The fertility rate has been declining, spawning test-tube babies and infertility clinics, exposing gaps in Kerala’s record on the human development index. Kerala lags behind the national average in fertility.
The infertility rate has rapidly increased among women during the last two decades.

The infertility rate among couples, which was only 10 per cent two decades ago, has gone up to more than 20 per cent, higher than the national average of 16 per cent.

Several reasons have been cited, but the most important factor has been the late marriage among women.

“The most fertile age of women is between 18 and 23 years. Chances for conception gradually decline with age. Chances for medical complications like endometriosis and fibroids in women grow with age,” said Dr K.K. Gopinathan at the Centre for Infertility Manage-ment and Assisted Reproduction (CIMAR), a unit of Edappal Hospitals Pvt Ltd.

Endometriosis is a condition in which endometrial cells (normally found lining the uterus) proliferate outside the uterus, causing irregular bleeding, excruciating pain and chronic fatigue. Endometriosis accounts for infertility among 30 per cent of women.

Dr Vijayalakshmi, a fertility specialist, observed that the state had the highest number of endometriosis cases in the country. Endometriosis was reported even among pre-teens.

“The rate of endometriosis is very common in the state. Whichever form you may get them, you get them as infertility patients,” she said.

Another reason, cited by Dr. Gopinathan, has been the change in sexual habit of couples, especially among middle and upper-middle-class families.

“There’s been a noticeable decrease in the frequency of sex after the initial phase of marriage owing to several factors, including stress at workplace. Chances for conceiving decrease considerably when sex becomes mechanical and less frequent,” added Dr. Gopinathan.

Other factors for the plunging fertility graph are lifestyle changes, spousal separation, the growing tendency among couples to delay the first child and female obesity.

“On average, more than 1,000 test-tube babies are born at assisted reproduction centres in the state every year. The state has three major infertility clinics and six medium clinics. The total number of IVF treatments at these centres is nearly 6,000 a year, of which 40 per cent are failures.

Of the 3,600 successful procedures, only 30 per cent couples go back home with babies,” said Dr. Vijayalakshmi.

A hospital in Kochi, established in 1996, had screened more than 50,000 childless couples, recording a gradual increase in the number of patients every year.

The high literacy among the female population, high standards of living and a growing sense of self-reliance, resulting in late marriages, add to the infertility phenomenon.

The rapid increase in the number of childless couples is not borne out by the number of patients visiting infertility clinics. There are still more out there, who can’t afford the treatment and hence stay off, says Dr. Gopinathan.

The in vitro fertilisation treatment in the state is relatively cheaper, compared to other states.
But many couples still can’t afford it. The average IVF treatment cost ranges between Rs1 lakh and Rs2.5 lakh. Many couples from outside Kerala and even NRKs flock to centres in the state, attracted by the less prohibitive treatment rates.

Increasing cases of infertility have created a market worth Rs120 crore. The boom in this market is evident in the opening of new international fertility centres.

Recently, the UK-based Bourn Hall Clinic started its first centre in Kochi, which is its first clinic outside UK.

Such stats do not reduce the social stigma faced by childless couples. This is reflected in the 90 per cent dropout rate among couples after their first visit to an IVF centre. Cost is the next major deterrent for couples, who want to conceive and bring up one of their own.

Childless couples seek CM’s financial support

With the infertility rate rapidly rising among couples, it’s high time the health department intervened to make the treatment affordable to common people.

As the treatment at assisted reproduction centres is expensive, couples from poor families are condemned to rue their fate and remain childless.

Recently, a group of childless couples from Mukkom, Kozhikode, formed Progeny-Free Couples Welfare Organisation to stay united to espouse demands of similar people in the state.

The organisation, formed six months ago, has been spreading its services to other districts. More than 500 couples are now registered with it.

It recently petitioned chi-ef minister Oommen Chandy, urging him to order a comprehensive survey on issues of childless couples and prevent their exploitation by private infertility clinics.

“Mr Chandy has promised to do the government’s best for the welfare of childless couples,” said the secretary of the organisation, M. Sasi.

Many such couples feel the need for a government-sponsored mechanism to provide fertility treatment and relaxations in impractical adoption rules.

Infertility treatments such as IVF is unaffordable for the average childless couple. The centres usually charge Rs1 lakh to Rs2 lakh for the procedure. Some centres carry out a few procedures for free. But, such humanitarian gestures are a trickle compared to the enormity of the problem.

Those destined to remain childless and short-changed by adoption hassles rest their hopes on the chief minister’s assurance.