An eminent fertility specialist, scientific director of GG Hospitals, avid traveler, writer, keen photographer, model and fitness enthusiast all rolled in one, Dr. Priya Selvaraj wears many hats. Specializing in fertility medicine for more than 19 years now, she helps couples conceive and have children. Dr. Priya Selvaraj has been celebrated for her tremendous contribution to the field of medicine and her achievements speak for herself. Here we are in conversation with Dr. Priya Selvaraj, one of the most prolific doctors in town.
You are one of India’s most popular fertility experts, what prompted you to work in this field?
Since my childhood, I have always wanted to be a doctor. I knew no other profession well enough, as I was raised in a nuclear family with my parents both being doctors. They worked very hard to raise us. My grandfather and Aunt were noted and celebrated actors but despite that, I got more rooted in my parents’ professional choice. Also, those were the years when one was expected to choose a professional path and often as kids you tend to choose what you see, live and breathe day in and day out.
How do you work towards achieving your goals and how long have you been in this field of medicine?
I have been working at our institution for the past 19 years. For training as a fertility specialist, I started even before I completed my postgraduate studies. My mother had sent me to attend the first basic course for infertility practice at the national university hospital, Singapore back in 1999. That was a turning point for me to realize that I would take it up as a super specialty. Since then, learning has never stopped. In medicine, you need time and patience. Miracles do not happen overnight. I make it a point to understand the reality of setting goals and limit mine to one or two per year where research is concerned.
You have pioneered some of the fertility techniques in India. How do you maintain such a high success rate?
Success rates, I believe, are only the result of standards of care and expertise. Being Pioneers we wish to bow down to quality rather than quantity. In the field of fertility medicine, success rates are still limited. One cannot claim 100%, let alone even 80% in test tube baby programs. We measure our clinical success by numbers of live births and the success of our laboratory work by a good clinical pregnancy. There are still pregnancy losses and still negative results that one has to be scientifically sound to explain, determine and treat, in a realistic manner. Establishing protocols and checklists and maintaining lab standards with constantly updating ourselves has helped us in our journey.
Do you collaborate with your mother, Dr. Kamala Selvaraj?
Is there pressure to live up to her legacy? Yes, we do collaborate when needed. The initial years of being in practice were a challenge and yes there was pressure. It is easy for one to assume that children may be living off a legacy, but the truth here is that unless our work is put to the proof, nothing is handed down. I have learned and unlearned many things in the process. Considering we are generations apart in our thinking and approaches, there is still common ground and much to appreciate.
You were the one who successfully came up with India’s first frozen oocyte baby. How did that happen?
In the year 2004, I had attended a cryopreservation workshop in Singapore. Back then a major portion of our lab supplies was being purchased from there. One supplier who was selling us the culture medium for growing our embryos poached a new concept of freezing the human oocytes, the medium for which had just been released into the market. It was a novel. It was also a new method of freezing human cells by a concept called vitrification (rapid freezing of cells) and it required special devices to load the oocytes. It had a learning curve and was not so easy to perform without technical advice. I was thrilled as I had read about it earlier and its applications in the field of oncology, where women would then be able to freeze their oocytes before debilitating cancer treatments that will affect their chances of having their biological children down the line. I immediately took the opportunity to connect with scientific personnel involved and ordered the media. It was not to be offered to patients until we had standardized protocols which meant we were going to be self-funded. I froze close to 300 oocytes by slow freezing and vitrification between 2005 until 2007 before we were able to offer the concept. It was very slow to pick up. But I found the right patients for use and that paved way for success.
You have created history by delivering a baby for a uterine cancer survivor, the first case in India. How did you manage it?
This particular case was unique. It was not that cancer survivors had never become mothers before. It was a case where she had to lose her womb young, owing to the early stage of uterine cancer, and we had to make her a mother by harvesting eggs from a single ovary located in her anterior abdomen instead of the normal location. We also had to employ surrogacy to complete the process. The technique of harvesting was the challenge and we had to attempt it three times before being successful in creating embryos. We had one miscarriage and one negative result before the surrogate could carry the pregnancy to term. The whole process was done over a period of two years. It showed the perseverance of the couple that inspired us to give it our all.
Is there a hope for such cancer survivors?
Yes, the success of this case has opened up possibilities of new surgical technique and oocyte retrieval as well. One can attempt to save the ovary just below the skin. The reasons for the positioning of the ovary were intended for other benefits but proved to be beneficial even for oocyte harvest. The onco surgeon was Dr. Chitrathara from Lakeshore hospital, Kerala. At least it spreads more awareness on preserving fertility without fear and provides hope.
