Selected news stories from the international press relating to Asian (In)Fertilities:
Chennai couples yearn for babies - Express Buzz (New Indian Express)
(8 June 2009)
The pink file sat between Manjula and Praveen at the hospital waiting room. The epitome of a modern couple, the two are physiotherapists who lead busy, high-pressure lives in Delhi, having re-located from this city. Barely two years after their wedding, they are at a clinic in Chennai for investigations into infertility. At the hospital, pink files were given to idiopathic infertility cases: infertility for no known reason.
“About 10 years ago, women used to come in for termination of their pregnancies after two children. Now, there is a drop in the number of abortions and a rise in infertility, says Dr M Muthulakshmi, head of the obstetrics-gynaecology department at the Kilpauk Medical College Hospital. Opinions on the reasons for this vary but most gynaecologists agree on lifestyle factors being a major contributor. “Nowadays there seems to be intense stress and pressure at the workplace. This, combined with excessive junk food and lack of physical exercise are all contributing factors,’’ says Dr Muthulakshmi. “We hardly see each other,’’ said Praveen, a dapper 29-year-old who works 12-hour days, seven days a week. “By the time I’m home, all I can do is plop into bed and not wake up until the next morning.’’ Manjula is quieter. The family pressure to have a baby seems to be taking a toll on her. She works six days a week, leaves home at 8 am and returns at 5.30 pm to prepare dinner and see to household chores. There hasn’t been time to relax in the last two years and the strain of living in a strange city where everything is different has added to her worries. With no leave allowed at either of their workplaces, Manjula and Praveen planned three months in advance to make this visit to Chennai. They are now waiting for results of the doctor’s investigations. According to an estimate, one in five are childless after two years of marriage, despite efforts to conceive. For the last decade or so, doctors and gynaecologists have been viewing with increasing concern the gradual but unmistakable rise in infertility rates in the State, a phenomenon that affects thousands of couples who desperately want a child but cannot conceive. Though the State government has no official statistics on infertility in the State, Director of Public Health Dr S Elango admits that it is a rising problem. “In fact, it has gotten to be so serious that we are considering assisted reproductive techniques, such as in-vitro fertilization in the government sector. So far it is only the cost factor that has been hindering us,’’ he said. At the Institute of Obstetrics and Gynaecology (IOG), the State’s referral government facility, a fertility clinic is run everyday to deal with the large number of cases that come in. Statistics from IOG show a gradual increase in the percentage of cases coming in for infertility treatment. The institute sees between 31,000 and 35,000 cases for gynaecological treatment every year. Of these, the percentage of cases for infertility has risen from 19.5 per cent in 2003 to 25 per cent in 2006. Figures from a private hospital also corroborate this. A leading hospital in the city has seen a steady climb in its number of infertility cases in the last three years: from 2,447 in 2006 to 2,720 last year. Though these represent total figures from India and abroad, most of the patients seen were from Tamil Nadu. Dr Priya Selvaraj of the GG Hospital, a fertility research centre in the city, explained how men and women who were already genetically predisposed towards a disorder, such as diabetes or hypertension, were now getting it earlier than ever thanks to a high pressure lifestyle. “With women, stress seems to lead to bad eating habits and no physical activity. This tips the balance in their acquiring conditions, such as polycystic ovarian syndrome to which they may be predisposed but could have avoided,’’ she said. Another factor in this lay in the increasing number of couples postponing their first child. According to the State report of National Family Health Survey-3, the use of family planning methods was widespread with female sterilization accounting for 90 per cent of all contraceptive use. “The postponing of childbearing is definitely on the rise,’’ said Dr Selvaraj, adding that even if career obligations were vital, couples should try to have their first child before the woman turned 30. “There is a need for balance in this regard,’’ she said. Dr Shanthi Dinakaran, director of the IOG, put the spotlight on another factor - late marriages. “After the age of 30 there is a definite decrease in the potential for conceiving. If this is combined with other lifestyle factors, the chances become even slimmer,’’ she said. More men may be firing blanks Increasingly, doctors are seeing a rise in male infertility as well. “Male infertility now contributes 35 to 40 per cent of all cases that we see,’’ said Dr Selvaraj. Low sperm count, erectile dysfunction and a low libido could all lead to low fertility levels, she said. While Dr Dinakaran placed the figure at 30 per cent, she too agreed that this seemed to be on the rise. More men were becoming diabetic and getting hypertension at a young age, often in their early thirties, Dr Dinakaran said. Incidence of diabetes in the city now stands at nearly 17 per cent. “Earlier it always used to be women who would be blamed for the inability to conceive, but families are beginning to realise that there could be problems with men as well. At least, in cities, the realization has sunk in. “In rural areas, even now, the woman is held responsible. The man can always marry again and it is socially acceptable,’’ said Dr Dinakaran, relating the case of a man who married three sisters all of whom were unable to conceive. In the end, a hospital test confirmed his infertility. “The work environment, pressure and the intensely stressed out lives men lead - all contribute towards this. If they have diabetes or hypertension, it just adds to the difficulty in conception,’’ said Dr Dinakaran, adding that expectations were now higher than ever. Lack of a nutritious diet and exercise exacerbated this. Heat generated from sitting too close to computers or laptops may also be a possible factor, Dr Dinakaran added. IT is the key contributor Of late, doctors are seeing increasing numbers of employees of the IT sector coming in with problems conceiving. “Over the last few years, the numbers of young couples we get from this sector has been on the rise,’’ said Dr Jeyarani Kamaraj, infertility expert at the Aakash Fertility Centre and Hospital. While there has been no official study or exploration into this, statistics from individual hospitals show a definite increase. GG Hospital has seen a gradual increase in numbers over the last three years with the figure touching 250 last year. “Their high pressure jobs, night shifts and stress - all seem to lead to a number of problems ending with infertility,’’ said Dr Priya Selvaraj. It begins with delaying of the first child, say doctors. When the couple does decide to have a baby, a combination of other factors makes it difficult. “We had a couple who worked two different shifts at two different IT companies. They barely saw each other and had no time for a healthy marital relationship. Deadlines were always on their minds and they ate out three times a day,’’ said Dr Kamaraj. Dr Selavraj feels if IT companies extract a lot of work out of their employees, they should also ensure their health and well-being. “Gyms for exercise and a canteen where they get nutritious food and not junk should be part of every company,’’ she said. This gets coupled with the intense anxiety of not being able to conceive and familial pressure to do so. “All of this can lead to a hormonal imbalance, which in turn affects their fertility,’’ said Dr Kamaraj.