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).
Infertility 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.
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.
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.
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 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.
The IVF market – The Scope
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, 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.
Surrogacy – A Hope for Childless Couples
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,” 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 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.
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.
What Causes Infertility in Men?
Male infertility is caused by abnormal semen (the fluid containing sperm that is released during sex).
• 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.
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.
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.