rich than the poor to avail secondary and tertiary care in our country. The poor person opts for Government hospitals, as it costs less to avail treatment there while the rich seek facilities through private healthcare providers."

Industry Presentation Dr Manjiri Bakre

CEO & Founder OncoStem Diagnostics Pvt Ltd

"Chemotherapy deteriorates patients’ quality of life. At the early stage of cancer, there is very minimal effect of chemotherapy. Three out of four patients diagnosed with early stage cancer may not need chemotherapy. CanAssistBreast, an innovative test which we have developed, validated, and marketed in India, can predict risk of cancer reoccurrence in early stage breast cancer patients. It is inexpensive alternative to western tests."

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December 2018

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Kapil Ahuja Regional Head, Jio

"Digital technology is the key which can minimise the gap of resource in terms of doctors’ availability across the country. We provide reach to billions of people with 4G and other mobility services. With giga fibers, we have laid lakhs of kilometers of fibers. We provide infra support on which thousands of healthcare applications and services are built. Also, we provide wi-fi services, video conferencing and other integrated services to hospitals."

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Jio Smart Hospital Solution

Special Address Bhavana Saxena

Special Commissioner, Andhra Pradesh Economic Development Board, Government of Andhra Pradesh

"Andhra Pradesh Economic Development Board is the single nodal point and the State version of Invest India. It ensures foreign investment as well as private investment in various sectors. The State of Andhra Pradesh has recently formed separate happiness department. In the vision statement, the Chief Minister has said that Amravati, which will be the new capital of bifurcated erstwhile Andhra Pradesh, is going to be one of the happiest cities of the world."

Sumit Puri

Dr Deepak Agrawal

Chief Information Officer Max Healthcare

Professor Neurology, AIIMS, New Delhi

"There is a significant gap in healthcare delivery. There is waiting time for everything in terms of diagnosis and getting appointment from doctors. Massive amount of information is generated every day from multiple sources in healthcare. One of the biggest challenges is how to utilise this plethora of data.

Artificial Intelligence, which is an ability of machines to perform functions similar to that of humans, can be a useful technology to reduce gap in healthcare sector."

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"There is an inequitable distribution in healthcare. Despite having one of the lowest cost of doctors and nurses in the world, why does India have costly healthcare? We have onetenth of the cost of the doctors in the United States or any other developed country.

India’s healthcare is expensive due to infrastructure. The costly equipment which we are purchasing, everything is being imported. Indigenous making should be given a priority."

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CONFERENCE report

Techno-Financial Dimensions of the Ayushman Bharat Initiative Dr Amitabh Rajan Chairman RBI Services Board of India

"Ayushman Bharat is a bold initiative with strong fundamentals.

We require clear revenue model to implement the programme.

Technology holds huge potential which can be leveraged to augment healthcare delivery system. At the same time, India must have a procurement law. Techno-financial framework is a pre-requisite to streamline process and it needs to be adopted in healthcare sector as well."

Opportunities Available from BiRAC for Healthcare Innovators Dr PKS Sharma

GM & Head (IT) Biotechnology Industry Research Assistance Council (BIRAC)

"In healthcare, BIRAC supports drug, pharmaceutical products, diagnostics equipment and vaccines. Most of our funding goes for development of healthcare products which include several steps. First is idea-generation followed by validation and at last approval is taken to launch the product in the market. We fund the project on every stage of development right from idea generation."

CSR Perspective Nixon Joseph

President and Chief Operating Officer SBI Foundation

"SBI foundation is CSR arm of SBI. It was formed in 2015 with the objective to do CSR activities in a focused manner. We have three flagship programmes i.e SBI youth for India fellowship, SBI Gram Seva, and SBI Center of Excellence for Disabled Persons.

As part of SBI youth for India fellowship, every year 100 highly educated youths from IIMs, IITs and reputed foreign universities join rural fellowship where they get an opportunity to work for 13 months in villages."

Medical Education Perspective Prof (Dr) Prema Basargekar

Programme Coordinator, Healthcare Management, K J Somaiya Institute of Management Studies & Research, Mumbai

"The Indian healthcare sector is growing by leaps and bounds at around 18 percent per annum. The vibrancy can be seen in this sector in terms of new innovation, business model and emerging start-up culture. Ayushman Bharat is one of the major game-changers and will give boost to healthcare delivery. Skilled manpower is need of the hour. Objective of our healthcare programme is to enable students with requisite competencies to leverage the advantage of evolving healthcare sector."

