Fertility segment in India has grown 20 per cent CAGR in the last five years. The country, reportedly, sees about 2-2.5 lakh IVF cycles in a year and has the potential to do about 5-6 lakh IVF cycles. In an interview with THE WEEK, Dr Kshitiz Murdia, co-founder and CEO, Indira IVF, talks about the sector, technologies involved, and how men and women have taken to IVF, over the past few years. Excerpts:
Q\ Have the cases of infertility in India gone up?
A\ I would say roughly 12-15 per cent of the population in the reproductive age suffers from infertility in India. The numbers have not really gone up or down in the real sense but the awareness has increased and people are going for check-ups now. This is a good sign as it will help us in detecting these cases early and do a timely intervention.
Q\ What are the most common complaints people have regarding infertility?
A\ With females, a majority of the problems pertain to blocked tubes and age-related complications that arise when women push family planning for later ages, as they prioritise their careers. In the case of men, it is very interesting to note that the sperm count has been gradually declining. I remember my father telling me 10 years back when we started IVF that when he used to practise two to three decades back, he would normally see a sperm count in the range of 50/60/70 million. At that time, as per the World Health Organization (WHO) too, sperm count of 60 to 120 million was considered to be normal count but now the WHO itself has lowered its normal sperm count rate to 15 million. And there was a recent report that got published which said that the male sperm count is declining rapidly and by 2045, all men will have zero sperm count. This could, in turn, be due to genetic factors, lifestyle factors, pollution, the food we are eating.
Q\ Which are the main problems related to infertility faced by women?
A\ The majority of the problems in women I believe are because they have been consciously delaying childbearing along with marriage. Even after they are married, the priority is not having a family but getting on with their careers. They feel that they are mentally and socially fit to have a baby at 35 or 37, but unfortunately, the body does not support it. It is important to know that there is an inherent difference between men and women in terms of reproduction - men could still be producing sperms at 40 or 70 years but females have a limited quota of eggs which gradually decline with every ovulation. By the time a female turns 45-50, the egg reserves deplete to almost zero. So, the quality of the eggs begins to decline post 32. After 35, we see a sharp decline in the number of eggs as well as the quality of eggs. Even if a woman conceives after 35, the chances of having some abnormality in the baby, including Down's Syndrome and other chromosomal abnormalities, increases, thereby leading to more abortions in this age group of the population.
Q\ How does IVF help in such a situation, especially when the couple is well over 35?
A\ The slight edge that IVF has is that we can detect chromosomal or genetic abnormalities in the embryos well in time, as they are implanted inside the uterus. So, the pre-genetic diagnostics wherein we detect the chromosomal status of the embryos before implantation is very important as it can help in flagging off many diseases, including mutations, thalassemia, among other things. We once had an interesting case of a couple in one of our centres in Delhi, where both husband and wife were thalassemia minor and had a previous child who was a thalassemia major. That child would require loads of therapies every now and then, ultimately necessitating a bone marrow transplant. So, we took the couple for IVF, and conducted genetic diagnostics on the embryos to differentiate the thalassemia major ones from the minor and normal ones. Then further testing followed and we transplanted a healthy embryo in the couple. So, with IVF, everything is possible, so as to make sure that the child born, is healthy, free of diseases.
Q\ Between the men and women who come to you, which gender contributes more towards cases of infertility?
A\ Roughly, it would be equal.
Q\ Which, as per you, are the underlying factors leading to infertility?
A\ In women, it could be the tubal block which could result from sexually transmitted diseases or even from tuberculosis rampant in rural India. Also, in many parts of the country, especially in Bihar, UP, and Jharkhand, there is a common tradition of 'cleaning the uterus' when people are not conceiving naturally. That's the major cause of ‘bad looking’ uteruses in women from those regions. Second major cause is premature ageing, which means females having less egg count at a particular age wherein their counterparts in the west may have better reserves. This could be related to nutritional or genetic factors. In men, we see low sperm count and decrease in motility and quality of sperms. It could be related to the places of work that are hot or heat generating, especially as excess heat tends to damage the sperm quality and lowers the count.
Q\ How has COVID-19 impacted the IVF industry?
A\ In March, we carried out the highest number of IVF cycles. Lockdowns have led to hiccups in normal functioning but we have people coming to us for investigations. Most of the clinics are doing 85-110 per cent of pre-COVID-19 business.