India’s fertility rate plummets, doctors seek solutions

A recent study in the medical journal The Lancet revealed a substantial decline in India's fertility rate, from nearly 6.2 in 1950 to just under two in 2021. The report further projects a continued decrease to 1.29 in 2050 and 1.04 in 2100. This decline aligns with global trends, with the total fertility rate (TFR) witnessing a similar decrease.

From over 4.8 children per woman in 1950, the TFR has dropped to 2.2 children per woman in 2021. Globally, it is expected to decline to 1.8 in 2050 and further to 1.6 in 2100.

Experts caution that if the findings of the Lancet study are accurate, India could face a significant decline in population in the years to come.

So what is the cause behind the low fertility rate in both men and women? We asked health experts to dig deep into the details published in the study. They dissect the causes, health impacts of infertility and solutions.

Dr Surabhi Siddhartha, consultant obstetrician and gynaecologist, Motherhood Hospital, Kharghar, "Several factors contribute to the rising infertility rates in both men and women. These include delayed childbearing due to various reasons like pursuing education, career goals, or financial stability. Environmental factors such as pollution, exposure to toxins, and climate change can also impact fertility. Stress, unhealthy lifestyle habits, obesity, and chronic medical conditions like diabetes can further exacerbate infertility issues."

Further, Dr Ritu Hinduja, fertility consultant, at Nova IVF Fertility, Mumbai, says, "Delayed childbearing, especially in women, increases the risk of infertility due to declining fertility with age. Further, lifestyle factors like poor diet, lack of exercise, smoking, excessive alcohol consumption, and drug use can also impact fertility in both men and women."

Infertility in men can occur due to factors such as low sperm count, poor sperm motility, or abnormal sperm morphology. This can be caused by conditions like hormonal imbalances, genetic factors, infections, or lifestyle choices such as smoking, excessive alcohol consumption, or drug use.

In women, infertility may result from ovulatory disorders, fallopian tube blockages, endometriosis, polycystic ovary syndrome (PCOS), uterine abnormalities, or age-related factors.

Other medical conditions such as endometriosis, sexually transmitted infections (STIs), and obesity can also cause infertility.

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How can climate change impact fertility rates?
Siddhartha: Climate change can indirectly affect fertility by influencing environmental factors like air and water quality, temperature fluctuations, and food supply. Exposure to environmental pollutants and toxins can disrupt hormone balance in both men and women, leading to reproductive issues. Additionally, extreme weather events and natural disasters associated with climate change can cause physical and psychological stress, which may affect fertility.

Does infertility have adverse health impacts:
Siddhartha: Infertility can have significant emotional, psychological, and physical implications for both men and women. It can lead to stress, anxiety, depression, and strain on relationships. Moreover, underlying medical conditions contributing to infertility may also impact overall health and well-being.

Hinduja: In men, infertility may be associated with hormonal imbalances and increased risk of conditions like testicular cancer. In women, infertility can impact hormonal balance, and menstrual regularity, and may exacerbate conditions like PCOS or endometriosis, potentially leading to long-term health consequences.

What role does a diet play in one's fertility?
Siddhartha: Diet plays a crucial role in fertility for both men and women. A balanced diet rich in fruits, vegetables, whole grains, lean proteins, and healthy fats provides essential nutrients like vitamins, minerals, antioxidants, and omega-3 fatty acids, which support reproductive health.

Hinduja: An unhealthy diet high in processed foods, saturated fats, sugar, and excessive caffeine or alcohol intake can negatively impact fertility by contributing to obesity, hormonal imbalances, inflammation, and oxidative stress.

What foods expose one to the risk of developing infertility?
Siddhartha: Certain foods and dietary habits can increase the risk of infertility. These include processed foods, sugary beverages, trans fats, excessive caffeine consumption, and alcohol. These foods can disrupt hormone levels, promote inflammation, and impair reproductive function in both men and women.

What foods can contribute to a healthy fertility rate?
Hinduja: A fertility-friendly diet includes foods rich in antioxidants (fruits, vegetables, nuts), omega-3 fatty acids (fatty fish, flaxseeds), and folate (leafy greens, legumes) which support reproductive health. Additionally, foods high in zinc (oysters, poultry, beans) and vitamin D (fatty fish, fortified foods) benefit fertility. Consuming a variety of nutrient-dense foods, staying hydrated, and maintaining a healthy weight are key to promoting fertility in both men and women.

How can men and women ensure a healthy fertility rate?
Siddhartha: To ensure healthy fertility, couples should adopt lifestyle practices that support reproductive health, such as maintaining a balanced diet, engaging in regular physical activity, managing stress levels, avoiding exposure to environmental toxins, and practising safe sex to prevent sexually transmitted infections.

Hinduja: Seeking regular medical check-ups and addressing any underlying health conditions promptly is also essential for optimising fertility.

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Can infertility be treated?
According to both experts, infertility can be treated effectively, depending on the underlying cause. Treatment options for men and women may include:

Treatment for men:
Medications: Hormonal therapy or medications to improve sperm production and quality.

Surgery: Varicocele repair, vasectomy reversal, or sperm retrieval procedures.

Lifestyle changes: Adopting a healthy lifestyle, including diet modifications, exercise, and avoiding environmental toxins.

Treatment for women:
Ovulation induction: Fertility drugs like clomiphene citrate or gonadotropins may be prescribed to stimulate ovulation.

Intrauterine Insemination (IUI): Sperm is directly injected into the uterus during ovulation to increase the chances of fertilisation.

In Vitro Fertilisation (IVF): Fertilisation of eggs with sperm outside the body, followed by embryo transfer into the uterus.

Surgery: Laparoscopic surgery to treat conditions like endometriosis, fibroids, or blocked fallopian tubes.

The choice of treatment depends on various factors such as the underlying cause of infertility, age, overall health, and personal preferences. Couples need to consult with a fertility specialist or gynaecologist to explore their options and develop a personalised treatment plan tailored to their needs.

How much do infertility treatments cost?
Siddhartha: The cost of infertility treatment can vary widely depending on the type of procedure, the clinic or hospital, geographic location, and any additional medications or tests required.

Hinduja: ART procedures like IVF or IUI can cost several thousand to lakhs per cycle, including medication, laboratory fees, and clinic charges. Surgical interventions may incur additional expenses for pre-operative tests, hospitalisation, and post-operative care. Couples need to discuss the potential costs and financial implications of infertility treatment with their healthcare provider and explore options for insurance coverage or financial assistance programs.

Disclaimer: This information does not replace professional medical advice. Consult a qualified specialist or your physician for personalised guidance.