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Parenting Paradigm: More Indians Are Turning Infertile

By: Dr Naresh Purohit* (Advisor, National Reproductive and Child Health (RCH) Programme) analyses the reasons for growing infertility in some states of India

New Delhi/Bhopal: India has the dubious distinction of being associated with population explosion but the reality indicates equally strong infertility trends.
Today, infertility is viewed as one of most prevalent health ailments globally. Intensive research has been instrumental in understanding the vulnerability and complexity of dealing with this specific issue.
While no concrete evidence confirms that the end of the human race due to infertility is nigh, it is necessary to understand the intricacies of nature, along with the possibility that such a threat cannot be completely neglected, given what we know of other species.

Over 15% of the world population, estimated to about 50 million couples worldwide, today are marred by infertility, estimates a 2015 US-based National Centre for Biotechnology Information (NCBI) report.

The fertility rate of Indians has plummeted by over 50% between 1975 and today, indicates the recent revised World Population Prospects report. These reports highlight that the fertility rate among Indians is expected to fall below 2.1 in the near future.

The recently released Census Report (2016) on the fertility status of India indicates declining fertility among Indian women, with an alarming decline of 31 per cent recorded for the period 1991 to 2016.
More and more women in India are failing to conceive naturally and need assisted reproductive methods to bear children. The rural-urban differential has also narrowed down, indicates the census.
Birth rates have declined in Andhra Pradesh, Delhi, Himachal Pradesh, Jammu & Kashmir, Karnataka, Kerala, Maharashtra, Odisha, Punjab, Tamil Nadu, West Bengal, Uttarakhand and Telangana. While Bihar has the highest birth rate among rural areas in the country, Uttar Pradesh holds the title for urban areas. The lowest birth rate has been recorded in rural areas of Kerala and urban areas of Himachal Pradesh.

The World Health Organisation defines infertility as a failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse. Evolutionary Studies, as a sub discipline of Biology, deals with the history and relationships among individuals or group of organisms to trace their origin and development.
It also examines the functions of organ systems in these organisms and includes an explanation of the complexities of the human reproductive system. These studies have proven humans to have the least reproductive success due to various complexities of their reproductive system. The reproductive success among humans is as low as 20%. This makes humans naturally the least fertile species on the planet.

Human infertility or infecundity is an ongoing, developing trend that has taken shape primarily in the urban world. The global prevalence of childlessness focuses greatly upon the modern world that emphasises on high usage of pesticides, hormone-disruptive chemicals, stressful lifestyle, pollution, improper diet, adulteration, smoking and others that has resulted in either male or female infertility.

An eminent research scholar on male infertility, Dr Hagai Levine of Hebrew University, Israel, suggests that the rate of falling sperm-count in men in Euro-America, has declined by about 60% over 40 years and has not shown signs of recovery. Other research on female infertility have proven the high occurrence of female infertility due to occupational hazards, hormonal imbalances, cystic fibroids and other causes that affect a woman’s fallopian tubes.

Several studies have proposed authoritative evidence about high rates of infertility among humans.

Reproductive biology research studies has evidence of disappearance and extinction in other animal species, too. The wildlife body the International Union for Conservation of Nature has identified the Giant Panda as “vulnerable species” since 2016.

There is a total of 2,164 Giant Pandas in existence, 1,864 of them in wild habitats and 300 captive in zoos and sanctuaries. Apart from the loss of habitat, the prime reason for their limited numbers is linked to their low reproductive rates, according to “Why Pandas Have Trouble Getting Pregnant”, on PBS News hour.

Yet, man still believes that he has the capability to overcome such an existential crisis that may threaten the human race. Thanks to advancements in technology and medicine that provide multiple avenues to ensure procreation in the human race. However, the limitations of medicine have also to be considered.

There are many factors that constrain the adoption and success of in-vitro fertilisation. Also, the high costs of medical treatments for infertility make them very class-oriented and not mass-oriented. That is, these treatments are not accessible to a wide population

The question is, will the human race cease to exist at some point of time if infertility continues to rise and become more common across the world, as it indeed appears to over the years.
Considering the advances in evolutionary studies, the continued existence of the human race is feasible only if we conform to the laws of nature, not by going against them.

ART Regulations-2023: The health ministry has tightened regulations for Assisted Reproductive Technology (ART), commonly used to treat infertility through vitro fertilization (IVF), aiming to rein in a mushrooming money-making industry.
Many couples with infertility issues opt for IVF. India has as many as 27.5 million infertile people, according to the Indian Society of Assisted Reproduction.
Many couples with infertility issues opt for IVF.
According to the recent government Ministry of Health notification, IVF clinics have to follow compliance procedures with respect to the retrieval of oocytes
(a developing egg in a female), limiting the number of oocytes in one cycle, and putting a cap on the number of embryos that can be transferred to the female during the treatment cycle.

The government has reminded clinics that procedures should be conducted in females of advanced maternal age and those who have faced recurrent miscarriages.

The Assisted Reproductive Technology Regulations, 2023 mention that a gynaecologist should transfer 1-2 embryos in the uterus during a treatment cycle depending upon the medical condition of the patient.

Only in exceptional circumstances—such as advanced maternal age, recurrent miscarriages and recurrent implantation failure—can three embryos be transferred. In any case, the doctor cannot transfer more than three embryos.

Now that the government has limited the number of embryo transfers, i.e., 1-2 in a cycle and in rare cases 3 embryos, the biggest advantage of this capping is that it will prevent multiple births like triplets or quadruplets.

Besides this, it will decrease morbidity in the newborns and thus, reduce the pressure on the healthcare system.

Many IVF clinics across the country operate with semi-trained staff and no expertise in the field that put patients lives at risk. Hence, such regulations are required from time to time to regulate the industry.

According to government notification clinics shall retrieve oocytes from the donor after the consent of the donor and for retrieving oocytes from the donor, clinics shall make efforts to retrieve not more than seven oocytes during one cycle.

Further, the notification said clinics shall retrieve all formed follicles and ensure controlled ovarian stimulation of woman to prevent ovarian hyperstimulation.

The tightening of regulations will have an impact on the mushrooming IVF industry and help rein in unnecessary procedures undertaken by clinics just to make money.
The ministry also regulated the procedure for embryo transfer in the uterus.


*Dr. Narresh Purohit-MD, DNB, DIH, MHA, MRCP(UK), is an Epidemiologist, and Advisor-National Communicable Disease Control Program of Govt. of India, Madhya Pradesh and several state organizations.)


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