• Kelaniya Medical Fac./Colombo North Teaching Hosp. IVF Centre project-in-charge, consultant obstetrician and gynaecologist, Dr. Pradeep Suranga Hettipathirana explained that IVF can be utilised to prevent genetic abnormalities in babies 

Thus far, the in vitro fertilisation (IVF) service was available only in Sri Lanka’s private sector and that too as a costly process. However, with the opening of the first public institution that conducts the IVF process, those in need can now obtain this service for free or at a minimal charge.

Noting this, consultant in obstetrics and gynaecology and Senior Lecturer attached to the Kelaniya University Medical Faculty, Dr. Suranga Hettipathirana, added that this IVF centre, opened at the Faculty, can also be utilised for research purposes and trainings. He discussed the importance of this centre and the future of IVF procedures in Sri Lanka during an interview with The Daily Morning.

Following are excerpts from the interview:

What is the IVF process?

In lay terms, babies born through this are called 'test tube babies'. Basically, this is a last resort that we use for the subfertile population. We take the eggs from the mother and sperm from the father. The whole process up to fertilisation is done in a lab, and that is where the term ‘test tubes’ comes from. The fertilisation, the forming of the embryo, and the growth of the embryo up to five days happens in an artificial lab setup. Once we make the embryos, we transfer to the mother's womb.

Recently, the first IVF Centre in the public sector was opened at the University. Why is this important and necessary?

Generally, around 10% of the population are subfertile. Sometimes, despite trying for more than a year, they still can’t get pregnant. There are simple treatment regimes for them which include giving medicines to push the ovulation. These are simple treatments which we can do at most private sector institutions and even in the Government sector. However, if they don’t get pregnant after this basic treatment, in some instances, we have to go for more-advanced treatments. This is the most advanced technique when it comes to making subfertile patients pregnant, and therefore, we go for IVF. The first IVF baby in the world was born in 1978. After that, millions of babies have been born through IVF all around the world. This technology came to Sri Lanka in 2002, and IVF pregnancies have existed in Sri Lanka since 2002. But, it is done only in the private sector. Therefore, IVF is a costly process. A fair number of patients are going through it with many difficulties, but, the majority of the patients don’t because they can’t afford to do this. 

We have a fertility unit in the Faculty in Ragama, and it has been functioning since 2002. We were providing different types of treatment options and processes. But, we realised that this is a necessity that has to take place in the Government sector, and that we should give it either free of charge or at least at a reasonable cost that is affordable for the people. With that intention, we started this project in 2021-2022, and ultimately, we managed to put up our own IVF lab and facilities with the funds generated on our own. We had a successful pregnancy this year. We started the process last year (2024), and we had a successful pregnancy. Although IVF has existed in Sri Lanka since 2002, this is the first IVF pregnancy that has taken place through the government sector.

How can one apply to obtain this service and what are the procedures and conditions that it entails?

We have completed the first step. We have put up an IVF lab. When it comes to trial runs, we did eight cycles, and three got pregnant. Unfortunately, two ended up with miscarriages. This is the successful, live pregnancy. As a first step, we now know that we have the facilities, technology, expertise and technical know-how to do IVF in the Government sector. That is in the Faculty’s IVF Centre attached to the Colombo North Teaching Hospital in Ragama.

As a second step, we need to move forward from this point. The biggest cost of the IVF process, which is equivalent to around 40-50% of the cost, is for medicines. We are planning to discuss with the Health Ministry to see whether the Government can provide the relevant medicines through the ministry’s Medical Supplies Division. If we can achieve it, we can provide this service as a totally free one. If not, the patient will have to bear the cost of the medicines. The next step is to discuss how we can offer this service to the patients.

For us to start this service, it might take another one or two months. One reason is that if we are going to charge patients, that decision has to go through a process to get the university’s and the ministry’s approval, after which we can start this service. Matters such as the selection criteria will depend also on whether patients will have to buy their medicines, and we will not have to have a very strict selection criteria because they are bearing part of the cost. But, on the other hand, if the Government is going to give everything for free, we will then have to discuss with the Government and see what are the conditions that we will have to adhere to. We have not yet finalised those things, and it will therefore take another one to two months. For the time being, we will continue what we have started. So, we might straight away start the first part where the patients bear the cost of the medicines, probably within a month or two. We can start it anytime. However, if the medicines are to be given for free by the Government, we will have to formulate a criteria as to how we are going to do it. That will take another one to two months.

What is the legal and policy background pertaining to the IVF process?

IVF processes have been conducted in Sri Lanka for the past 23 years. There were issues because we don’t have strict guidelines. However, this year, the Sri Lankan College of Obstetricians and Gynaecologists (SLCOG) has a concept paper saying how IVF centres should be run, what are the standards, and what are the ethical aspects. They have given it to the ministry as well. The Ministry has put it out as a guideline. But, it is not a very strict one yet and there is no legal basis still. So, strict protocols might come. I don’t know how long they will take. So we, as a Government institution, are going to adhere to those guidelines and move forward.

When it comes to the IVF process, there are various misconceptions such as children conceived through IVF being likely to have abnormalities? What is your response to such?

Those are actually myths. When it comes to IVF, what we are basically doing is conducting a natural process in an artificial setup. The reason for doing so is that this would increase the possibility of successful pregnancies. As a percentage, it increases the chance of getting pregnant. Other than that, we don’t modulate, change, or do anything artificial such as changing genes in this process. We just take the egg and sperm, fertilise them, and let it grow as normal in a lab setup. There is no increase in abnormalities just because of IVF.

Actually, we can utilise IVF to prevent abnormalities in babies, because IVF has developed to such an extent where we can check the genetic composition of the baby. We can take one cell before transferring to the mother, and check whether there are genetic abnormalities. We can then declare that these are abnormal embryos and these are not abnormal embryos, and transfer the healthy embryos.

Diverse types of families such as same-sex couples exist in the society apart from traditional heterosexual couples. Has this institution paid attention to providing them services?

We have not gone to that extent. The main reason is because there are a lot of social and other matters that need to be taken into account. More than that, we want to adhere to the Sri Lankan law. If you take same-sex couples, it is still not legal in Sri Lanka. In such a context, whether they can have a baby is a controversial matter. If we are going to pay attention to such matters, we have to get clear, set guidelines from the Ministry and the Government because once such babies are born, there would be legal issues concerning the baby. So, we are not going to touch on those aspects first. What we want to touch on first is straight, subfertile couples. Depending on the Government’s response and rules and regulations of the country, we are going to think of that as a next step, and not an immediate step.

Does this institution provide other services such as family counselling in addition to IVF?

This IVF process has been started at the Faculty's Obstetrics and Gynaecology Department. So, we have special clinics, and our consultants are conducting gynaecology clinics and obstetric clinics. We provide general services with regard to gynaecology-related issues and surgeries, for example, laparoscopy, fertility-related laparoscopic surgeries and fertility-related hysteroscopic surgeries. We had other fertility-related treatments, examples being seminal fluid analysis and intrauterine insemination. Now, we have upgraded our lab facilities, and we are continuing those facilities. In addition to that, we are starting IVF for the first time in the Government sector.

What do you think about awareness in society about the IVF process?

It should definitely improve. There is inadequate awareness because this process is only available in the private sector and it is costly. We have to do more public awareness, saying that this facility is available in Sri Lanka’s Government sector as well. Then, hopefully, visiting obstetricians and gynaecologists will get this message and refer people. We can then give this service to those in need.