Seeking a ray of hope

They call it the race against time. Fighting against the high stress of urban living, lengthy commutes, ensuring double incomes to meet rising expenses, many couples are increasingly putting off children as long as possible.  Then suddenly, one day they realise that the biological clock is ticking and try to have a child.

Sometimes it works, sometimes they have to wait and sometimes, the wait becomes unbearable. Then hesitatingly they consult a doctor and come face to face with one of the most painful words ever – infertility.

According to the World Health Organisation, worldwide, couples view infertility as a tragedy which carries social, economic and psychological consequences. The Department of Reproductive Health and Research recognizes that infertility is an unmet need in family planning in both the developed and developing world.

As per WHO data, one in four ever-married women of reproductive age in most developing countries are infertile because of
primary or secondary infertility. There is a need to develop, support and establish protocols for infertility prevention, diagnosis and management.

Unfortunately, many definitions used in medically assisted reproduction (MAR) vary in different settings, making it difficult to standardise and compare procedures in different countries and regions. With the expansion of infertility interventions worldwide, including lower resource settings, the importance and value of a common nomenclature is critical.

While life expectancy is higher for women than men in most countries, a number of health and social factors combine to create a lower quality of life for women. Unequal access to information, care and basic health practices further increases the health risks for women.

Discrimination on the basis of their gender leads to many health hazards for women as well. Tobacco use is a growing threat among young women, and mortality rates during pregnancy and childbirth remain high in developing countries.

Many infertile women in developing countries consider that, without children, their lives are without hope. While complications like an ectopic pregnancy can lead to infertility, more common causes include tubal occlusion from reproductive tract infections, postpartum complications or unsafe abortion practices. In countries such as India that have high rates of tuberculosis, genital tuberculosis is also a major, often undetected, cause of infertility.

Infertility affects up to 15% of reproductive-aged couples worldwide according to WHO demographic studies. Although male infertility has been found to be the cause of a couple’s failure to conceive in about 50% of cases, the social burden falls disproportionately on women. In many cases, childless women suffer discrimination, stigma and ostracism.

According to WHO experts, if couples are urged to postpone or widely space pregnancies, it is imperative that they should be helped to achieve pregnancy when they so decide, in the more limited time they will have available as well.

Despite their importance, infertility prevention and care often remain neglected public health issues, or at least they rank low on the priority list, especially for low-income countries that are already under population pressure. Low fertility is becoming more common worldwide, particularly in ageing populations and many urban settings where women are having their first babies at older ages.

Health policy-makers are increasingly being urged to begin to integrate infertility prevention, care and treatment into the work being done to strengthen maternal, newborn and reproductive health-care systems.

For many infertile women, particularly those with problems such as blocked or severely scarred fallopian tubes where surgical tubal repair is either not successful or not advisable, in vitro fertilization (IVF) can help. In India, pioneer programmes have been able to cut costs by one third by giving low doses of hormones to stimulate ovulation.

Infertility prevention should ideally begin with health education and empowering women. So the important thing is making the right health choices at the right stage in life. There are solutions for resolving infertility as well but it’s all about taking the first step as soon as possible.

Services to assist infertile couples need to be integrated and holistic, starting from the community level to demystify the cause and prevent infertility when possible, and to provide referral for affordable care if infertility is unavoidable.

The thing to keep in mind is that infertility prevention also involves important lifestyle choices. Tobacco use among younger females in developing countries is rising rapidly. Women generally have less success in quitting the habit, have more relapses than men, and nicotine replacement therapy may be less effective among women.

Focusing on women’s health and educating them to take preventive steps against infertility well in time is therefore, a top priority in the present scenario.