IVF Centres Dotting Kerala Towns Rekindle Parenthood Dreams

IVF Issue Theme

Thiruvananthapuram: One in every four couples in developing countries suffers from infertility and it has been the case for over two decades now, according to studies. And, infertility is a rather agonising phase in the life of childless couples. Offering a remedy to it, in vitro fertilization (IVF) or Assisted Reproduction Technology (ART) and other treatment methods for infertility have been there in India for well over 20 years now.

But it was only in recent years that such scientific methods of assisted reproduction, which remained largely overlooked for many years, gained prominence as alternative treatment options. The reasons why they had been ignored were many. They range from conservative beliefs about child conception to ignorance about treatment protocols to doubt about the cost involved.

In the modern age, due to tremendous career pressure, unhealthy food habits, particular lifestyles upsetting the rhythm of life and other unknown reasons, the number of young couples who could produce their offspring in the natural way has come down and hence, many of them started opting for assisted reproductive methods for conceiving. And, Kerala was no different in this aspect compared to the other parts of the country. It is not infertility alone that is causing a spurt in the number of people who prefer IVF treatment. Couples are looking at it as a safer option than going for natural conception. And what is more, they are even willing to meet the expenses involved as most of them feel that this is a trust-worthy conception method.

In Kerala, IVF and infertility centres are currently undergoing a period of boom. Organisations like Indian Society for Assisted Reproduction (ISAR), a collective of doctors specialising in infertility treatment, have become the face of the specialty in India. “I started providing treatment for infertility in 2002,” says Dr. Fessy Louis, Secretary, ISAR, Kerala Chapter. In 2002, there were less than 10 IVF centres in Kerala. But in the last 15 years, the number of IVF clinics in the State has gone up to 42.

However, practicing experts in the field feel that the cost of IVF or infertility treatment has not shown any ‘drastic’ increase in the past 15 years as the market potential of IVF is very high in Kerala. “Having a population of 3.5 crore, the market potential for IVF in Kerala is very high as close to 15 per cent of the married couples suffer from infertility and related conditions,” says Dr. Madhavan Pillai, Managing Director, Samad IVF Hospital in Thiruvananthapuram.

“Couples have found the procedures affordable, awareness about the treatment methods has increased and best practices and technologies from abroad have become available here,” says Dr. Louis, explaining why IVF treatment has become popular among families in the State which maintained a very conservative attitude on such issues a decade ago.

IVF treatment facilities have even been made available in three of the State’s government medical colleges – Thiruvananthpuram, Kottayam and Kozhikode. Even though cost of the treatment process is significantly low on par with that in other countries, IVF treatment still is an expensive option for middle class segments of the domestic population.

It could be the absence of domestically-produced IVF medicines, lab technology and equipment which makes the treatment costlier even in government-run medical colleges. In fact, most of the medicines used in IVF treatment are imported and hence, costly. Similarly, the medium in which eggs, sperm and embryos are kept or grown are sourced from foreign countries.

There are different stages of treatment for infertility depending on the condition’s severity. According to experts, Assisted Reproductive Technology such as IVF is probably only the last step in the treatment process.
Normally, during natural fertilization, egg and sperm gets combined in the womb of the mother. But during IVF treatment, egg and sperm sourced from the parents are combined artificially outside the body and later the embryo thus formed is placed in the womb of the mother.

Although the success rate of this method of treatment may not appear very encouraging, nearly eight million babies have been so far delivered with the help of IVF treatment globally. The general success rate of IVF treatment across the world is 45-50 per cent. ‘‘The chances of success also depend on several other factors like age and other medical conditions of the carrier Also, there is a two to three per cent chance of abortion,” Dr. Louis adds.

Early diagnosis and right kind of infertility treatment at the right age would substantially increase the chance of success. Right treatment for infertility may get delayed due to wrong diagnosis.

Dr. Pillai says: “Medical practitioners who specialises in general medicine or other specialised streams should be judicious enough to direct an infertile couple to an IVF specialist instead of wasting their time and money.”
Meanwhile, the relative affordability of IVF treatment in Kerala has helped create a benchmark on the global medical tourism map. Even in countries like the United Kingdom, which offers highly subsidised medical care through schemes like the National Health Service (NHS), IVF treatment in certain parts of the country would cost more than Rs. 8.5 lakh without including the expenses for medicines. Also, things are in no way different in the Gulf countries as it would cost more than Rs.5 lakh for undergoing IVF treatment. That is exactly what gives more scope for IVF-oriented Medical Value Travel in Kerala. In India, cost for one-time IVF treatment ranges between Rs 1.2 lakh and Rs. 1.5 lakh.

On the other hand, Dr. Pillai feels that IVF treatment offers not much scope for promoting health tourism. “The difference between other specialty treatments and IVF is that in most other cases, treatment could be decided and executed in one sitting. In the case of IVF treatment, it is not the case,” says Dr. Pillai. “It would have already picked up here if it was feasible for the people coming from abroad.

‘‘IVF treatment will take a long time. Even the pregnancy period may span a little more than nine months. Such difficulties often discourage foreigners from taking up such tedious stay,” he adds.

The number of doctors who have specialised in IVF treatment is considerably less in India, according to industry insiders. There are only 45 doctors attached to the Indian Society of Artificial Reproduction (ISAR), an association of doctors and technicians specialised in IVF and infertility treatment. In Kerala, there are 10 well-experienced embryologists and around 15 junior embryologists. Embryologists are technicians who combine the egg and sperm outside the human body.

The setting up of IVF treatment facilities is very expensive. According to the experts in the field, it may cost well above Rs. 5 crore to setup the infrastructure, including lab facilities and equipment, for a fully-equipped IVF clinic. Besides, the IVF market in India is considered to be fragmented in nature, mainly owing to various medical requirements of the individual patient.

“Be it any specialty, no private hospital management would be willing to run suffering losses. They will always look forward to recover the expenditure in the short to medium-term. Immediate recovery of the expenditure is not a plausible option in IVF.,” says Dr. Louis.

The Indian Council of Medical Research (ICMR) has laid down clear guidelines governing the ethical practices in IVF treatment. While the UK has regulatory bodies like Human Fertilization and Embryology Authority (HFEA), India is yet to come out with such a piece of legislation for regulating the sector.

“An ART law is a must because the field of IVF treatment involves many ethical issues. There may be people who misuse the treatment procedures. There needs to be a regulatory body to audit the procedures in IVF clinics,” Dr. Louis observes.

In fact, ART Bill was drafted by the ICMR in 2008. But 10 years later, there has been little initiative to bring in a piece of legislation in this regard. Currently, foreign nationals as donors are banned in India. The Bill was revised by the Union Ministry of Justice and Law in 2013 and when it was tabled in Parliament, it got mired in a slew of legal conflicts, mainly pertaining to the ethical constraints of surrogacy in India. As a matter of fact, such issues could, in fact, become major hindrances impeding the growth of IVF market in India.

According to inferences made based on various collated data, nearly 30 million couples in India suffer from various infertility issues. However, compared to other countries like the United Kingdom, Japan, Germany and the US, IVF services in India have not yet been successful in penetrating the global market.

For example, according to Society for Assisted Reproductive Technologies (SART), 1.34 lakh IVF cycles were performed on every million infertile women in Japan in 2010. On the other hand, only 2,786 IVF cycles were performed on every million infertile women in India, as of 2015. It indeed throws light on the true potential of Indian IVF market.