Of life and death

India’s first test-tube baby will turn 40 next week. Kanupriya Aggarwal’s birthdays never meant much when she was growing up in Kolkata. There were no grand parties or cakes to be cut, but quiet events. That is how Aggarwal would have liked to mark her 40th on October 3 — enjoy a normal yet nice day at work and home. But, of late, it has hardly been so. Over the past decade and a half, her birthday is remembered for two reasons — a milestone in science as well as the death of a doctor.

When she turned 25, Dr TC Anand Kumar, former director of the National Institute for Research in Reproductive Health and the man till then credited with creating India’s first test-tube baby, introduced Aggarwal to the world. Kumar chose her birthday to set right a wrong — that it was not he, but doctor-scientist Dr Subhas Mukherji who was the architect of the country’s first IVF (in vitro fertilisation) birth.

Mukherji was 50 when he killed himself in 1981, after the West Bengal government and the medical fraternity discredited his work in the birth of the country’s first test-tube baby. Director Tapan Sinha’s 1990 film Ek Doctor ki Maut is loosely based on Mukherji’s life, and another film — by a big Bollywood production house — is being planned.

Show and tell: Kanupriya Aggarwal wants Subhas Mukherji’s work to be known widely among the international scientific community

Kumar had been fighting since 1997 to give Mukherji his rightful place in medical history. By speaking and writing extensively — both in India and abroad — about Mukherji’s work, he turned the spotlight on a man who had been pushed to the brink till he could take it no more. When he introduced Aggarwal to a small audience in Bengaluru, he gave the late doctor’s path-breaking achievement a face. “I was 25 and old enough. Till then my parents were not sure how ‘coming out’ in public would impact my future. I said it would be silly not to,” says Aggarwal, who works with a multinational company in Mumbai.

Since then Aggarwal has emerged as the poster girl of IVF. Talks and meetings are organised by medical bodies around her birthday. On October 5, she will be in Pune to attend a meeting organised by a community of IVF practitioners in her honour. She accepts invitations as they give her a chance to remember and acknowledge Dr Mukherji’s work.

“I wonder if I’m speaking at the right forums. Most people are now talking and celebrating his achievements but nothing has moved beyond that,” she observes. “Could we have done anything more?… Mr Mukherji has no family left to keep his legacy alive,” she says.

At 25, Aggarwal joined a small band of people who quietly, yet determinedly, were fighting to clear Mukherji’s name and to get his work acknowledged. His Oxford-educated wife Namita was among them, as was Kumar. Spearheading the battle — then and now — is Sunit Mukherjee, now a frail man of 88 and the only surviving member of the doctor’s team that helped in Aggarwal’s birth. Kumar and Namita are no more.

Ray of hope

Kanupriya’s father, Prabhat Aggarwal, does not let an osteoporotic knee come in the way when he arrives for a meeting at the Calcutta Club to discuss the scientist behind the birth of his child. He is not sure if he has done enough for the person who brought joy into the lives of the Aggarwals.

Prabhat Aggarwal’s wife, childless after 15 years of marriage, was referred to Dr Mukherji at the Sir Nil Ratan Sircar (NRS) Medical College in Kolkata after initial examinations showed she had damaged fallopian tubes.

Jot it down: A handwritten note from Subhas Mukherji’s papers

“When we met Dr Mukherji, he said there was one method he could try (to help them have a child). But he warned that it was a method no one had tried with success till then — of a test-tube baby. He offered no guarantee and it was our choice to go ahead,” recalls Prabhat Aggarwal, who is a businessman. After treatments that went on for a couple of years, his wife was pregnant and Kanupriya, popularly known as Durga, was born on October 3, 1978 — 67 days after Louise Brown, the world’s first test-tube baby.

The birth of their daughter set off a whirlwind that threatened to unhinge the Aggarwals’ lives. Media teams swarmed their apartment seeking to interview the couple. Television crews from Australia and Japan put out offers to fly the family for more media interactions. “We told everyone we had no desire to be anywhere else, nor did we need the monetary gains offered to us. We had been blessed with a child and we were happy,” he says. They retreated into a quiet life.

Mukherji’s life, on the other hand, was falling apart. His team’s claim of successfully producing the country’s first test-tube baby found few supporters in Kolkata. A committee set up by the West Bengal government concluded his claims were bogus, and the then Left Front government shunted him out of the NRS Medical College, the hub of his research, to the Regional Institute of Ophthalmology (RIO). Humiliated and broken, he hanged himself to death at his house on June 19, 1981.

