High Cost of Infertility Assisted Reproduction

  • Aditya Sinha
  • Publish Date: Jan 19 2016 3:17PM
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  • Updated Date: Apr 5 2016 1:27PM
High Cost of Infertility Assisted Reproduction

Clutching a rim of prescriptions and medical reports, 32-year-old Sameena (name changed) is patiently waiting for her consultation with infertility specialist at a high end clinic in Srinagar. “This is my second visit,” she says softly as her eyes scan the faces of women coming out of doctor’s chamber. Her eyes light up when she sees a woman leaving the chamber wearing a big smile.

As an office assistant calls for another patient to go inside, Sameena opens up a bit. “For the first year of my marriage everything was fine. But when I did not conceive after two years of marriage, people started asking questions,” said Sameena. “We turned to doctors and for next four years I tried every medicine from almost every doctor. But nothing helped.”

After a doctor advised Sameena to go for follicular study, the couple approached Kashmir Asisted Reproduction Center at Hyderpora. Here she has to go for some more tests and if all goes well, Sameena will have a baby via In Vitro Fertilisation (IVF), a process in which the gamete formation takes place outside the woman’s body.

Sameena is not alone to opt for such a treatment as rising rate of infertility among women in Kashmir has forced thousands like her to go for assisted reproduction.

Of late, increased age of marriage, changing lifestyle, deficiency of vital nutrition and other reasons have spiked the rate of infertility among women during the last decade.

A 2007 study published in American Journal of Infertility by leading endocrinologist of valley, Dr Abdul Hameed Zargar, puts the primary infertility in Kashmir at 15 percent. With statistics not updated for a long time, gynecologists believe that the rate of primary fertility confronting a large number of women in what is called the ‘reproductive ages’ has dramatically increased.

Dr. Ashraf Ganai, another expert in the field and head of many research projects at AIIMS, says that the percentage of women affected with Poly-Cystic Ovarian Syndrome (PCOS) in Kashmir is perplexing. A recent survey conducted in schools by Dr. Ganai, which was carried out under Indian Council of Medical Research (ICMR) project on PCOS, reported that more than 29 percent of adolescent girls have early signs of PCOS, making their chances of a smooth reproduction really bleak.

Health experts say that the best reproductive years in a woman’s life are between the age of 18 to 28 years. However, in Kashmir, late marriages have become a trend due to many socio-economic reasons. It is due to delayed marriages in late 20s and thirties that place women in the uncertain arena of infertility.

“With age the quality of eggs produced by women also get affected. The quality among women over 30 won’t be as good as those produced by women in their 20’s. So with advanced age the chances of conceiving decrease proportionately,” said Dr Teng.

There is also a greater chance of Premature Ovarian Failure (POF) as women age. “I would not call it Premature (OF). It (ovarian failure) is like greying of hair. In some it happens in 30s, in some forties. But as you age, chances of Ovarian Failure are increased,” said Dr Teng. “The trends are changing. POF was not seen previously, but now we are seeing it as an emerging cause of infertility in Kashmir,” he said.

Many scientific studies have found a strong correlation between Vitamin D deficiency and PCOS. Similarly the link between physical inactivity, high calorie-low fibre diet has long been established. Many experts feel that the role of cultural mores that restrict the mobility and physical activity of girls and its link with PCOS has not been explored fully.

“We proudly say that our girls do not move out and prefer to remain indoors. We make girls believe that playing, running around, physical activity etc is not for them,” said Dr. Teng. “We despise girls who are out and get sun-tanned. We want them to remain indoors, preferably sitting idle.”

She and many other fertility specialists advocate that schools and colleges should be sensitised towards the importance of physical activity and sunshine among females.

Diet has been shown as an important factor affecting the onset of PCOS too. “A girl, given the kind of food habits we have, develops certain chemical changes in body that directly affect ovaries,” said Dr. Teng. “Much of it could be changed if we could encourage girls to be physically active, sun-loving and smart about what they eat.”

  Assisted Reproduction

At the clinic, Sameena is flanked by scores of women seeking assistance for conceiving. The assistance, as per the doctors, ranges from ovulation induction with the help of drugs to In-vitro fertilization where the gamete formation takes place outside the woman’s body.

Started in 2006, IVF has become the last hope for couples diagnosed with infertility. Dr. Teng says couples are quite open to advancements in assisted reproductively. “Procreation is a natural and strong instinct. People would not stop at anything and are quite receptive to the options available to them,” she said.

Although religious scholars have not been soft on IVF that involves eggs or sperms not from the couple, gynecologists say that opinion has hardly restrained people from exploring. Given the minimal Assisted Reproductive Technology (ART) facilities in Kashmir, clinics in Amritsar, Delhi and Mumbai have been the preferred locations for couples trying their luck at IVF.

“Many people want to be secretive about the process and logistics that go into IVF. They therefore prefer an outside clinic,” said Dr. Bobby of Royal Infertility Clinic in Raj Bagh Srinagar.

The Royal Infertility Clinic used to be quite abuzz with people choosing to go through the process of IVF in Kashmir itself, but September 2014 flood rendered it defunct. “Our equipment was devastated. We are renovating the clinic but right now, we do not offer IVF here,” says Dr. Bobby. “We send our patients to Mumbai. Of course this is for those who can afford.”

In Delhi’s SCI Heallthcare Center, Dr. Jai Kumar says their IVF Center receives 50-70 couples every month seeking solutions for infertility. “IVF is picking up in Kashmir,” he said. “It is an untapped venture.”

Cost

One cycle of IVF costs between 1.5 lakh to 2 lakh rupees plus hospital stay, boarding, lodging, and travelling expenses to outside states. This makes IVF and many other ART inaccessible to women belonging to lower economic strata.

“Women try everything else before seeking specialised help from fertility specialists,” said Dr. Teng, adding that that many women arrive late at the ‘right place’ that has an experienced doctor available.

At Lal Ded Hospital, there is no speciality section of fertility. The overcrowded and overburdened doctors, as per many experts and patients, are not in a position to cater to the needs of women facing infertility.

Dr. Farhat Jabeen, a gynecologist, says that on an average 10 to 15 percent of women in OPD of LD Hospital come with a complaint of infertility.

“In India, the aim of healthcare policy and professionals is reducing birth-rate, not increasing chances of conception,” informed Dr. Teng. This perhaps is the reason that no service is available in government sector that could come as a respite to the poor women with issues related to fertility.

ART is primarily a private sector domain in Kashmir and most parts of India. The AIIMS New Delhi has recently started an Infertility division.

“Infertility is a dungeon for all women who face it but for poor women, there seems to be no ray of hope,” said Dr. Farhat Jabeen.