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December 2018

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CONFERENCE report

Panel Discussion: Healthcare Innovation: The Road Ahead

Panelists discussing various challenges and opportunities of healthcare sector at Healthcare Innovation Summit, Delhi

Dr Sudha Chandrashekar

Consultant, Health System Transformation Project (BMGF & Tata Trust), World Bank

"Innovations need not be always about disruptive technology but it should be patient-centric. As per various surveys, patient dissatisfaction is an important issue. It needs to be addressed.

Human touch is an important aspect in healthcare delivery that needs to be focused upon. At the same time, health financing is equally important i.e. innovative mode of health financing is gaining a lot of ground in terms of research mobilisation."

Abhimanyu Saxena

Technical Lead, Supply Chain Management & IT- Health, UNDP

"It is very essential to maintain a balance between health innovation, scalability and sustainability. Health innovation or any kind of innovation will not solve the purpose till it is complemented with standard operating procedure, good governance and empowered manpower. eVINÂ (electronic vaccine intelligence network)Â is an ambitious programme by the Ministry of Health and Family Welfare. It is technically supported by UNDP. We have designed very easy to use mobile application for the last-mile health workers. They just need to fill the data."

Dr K Venkatramanan Director Bhaktivedanta Hospitals

"In our country, top 20-25 percent avail private facilities while bottom 20-25 percent population goes for the government schemes. Bhaktivedanta Hospital introduced EMI scheme for middle class in healthcare. We conduct more than 600 plus camps for the needy. Leveraging PPP model, we have catered 10,000 to 12,000 patients. All our facilities are NABH accredited."

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Panel Discussion: Emerging Trends in Hospital Management and Administration

Healthcare luminaries with speaker mementos at Healthcare Innovation Summit, Delhi

Dr Sandeep Chatrath

Dr Priti Nanda Sibal

"Compliances are making us more patient-friendly and environment-friendly. We are moving towards safer healthcare delivery system, enabling people for a better care. Besides documentation, implementation of processes is utmost important. Technology has played a key role for process improvement and real time capture of patient feedback. It is making healthcare more accessible and available. At the same time, technology is proving to be a challenge as well due to constant upgradation on the front."

"We keep track of patients, right from their entry into the hospital to the exit and every process has been developed accordingly. To contain the cost, we have decided to do only four surgeries at the Central Government Health Scheme (CGHS) rates. We are leveraging technology to enhance patient care. We have facility where patients can book prior appointment with doctors to save time. Every week, we monitor the time taken for every step of the patient interaction at the hospital."

Regional CEO Metro Hospitals

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December 2018

Medical Director AB Hospitals

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Dr K K Aggarwal

Maj Gen (Retd.) S C Pareek

President Heartcare Foundation of India

Executive Director Bhagwaan Mahaveer Cancer Hospital & Research Centre

"Referral fee is in the interest of patient. Harm reduction will be going to change medical practice tomorrow. If a person can’t stop alcohol, we do a harm reduction by giving him less harmful alternative i.e. tobacco or alcohol harm reduction. Concept of harm reduction will be the future. Medical education needs to be promoted through telemedicine to make it more affordable."

"In today’s times, patients enter a hospital with a lot of information i.e. about the diseases, cost of treatment, and implications of medicines. In the wake of lots of complaints from patients in terms of facility and services offered by healthcare providers, an evolved system is need of the hour. Bhagwaan Mahaveer Hospital has introduced a system of patient relationship person at OPD areas and reception. We also have acute myeloid leukemia (AML) ward."

Rajiv Goyal

B Girish Babu

"There are various means by which technology can actually help to reach healthcare to its desired destination. There are specialties like ophthalmology, dermatology and radiology which can be made accessible through smart phone technology.

Teleradiology has proved to be a boon where doctors sitting at remote locations guide local physicians to perform basic things related with patient care. Social media is also a very important tool to enhance healthcare delivery in tier-two to tier-three cities."

"From regulation point of view, compliance is all about managing system in systematic manner. It plays a crucial role in strengthening healthcare delivery. It is an important part of teamwork. There are some grey areas like transplantation and organ donations, where you need to engage local agencies."