Fight for recognition

It was his associates — notably Mukherjee — who took up the battle. The Food and Nutrition division of the Dr Subhas Mukherji Memorial Reproductive Biology Research Centre in the sprawling Behala Industrial Estate appears an unlikely nerve centre for a struggle that has gone on for almost four decades. The institute, effectively a large hall, is also the office where Mukherjee sits among decades-old files. Among them are a handful of handwritten notes by the doctor on subjects ranging from fish protein to the long-term effects of organised despotism.

Dr Maverick: Subhas Mukherji had a holistic approach to medical research and practice and spent much of his time at the lab in the NRS Medical college

Mukherjee, the doctor’s long-time friend and the former head of food technology and biochemical engineering in Jadavpur University, compiled the papers taken from Mukherji’s home after his death. He took them to Kumar when the latter was in Kolkata for a talk in 1997. Kumar, along with his team, had been credited with producing India’s first “scientifically documented” test-tube baby — Harsha — in 1986.

After studying the notes, Kumar took it upon himself to clear the doctor’s name. Mukherjee picks out a copy of a letter, signed by him, Mukherji and Dr Saroj Kanti Bhattacharya, the gynaecologist who helped during the birth of Aggarwal. The letter, written two weeks after her birth, was sent to the Directorate of Health Services, informing the West Bengal government of the process adopted in delivering the country’s first test-tube baby.

“It is among the reports I showed Dr Anand Kumar in 1997,” says Mukherjee. The two-page typed report had surprised Kumar. “Dr Anand Kumar said to me, ‘I take no credit. I’m not the first in India to produce the first test tube baby’,” Mukherjee recalls.

He describes Kumar as a “true patriot” who took up Mukherji’s cause knowing that it would take away the credits against his own name. In April 1997, Kumar wrote an extensive piece in the journal Current Science . “Material for this article comprised Mukherji’s handwritten laboratory notes, list of his publications and papers presented at various scientific meetings, his correspondence with various scientists abroad and the Government of West Bengal, under which he served and the personal interviews I had with some of the major dramatis personae in this whole episode,” he wrote in the essay titled Architect of India’s first test tube baby: Dr Subhas Mukherji (16 January 1931 to June 1981) .

He rued how India had missed the bus in failing to take the credit as “the first in the world to have succeeded in not only fertilizing human eggs in vitro but also having successfully cryopreserved the embryo, thawing it and leading to the birth of a healthy normal baby”. Kumar blamed Mukherji’s plight on the Indian Crab Syndrome — where crabs in a basket pull each other down, letting none get to the top.

Late recall

Efforts are now on to give Mukherji the recognition that bypassed him when he was alive. The Mamata Banerjee government recently named two chairs, one in the physiology department of the NRS Medical College and another in the School of Tropical Medicine, in Mukherji’s name.

“Many talk of Subhas’s achievements. But nobody clearly says what his contributions were,” his old-time friend says. He largely excelled in three major areas, Mukherjee points out. At a time when many were working on IVF-aided births, few thought of accessing the ovary through the vagina. “Subhas did that; he made an incision and directly accessed the ovary when others were relying on the more cumbersome laparoscopic method,” he says.

Big gesture: Sunit Mukherjee remembers with gratitude the role played by TC Anand Kumar, who took up Dr Subhas Mukherji’s case despite knowing that it would shift the spotlight away from his own achievements

Mukherjee also refers to the doctor’s work in human menopausal gonadotropin (hMG), a hormonal medication in infertility treatments. “He was the first to use the hMG for super ovulation. He was also keen to find the source of hCG, a hormone found during pregnancy,” he adds.

An innovation in which Mukherjee participated in was freezing the embryo before it was transferred into the uterus. “Subhas maintained that removing the eggs or fertilisation was not the issue, but implantation was. If you do not get the right timing, it will not be successful. So he experimented with freezing the embryo, thawing it at the right time and transferring it. Now everyone is freezing an embryo,” he says.

Mukherjee recalls working with the doctor at his home to freeze the embryo. He prepared an alcohol dry ice bath in which the embryo was cooled slowly to a temperature below minus 40 degrees Celsius, and dipped in liquid nitrogen and stored for 53 days.

Four decades on, Rajvi Mehta, academic and scientific consultant for IVF, and a former student of Kumar, says many of Mukherji’s methods are now standard operating procedures in IVF. “Some of his processes were different from those of Robert Edwards,” says Mehta. Physiologist Edwards and gynaecologist Patrick Steptoe, the creators of Louise Brown, were awarded the Nobel Prize in Physiology and Medicine in 2010.

