All our Indian cities today are booming with infertility clinics and speciality centres. As an infertility researcher, the one thing that comes to my mind when I see this- How is India, the world’s second largest population in trouble with regards to fertility? The statistics just don’t seem to add up right?

The World Population Prospects: The 2017 Revision report sets forward staggering estimates that the fertility rate of Indians (measured as the number of children born to a woman), has plummeted by more than 50 percent, from 4.97 during the 1975-80 period to 2.3 for the current period of 2015-20. By 2025-30, the report projects, the rate will nosedive further to 2.1, touching 1.86 from 2045-50 and 1.78 from 2095-2100. A fertility rate of about 2.2 is generally considered the replacement level, the rate at which the population would hold steady. When the fertility rate dips below this number, the population is expected to decline.

To put things in perspective, as per Indian Society of Assisted Reproduction, 10-14% of Indian population is affected by infertility. This is an average for the country. In some urban areas, 1 in 5 couples are struggling. Nearly 27.5 million couples actively trying to conceive suffer from infertility in India. Of this only 40-50 percent of the cases are attributed to problems with women while for the rest it is men (about 30 to 40 percent). What is more surprising is the fact that male infertility in India is on a rise with every passing year.
These are only the reported statistics. Reality is much much worse!

So why are we at such a decline with respect to fertility? I’m breaking it down to two parts- Physiology and Lifestyle.

PHYSIOLOGY

Are you tired of hearing that you should plan pregnancy early and not wait too long? Have you argued with people that it’s an ancient concept and women need not worry about age and pregnancy? Sorry to burst your bubble but whether we like it or not, age does have a strong effect on your fertility. It’s not the only factor but it is a defining factor.

Human body, like any organic organism, has a lifespan and we deplete over time from birth to death. A woman is born with all the eggs she’ll ever have, which at birth, is typically around 1 million. By puberty, she usually has half that—and each month after puberty, she loses up to 1,000 eggs. Of those, only one egg is matured and ovulated each month.
Our “reproductive life” begins when we get our first period, usually around age 12 or so, and lasts until our last menstrual period some four decades later (that’s menopause). But because egg count and egg quality decline as we age, we don’t remain fertile for the entirety of this timespan. Our fertility doesn’t cliff drop at 35 as we’re used to believing. Fertility decline happens throughout our adult life but in a snowball way i.e. as we age, fertility declines and the rate of decline increases every year! A 25-year-old has better chances than a 30-year-old than a 35-year-old. Fertility goes into a sharper decline around age 35—over 10 years before menopause.
Men, unlike women are not born with limited sperms. They continuously produce sperm till 40-45 years of age at least and still continue. There are medical reasons for male infertility, but on-the-rise are the lifestyle-based causes of infertility.
Now, a very common question I get is, “Infertility issues are being faced by couples of all ages. If the above physiology is right, then why are young couples struggling as well?”. The above stated physiology is a constant. What makes it better or worse is lifestyle.

LIFESTYLE

PCOD has become a common household term now and is one of the leading causes of infertility. Adolescents develop PCOD which in turn puts them in a vicious cycle of hormonal medicines, obesity and ill-performing reproductive systems. The only way to break out of PCOD is to change your lifestyle- exercise more, eat a nutritious diet and lower stress levels.

Obesity is a world-wide epidemic and India is one of the leading countries in that aspect. Male and female obesity is on the rise and this has a direct impact on fertility levels. Tackling obesity is a necessity if you are looking for a healthy pregnancy. Its common practice that the pressure is put on the woman to lose weight and the fathers are not taken in the equation. The father needs to look after his health if he wants to produce healthy sperms. Exercise and balanced diet are critical to both- egg and sperm quality.

Stress- You ask anyone today about their life- “stressful” will be part of that sentence. What a lot of people don’t understand is that excessive stress releases a hormone- cortisol which is counter-productive to fertility. I know stress is a part of 21st century lifestyle but its important that you are aware of its effects on your body. Excessive stress is one of the reasons of unexplained infertility. Ensure that you put in some stress-relieving activities in your routine. Exercise, meditation, spending relaxed time with your spouse, occasional holidays etc are some ways you can think of.

Alcohol & Tobacco- This is something everyone knows but chooses to ignore. Excessive alcohol and tobacco consumption have serious effects on fertility levels of both men and women. If you’re planning a pregnancy, this needs to be kept in mind. Ideally the couple should quit alcohol and smoking few months before they start trying. Research has proven time and again that smoking seriously affects the sperm count in men.

A combination of these lifestyle factors and physiology can affect your fertility. You can do the permutations and combinations yourself. For example, a 27-year-old with higher lifestyle risk will have lower chances of conception than a 32-year-old with a healthy lifestyle. Risk is higher with increase in age and lifestyle issues. Also to be kept in mind that there are lots of medical issues that lead to infertility and sometimes they are genetic or unavoidable but that’s a smaller part of the pie.

A lot of people live in a “ignorance is bliss” ideology. I believe that if you are considering pregnancy, you need to be aware of factors affecting your fertility so that you can plan ahead and not be completely surprised if things don’t work out the way you expected.

For women, I know and understand that pregnancy can affect career growth and a lot of women decide to postpone pregnancy for this reason. As long as you are aware of the pros and cons and make a conscious choice, it is fine. When you make a conscious choice, you are better equipped to deal with consequences- positive or negative.

A lot of the lifestyle issues arise due to peer pressure. Like I said above. Be aware of the pros and cons and make conscious choices (I don’t know what the pros of a bad lifestyle would be… but still!). If you don’t put in effort to take care of your body, how do you expect it to perform well?

I’ll end with one of my favourite quotes- “Everything in your life is a reflection of a choice you have made. If you want a different result, make a different choice.”

Author: Anjali Raj
Anjali is a childbirth and lactation educator, doula and Hypnobirthing trainer. She is pursuing her PhD from Warwick Medical School on Infertility and Mental Health. She is a co-founder of ILove9Months.

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