Infertility related problems among young men and women all over the world reveal a phenomenon Kashmir has been more prone to because of the stressful and special conflict conditions here. With the spread of fertility clinics stigma attached to the problem is slowly going away and the awareness about availability, IVF treatment is also spreading. Saima Bhat examines and explains the issues involved.
Infertility has become a serious issue ensuring a lot of attention throughout the world. Some experts say the problem may have assumed proportions of ‘an epidemic’ with sterility almost tripled in recent years even among couples trying to have babies early.
The condition is somewhat similar in Kashmir. According to a study carried out by the Department of Endocrinology at Sher-i-Kashmir Institute of Medical Sciences in 2008, 15.7 per cent of women in Kashmir who are of child-bearing age will never have a child without clinical intervention. PCOS (Poly Cystic Ovarian Syndrome) is believed to be one of the main reasons for this problem. Kashmir’s renowned endocrinologist, Dr Ashraf Ganaie says that in recent years there has been a tremendous increase in the number of PCOD patients. A specific unpublished study revealed that 90% of female infertility problems are due to PCOD and related diseases, 5% are due to POF (Premature Ovarian Failure) and another 5% due to other stresses in our lives.
“These problems are not only female specific. It is also present in males with metabolic syndrome. We call it a genetic disorder,” says Dr Ashraf, who believes late marriages are adding to this problem.
All these problems have led to a blooming of IVF (In-vitro Fertility) treatment centres in the valley. The IVF is a treatment where fertilization of the egg is done outside the womb in a Petri-dish. The man’s sperm and woman’s egg are fertilized in a vitro (glass) dish and after fertilization, the resulting embryo is transferred into the uterus of the woman. The worldwide success rate of this IVF treatment is 40%.
However, the percentage varies with age. It is highest when the patient is between 25-30 years while for patients below 21 and above 40 it can be less than 20 per cent. Initially, it was used on women who had tubal factor infertility, a condition in which the fallopian tubes are blocked, damaged or absent but today it is tried on most of the infertility patients.
IVF started in Kashmir valley in 2003 with Rotunda Hygeia Clinic that hires doctors from outside the state for the treatment. A few others are run by the gynaecologists from the valley. The first clinic is believed to have done about 1000 successful pregnancies in 8 years. Such clinics witness a huge rush of patients with each passing year and with an increasing number of problems leading to infertility.
“In females, it is because of stress, POF, late marriages, endometriosis, fibroids, PCOS, tubal blocks, PID (pelvic inflammatory disease), pelvic Koch’s, hormonal disorders (prolactin and thyroids). In males it is due to contact with pesticides, alcohol consumption, smoking, in laptop users, people exposed to more heat like drivers and mechanics as due to heat their sperm count gets reduced so naturally, their mortality decreases,” says Dr Ruheel Nisa, Lab Director Rotunda Hygeia clinic. “Most of the infertility problems in males are due to the interrogation in jails.”
Infertility in tortured people is very common in Kashmir where two decades of conflict has inflicted psychological as well as physical sufferings.“In jails people (males) are interrogated on their private parts resulting in their infertility.
Females have also got affected equally, like PTSD (Post-traumatic stress disorder) leads to their infertility. For the rape victims, mostly, it is very difficult to conceive,” says Dr Ashraf. Dr Arshid, Psychiatrist, at government Psychiatric hospital is of the similar opinion. He also says stress changes the neuro-hormonal environment of the body affecting fertility.
Stress disorders have reduced the reproductive age of Kashmiri women by almost 10 years, reveals a finding by Dr Abdul Hameed Zargar, former Director SKIMS. The finding shows that 11 per cent women out of the 2,000 women examined between 2004 and 2006 in J&K suffered from premature menopause — a rise of 2 per cent from the late 90s. Some experts also claim reproductive age has reduced but Dr Ashraf says it is puberty which starts early, then due to late marriages like at 30 or 32 reproduction period reduces.
