KOCHI: After waiting for more than 20 years, Kottayam resident Teena (name changed) underwent in-vitro fertilisation (IVF) in 2021. Teena and her husband chose IVF after exhausting various treatment options to have a child. She was in her late 40s when she gave birth to a boy in 2022.Teena and her husband are among an increasing number of couples opting for IVF in Kerala.
“Mostly, couples in their 40s opt for IVF,” says Dr Vivek Kumar, an infertility specialist at Kinder Hospital in Kochi.
“People usually try other treatments before opting for IVF. There are situations where the couple refuses to accept the treatment despite doctors suggesting it. They choose IVF later.”
Experts attribute the significant rise in the number of people opting for IVF over the past 10 years to its accessibility, affordability and greater awareness.
“The cost of IVF treatment is much cheaper compared to a decade ago. Success rates are higher and the technology and the materials used have evolved,” Dr Vivek points out.
The secretary of the Indian Fertility Society’s Kerala chapter, Dr Raju Nair, says, “People with indications and who have late marriages prefer the treatment for fast results.”
Prevalence of lifestyle diseases and the rising marital age are among other reasons for the popularity of IVF, points out Dr Reji Mohan, associate professor with the department of reproductive medicine at the Government Medical College in Thiruvananthapuram.
“Also, young couples often prefer to have a child once they are settled and financially stable. As women grow older, chances of conception decrease. Hypertension, diabetes, obesity, lack of exercise, etc. can be linked to it. Further, partners may not be staying together or may migrate to other countries as well. This can also be a factor contributing to infertility,” he says.
Dr Reji says the sperm count and quality too are decreasing these days.
“Most of the time, doctors prescribe IVF treatment because of the social pressure the couple is facing,” he says.
Some couples can possibly make it a normal pregnancy if they wait for six months or a year, says Dr Vivek.
“But the couple isn’t convinced and is encircled with questions, peer pressure and family pressure. The doctor is thus forced to prescribe IVF. The couple need to have the liberty to choose when they are mentally, physically and financially stable for it,” he stresses.
Couples who don’t have children experience social pressure though it varies according to their backgrounds, age and profession, says Dr Raju, who is also the head of the fertility unit at the Mitera Hospital, Thellakam, in Kottayam district. “Such couples also choose this option as an easy solution,” he says.
Further, he says the social stigma around the treatment is waning. “Even if there is resistance initially, people opt for it once they realise IVF is the solution for the issue. Counselling and better clarification about the scenario help couples make the decision,” he says.
In line with the trend, many IVF centres too have been established in the state over the past few years, Dr Reji says.
“Earlier, anyone with a degree in gynaecology could establish a centre. According to the 2021 Act, only trained persons can start an IVF centre. There are Level 1 and Level 2 classifications. We need to ensure that the centre has the required facilities and expertise,” he points out.
What is the right age for IVF?
The Assisted Reproductive Technology (Regulation) Act, or ART, has set an age limit for males and females who can undergo the treatment. Women above the age of 21 and below 50 and men above 21 and below 55 are allowed to undergo the treatment to have children. However, the age limit stipulated by the Act remains a point of debate as it denies treatment to couples outside that particular age group. The Kerala High Court, in December 2023, passed an interim order permitting couples where the husband is 55 or older and the wife is below 50 to avail the assisted reproductive technology. However, according to experts, the age restriction has sociological and medical reasons behind it.
“If a child is born to those above 50 or 55, they will become old as the child grows up. It will affect the future of the child. We don’t leave our children once they are 18. Our culture is to protect them till 25 or 30. The age gap between the parents and the child can pose a problem,” Dr Vivek says. Citing a couple who underwent IVF in their 70s in Punjab, Dr Reji says, “In most such cases, they use young donor eggs for treatment. Later, if something happens to the parents, it affects the lives of the children. The well-being of the child is also our priority and setting an age limit is crucial.As women get older, the egg quality diminishes,” points out Dr Raju.
“Also, there are age-related complications and conditions like diabetes and BP. It affects pregnancy and can even lead to maternal mortality,” he says, adding there are issues in child-rearing too. “In medical science, we cannot deny treatment. But regulation is required even though it affects 10% of people,” Dr Raju says. Dr Reji points out that the restriction also affects healthy couples in their 50s. “In such cases, they have to approach the court and get the approval to go ahead with the treatment. The restriction has its advantages and disadvantages,” he says. If there are proper indications, IVF has to be done in younger couples as well, he says. “In case of low or absent sperms and challenges for the uterus or ovaries or fallopian tubes, they have to opt for IVF,” Dr Reji stresses.
Contributing factors
As women grow older, chances of conception decrease. Hypertension, diabetes, obesity, lack of exercise, etc. can be linked to it. Further, partners may not be staying together or may migrate to other countries as well. This can also be a factor contributing to infertility