AVP QRG Central Hospital & Research Centre

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CONFERENCE report

Panel Discussion: Changing Dynamics of Hospital Management and Healthcare Delivery

Experts deliberating upon how to create an ideal healthcare delivery model at Healthcare Innovation Summit, Delhi

Dr Harish Nadkarni

40

Shilpa Saxena

CEO, National Accreditation Board for Hospitals & Healthcare Providers (NABH)

GM- IT & Digitalization Aakash Healthcare

"IT Department should have more graphics. Tables and numbers are not easily disabled. Unless we see them as graphics, it is not possible to streamline things. About the integrated programme, NABH was trying to work anonymity graphically. That will reduce fudging and at the same time it will give you realistic information where exactly you lie."

"Technology has become a lifeline for everyone as it increases efficiency of delivery of services. It has potential to transform traditional healthcare into digital healthcare. At Akash Hospital, everything is automated. We have complete HIS i.e EMR, PACS, patient portal, mobile app, integrated lab and radiology images.

EMR is keeping the patient data in a single window which can be accessed by any authorised person from anywhere."

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Dr Devendra Kumar Punia

Shailesh Kumar

Head-Corporate IT Paras Hospitals

Manager IT Dharamshila Narayana Super Speciality Hospital

"Data is the key in healthcare delivery and IT department of any healthcare provider is custodian of these data. IT department must evolve from custodian of data to facilitate the business side. We can’t pass on the cost of inefficiencies of the hospitals to the patients. And data plays a major role on this front.

IT department should take a lead in collecting, analysing, interpreting and assisting the business side."

"In today’s time, healthcare ecosystem can’t be imagined without IT. Teleradiology is one such IT-enabled solution where patients avail best treatment without the presence of the expert doctor at the location. Images are sent to doctor sitting at any tertiary care hospital in the city and local physicians are guided how to go about it. Another application of technology is on billing front. Earlier, it took lots of time to generate bill manually.

Now, technology enables hospital to generate bill within 15-20 minutes."

Namit Soni

Dr Narendra Anandani

CEO Soni Group of Hospitals

Director, Anand Multispeciality Hospital and Research Center

"Inputs make a lot of difference and affect patient care. We are first hospital in Rajasthan which puts up our Bhamashah counter in casualty itself because we wanted to define a process where a patient doesn’t need to go into customer care department for photo verification and finger print verification.

His first criteria is to be addressed within Golden Hour itself.

IT plays a major role in ensuring that hospital processes are retained and speed up delivery process."

"IT technology starts playing its role the moment patient steps into the hospital. Its application can be seen everywhere i.e on reception counter, billing area, emergency care, and OPD. Technology and innovations play a crucial role in healthcare delivery."

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CONFERENCE report

Panel Discussion: Emerging Global Innovations and Technology Interventions in Healthcare

Pannelist deliberating upon various aspects of healthcare delivery at Healthcare Innovation Summit, Delhi

Shuvankar Pramanik

Dr Rajesh Gupta

"Innovations are important vis-a`-vis patient care, clinical and administrative point of view. It has played a major role to boost healthcare delivery enabling people to avail quality and cost efficient medical facilities. There are many useful apps and software like Artificial Intelligence (AI), Blockchain and Chatbot in healthcare. We are also in the process to adopt these cutting edge technologies to enhance patient care."

"Innovation is all about how you improve the experience of patient care at hospital. Neither AI nor any other modern innovative solutions work until or unless data is well-structured, captured and consistent. It can be done through robust processes. Innovations happen due to two reasons, one because of somebody’s pain or somebody’s dream or both. Innovation is useless if it is not solving issues."

Chief Information Officer Sir Ganga Ram Hospital

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December 2018

GM- IT Medanta The Medicity

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Balihar Virk

Avinash Pandey

"If we are able to address any pain point in patient care area, that itself is innovation. Technologies must not increase cost to avail healthcare facilities. We shouldn’t fall in the trap of escalating healthcare cost which goes beyond the access of common man. Innovation is all about how whole system works efficiently with respect to patient care."

"There are multiple innovations, technological interventions taking place in healthcare sector across the globe. Recent advancements made in next-generation genetic sequencing have led to the development of diagnostics test that is able to identify at risk population much earlier. It helps in saving the downstream healthcare cost."

GM- Information Systems SPS Hospitals

CTO Care Hospitals

Murlikrishna Iyyanki Senior Consultant Administrative Staff College of India, Hyderabad

"There are three different aspects of IT and innovation in healthcare.

One is bio-instrumentation followed by public health management and population health management. Each has got its own importance. As far as applications of IT solutions like data analytics is concerned, we are able to concentrate on developing some specific instrument for diagnosis of particular disease or addressing any other issues within body."

