Dr Rita Bakshi, Founder of RISAA IVF is an IVF specialist with a backdrop from AIIMS, Lady Hardinge Medical College and St Stephens. Her work with institutes from Singapore, Germany and Belgium has delineated her worthy experience in the fields of Gynecology, Obstetrics, Laparoscopy and Assisted Reproduction. She has proficiency in IVF, IUI, ICSI, surrogacy, recurrent miscarriage, endometriosis and ovulatory disorders and their treatments.

BW Healthcareworld engages with Dr Rita Bakshi, to get deeper insights on rising infertility among couples, major reasons behind it and it's relationship with the pandemic. Excerpts:

How have the fertility rates of couples in metros been impacted by COVID? Please share trends and statistics.

COVID has been found to have no direct impact on fertility. SARS-CoV-2 infection is unlikely to have long-term effects on male and female reproductive function. There is fear in the mind of people owing to COVID-19. The pandemic has not only affected the physical health of individuals but also adversely affected mental health and social interaction. It has resulted in depression, anxiety, stress, social isolation. All this may have an indirect impact on the fertility of the couples. 

The second phase of data collected by the National Family Health Survey-5 (NFHS-5) for 2019-21 was released on November 24, 2021. The survey was conducted in two phases due to the COVID-19 pandemic. The data was collected in the first phase from 22 states and union territories before the COVID-19 pandemic was released in December 2020. According to NFHS-5, for the first time in India, the birth rate has fallen below the replacement ratio of 2.1. According to the survey, the country's fertility rate has come down to just 2 from 2.2 in the NFHS-4 (2015-2016) and 2.7 in the NFHS-3 (2005-2006). The fertility rate is 1.6 in urban areas, while it is still 2.1 in rural areas which is equivalent to the replacement rate. According to the NFHS-5, only five states of the country, Bihar (3.0), Meghalaya (2.9), Uttar Pradesh (2.7), Jharkhand (2.4) and Manipur (2.2) have recorded relatively high fertility rates and this is also above the replacement rate. From 1950 to 2021, the fertility rate has come down from 5.9 to 2.

Why do you think this has happened?

The burden of infertility is linked with the changing lifestyle, increased use of contraceptives and exposure to toxins. Stress, sedentary lifestyle, fancying consumption of alcohol and tobacco, obesity increases the chances for sperms to die. All these contribute to the declining rates of fertility. COVID-19 is not the only wrongdoer. There is not only a decline in female fertility but male fertility is also attributed to it. In metro cities like Delhi, Mumbai and Chennai, over 15 per cent of the male population is infertile. This rate is greater than that of the female infertility rate.

Do you feel this trend will become the norm in the future?

Stress, obesity, sedentary lifestyle, smoking and alcohol, polluted environment are the contributing factors to declining pregnancy rates. Westernised lifestyle and contaminated environment play a major part in infertility amongst couples and increased miscarriage. Reduction in testosterone in males and estrogen in females results in loss of libido. As the age increases, sperm motility and quality decrease. COVID-19 has not directly impacted implantation of pregnancy and miscarriage rates. No such evidence has been found in seminal fluid or follicular fluid.

Is this a pan-India or global phenomenon?

It’s a global phenomenon, but in a country like ours with overcrowding and thus causing fast spread, problems can be more. There are more chances of the spread of the virus because of overpopulation. 

Fertility rates have fallen not just in India but worldwide. The main reasons behind it are the expanding opportunities for women, their work shifts, increasing labour market participation, stress, changing lifestyle, eating and drinking habits, urbanisation of families. Urban women have a prime focus on career and education. 

How has the pandemic changed relationships among couples?

Relationships among couples have changed keeping in view the stress and fear of the pandemic leading to generalised depression and anxiety which is bound to affect the sex life of the couple, hence adding to fertility problems even more. There are couples who are facing economic hardships, some of them have lost their jobs and are stressed figuring out how to pay rent or to take care of their children. While other couples are self-sufficient, they may be able to take benefit and spend quality time together. Some couples faced increased anxiety, stress due to their valid reasons, which has shaped a strained relationship, regardless of love and regard. Pandemic-related stress had an impact on the relationships.