Past, present and the future – So past as we know everybody should learn from the mistakes what they were done in the past.
Present – know what is happening in the present life and the future what innovations what’s happening that will give us the progress. Origins you know before in the olden times the myths and legends tell us the stories about miraculous births of people having hundreds of babies the Mahabharata and then in 1900 the fertility issues were not even seen by doctors but it was better of going to religious authorities. Fertility was considered so important that any trouble with it was considered as direct punishment by God.
So, after that in the history is interesting like in 1934 at Harvard a scientist was playing around with the rabbits and yes, the rabbits got pregnant with IVF and everybody went against him and denounced him and said it’s unethical work and you cannot play God. But after within few years in 1978 with the birth of Louis Joy Brown gave hope to millions of infertile patients. Public opinion suddenly reversed almost overnight in favour of IVF.
Innovation of IVF – yes in few decades from IVF within last 30 years we are doing ICSI and the success rates what were 10% has gone up to about 30 to 40% now. It’s just under 30 years that ICSI has started and where wherein we just take a single sperm and inject into the egg it helps a lot of people with low sperm count. Demographic trends previously people used to get married by 18 20 have their family by 23 24 complete their family by 28.
Now people do not get married before 30 to 34 years of age. So at least we should talk to people wherever where a career orientated females about egg freezing. Egg freezing is really important.
People should bank their eggs at an earlier age maybe at 30 – 31 let them decide their career if they want to get married later doesn’t matter but we everybody should talk about egg freezing now. The risk factors that are leading to high prevalence of infertility lifestyle increasing maternal age. Nobody wants to get married early or they just want their career to be settled.
Nothing settles that easily so we have to go ahead and decide, take the decision. Increasing number of working women, rising alcohol and tobacco abuse consumption, high level of obesity. Clinical factors you see a lot of PCOD sexually transmitted disease, endometrial tuberculosis and studies also suggest that South Asian women have poor ovarian reserves compared to the Caucasian women and they have a poor outcome of infertility too.
Infertility in India
India faces a serious challenge with high infertility rate and low fertility treatment. The IVF market is highly under penetrated. Demand being 9 to 12 times higher than the current market even in large metro cities. Affordability, access, awareness and assurance are the key barriers that limit the diagnosis and treatment in India. Infertility in India there around 27.5 million people who are infertile.
Only 2,70,000 people come ahead for treatment and around 65,000 patients have got treated. Last in 2015 there were about 1 lakh cases of IVF done. The infertility market is highly fragmented with very few players performing more than thousand cycles per year.
The market is fragmented. If you see there are less than 2 to 4 centres performing more than thousand cycles. Around 5 to 7 centres performing about 500 to thousand cycles per year.
The IVF market in India is growing at a robust rate of about 20% but the penetration is still very low compared to the other global markets. What is the strong focus? We should focus on the referral marketing, collaboration with the young IVF specialists, gynaecologists. There are so many gynaecologists who want to know how to go ahead so we can at least train them. Structured Fellowship in Infertility can help bridge this gap by equipping gynaecologists with the knowledge required for fertility assessment, stimulation protocols, and timely IVF referrals.
Like stimulate the patients and you can send them to our centres. Do not go ahead continuously doing IUIs around 10, 12. There should be some limit.
Do around 4, 6 indicated IUIs. When the time is right, shift them for IVF at the right time. And training of good gynaecologists.
Educational marketing campaigns, international protocols and state-of-the-art technology. If you have a good lab with everything, you know, the lab is with a modular lab with the AHU. I’m sure everybody’s going to get good results.
Affordability – With the cost of IVF in India is 3 to 4 times lower than in the US. Treatment is unaffordable for around 80% of the population due to low average housing income.
People cannot afford – People earn 2 lakhs per year and how can they afford an IVF cycle? The majority of the public and private insurance programmes do not cover fertility.
Small pool of senior IVF specialists in India with limited brand portability. Limited organised training of fellowship programme for building in pool of skilled IVF specialists and embryologists. Few specialised IVF chains with established brand.
