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Infertility - A Growing Concern For India

Women and men are advised to undergo tests to determine their fertility quotient and seek appropriate medical advice

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The total fertility rate for India, measured as the number of children born to a woman, has fallen from 4.97 during 1975-80 to 2.3 for the current period of 2015-20. The NFHS4 (2015 -16) also indicates a sharper fall in fertility amongst the urban population as compared to the rural This may be welcome for the highly populated state of India that is burgeoning under its effect, but it also points towards the trend of young couples unable to procreate.

In recent years the prevalence of couples unable to conceive has increased drastically and over 20% of the married couples fall into that category. Interestingly, both male and female partners are equally responsible for this decline. Though the proportion of women in their reproductive age i.e. 20 to 44 years also increased in the last decade, it is majorly the women over 30 who are under the burden of infertility in India.

Studies have indicated an overall pattern of decreasing fertility with increasing female literacy rates. More educated women are more likely to postpone marriages and childbirth. They also likely to opt for smaller family size and with the increase in per capita income, there is a change in the lifestyle of both the urban and the rural populations. Lack of exercise and a sedentary lifestyle has led to an increase in obesity and hormonal disorders like PCOS. Consequently, more women are seeking medical help.

With lowering of social barriers coupled with an existing lack of sexual health awareness, there is a rise in unprotected sex which leads to STDs and a rampant use of the emergency contraception and surgical abortions. This also leads to serious infections that may cause irreversible infertility.

In the rural segment, the majority of women are rendered infertile by genital infections like tuberculosis that leads to blockage of tubes. Fertilizers and pesticides too are responsible for the declining fertility amongst the villagers.

While causes mentioned above are treatable, there are a few unfortunate women where reproductive aging is setting in fast. A study comparing the Caucasians and Indian women found that Indians age five years ahead of their European counterparts. The average age of menopause in India is 47 yrs as against 52 yrs amongst the Western nations. This sharp decline in fertility is being attributed to environmental toxins, rampant use of plastics, a change in diet that also contains chemicals and genetic mutations. The declining sperm counts are also a cause for worry. While a small 4-5% may be due to treatable causes, the majority of it is due to unknown causes. The exact cause is not known, but it is also being attributed to similar causes as in women plus others including smoking, consumption of alcohol and increased use of gadgets like mobile phones and laptops. But since the cause is unknown, there seems no cure for it.

It is vitally important to make both men and women aware of this impending doom so that they can make informed decisions about their lives. Medical breakthroughs in reproductive health have however enabled doctors to help them by preserving their sperms and eggs for future use - popularly called fertility preservation. Future research in stem cell therapy may find ways to re-form the eggs and sperms - fertility rejuvenation as it is called.

Till then, women and men are advised to undergo tests to determine their fertility quotient and seek appropriate medical advice.

Disclaimer: The views expressed in the article above are those of the authors' and do not necessarily represent or reflect the views of this publishing house. Unless otherwise noted, the author is writing in his/her personal capacity. They are not intended and should not be thought to represent official ideas, attitudes, or policies of any agency or institution.

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Dr Sonia Malik

The author DGO, MD, FICOG, FIAMS Director & HOD Southend Fertility & IVF Department of Fertility, The CK Birla Hospital for Women, Gurgaon

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