Infertility can trigger depression, as the emotional toll of unfulfilled longing for a child weighs heavily on individuals and couples. Studies suggest couples who attend therapy together report lower stress and better emotional resilience. Those who balance treatment with emotional outlets tend to fare better, says Dr Lekha KL (senior consultant, obstetrics and gynaecology, Apollo Adlux Hospital, Angamaly) in an interview with Anna Jose. Edited excerpts:
Studies show that the infertility rate has increased from 22.4% in 1992-93 to 25.3% in 2005-06 and then increased to 30.7% in 2015-16. What is causing a rising infertility rate in India?
Infertility is a fast-emerging global disease. The rising infertility rate is indeed a growing concern that reflects changes in both society and health over the years. When looking at the period from 1992 to 2015-16, a mix of factors is seen at play — some biological, some lifestyle-related, and others tied to how lives have evolved. Interestingly, studies show primary infertility has actually decreased slightly over this period, from about 2.8% in 1992-93 to 2% by 2015-16. But secondary infertility has shot up, from 19.5% to 28.6% in that same timeframe. So, the overall increase to 30.7% is largely driven by this rise in secondary infertility. Southern states with higher infertility rates also show lower overall fertility rates. One factor is age. Over these decades, people in India, especially in urban areas, have been delaying marriage and childbirth. Biologically fertility declines with age. After 35, a woman's egg quality and quantity drop significantly. For men, sperm quality can also decrease after 40. Couples who conceive easily the first time might face challenges later due to this age factor.
How does changing lifestyle contribute to infertility?
Lifestyle changes are a huge contributor. Since the 1990s, there has been rapid urbanisation, more sedentary habits, and a shift toward diets high in processed food. Obesity has become more common, and it is a known disruptor of hormones that regulate reproduction—for both men and women. Add to that smoking, alcohol, and stress from fast-paced lives, and it is a recipe for fertility issues. For men, these habits can lower sperm count and motility, while for women, it can lead to conditions like polycystic ovarian syndrome (PCOS), which is increasingly common and a major cause of infertility. Pollution, exposure to chemicals, and infections are significant factors contributing to infertility. Specifically, exposure to substances like those found in plastics and pesticides can disrupt hormones crucial for conception. Stress and sleep deprivation are other factors contributing to infertility. Also, untreated sexually transmitted or pelvic infections, often stemming from poor menstrual hygiene or unsafe abortions, can damage reproductive organs, particularly the fallopian tubes, leading to secondary infertility. Non-communicable diseases such as diabetes, hypertension, and thyroid disorders, partly influenced by lifestyle shifts, can affect ovulation, sperm production, and the ability to carry a pregnancy to term.
How should the issue of infertility be tackled?
Maintaining a healthy weight and balanced diet, engaging in regular physical activity, practising stress-reducing techniques, such as yoga or meditation, adequate sleep, avoiding smoking, excessive alcohol consumption, and substance abuse can help. By adopting a healthier lifestyle, individuals can reduce their risk of infertility and improve their overall reproductive well-being.
What is the role of detecting and treating conditions like PCOD/PCOS and oligospermia in tackling the situation?
Ovulatory dysfunction (defective egg release) is the major cause of female infertility and PCOS is the main cause of ovulatory dysfunction. It affects around 10% of reproductive-age women. Oligospermia (low sperm count) affects men and is often discovered during fertility evaluations. It can result from lifestyle factors, hormonal imbalances, or varicoceles. Smoking, excessive alcohol consumption, certain childhood infections like mumps, and systemic diseases like uncontrolled diabetes and varicocele can negatively impact sperm numbers. Early detection of PCOS and oligospermia is crucial, as couples often remain unaware until they try to conceive. Timely intervention can empower couples to take control of their fertility.
Infertility often leads to depression. How can couples/individuals deal with it?
Infertility can indeed trigger depression, as the emotional toll of unfulfilled longing for a child weighs heavily on individuals and couples. The journey often involves grief, guilt, and a sense of loss, compounded by societal expectations or personal dreams. For couples, open communication is key. Sharing feelings — whether frustration, sadness, or hope — prevents isolation and builds mutual support. Some seek professional help, like therapy or counselling, to process emotions and strengthen their relationship. Studies suggest couples who attend therapy together report lower stress and better emotional resilience. Support groups also offer a space to connect with others facing similar struggles. Those who balance treatment with emotional outlets tend to fare better. Faith or spirituality also sustains many, offering comfort and meaning amid uncertainty.
Has the emergence of assisted reproductive technologies in recent years helped in improving the rates?
Assisted Reproductive Technologies (ART) is a game-changer for fertility. In recent years, ART has undergone tremendous advancements, including, IVF (in vitro fertilization) refinements in IVF protocols that have enhanced success rates, ICSI (intracytoplasmic sperm injection), PGD (preimplantation genetic diagnosis). PGD enables genetic testing of embryos, reducing the risk of inherited disorders and egg and sperm freezing. ART has enabled thousands of couples to achieve pregnancy, reduced multiple pregnancy rates and enhanced genetic testing. ART has also expanded access to fertility care. While there is still room for improvement, ART has undoubtedly enhanced fertility rates and expanded access to fertility care.