Lack of diagnostic offerings – Like, you know, if you see in these small hospitals, they might be having only 36% offered only IUI treatment. No public sector is doing any IVF.
The propensity to seek fertility treatment is high as the need for parenthood and social status of parenthood is very high in India. People can do anything. Very low-income group and very high-income group are the same. They can give anything just to have a child, whatever.
Lack of regulatory framework – Now, as they were talking about the ART bill coming in, so everything should change.
Opportunities – There are limited number of IVF specialists in India and the brand portability of many doctors is limited only to small region. Some IVF specialists extend their brand value by consulting in several cities.
With more and more people recognizing the importance of fertility care, we see a growing need for specialized centres that offer evidence-based treatments, high-tech laboratory facilities and multidisciplinary teams. Healthcare centres like Dr. Kamini Rao Hospitals are instrumental in this respect. They deliver personalized care to patients and ensure clinical excellence using state-of-the-art reproductive technologies. Often referred to as one of the best IVF Hospital in Bangalore, Dr. Kamini Rao Hospitals offers comprehensive fertility evaluations, assistive reproductive technologies, fertility preservation, and customized treatment protocols for all patients. This ensures improved outcomes and wider access to reproductive medicine services, supported by skilled fertility specialists and advanced embryology labs.
So, one doctor, how many cities can they go ahead? Maximum 5-6 cities. They can do maximum 80 cycles.
They are going to; they cannot go ahead more than that. The field of speciality is not increasing due to lack of training availability for the junior doctors. They need to teach them what is IVF because after they come out, they finish their MS, they have no idea whether, do they have interest, what is it.
It is clear that we need organized, available and clinically useful learning experiences for young doctors and practicing gynaecologists to fill this growing void in fertility education. Institutions like Medline Academics are taking strides in the endeavour to boost reproductive medicine education via mentor-led programs, clinician-led educational events, and hands-on training to bring together theory and practice. Offering a structured learning ecosystem which includes an Fellowship in IVF, Medline Academics offers an opportunity for clinicians to hone skills infertility assessment, ART procedures, patient counselling, stimulation regimens, embryology training, and evidence-based fertility management strategies that will undoubtedly lead to a prepared workforce for the future.
So, there should be a subject already added in the, while doing the Guinac. A large international study demonstrated that Indian economy, Indian seems to have a high propensity to seek fertility treatment but the awareness is a major barrier.
People are not aware of IVF. We have to do some, government has to do, to let people know, let them be aware, there is treatment. Need for the parenthood is the greatest in India and lowest in Japan.
Social status of parenthood is more influential in India and China and less valued in countries in higher level of economic development. Awareness of fertility problem is lowest in India. With more infertile couples coming forward for treatment, the IVF market is estimated to grow in 2020 by 20%.
So hopefully we’ll be doing around 2,60,000 cycles in 2020. Why? Because the income is increasing. Now people are going to be making decent amount of money and so typically like the IVF cycle cost around 1,50,000 to 2,50,000.
So, there is something called as a CRISPR which is a gene editing technology. This mechanism, this is the future. Actually, CRISPR is going on now.
So here the mechanism behind this is the attempt to edit out bits of DNA that prevents an embryo from developing properly which may answer important questions about infertility.
What is the future?
The future is exogenesis. This concept of exogenesis has been not yet accomplished. For example, Japanese investigate developed a lamb up to halfway through the gestation. So the baby is not in the womb. It’s in outside.
It’s going in vitro. So, an exogenesis can be achieved and I feel sure that will be sooner or later and it would eliminate the necessity for surrogacy and the social and legal complications associated with that technology.
And somatic reproduction that is the eliminate the need for donor gametes. We do not need donor gametes and eliminate the complications caused by the use to achieve genetic lineage. So, we can use the eggs and the sperms.
We do not need to go for donors. Efforts need to be made to accelerate the development of viable gametes from homologous somatic cells. In short, we need to pursue the road to somatic reproduction.
