Infertility Trends, Innovative Solutions For Better Pregnancy Outcomes
In conversation with Dr Nandita Palshetkar, President Federation of Obstetric & Gynecological Societies of India (FOGSI), Dr. Ameet Patki, Medical Director, Fertility Associates and Sieneke Bult-Muntinga, Site Director, Abbott Weesp, the Netherlands creating awareness of infertility trends and evidence-backed innovative treatments available to couples who are planning for a child today.
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A quarter of the women who suffer from infertility in the world, i.e., 15-20 million, reside in India. Though infertility has multiple causes, studies suggest that advancing age of motherhood is one of the key risk factors. Given rapid urbanization and the shift in cultural dynamics, maternal age in India is advancing.BW Healthcareworld got into the conversation with Dr Nandita Palshetkar, President Federation of Obstetric & Gynecological Societies of India (FOGSI), Dr Ameet Patki, Medical Director, Fertility Associates and Sieneke Bult-Muntinga, Site Director, Abbott Weesp, the Netherlands to peep into the infertility trends and innovative solutions available in the country.
Here is some excerpt:
Rise of infertility and pregnancy health conditions in India
Dr. Nandita Palshetkar: Around 10-15 per cent of clinically recognized pregnancies worldwide end in a miscarriage. The actual rates of miscarriage might be higher, as many women have very early miscarriages without ever realizing that they are pregnant. Some women can even experience recurrent miscarriage (or recurrent pregnancy loss), which is defined as three consecutive pregnancy losses prior to 21 weeks before their last menstrual period. Moreover, an increase in the number of miscarriages can lead to an increase in the likelihood of subsequent miscarriages, to 13-17 per cent after the first miscarriage, and 55 per cent after the third miscarriage.5 This underscores the need for medicines and treatments that ensure healthy pregnancies.
How does lifestyle impact infertility?
Dr Ameet Patki: A number of lifestyle factors affect fertility in women such as nutrition, weight, exercise, physical and psychological stress, environmental and occupational exposures, substance and drug use and abuse, and medications. Understanding lifestyle behaviours and how they may benefit or harm fertility by consulting a doctor at the right time is very important in order to minimize complications and to maximize fertility outcomes. As we understand lifestyle behaviors and modifications in their lifestyle, men and women will be more capable of controlling their own fertility potential. Deferring pregnancy beyond the age of 35 years due to social and career goals can also drive the need for fertility treatment.
How have infertility treatments evolved?
Dr Ameet Patki: Until 10 years ago, advanced fertility treatments were available in key metros. There are a lot of social stigma and myths about infertility and the available treatment options made fertility clinics inaccessible to even those couples who could afford the treatment. Now with a lot of media attention and awareness amongst the general population, with the addition of fertility clinics even in tier 2 and 3 cities, accessibility and affordability have increased. Most couples need minimal treatments, which are available in most parts of India. The high-end treatments are needed for only 30 per cent of infertile couples. Increasing awareness, women empowerment, and increasing incidence of infertility, in general, has made couples approach fertility clinics.
Due to hectic work-life balance, couples are delaying pregnancy. How does that impact the fertility and pregnancy health of the mother and child?
Dr Nandita Palshetkar: Advancing maternal age is one of the factors contributing towards infertility, but there are other causes too, including increasing pollution, hormonal imbalances caused by polycystic ovarian syndrome (PCOS), endometriosis, menstrual hygiene, certain infections, lifestyle factors, socioeconomic status and occupational hazards. Fertility naturally declines as men and women age. Where circumstances permit, women who desire to bear children should start trying to conceive by the age of 30. It is also important to get tested for fertility regularly to ensure that couples can plan childbearing in an informed manner.
How do various IVF centres and Fertility consultations help couples in planning their pregnancy?
Dr Ameet Patki: Every fertility center offering a range of treatments has a team consisting of a counselor, fertility nurse, clinical doctors and embryologists. Each of them has designated roles to describe the treatment, offer to counsel and explain the procedure in detail with its risks and benefits. Every couple undergoes pre-IVF investigations and at each stage of treatment, the couple is kept informed of the progress.
How is dydrogesterone swiftly becoming the standard of care to support IVF treatment?
Dr Ameet Patki: To have a healthy pregnancy, a woman needs to have sufficient levels of progesterone, which is an important female hormone. A deficiency of progesterone can cause implantation failure and early miscarriages. Dydrogesterone, which has a structure similar to that of the body’s progesterone, can increase the chances of a successful pregnancy in women with a history of recurrent spontaneous abortion. In fact, one study shows that the use of dydrogesterone can reduce the incidence of miscarriage in women by 47 per cent.
Furthermore, the LOTUS I and LOTUS II studies have shown that dydrogesterone can be used effectively and safely for luteal phase support as part of in-vitro fertilization (IVF) treatments. While micronized vaginal progesterone (MVP) is the most commonly used method of administering progesterone in IVF centers globally, it is also associated with side effects, such as irritation and discharge, as well as poor patient acceptance. Since the publication of LOTUS I and LOTUS II, dydrogesterone has been approved for use in luteal support as part of assisted reproductive technology treatment in several countries, including India. Approximately 40,000 women in India undergoing in vitro fertilization (IVF) treatment each year can benefit from oral dydrogesterone.
Dr Ameet Patki on International LOTUS II study
The International LOTUS II study was performed to understand the viability of oral dydrogesterone versus intravaginal micronized progesterone gel (MVP) for luteal phase support in IVF. The study showed that oral dydrogesterone results in higher rates of ongoing pregnancy and live birth in women, and is non-inferior to MVP with a similar safety profile, for luteal support as part of an Assisted Reproductive Technology (ART) treatment. Due to its patient-friendly oral administration route, dydrogesterone can replace MVP as the standard of care for luteal phase support in fresh-cycle IVF.
A global expert’s perspective on Abbott’s dydrogesterone, a medicine which has helped more than 100 million women with a variety of health issues, and facilitated 20 million pregnancies worldwide for 60 years.
Pregnancy is an emotional journey even when everything goes right. Any medicine which can improve the conditions for birth is invaluable. But such medicines need to be of the highest manufacturing quality and need to be accurate in their ingredients. Sieneke Bult-Muntinga, Site Director, Abbott Netherlands added "Evidence from over 300 published studies, including the recent LOTUS II study, shows oral dydrogesterone is a potent treatment for many different gynecological disorders, including prevention of miscarriage during the first trimester and for luteal phase support for in-vitro fertilization. Dydrogesterone with its unique manufacturing process is one of many examples of Abbott's life-changing technologies that are helping people live better and healthier lives. And we are proud to aid healthier pregnancies in India by making quality dydrogesterone available in this country."