“Unlike Edwards, Mukherji stimulated the ovaries using hMG. Now very few practitioners work with the unstimulated cycles,” she adds. Cryopreserving (a method of preservation by cooling to very low temperatures) the embryo and delaying its transfer to the subsequent cycle, both methods which Mukherji followed, are now common. “He accessed the ovary through the vagina. That method is followed now, only that it is done through ultrasound,” she adds.

Mehta points out that these steps were published as achievements of scientists from Australia and England in reputed international journals some years after Mukherji’s experiments. “The fact that he did not publish all his findings in a science journal is often held against him,” Mehta adds.

There were possible reasons why he did not do so. The late 1970s were difficult years. India was coming out of the Emergency period, when population control had become a contentious issue. The phenomenon of test tube babies also set off complex ethical debates. “Edwards had to fight eight cases in a UK court,” Mehta points out.

Man and the doctor

Mukherji was always a bit of a maverick. A medical graduate from Calcutta University, his areas of interest ranged from endocrinology to reproductive physiology. When Kolkata — or the rest of the country — hardly had any endocrinologists, he was sent by the state government under the Colombo Plan to pursue a doctoral degree from Edinburgh. He came back to NRS as a professor of physiology.

“He was a young professor of about 35 when he taught us. He was always cheerful and soft-spoken,” remembers student Dr Ashis Kumar Thakur, a retired government doctor. “He was the only endocrinology expert at the time and conducted endocrinology OPD (outpatients’ department). A lot of gynaecology patients too came for consultation.”

Research was inseparable from his work and the doctor had built an animal house in the NRS hospital. “He used to do everything with his own hands. He would watch the animals, give injections, feed them and collect specimen for analysis. That was how he did his work. He lived there with his wife,” says Mukherjee.

The doctor’s approach to research and practice was holistic, asserts Mukherjee. When his fraternity condemned him after he announced his success with the test tube baby, he found the humiliation hard to bear. “Dozens of senior gynaecologists were against him and it was only for economic and professional reasons,” Mukherjee says. The business prospects of producing a test-tube baby were not missed by anyone and in an intensely competitive field it was motive enough to cast aspersions on Mukherji’s efforts. “The step meant that patients, both rich and poor, would now go to Subhas,” says Mukherjee.

But for Mukherji it was being robbed of his research that eventually broke him. He was transferred from NRS to Bankura and then to the RIO. “Being transferred to the ophthalmology institute was the death blow. Many asked him to take up private practice. He would say, ‘How can I? I need to do my research and I don’t have the capital for it’,” adds Mukherjee . Always the one to stand up for his best friend, he adds, “I don’t know if he was right or wrong to take his life. But I can justify him easily.”

Restoring a name

Mukherjee’s unwavering commitment to his friend — and that of Namita to her husband — succeeded in keep his legacy alive. It began as the annual Dr Subhas Mukherji memorial lectures that they organised from 1982. He recalls how difficult it was for him and Namita, a schoolteacher, to break into the closed medical community. Mukherjee breaks down when he remembers how Namita was humiliated by a senior gynaecologist she invited for a memorial lecture. “She turned away Namita saying, ‘Your husband is a cheat. I will make sure that none of my colleagues attends the lecture.’”

Yet, over the years, many well-known scientists and gynaecologists such as Connor J Carr from Ireland and Kurt Semm from Germany addressed the gatherings. “Most of our speakers came from outside since the Kolkata people wouldn’t participate in the memorials,” says Mukherjee.

Much of it changed after Kumar’s endorsement of Mukherji’s feat. The Indian Council of Medical Research has recognised the doctor’s work, and his name figures in the Dictionary of Medical Biography , where he is given credit for the first successful in vitro fertilisation in India.

Kumar himself delivered two lectures and attended many more. But with his death in 2010 and Namita’s in 2014, the small team lost its chief spokespersons. Mukherjee is the lone warrior and the annual lectures have been erratic since 2015. All that he wants is greater recognition for his late friend. “There is not even a road named after him,” adds Aggarwal’s businessman father.

Aggarwal stresses the need to make his experiments known at international fora. “We need politically charged scientific minds who will take up his case at the international level. We need to document his achievements prominently in the international space and get the record straight,” she says.

In a country starved of heroes in science, Mukherji has to be shown as one, she says. Aggarwal received scores of e-mails from Indian scientists settled abroad who wrote to her after Edwards and Steptoe won the Nobel to say that this was why they chose to migrate, so as not to be in a system that stifled growth.“It is time to show a generation that the kind of commitment Dr Mukherji showed will not go unnoticed,” she says.

P Anima

COMMENT NOW