The Great Urban ‘Fertility’ Crisis

About 15% of Indian couples in the cities are today grappling with some form of infertility. Here is what you can do to increase your chances of starting a family

The modern urban lifestyle has touched all aspects of our health, for better or worse, but none has been as overlooked as fertility. This may be because fertility is usually the last thing on the mind of an average working couple juggling family life with the taxing demands of a corporate job. It is easy to leave one’s reproductive health unattended, especially as its drastic fall does not come with alarming symptoms. According to the World Health Organization (WHO), about 8-10 percent of all couples in the world experience some form of infertility. In India, around 15 percent of couples of fertile age are estimated to suffer from infertility, and the figure is rising.

Delayed Marriages and Biological Clock

A major factor is that more and more boys and girls are delaying their marriages and reproductive events due to financial issues or career growth. This does not affect men so much, as sperm production is an ongoing process and continues well into old age, albeit in decreased quantity and quality. For women, however, fertility is an age-related event as they are born with only a finite number of eggs, and these keep getting expended at regular monthly intervals starting from puberty. The plateau is reached at 35 years of age. At 37, there is a sharp decline in the number of eggs and fertility goes downhill after that. A point is finally reached where the fertility potential of a woman is exhausted (menopause) and she can no longer produce healthy eggs.

Other age related factors which adversely affect a woman’s fertility include an increase in incidence of miscarriages, deteriorating egg quality and complications of pregnancy at an advanced age. Medical wisdom dictates that women should have babies by their early thirties. After 35, they are on the wrong side of the biological clock and may face complications in conception and delivery. This age group’s response to fertility treatments is also sub-optimal. Their ovarian response is poor and they sometimes have problems carrying their pregnancy to term. Many urban men and women with fertility impairment are highly motivated go-getters. It is a classic case of (computer) mouse replacing the spouse! Some couples request artificial insemination because they have no time for sex due to long work hours, night shifts and frequent out- station travel! Employees working in the graveyard shift suffer from hormonal disturbances caused by the changing sleep rhythms and bio-cycles. In women, these lead to irregular egg release and ovulation. Fertility of men is similarly affected by late hours, unhealthy eating habits, over-consumption of alcohol, smoking and stress.

Tips for couples looking to start a family:
* Take regular holiday breaks with your spouse for relaxation and intimacy
* Cut down on alcohol and stop smoking
* Lose weight if you have high BMI
* Avoid processed food, as preservatives are bad for you
* Stop the diet-binge-diet cycle
* Make space for moderate physical exercise  in your daily routine
* Go for regular health checkups
* Marry early and plan a family before you turn 35
* Eat a judicious selection of organic food and sea food
* Pre-natal vitamins and anti-oxidants are important for healthy pregnancy
* Anovulatory women can seek ovulation induction with patent tubes
* IUI can be used to counter some of the cervical, semen and ovulatory factors
* IVF/ICSI recommended for damaged or blocked fallopian tubes, severe sperm abnormalities and low sperm count.
*Go for minimally invasive fertility surgery for fibroids, polyps, ovarian cysts, etc.
*Newer technology like ERA, PGS helps counter failures in fertility treatment

Food and Lifestyle

The reason for compromised reproductive health of a person may go as far back as childhood when eating habits develop. In this age of fast food, the concept of eating healthy meals, including fruits and vegetables, is not being stressed enough by parents. Unhealthy eating practices, including too much fried food, oily meals, and over-cooked vegetables, along with a lack of physical exercise are carried over to adolescence and adulthood. The result is assorted health problems, including impaired fertility.

The incidence of obesity is rising in urban population. Weight gain, along with some genetic factors, disturbs the hormonal milieu of women, leading to irregular periods and anovulation. This may manifest as polycystic ovarian syndrome. Lifestyle modification, diet planning and weight reduction can substantially boost the chances of women to conceive. Even a 5 percent weight loss, achieved scientifically, helps to improve the response of ovaries.

On the other end of the spectrum is the newer phenomenon of crash dieting and distorted body image among teenagers. This is an import from the west and is usually seen in Indian metropolitan cities. The incidence of anorexia nervosa among girls is more common now than one would imagine. This is due to unreasonable expectations from one’s body and unhealthy competition among peer groups. This type of lifestyle can cause serious imbalance in fertility hormones of girls, leading to absence of menses, severe anemia and renal disorders. The condition needs medical as well as psychological attention. Obsession of the youth with their body image needs to be cured by boosting their self-confidence levels and using the family support systems.

Excess of anything is bad. So while exercise is highly recommended to keep the body healthy, too much of athletics can have its effects. Over-vigorous athletic activity can send signals to the brain and reduce the outflow of fertility hormones. This is commonly seen in female athletes and affects their future fertility. The new fad of body building that has caught the imagination of Indian youth is fuelled by the recent trend of movie celebrities building a perfect body in the shortest time possible. Such body builders often start consuming protein and health shakes and hormone supplements. Some constituents of these substances signal the brain to reduce the production of male (and female) hormones and lead to fertility problems.

Other issues

Environmental toxins are an offshoot of urbanization. Adulterants, pollutants, additives and dyes used in food items and toys have become a health hazard. Many coastal areas have been identified as having high mercury levels in their sea food. This, in turn, has been linked to the high incidence of sperm abnormalities and ovulation problems. Men working in the chemical industry, who come in daily contact with paint fumes, dyes, and other chemicals, also tend to have a lower sperm count.

Another cause of low fertility is a medical condition called endometriosis that has begun to be increasingly seen in Indian women due to the adoption of the Western lifestyle. In this, cells from the lining of the uterus (endometrium) appear and flourish outside the uterine cavity, most commonly on the membrane that lines the abdominal cavity.

In sync with the menstrual cycle, this tissue builds up, breaks down, and sheds each month. Unfortunately, it has no way of leaving the body. As a result, it causes internal bleeding and inflammation resulting in pain and infertility, among other problems. There is no medicine to cure endometriosis and surgical removal is the only option.  However, pregnancy ensures a nine month disease free period when symptoms reduce.

Dealing with fertility problems is a medical as well as lifestyle issue. Doctors need to recommend as soon as possible a tailor-made treatment plan for couples grappling with fertility issues. This is because the ticking of the biological clock never stops for anyone.

By Dr Richa Jagtap, Infertility Specialist Nova Group of IVF centres. She graduated with distinction in OBG and pursued post-graduation in JJ Group of Hospital and Grant Medical College, topping her college and second merit holder in Mumbai University. She has been instrumental in development of SOP, Fertility Software and training of personnel as well as setting up of start-up IVF centres. Her focus has been on ultrasound, fertility medicine and genetic studies in infertile couples. She is on the Ethics Committee for Nova Group of IVF centres.

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