With a substantial portion of the practice of gynaecology veering towards treating infertility among couples, the recent visit of Raine-Fenning Nicholas, director of research for Nottingham University Research and Treatment Unit in Reproduction (NURTURE), to Chennai turned out be an event of modest interest. Ramya Kannan records what he says about rising infertility rates and how technology has advanced by leaps and bounds to help women who cannot otherwise bear children.
“If you take infertility as a whole, it is definitely increasing across the world. There have been studies to prove this, though I am not sure if there are similar studies in India,” Dr. Nicholas said. In the United Kingdom, the biggest problems are with tubal defects in women, which lead to infertility. There is also a lot of anecdotal evidence about problems with the male and female factors – producing good quality and quantity of eggs and sperms.
Increasing instances of poly cystic ovaries (PCOs) are also being diagnosed in women. PCOs are directly influenced by obesity, which interferes with ovulation. Diabetes and obesity are closely linked, Dr. Nicholas, explains in response to a question on the relationship between diabetes and infertility.
Agreeing with the genetic factor that makes Indians prone to diabetes, he remarked that in the United Kingdom they were not seeing many younger women with the metabolic disorder.
“The biggest thing we are seeing is women delaying families, mainly due to professional compulsions. We know fertility declines massively with age. From 35 years onward, there is a big, big decline in fertility rate. It rapidly accelerates after 38 years. The chances of natural conception after 43 or 45 years are very very low,” he explains.
It is this category of people who have a good shot at in-vitro fertilisation (IVF), says Dr. Nicholas. He is also consultant gynaecologist and associate professor of reproductive Medicine and surgery at the Nottingham University Hospitals.
“Treatment is expensive, but if someone can afford IVF, you are looking at success rates of at least 25 -30 percent for live births, not just getting pregnant. That is extremely high,” he says.
For some people there is just no hope of having children and starting a family without IVF. Currently, insurance does not cover treatment, but some assessments of infertility are paid for by insurance companies.
Lots of developments have taken IVF ahead over the last few years, success rates have increased quite dramatically, but have begun the swing down on the curve.
“We have been involved in a lot of technology development, particularly using ultrasound to try and individualise IVF for patients,” Dr. Nicholas says.
He goes on to add that in most clinics, it seems to be one treatment fits all. “But when we make it more personal, we increase the chances of success and also dramatically reduce the risks involved. There are risks because we overstimulate the ovaries to produce eggs.”
While earlier the trend was to pick as many eggs from a woman as can possibly be sourced, more recently infertility experts have adopted a more sensible, safer and cheaper option.
“Get a limited number of eggs – go for quality rather than quantity, without much risk. With lower doses of drugs, costs also come down,” he adds.