Recently there are a lot of rumors going around about the sperms/eggs been exchanged or wrongly inseminated. What is your take on this?
According to census globally, the most common errors are human. So yes, there have been cases of mix up in labs. The responsibility is on the individual embryologist involved. Unfortunately, the clinician gets blamed for these episodes. However, as part of strict lab protocols, all processes should have double witnessing and documentation. Errors if noticed should encourage active discussions and preventive strategies rather than cultivate the habit of blame game. A good lab director will ensure that these risks are minimized or rather never occur at all. The solution is that once the error is identified then one should not carry out any procedure at all.
With the increasing infertility rate, what will you suggest for both men and women to have a healthy lifestyle?
In the past decade, we have seen climbing rates of infertility for varied reasons one of which is the lifestyle. An increase in smoking and alcohol consumption, Late hours, couch eating, instant foods including junk food, sedentary jobs, stress and unrealistic expectations at work all compound male and female factor infertility. The easiest way to effect a change is to change one’s lifestyle. A well-balanced diet, regular fitness routines, avoiding instant cooking, eventually stopping smoking and reducing or stopping alcohol intake can bring about a visible change in sperm counts, hormonal imbalances in the female and overall better ovulation rates and regular menstruation. These days more emphasis is laid upon fitness and what we put on our plate.
The booming ‘rent a womb’ (commercial surrogacy) is banned in India recently as the bill claims unethical practices carried out by the surrogacy clinics. What is your take on this issue?
Surrogacy had been a booming business in India making our country the world capital for surrogacy. It became a billion-dollar business. The lack of firm regulations or the delay in implementing the regulations was instrumental in the controversies shrouding surrogacy. By way of concept, it is not wrong but by way of conduct of the whole process, many unethical issues have forced the government to take a blanket action, thereby denying even the rightfully indicated case scenarios the rights to surrogacy. This is a country where there is exploitation of women and particularly the girl child. I do believe in curtailing the process of surrogacy with a scientific and rational approach rather than making it an altruistic and narrow minded one.
Compared to other fertility methods, surrogacy is relatively low in India. Why is that so?
Surrogacy is not a method one employs as part of a regular IVF process. It has certain indications and since it involves another woman carrying the baby for a couple there are formalities and legalities to be fulfilled. It has to be done for the right and genuine reasons and also there need to be healthy volunteers who are willing to be a surrogate. In our country, it can hardly be altruistic because of socioeconomic reasons and can become an expensive affair for a regular income group. It needs to be a completely regulated process whereby the health and future well being of the surrogate mother receives the utmost importance.
There are a lot of rumors out there that vegans often do not get enough proteins or nutrients because of all the foods they exclude from their diet. Based on your experience do you feel it is easy to keep yourself on track health-wise?
Absolutely easy. I have better calcium and vitamin D3 levels with no signs of insufficiency compared to my staff who thrive on a dairy diet. There is a fallacy that vegans suffer from a lack of proteins and calcium. I can enjoy curd rice with soy milk curd. Sometimes it becomes an acquired taste. There is also no concrete evidence to say one needs milk and yogurt every day in one’s diet, especially from another species. There are others who are flexivegans, where is the source of diary is from a “Goshala” (where the product is not for commercial purposes), or if people raise cattle and produce on their farms only for themselves. (like back in the good old days) they may consume the diary. We have a vegan group headed by a close friend where recipes are posted for one to learn and share. She also makes and sells mock meat using soya as a base. We do not lack protein at all in Vegan diets. For instance, everyday South Indian food is a good balance of carbohydrate, fat, and protein. Tofu is a major contributor. As for calcium, all green leafy vegetables, soy, almond, oat milk, dried fruits and nuts, and pulses. It is also advised that people take supplements in addition to our diet, not just for vegans but for everyone.
Besides being a doctor, you’re also an avid writer and fitness enthusiast. How do you nurture your passion and what are your other interests?
Fitness is an integral part of me. I think if one realizes their immense responsibilities they will automatically become health-conscious and driven. I dedicate my morning hours to fitness, be it a cardio routine or yoga. Writing just happened to me and I landed a column for 8 years, which I think gave me the much-needed freedom to my thoughts. It is in a way liberating. I love music and dance. I am in an on off relationship with classical dance. Guitar and vocals are in the nurturing phase. I just keep going back to these as and when time permits. There is no age bar to learning, however, time is a big constraint and so one should be perseverant.