Dr Ashok Seth, Chairman, Fortis Escorts Heart Institutes sharing a lighter moment with J Goburdhun, High Commissioner of Mauritius to India at Healthcare Innovation Summit, Delhi

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Delegates listening to panel discussions attentively at Healthcare Innovation Summit

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Glimpses of Healthcare excellence awards

Healthcare Excellence Awardees with Dr Amitabh Rajan, Chairman RBI Services Board of Inda & Dr Ravi Gupta, Founder Publisher, CEO & Editor-In-Chief, Elets Technomedia Pvt Ltd

Medicover Fertility

Medanta The Medicity

Smith Medicals

Dr Sandeep Chathrath

Simply Healthplus

National Heart Institute, New Delhi

Pulse Healthcare Associates

CK Birla Hospital, Jaipur

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Industry Perspective

‘Need to Make IVF Treatment Part of Social Discussions’ A lot of research is going on to improve In-Vitro-Fertilisation (IVF) treatment in India. Along with technology advancement in this sector, it is also needed that people suffering with any such problem feel free to discuss about it, says Dr Aradhana Kalra, Consultant IVF, QRG Central Hospital, in a conversation with Elets News Network (ENN).

Q

What are the opportunities and challenges for the rapidly evolving In-Vitro-Fertilisation (IVF) market of India?

The Indian IVF market is evolving at the same rate such as in country like the US or in Europe. As far as challenges are concerned, one of the major problems is that neither infertility nor its treatment is funded or insured in India which poses a financial burden on the patients many a times. Though the market is evolving but the ban on surrogacy has reduced the good opportunities of medical tourism in the country.

Q

Given the burden of infertility, where does India stand when it comes to fertility treatments?

One in every eight couples in India’s urban areas is suffering from infertility. As per different reports, the total estimated burden is over 27 million which might be a small picture of a big problem. In terms of treatment, a good infertility centre in India offers all such services at par with the global standards. The waiting period is less in comparison to UK and doctors in India are easily accessible. Cost of infertility treatment in India is also significantly less as compared to other countries across the globe. However, more research work needs to be done in this along with effective government policies for any such treatment.

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December 2018

Q

Tell us about latest trends and innovations in the segment.

A lot of work has been done in male infertility and selection of good sperm in cases of abnormal semen parameters like IMSI, PICSI, and Microsurgical sperm retrieval etc. Scientists across the globe are doing researches on ways to improve poor ovarian reserve. By multiple oral agents, different simulations protocols, and stem cell therapy.

We are also doing study of PlateletRich Plasma (PRP) in cases of poor endometrium and have found considerable outcomes.

The modern laboratories have evolved with blastocysts culture being done at most places. Use of embryoscope which can take pictures of forming embryos at a time interval and can detect the progress of developing embryo in repeated implantation failure (RIF) cases.

Q

How can establishing a regulatory body streamline the unorganised Indian IVF sector?

The Indian IVF sector is highly unorganised and there are many unregulated centres run by underqualified or unqualified people. A regulatory body is mandatory but it should be beneficial to the society and the doctors. Moreover, to regularise the IVF sector, we also need strict laws.

Dr Aradhana Kalra

Consultant IVF, QRG Central Hospital

Q

Infertility is something which many people don’t want to talk about. How spreading awareness among people can help to keep myth and stigma surrounding infertility at bay?

Infertility and its treatment are a taboo in our country. People request us not to tell their relatives that they underwent IVF. Social awareness and counseling play a major role. Also, it needs to be emphasised that both male and female can have problems so none should be blamed. IVF treatment should be treated the same way patients visit the doctor for general illnesses. Moreover, doctors should be consulted for treatment of infertility rather than believing any superstition.

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Corporate Acquisitions/Appointments KKR-backed hospital management firm Radiant Life Care has said it will acquire a majority stake in Max Healthcare through a merger to create a combined entity valued at Rs 7,242 crore.

The deal, to be carried out through a series of transactions, will see KKR becoming the majority shareholder while Radiant Life Care promoter Abhay Soi will lead the combined company as Chairman. Max Healthcare promoters led by Analjit Singh will step down.

“The combination of Radiant and Max Healthcare will create the largest hospital network in North India, which will become among the top three hospital networks in India by revenue and the fourth largest in India in terms of operating beds,” the companies said in a joint statement.

