Desperate to have a son , Mumbai couple are parents at 60 via IVF


-INPUTS BY GITANJALI CHANDRASEKHARAN

Mumbai couple that turned parents at 60 via IVF juggle ecstasy and ethical dilemmas 35 days into nurturing their first-born.It’s 39 degrees on a Friday morning in Vond village of Bhachau in Kutch district, Gujarat. The rains have been playing characteristically truant. In a courtyard canopied by jamun trees lies a cot lined by a lived-in cotton razai. A bundle of white mul sits at its centre, a box of pendas lying to one side. Suddenly, there’s movement.

As if in sync, four women who up until then have been sharing a leisurely chat, spring to their feet. One reverentially lifts the mul. Punjiben Patel’s 25-day-old son has risen from his siesta.

HOLY MOTHER OF GOD!

Mumbai couple that turned parents at 60 via IVF, juggle surprise, ecstacy and ethical dilemmas 35 days into nurturing their ‘miracle’.

“Maaro dikro, maaro Nandlal,” she coos, holding him up, his plump cheek pressed against hers. The smothering is warranted.

Punjiben became a mother for the first time at 60, 15 years after menopause pulled the plug on her hope to conceive. On May 30, she delivered a healthy baby boy weighing 3.9 kg at Ahmedabadbased IVF specialist Dr Mehul Damani’s clinic. Back in their village, she and husband Ranchhodbhai have been playing host to a relentless stream of visitors keen to meet the miracle baby. Among them is Dimple Premji Patel, an 18-year-old Class 12 student, excited to meet her newborn ‘uncle’. Daughter to Ranchhodbhai’s cousin, Premji Patel, she laughs, “He isn’t just my kaka. Ranchhod kaka’s grand niece was born just the other day, which makes this little one a nana (grandfather) too!”

The family tree synchrony spoiled by age is hardly a concern for the Patels. What is, is what the baby should be named. It’s Jeth month, a time of darkness, which is why Punjiben has decided to name him post-Amavasya when Ashadi Beej sets in. “Then it will be light again,” one of the visitors say in approval.

“We might name him Rudra,” Dimple interrupts, referring to a name for Lord Shiva. “After all, he is god’s gift.”

A neighbour walks in with a plastic bag that carries new clothes for the baby. She places the gift beside him on a cot, her time-worn fingers fiddling with his little fist. Startled, the baby lets out a cry. The women laugh, handing him over to Punjiben, who breastfeeds him.

This is one of many surprises in Punjiben’s case that Dr Damani has been pondering over. “Rarely are IVF mothers able to produce breastmilk due to low hormone levels,” he says of his oldest patient. “The Patels had made the rounds of a string of doctors but hadn’t considered invitro fertilisation (IVF). When she first came to me in 2014, she was menopausal. But she conceived in the very first cycle. Usually, it takes at least three attempts.”

What Dr Damani considers a problem arising out of poor quality eggs or blocked fallopian tubes was compounded by Ranchhodbhai’s profession. As a plumber with a firm in Dubai, he’d come back home to Punjiben, who he married in 1982, only two months of the year. But in an attempt to give starting a family his best shot, he relocated to Mumbai in 1989, staying with Punjiben at their Vashi home, while a hardware shop he set up in partnership with a friend kept the home fires burning. “We have visited so many specialists, I’ve lost count. Doctors in Ghatkopar, Andheri, Bhuj, Anjar…Homeopathy, allopathy, Ayurveda, we tried it all,” says the 65-year-old. Finally, dejected, the two decided to move to Vond in 2006.

What they couldn’t abandon was hope. Spirituality was their refuge. Punjiben, together with family, trekked to their kuldevi’s temple in Pavagadh, a hill station near Baroda, vowing to renounce footwear for six months. A year passed by with no results. “I resolved to continue walking barefoot. Even when we travelled to as far as Kerala and Bihar, I wore no chappals. I even worked in our fields without them. Now that my baby is here, I have given up my ‘baadha’. But habits die hard. I keep forgetting to wear them,” she giggles.

It was a neighbour in Mumbai, who managed to conceive after 20 years, who suggested the couple try IVF. “After menopause, the uterus shrinks due to hormone deprivation, from about 8 cm to 6 cm. The endometrium lining of 6 mm thins to 1 mm. Punjiben was put on a high dose of progestrone to kickstart menstruation. We had to regularise the endometrium or the inner membrane of the uterus. This required a combination of oestrogen and progesterone pills. It developed well despite her age, and she started menstruating. The uterus was responding,” Dr Damani shares.

Since a woman produces a limited supply of healthy eggs in her lifetime, a donor egg was fertilised with Ranchhodbhai’s sperm in an embryology laboratory. “We transferred three embryos into her uterus, and surprisingly, we hit success immediately,” he says.

The string of surprises has made Punjiben call her baby Lord Krishna’s avatar. “Despite my age, I had no problem during pregnancy. Even now, look at him. He is far from troublesome. He eats and sleeps on time,” she smiles as Premji’s wife Puriben hovers around to take the baby for a bath.

Punjiben, who never went to school, didn’t need parenting books. In a reversal of norms, she learnt the tricks from younger women around her. “One of our daughters-in-law was pregnant the same time my pregnancy was confirmed. I observed how she took care of herself and did the same. I rested at home, refusing to step out to buy supplies or visit relatives. People around began whispering about my strange behaviour. When the fifth month sonography revealed the baby’s form, we finally shared the news. The villagers went crazy. Women streamed into my home, offering help. It’s been easy,” she says, watching Puriben dress the child.

While the ethical questions surrounding the rising age of first motherhood fuelled by a burgeoning fertility industry continue to be raised, Dr Damani says he is willing to help a couple give parenting a shot irrespective of age, provided the mother is mentally and physically fit, and the couple is financially sound.

“Legally, there is no age restriction for IVF, but sometimes, we refuse treatment to mothers suffering from hypertension or cardiac problems. What’s vital is considering every case individually,” he says.

Dr Hrishikesh Pai, president of the Indian Society of Assisted Reproduction, says five per cent of his clients are women aged 40 to 50. The inability to land the right partner, pre-mature menopause and low levels of anti-mullerian hormone, which is indicative of the egg pool, are cited as chief reasons for late first motherhood. “After 45, pregnant women risk post-partum haemorrhage and pregnancy induced hypertension. As long as the donor egg is from a younger woman, the child is unlikely to be affected. However, if the mother suffers from diabetes or hypertension, there are chances of premature delivery or growth retardation,” he explains.

While adoption is not an option after 45, for the moment, women can give IVF a shot irrespective of age. However, this is about to change, says Pai. “The Indian Council of Medical Research (ICMR) is in the process of framing regulations to lock an upper age limit of 53 for women undergoing IVF, irrespective of the method used.”

Currently, ICMR allows a maximum of three embryos to be placed in the uterus. “But, if the patient has twins or triplets, the pregnancy can get complicated and the chance of premature birth is high. In Scandinavian countries, only one embryo can be inserted at a time,” says Pai. “What we need is self-regulation. There was a time when specialists were driven by the challenge of managing a pregnancy at an impossible age. Now, we need to consider additional factors.” – Inputs by Gitanjali Chandrasekharan

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