People who are opting for treatment are from the elite as well as from middle-class sections of the society, mostly from areas like Sopore and Anantnag. Some people call it gambling because the treatment costs 1.5 lacs to 2 lacs rupees and there is no guarantee whether the patient will conceive in the first attempt or not.
“I went for IVF treatment thrice, on the first attempt, I got an abortion in the 7th month, on the second attempt I again got an abortion in the 6th month, this was during last year’s summer turmoil. In IVF procedure patients have to be on full medication but last year, Kashmir was under curfew so I couldn’t get medicines from the clinic which resulted in abortion. Now I have gone again for the treatment, I hope this time I could make it,” says Mrs Zahida who’s dreaming of becoming a mother for the past 15 years.
In Kashmir, there is a social stigma attached to this kind of treatment. In some cases, patients use their fake names and addresses in such clinics because the society they live in doesn’t easily accept the problem can be with male partners also. Only females are blamed for it.
“In my 10 years of marriage I couldn’t conceive a child due to some problems in my husband but all my relatives thought I was sterile. I never told them the problem was with my husband. But the day we decided to go for the IVF treatment I felt hopeful about becoming a mother,” says Shazia, who is preparing to go for IVF treatment. She also says that they never thought of adopting a child because they always wanted to have a child of their own.
Before 2003, patients used to go outside the state for IVF treatment, which was like a dream in those days. “We had been married for 8 years and went to Delhi in 2000 for IVF treatment because doctors there told that my wife can’t conceive without any clinical intervention. It cost us about 5 lacs(Rupees) and luckily my wife became pregnant. We were really happy. But our family and relatives weren’t happy at all. They were not ready to accept this procedure.
Finally, after 7 months, my child got aborted adding to our miseries,” says Mohd Yousuf. “That was a very hard time for both of us and after 2 months of that abortion my wife got pregnant again and that too naturally. Oh my God! I can’t forget that day, that was the best day of my life. Miracles do happen and now we have two daughters”.
There have been cases when infertility problems reduced or completely vanished after first pregnancies but there are many other cases where complicacy happened after the first pregnancy.
“I became pregnant after a year of my marriage but the fetus got aborted. The doctors said I was having Peritubal adhesions and thyroid problem due to which abortion happened. Now it is the 10th year of my marriage and I am trying to be pregnant again but all in vain. We have planned to go for IVF treatment now as doctors say it’s the best way out for tubal blocks. These days I am completing all formalities like tests etc. In these 9 years, I have consulted three or four doctors and have spent 8 to 9 lacs on treatments excluding the money spend in Shrines or on peers. We have hardly skipped any religious help,” says Saba while waiting for her turn in one of the infertility clinics.
Some people believe the IVF treatment is not legal as per Islamic laws but the Lab Director at Rotunda Hygeia clinic says that they go for same partner IVF’s only and if it’s the same partner then there is no religious binding on that. Some people also say such clinics are just money making machines.
“I was planning to go for IVF and did a survey first. First, the procedure does not have any guarantee and is extremely costly. My doctor in Kashmir told me they are having lowest possible rates in India but when I cross-checked, the rates were encouraging in Amritsar where they charge just 60,000 rupees for the treatment,” says Nisar Ahmad. “The medicines needed in the treatment are available in such clinics only, they are not available outside which clearly indicates they must be earning margins from that also. He has now decided not to go for this treatment”.
Before going for such treatments gynaecologists suggest dozens of tests and screenings that cost thousands of rupees but an FSH level test is enough to check if the patient can go for IVF treatment. The FSH level gives an indication of whether or not the woman will produce enough eggs after super-ovulation. If the FSH level is high (greater than 10 mIu/mL) it suggests early ovarian failure.
However, despite the easy and spreading availability of treatment for infertility, cases where husbands support their wives if the wife has a problem are rare. Khalida was married for 6 years but couldn’t conceive. After her brother-in-law passed away he left behind two children. After three months, with the consent of their family, her husband married his brother’s widow. She couldn’t bear this and she decided to return to her father’s home.
(All names of patients have been changed).