The merged entity will operate over 3,200 beds throughout 16 hospitals across India, it added. “The acquisition will be undertaken through a series of transactions, including Radiant’s purchase of a 49.7 per cent stake in Max Healthcare from South Africa-based hospital operator Life Healthcare in an all-cash deal,” it said.

Home healthcare startup Portea raises venture debt of Rs 25 crore

ACCESS Health India appoints Dr Krishna Reddy as Country Director

Bengalurubased startup Portea which deals in home healthcare services has raised Rs 25 crore venture debt led by Alteria Capital Advisors LLP. “The team at Alteria Capital is quick to understand the needs of the business and is long term partners.

Venture Debt is a great alternate source of capital for high growth businesses like Portea and we are excited to partner with Alteria,” Meena Ganesh, Co-founder and CEO, Portea was quoted as saying.

Portea offers services ranging from physiotherapy, doctor consultations, new-mother-and-baby care to diabetic care. The health-tech startup which had raised equity funding of $26 million last year, will use the money to expand its base and improve service offerings.

The company claims to be working with more than 50 leading hospital partners, 15 pharma majors and leading insurance companies in India.

Distinguished Cardiologist Dr Krishna Reddy has been appointed as Country Director of ACCESS Health India, the company said in an official announcement.

Dr Reddy has a long and distinguished career in India and is known internationally as a pioneer in comprehensive primary care, digital health, and integrated care.

“I can think of no better person than Dr Reddy to lead our work in India and in other emerging economies. He has been a friend and supporter of ACCESS Health for many years, even helping us set up our first office in Hyderabad more than ten years ago,” said William A. Haseltine, ACCESS Health Chair and President.

“Dr Reddy brings a lifetime of experience in providing high quality care to people across rural, urban, high income, and low income areas.

We are delighted to have him on our ACCESS Health India team,” Haseltine added.

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Siddhartha Bhattacharya appointed Secretary General of NATHEALTH

NATHEALTH, Healthcare Federation of India has appointed Siddhartha Bhattacharya as new Secretary General effective from December first, 2018.

With over 20 years of leadership experience in health and technology enabled services sector across India and USA, Bhattacharya will give fillip to NATHEALTH’s vision/ mission to spearhead the goal of high quality, affordable health for all.

“Siddhartha Bhattacharya is very well respected and one of the most seasoned and dedicated healthcare leaders of India,” said Daljit Singh, President NATHEALTH. “His decades of experience in launching successful partnerships in the public and private healthcare sectors and extensive background in healthcare systems and technology will be a tremendous asset to NATHEALTH. We are delighted to welcome him on board.”

Corporate update

Radiant Life Care to acquire Max Healthcare

Sun Pharma acquires Pola Pharma to boost dermatology segment

Sun Pharma recently made an announcement to acquire Japan-based Pola Pharma. The deal, which will help Sun Pharma to strengthen its presence in dermatology segment across the globe, was struck for $1 million.

The firm has entered into a definitive agreement to acquire Pola Pharma, which is engaged in research and development, manufacture, sale and distribution of branded and generic products in Japan, Sun Pharma said.

Pola Pharma’s portfolio mainly comprises dermatology products. It has two manufacturing facilities in Saitama, with capabilities to manufacture topical products and injectables.

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News Highlights

Latest from Health World Lok Sabha passes Surrogacy Regulation Bill; bans commercial surrogacy Delhi High Court bans online sale of medicines across country

With the aim to regulate and streamline surrogacy practices in India, the Lok Sabha recently passed Surrogacy (Regulation) Bill 2016. It prohibits commercial surrogacy and allows close relatives to act as surrogates to needy infertile couples for “altruistic” reasons.

Terming the proposed legislation historic, the Union Minister of Health and Family Welfare J P Nadda said different sections of society, political parties, the Supreme Court and the Law Commission have spoken against commercial surrogacy and the bill addresses these concerns.

India had become a hub of commercial surrogacy and surrogate mothers also suffered from exploitation, he told the Lower House. Nadda said the aim of the bill was to stop commercial surrogacy but at the same time save families by allowing them to have children by using modern science.

Only defined mother and family can avail of surrogacy and the same was not permitted for live-in partners or single parents, he said.

In a landmark judgement, the Delhi High Court has ordered a ban on sale of online medicines by e-pharmacists across the country. The court directed both Central and State Government to immediately implement the order.

A bench of Chief Justice Rajendra Menon and Justice V K Rao recently passed the judgement while hearing a PIL filed

by Delhi-based dermatologist Zaheer Ahmed.

