By Dr Sahil Gupta
With the advancement of fertility treatments in India, it is still far behind in fulfilling the growing demand. A double digit growth of infertility in India has made it a personal as well as public health issue. Social stigma apart, infertility leads to tremendous financial and emotional stress for couples. As a perilous public health issue, it needs serious attention of all stakeholders-patients, experts, policymakers and health insurers.
Among Indian population about 10-14 per cent couples are currently affected with infertility, as per the Indian Society of Assisted Reproduction (ISAR) estimates. In urban areas, prevalence of infertility is higher compared to rural areas. In urban areas, one out of six couples is impacted. A research by Med Tech Company reveals that nearly 27.5 million couples actively trying to conceive suffer from infertility in India. The number is estimated to rise by more than 10 per cent by 2020.
The fertility treatment in India has made considerable progress in terms of expertise and adoption of procedures such as in vitro fertilisation (IVF). Infertile couples have now option of IVF treatment where the eggs and sperm are combined and fertilised in vitro or outside the body, however, currently, only one per cent infertile couples seek any kind of fertility treatment.
Reasons for infertility
It is widely admitted that a modern lifestyle, rapid urbanisation, hormonal changes (especially in prolactin levels), job pressures, stress, vehicular pollution, and postponing parenthood are main reasons for infertility in India. Lifestyle diseases such as obesity and diabetes lead to infertility. Moreover, sexually transmitted infections, polycystic ovarian syndrome, fibroids, and genital TB are other new areas of concern among women. A rise in unprotected sex had led to sexually transmitted infections (STIs) and widespread use of both emergency contraception and surgical abortions, which can trigger serious infections that may cause infertility. The average age of menopause in India is 47 years as against 52 years in the western countries. This sharp decline in fertility can be attributed to environmental toxins also.
It is a myth that the problem is gender-specific. In reality, both male and female partners can be equally responsible for the inability to conceive a child. We found only 30 per cent of Indian men have normal semen characteristics leading to conception problems for women. There is a tendency among couples to avoid tests and we firmly believe that visiting infertility specialists directly can help in managing a large number of cases with simple, routine treatments. Only genuine cases need to be referred for advanced infertility treatments like IVF, egg donation or surrogacy. Awareness and sensitisation are key to making both genders aware of the problem. Medical breakthroughs in reproductive health have facilitated the preservation of sperms and eggs for future use – popularly called fertility preservation. Stem cell therapy is also poised to discover ways to re-form the eggs and sperms through what’s called “fertility rejuvenation”.
IVF & health insurance
Fertility treatments are becoming a financial and physical risk for many and insurers can help in a big way for those who are not able to afford it on their own. Currently, both private and public health insurers do not include fertility procedures and treatments under their cover plans. Health insurance plans, providing cover for all procedures, treatment and care, would come as a boon for those infertile couples who have been derived of the benefits of advanced medical facilities due to the cost factor.
The cost of IVF procedure in India varies from Rs 1 lakh to Rs 2.5 lakh. Cost can be a limiting factor for many couples who want to opt for this procedure. There is a need to take fertility treatment from ‘out of pocket’ to the insured space. Experts can take care of physical and medical risks; however insurers can help in a big way to minimise financial risks.
The insurance companies face challenges to provide mediclaim for fertility treatments because they provide cover mainly for illness and diseases which require hospitalisation. Fertility treatments are related to pregnancy or pregnancy related issue, which is not considered as any illness. Only maternity is covered in health policies not the fertility treatment. Insurance companies cover only certain diagnostic and therapeutic, but not overall cost of procedures. Usually, insurance covers most of the aftermath but not the preplanning.
Paying out of pocket, in absence of adequate health insurance, is not a viable option for many. Hence, majority of infertile couples are compelled to stay away from fertility treatments. Fertility treatments are complex; hence, it needs a comprehensive care and insurance coverage. It is recommended that insurers must include intrauterine insemination (IUI), in vitro fertilisation (IVF), or frozen embryo transfer (FET) in their products. Comprehensive care and coverage for fertility treatment would open a new vista for all the stakeholders in the fertility sector.
(The writer is founder, Aveya Fertility & IVF Centre.)