Infertility Management in India: Issues and Potential Solutions

Abstract

Infertility is a significant global issue affecting numerous couples, with India experiencing a considerable prevalence. Limited access to assisted reproductive technology centers and social stigmas result in underreporting and low service utilization. The financial burden of infertility treatment is substantial due to high costs and lack of insurance coverage. The absence of national guidelines and monitoring raises concerns about unethical practices. Standardizing ART practice and infertility management guidelines, integrating care into primary healthcare, and raising awareness to reduce social stigma can enhance the quality and accessibility of infertility treatment.

Infertility is the failure to conceive after 12 months or more of regular unprotected sexual intercourse, affecting approximately 10–15% of couples worldwide. Infertility is a significant health issue in India, with an estimated prevalence of 3.9% to 16.8%, higher in urban areas. [1] In 2019, there were 1500 ART (Assisted Reproductive Technology) centres across the nation, including 350 private physician clinics and 1000 clinics run by lone practitioners. In public hospitals, there were just 10 ART clinics. [2] However, cultural, and social stigmas, as well as limited healthcare access, can lead to underreporting and low utilization of services. In contrast, high-income countries like the USA have better surveillance systems for infertility, with the Centres for Disease Control (CDC) and the Society for Assisted Reproductive Technology (SART) monitoring ART utilization and success rates. [3].

Infertility treatment in India is associated with a significant financial burden for patients and their families. Depending on the various settings, the price of infertility therapy varies greatly. The cost of infertility treatment is not currently recorded by any most recent data. According to a 2012 study, depending on the location and state, IVF cycles can cost anywhere between 30,000 and 400,000. [4] The high cost of infertility treatment is driven by several factors, including the high cost of drugs and consumables, the need for specialized equipment and infrastructure, and the lack of insurance coverage for infertility treatment. In addition, the lack of regulation in the sector has led to a wide variation in pricing among different infertility clinics. Patients often face additional costs such as travel expenses, accommodation, and lost wages due to the need for multiple visits to the clinic. As a result, many couples are unable to afford infertility treatment, and those who do undergo treatment often experience financial strain and may need to take out loans or sell assets to cover the costs. [5].

Infertility management in India has lacked national guidelines and a centralized system for monitoring the provision of infertility services. The Reproductive, Maternal, Newborn, Child Health and Adolescent Health (RMNCH + A) programme is a comprehensive initiative of the Indian government aimed at improving the health and well-being of women and children. However, the infertility services through the programme are only limited. RMNCH + A lacked in incorporating a dedicated care pathways for infertility management. Also, there are concerns about the lack of standardization and regulation in the provision of infertility treatments, which can lead to unethical practices and exploitation of vulnerable couples. Some attempts were made in India as the Indian Council of Medical Research (ICMR) released the National Guidelines for Accreditation, Supervision, and Regulation of ART Clinics in India to standardize the practice of ART and ensure quality assurance and patient safety. [6] These guidelines also recommended protocols for infrastructure, staffing, and patient care in the ART clinics. Additionally, the Federation of Obstetric and Gynaecological Societies of India (FOGSI) published clinical practice guidelines for infertility management covering the evaluation and treatment of male and female infertility. [7] The FOGSI guidelines suggest diagnostic tests such as semen analysis and hormonal assays, lifestyle modifications, medical treatment, ART, and address ethical issues like informed consent and the use of donor gametes.

The guidelines are likely to enhance the management of infertility in the coming years, but what is truly necessary is a well-defined infertility care pathway that can be integrated into the system. Strengthening primary healthcare is vital for comprehensive infertility management in India, as it would make infertility care a routine part of healthcare. This would facilitate early detection and access to infertility care, which is typically scarce in rural areas. Establishing a national infertility registry can ensure uniform identification and management of infertility by utilizing the eligible couple registers already maintained at the sub-centres. Affordable and high-quality infertility care should be made available through public–private partnerships and government-insured schemes to reduce the financial burden of treatment. Reducing the social stigma surrounding infertility is crucial, and education and awareness programmes can help achieve this. The adoption of evidence-based guidelines would standardize and enhance the quality of infertility care.

Declarations

Conflict of interest

None declared.