Apart from destroying many Indian families, the Covid-19 pandemic has also ruined the prospect of starting a new family for many. Across India, every year, almost 2-2.5 lakh women undergo the In vitro fertilization (IVF) treatment to have a child. However, as the pandemic ravaged our country and overburdened the healthcare system, any other healthcare facility that isn’t the matter of life-and-death has obviously been put on the back burner, including the desires of several women in India who want to be mothers.
When the first lockdown was initiated in the country last year, all IVF clinics were closed because the procedure was not considered to be an essential service. At the time, all the IVF cycles were halted abruptly. Women who had just started with consultation and medicines were advised to continue later; the blastocysts of couples whose samples were collected were cryopreserved so that they could be implanted when safe.
As the country-wide lockdown eased at the end of 2020, ART (Assisted Reproductive Technology which also includes IVF) clinics re-opened in many states of India. The ICMR had put forth a set of guidelines to ensure the safety of both patients and treatment providers in such clinics, and in most cases, the protocols were strictly observed. This included giving their consent for patients, a risk-assessment questionnaire to be filled during every visit to the clinic that helped identify the high-risk patients, a negative RT-PCR test preferably a week or less before commencing treatment. If patients contracted COVID-19 during the treatment, their eggs/sperms/blastocysts are required to be cryopreserved, as the case may be. In the case of staff, COVID-19 protocols included collecting triage information regarding their health status, RT-PCR test in case of symptoms, thorough contact tracing and testing, and quarantine for the mandated period. Additionally, practices such as booking appointments, temperature checks, and methodical sanitization and disinfection protocols were also integrated into the Standard Operating Procedure.
However, with the burgeoning cases of COVID 19 and the ongoing second wave now leading to subsequent lockdowns in some states, a delay in treatment can cause further emotional turmoil for many such women, who generally opt for IVF after struggling to have children without any medical assistance for years. In most cases, these women are also in their late thirties, and time is of the essence in their child conception journey. The onus, thus, remains with fertility treatment providers to put their patients’ minds at ease and help them as best as they can.
The volume of IVF cycles performed annually has seen a dip during the pandemic. In India, about 250,000 IVF cycles are performed in a year which we estimate to have gone down to 150,000-180,000 in 2020. This is disturbing news because IVF treatment not only helps women to conceive safely but also identify any other underlying ailment they may be suffering from.
The root cause of maternity-related deaths in India is the mother’s health before and during the pregnancy and the lack of timely medical intervention, which has become even more difficult during COVID-19 times. Certain ailments can be the reason for infertility in women, while others can be life-threatening in those who have conceived.
For instance, women with thyroid disorders may be diagnosed with anaemia during their term and see a spike in their blood pressure, causing preeclampsia; in some cases, the mother may experience vomiting and dehydration. In the case of the developing child, it may result in stillbirth or miscarriage and premature birth, endangering the child’s life.
This is where IVF can play an essential role to determine and contribute to the treatment of such diseases before women set on the journey of motherhood. Every IVF cycle starts with a counselling session with an IVF specialist, which helps to establish expectations from the procedure. This is followed by a number of panel tests in both men and women. In women, this includes blood tests that check for the presence of polycystic ovaries, diabetes, liver damage, sexually transmitted infections, and levels of hormones such as prolactin, among other factors. Image-based scans such as ultrasound may also be used. This helps to unearth the cause of infertility and ascertain if there is any health condition that needs to be medically addressed before starting the IVF cycle. For instance, if a woman seeking IVF treatment is found to have severe diabetes that can affect pregnancy and its outcome, she will be referred to an endocrinologist; if someone is found to have uterine fibroids, they will be removed using laparoscopy or surgery.
These newer technologies safeguard the different checkpoints in the procedure and become a crucial element of ensuring a safe gestation period for mothers and reducing maternal mortality. Additionally, this negates the need for multiple embryo transfers into the uterus, which increases the probability of live birth. However, it can lead to pregnancy complications due to the presence of more than one developing child. Single embryo transfer, which is safer in comparison can thus, become the norm.
While IVF treatment can help in the identification and timely remediation of underlying conditions, it is imperative to note that all do not require it. Typically, couples who have been unable to conceive naturally for over a year, sometimes even decades, opt for such treatments. In India, that number is estimated to be about 10-15% of the country’s total population, accounting for about one in six people, but not all seek treatment due to stigma or financial constraints. Ongoing R&D, awareness initiatives by practitioners and policy developments such as the discussions on the Assisted Reproductive Technology (Regulation) Bill 2020 can bolster faith while also being active promoters of fighting against maternal mortality rate.
Previously, the Government of India had launched a number of interventions to safeguard the health of to-be mothers and their children. Surakshit Matritva Aashwasan (SUMAN) and the Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) are initiatives that ensure dignified maternal care is a priority in the country. However, despite proactive measures, maternal mortality rate or MMR is a leading cause of death among women.
The latest data accounting for MMR in India spans the years 2016-18, which found that the country observed 113 maternal deaths per 100,000 live births. Although this number has reduced over the years, we are still way behind the UN sustainable goal mandate. And, with the COVID-19 pandemic, which has thrown up many challenges for pregnant women to access the healthcare system, the MMR in India can worsen if checkpoints are not introduced proactively by the government and assisted reproductive treatments such as IVF is not made readily available. They are critical care that women need in their journey to motherhood, and as we battle the pandemic, it is imperative that we do not ignore them.
Dr. Kshitiz Murdia is the Chief Executive Officer of Indira IVF. Indira IVF is India’s largest infertility speciality clinics chain with 94 centers across the country. The chain performs approximately 30,000+ IVF procedures every year.