Did you know that 1 in every 4 couple in the reproductive age in India struggle with infertility? And you thought that population is our only problem? Well, you will be surprised to know that WE – the second most populated country in the world will soon become another Germany or Japan with dwindling fertility rates. While we do want to control population, we don’t want to take away the fertility options for a couple who really want to have a child. But if we carefully analyze the fertility statistics of India, a completely different picture unfolds before us.
Fertility statistics and what are the causes of rising Infertility in India?
The number of couples in the reproductive age struggling with lifetime infertility in India stands at approximately 22 to 33 million; of this only 40-50 percent of the cases are attributed to problems with women while for the rest it is men (about 30 to 40 percent). What is more surprising is the fact that male infertility in India is on a rise with every passing year. There are many reasons that have impacted the infertility rate in this country. Let’s take a look at some of them.
Higher use of contraceptives: It has been observed that the total fertility rate or the number of children a woman can bear between 15 and 49 years has declined from 3.9 in the ‘90s to 2.3 by 2013. This apparently is because of increased use of contraceptives and decision to marry late. Assuming that the marital rate in 2020 will be similar to the current rate and given the fact that the number of women in the reproductive age will increase by then, infertility will further be on a rise.
Medical reasons: Studies have shown that there is an increased percentage of women suffering from medical reasons that lead to infertility – PCOS (ranging from 3.7 to 22.5 percent), Endometrial Tuberculosis (about 18 percent), Obesity (from 10.6 in 1998 to 24.7 in 2014), and sexually transmitted diseases. For men, the causes that attribute to infertility could be tobacco consumption which known to cause low sperm count, abnormal morphology and altered motility, higher estrogen and low testosterone levels. Alcohol, on the other hand, is known to increase leukocyte count in seminal fluid, reduce semen quality, reduced FSH and LH levels and low testosterone.
Lifestyle: Almost all studies point out to changes in lifestyle that has an inverse effect on fertility. And it appears that intensification of lifestyle risk factors might lead to an increased prevalence of infertility among women. Interestingly, quality of lifestyle is also expected to lead to an increased prevalence of infertility in men, with regional estimates as high as 20 to 30 percent.
It is quite surprising that a country like India with the high rate of infertility faces a serious challenge of significantly low treatment rates. While the number of infertile couples in the reproductive age stands at 27. 5 million (approx.), only 1 percent (270,000) of them are coming forward for analysis and treatment, of whom merely 65,000 are prescribed and opt for IVF.
The infertility market is heavily fragmented with very few players coming forward and performing over 1,000 cycles in a year in major metros in India. This further means that the supply chain is further fragmented. Again what comes as a surprise is that 50 percent of the cycles performed are in the top 8 metros (Delhi-NCR, Mumbai, Ahmedabad, Chennai, Kolkata, Hyderabad, Bangalore, and Pune), which further indicates that access to IVF is skewed geographically. This means that the facilities for treatment are not distributed equally across the country but are more easily available in the metros. However, the IVF market in India is growing at the rate of 18 percent (CAGR) through the penetration is very low when compared globally. In fact, a closer look reveals that the addressable demand is 9 to 12 times higher than the current market, even in large metros.
What Restricts Access to Treatment?
If Treatment is available, what restricts its access? Here are some of them:
Reduced Affordability: Though the cost of IVF treatment in India is 3 to 4 times lower when compared to the US, yet people cannot afford it because of most of the couples in need of treatment fall in the lower income group. Besides, insurance programs, whether public or private do not cover infertility treatment cost.
Lack of Access: In India, both IVF specialists and diagnostic facilities are fewer in number. Though there are senior IVF specialists, their brand portability is limited to a certain region. Besides, specialized, branded IVF chains are limited. So, some doctors may be ready to extend their treatment facilities beyond their region but that does not extend beyond 3-4 cities and the number of cycles also does not go beyond 75-80/month.
Limited Awareness: In India, socially it is important to bear children; the need for parenthood is the highest yet, many couples do not suspect that they have fertility issues at a time when they should actually be under treatment. Again, though there are many couples ready to go in for fertility treatment, awareness of ART (Assisted Reproductive Techniques) is still at a nascent stage. More awareness of the brands needs to be generated to enable couples seeking treatment.
No Clear Framework: Though couples may be ready to opt for ARTs, there is no regulatory framework for management of IVF centers and safety of patients. ART clinics and banks do not require legal registration. Hence they neglect to comply with the best practices when it comes to ART techniques such as surrogacy, embryo handling, gender determination and so on. This further hinders couples to come forward confidently for treatment.
With more and more couples coming forward for treatment of infertility, the market is expected to grow at 20 percent by 2020. But if this has to be possible, industry stakeholders must make impressive improvements in the following areas:
- Institute a regulatory framework at the national level for monitoring and supervising ART methods.
- Expand care facilities to include more experts, gynecologists, and embryologists, improving financing options (include fertility treatment under insurance schemes) and bring in innovative methods of treatment to reduce cost.
- Awareness for ART has to be increased through national educational programmes making people aware of the causes of infertility and the treatment options available.
Note: All the Information in this article is taken from the EY report published in July 2015, titled, ‘Call for Action: Expanding IVF Treatment in India’.