Through the plea, Ahmed had contested that lakhs of medicines were being sold on the internet every day in unbridled manner and without any regulation posing a huge risk to people. She had also put up the argument that online sale of medicines is not permitted under the Drugs and Cosmetics Act, 1940 and Pharmacy Act, 1948.

ICMR releases draft of India’s first essential diagnostics list In a bid to ensure quality diagnostics at all levels of healthcare facilities, the Indian Council of Medical Research (ICMR) has formulated draft of new National Essential Diagnostics List (NEDL).

“The list is on the lines of the drug list. It is a scientifically designed list, which has been based on the World Health Organisation’s list of essential diagnostics for key areas like HIV and hepatitis, but it also takes into account the priority areas of non-communicable diseases and diseases prone to outbreaks such as dengue,” Dr Kamini Walia, senior scientist at ICMR was quoted by a leading daily as saying.

ICMR, the research body of the Union Health Ministry is responsible for the formulation, coordination and promotion of biomedical research in India. However, it is not the implementing authority and cannot fix prices of the test.

“The list prepared by ICMR may be considered by the

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committee that is in the process of developing the new national medicine list for 2018. If the diagnostic list is included, the prices will be regulated under the Drug Price Control Order, 2013,” said a senior official from the country’s apex drug regulator Central Drugs Standard Control Organisation (CDSCO).

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Rajasthan Govt appoints Rohit Singh as Principal Secretary, Medical & Health In a first bureaucratic reshuffle under the newly formed Ashok Gehlot led Rajasthan Government, Rohit Kumar Singh has been appointed as Principal Secretary in Medical, Health and Family Welfare Department, Government of Rajasthan.

He was Chairman and Managing Director, Jaipur Metro Rail Corporation Limited till now.

The 1989-batch, IAS officer, Kumar had earlier served as Member(Finance), NHAI and Joint Secretary (Highways) in the Ministry of Road Transport and Highways, Government of India.

Dr Samit Sharma has been appointed as Mission Director, National Health Mission & Special Secretary, Medical Health and Family Welfare Department, Government of Rajasthan, by newly formed Ashok Gehlot led Rajasthan Government.

He has also been given an additional charge as CEO, State Health Insurance Agency, Jaipur.

Dr Sharma has been Commissioner, Industry, Corporate Social Responsibility Department and Principal Secretary, Industries Department, Rajasthan till date.

He is known for his work in providing affordable healthcare, particularly generic drugs, under the free medicine scheme of the previous Congress government.

Cabinet nod for AIIMS in Madurai

Mobile App to help quit smoking

A research team at the Indian Institute of Technology Kharagpur is developing a mobile application to help smokers quit smoking by raising an alarm everytime they try to lit a cigarette.

The app, a prototype of which has been developed by researchers led by Ram Babu Roy, assistant professor at Rajendra Mishra School of Engineering Entrepreneurship at IIT-Kharagpur, is capable of monitoring the activities in daily lives along with the smoking habits.

It can be integrated with a fitness band or a smartphone for automated recognition of addictive and depressive behaviour.

Using a sensor-based technology, the app works with a real-time approach and offers interventions in the form of a text/audio/video messages or a phone calls from family members/friends/doctor to convince the smoker to stop smoking while he is at it.

The app creates a smoking behaviour profile of the user, based on which estimates of the cumulative effects of smoking on the individual would be done.

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Rajasthan Govt appoints Dr Samit Sharma as MD, NHM & Special Secretary, Medical & Health

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The Union Cabinet has given its approval to build an All India Institute of Medical Sciences (AIIMS) in the district of Madurai in Tamil Nadu, which is expected to come up under the Pradhan Mantri Swasthya Suraksha Yojana in less than four years.

To be constructed at an estimated cost of Rs 1,264 crore in 262.62 acres at Thoppur, the 750-bed premier institute will have 15-20 superspecialty departments, according to the proposal submitted to the Cabinet. as the site for the proposed institute.

AIIMS Madurai will be equipped to handle around 1,500 outpatients per day and 1,000 inpatients a month. The facilities will include a medical college, auditorium, night shelter, AYUSH block, guest house, hostels and residential facilities.

The institute will also have 100 MBBS and 60 BSc (nursing) seats.

In his budgetary speech in February 2015, Union Finance Minister Arun Jaitley had announced construction of an AIIMS campus in Tamil Nadu.

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