The epidemic of male infertility in India and the struggle with IVF

In vitro fertilization (IVF) plays an important role in reproductive medicine and has given hope to couples struggling with infertility.

Infertility is a major public health problem in India and around the world. According to the World Health Organization (WHO), Infertility is a disorder of the male or female reproductive system It is defined as regular unprotected sexual intercourse for at least 12 months without resulting in pregnancy.

What is IVF?

In in vitro fertilization, Fertilize with sperm from a female partner This is done in a laboratory. If male infertility is the cause, ICSI (Intracytoplasmic Sperm Injection) is used, where a single healthy sperm is injected directly into the egg to increase the chances of fertilization.

The technique avoids many of the obstacles sperm face in natural conception, such as swimming through the female reproductive tract and entering the egg.

Why is male infertility so high?

While female infertility has long been a focus of reproductive health, in recent years there has been a significant increase in male infertility rates.

The increasing incidence of male infertility, caused by low sperm count, low sperm motility or abnormal sperm morphology, is believed to be related to environmental and lifestyle factors rather than genetic factors.

Dr Duru Shah, director of Gynaecworld and consultant at Breach Candy and Jaslok hospitals, highlighted that smoking, alcohol consumption, obesity and advanced paternal age are major contributing factors.

“Smoking is a known danger, Affects sperm motility, number, and morphology“Chronic alcohol consumption inhibits normal sperm development and also leads to sexual dysfunction,” Dr Shah told IndiaToday.In.

Dr KD Nayar, principal consultant and director, Akanksha IVF Centre, said infertility has become a bigger issue among couples with the male factor rising to 50 per cent.

Environmental factors include exposure to toxins, pesticides, and heavy metals that are known to inhibit spermatogenesis.
Studies have shown that men exposed to high levels of environmental pollutants experience a significant decline in sperm quality and increased infertility.

Research suggests that heat stress can lead to a temporary decrease in sperm count and motility.

“In some cases, IVF may be the best treatment for male infertility. When semen analysis reveals that there are very few normal sperm present, IVF is recommended to treat male infertility,” explains Dr Archana Dhawan Bajaj, gynaecologist and IVF specialist at Nurture IVF Clinic, New Delhi.

Experts stressed the effectiveness of IVF, especially in cases where there are multiple infertility-related problems, such as low sperm count and blocked fallopian tubes, ovulation disorders and late-life childbirth.

“It is still possible to perform IVF, where less-motile sperm are used to fertilise an egg. In the lab, fertilisation can be controlled by placing the sperm and egg close together in a petri dish, reducing the distance that less-motile sperm have to travel to reach the egg,” Dr Bajaj said.

How can IVF help?

IVF can use sperm collected in a variety of ways, including testicular sperm extraction (TESE), in which sperm are collected directly from the testicles in cases of azoospermia (absence of sperm in the ejaculate).

Dr Shah highlighted the groundbreaking impact of IVF and ICSI on male infertility. “In IVF, fertilisation is achieved by fertilising a single egg with around 50,000 sperm in a petri dish. But with the discovery of ICSI in 1992, even severe male infertility can now be successfully treated,” he said.

According to experts, IVF and ICSI have a success rate of almost 40-50% per cycle, depending on the risk factors of both.
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In addition to this, Dr Shah emphasised the importance of understanding the mental and emotional factors that men experience when it comes to infertility issues.

“We also need to take into account the fact that men tend to feel threatened when diagnosed with infertility. Understanding the mental and emotional factors that men face during the fertility treatment journey should not be ignored,” Dr Shah said.

Challenges of IVF in India

While IVF offers hope, many challenges face it in India, with significant hurdles in terms of access and cost making it a difficult reproductive option for many couples.

Dr Shah noted that while urban areas are “expanding with fertility clinics”, fertility treatment remains difficult to access in rural areas.

“The stigma associated with infertility can lead to depression, anxiety and relationship breakdown,” Dr Shah added.

Dr Nayar added that the cost of IVF ranges from Rs 80,000 to Rs 250,000, making it inaccessible and expensive for most couples, especially in India's low per capita income. Introducing IVF in medical colleges in India would improve accessibility, he added.

Both Dr. Nayar and Dr. Shah advocated for insurance coverage and called for increased government regulation and standardization of IVF clinics.

By facilitating fertility, IVF addresses high rates of infertility in men, provides a viable pathway to parenthood, and reduces the emotional and social burden associated with infertility if the challenge is addressed promptly.