Like Swati and Nitin, many double-income couples who have everything but the baby are discovering that you can't 'just do it' anymore and jumpstart a family. Scores of highly successful single-income partners like Nikhil and Rashmi are having bad luck in bed. No matter how frantically they try, there doesn't seem to be any 'good news' coming their way. Inquiries from in-laws and friends have begun to grate on the nerves. One visit to a doctor diagnoses this condition as 'infertility'—the inability to conceive even after 12 months of unprotected sex. When suddenly many couples discover it wasn't just the joy of whoopee that went out of their bedroom window when work became a basic instinct; it was also their fertility flame that blew out while racing along the fast track. Now their prime anxiety is about whether they'll ever have a baby.
"One in six couples in India are infertile and at least 20 per cent of young urban professionals are facing unexplained infertility that's stress-related," says Dr Anirudh Malpani of Malpani Infertility Clinic, Mumbai. A recent study shows exactly how jobs have caused conception havoc amongst IT professionals in Bangalore. Dr Kamini Rao of the Assisted Conception Centre observed that in 57 per cent of the couples who walked into her clinic for infertility treatment between January 2002 and 2003, at least one partner was a software professional. All of them in the 26-32 age bracket also had a significantly higher incidence of hypertension, diabetes, obesity and libido trouble related to their lifestyle. But the most disturbing discoveries were low sperm counts in men and excess levels of prolactin hormone and menstrual disturbances in women. All conditions caused by stress, and which hinder conception.
Lifestyle-influenced infertility isn't just restricted to the garden city or the IT industry. Urban professionals seeking treatment (see box) are arriving at clinics in all metros. "The number of such patients has doubled," says Dr Urvashi Sehgal, infertility specialist at Delhi's Phoenix Hospital. "Stress is the major indirect contributory cause in most cases," opines Dr Gautam Allahbadia, scientific director, Rotunda Centre for Human Reproduction, Mumbai. "In many yuppie couples, high job pressures and long working hours are resulting in infrequent sex and fertility problems," says Dr Rupin Shah, consultant andrologist, Lilavati and Bhatia Hospitals, Mumbai. Even Pune has about a hundred infertility specialists and five infertility centres today.
"We have taken no steps to prevent infertility as a lifestyle problem," says Dr Bharati Dhore Patil, co-founder of the Pune Fertility Centre. "Late marriages and the decision to postpone childbearing is often the cause," says Dr Kamala Selvaraj, Fertility Research Centre, C.G. Hospital, Chennai. She also feels there are too many couples trying out their own family planning methods, without checking on their fertility, and then suddenly discovering they aren't biologically primed for parenthood.
However, each of the specialists Outlook spoke to believe that infertility does not restrict itself to successful thirtysomethings. They say its prevalence is 12-15 per cent among India's population. But most of it goes unrecorded since the poor, unable to afford specialist fees, often opt for non-medical avenues. Says Dr Anoop Gupta, Delhi IVF, Fertility Research Centre: "Don't forget that this is India, where many seek sadhu ka aashirwaad." He's simply referring to Hinduism's divine euphemism for donor sperm, a paternity prank that is still performed by oddball babas today.
There are common fears that unite urban childless couples. Often the hostile connection between home and office comes to light within a clinic's cold white walls. "Among many young, healthy, working professionals, the frequency of sex is subnormal," observes Dr Kurush Paghdiwalla, a Mumbai-based gynaecologist. "Male sperm counts have dropped drastically in the last decade and there's a high degree of infertility among men with stressful jobs," says Dr Selvaraj. "Stress affects ovulation and prevents the release of an egg," opines Dr Malpani. "Libido is at an all-time low," rules Dr Avinash Phadnis, Shree Clinic, Pune.
The dire causes lie outside the bedroom. Most jobs in vogue seem to have been created to distract the amorous and destroy natural biorhythms. From call centres that pay Jignesh to believe he's Joe and day equals dark to media machines that need reporters to break news 24x7 to airlines whose hi-flying crew keep time in Mumbai and Milan. So much so that the most atypical event in the lives of most young people today is getting into bed and finding a spouse both ready and willing. "Sometimes we wonder why we bought a double bed," say Mumbai-based TV editors Dipali and Raghav Menon, aged 31 and 33, "the only time we spend side by side is when we are at an editing suite."
And once such couples decide to put Mission Conception on the top of their overloaded agendas, the demands are enough to drain out their already weakened biological batteries. Pronounced guilty of not making love enough, faulted for not making love that's 'good enough' and accused of bad reproductive health, the duo must move heaven and earth, to be together and, believe it or not, nonchalant. From trying to tame the uterus, notorious for its reactions to nervous tension, to finding easy ways to digest all the unpleasant vibes at home and office, they must conjure up 'invisible hours' of togetherness during which they can silence cell phones, consult doctors, do endless tests and have planned sex. "I have never lied as much about being early and late, both at work and at home," says Roxanne Desai, 32, a Mumbai-based designer, "but I've got to perform to two clocks—one at office and the other inside me."
Besides time, white lies and an abundant cash supply, this treatment line also requires a high count of blood, urine and semen samples which are tested on hormonal parameters. While women are assessed on criteria like ovulation, menstrual frequency and whether their fallopian tubes are blocked or not, men are initially tested on one ground—sperm count. "In the last three years, referrals for infertility tests have doubled," says Dr Lal of Dr Lal's Path Lab in Delhi.
An overwhelming X-factor has come to light as a result of testing. "Male infertility is on the rise and its incidence has doubled," warns Dr Shah. While sperm counts have been decreasing for the last hundred years all over the world due to environmental toxins, stress is a major cause among most cases. Says Dr Kochar, infertility specialist at Delhi's Gangaram Hospital: "Smoking is terrible for sperms, and during difficult times men tend to smoke more which only makes things worse."
This is why most specialists are unwilling to subject women to any invasive tests, unless the man goes under the microscope—first. And the baseline test is a semen analysis, even if you are already a father. Christina and David De Silva, who first became parents five years ago, found that they couldn't produce a sibling for Ryan. That's when they discovered that David's sperm counts were terrifyingly low, caused by his work on oil rigs, where they actually wear badges to monitor radiation. "But," says Dr Subramanium, consultant andrologist and urologist, Apollo Hospital, Delhi, "what is very heartening today is that men are willing to take responsibility and undergo tests."
Yet, whether the fault is with yin or yang, infertility treatment needs total commitment from both partners. It's a situation that can make the psychological status of even a bionic being plummet from stressed to deeply distressed. "Every time I ovulated, Nitin was travelling. The last straw was when he was actually in town and I called him at work to say we needed to be together and all he could say was I can't make it," says Swati. Most men when faced by such deadlines go through "situational impotence" aka performance anxiety.
Still, for most couples, it's tough to get off the treatment spiral since the advances of reproductive medicine are so great today that you can run out of money long before you can run out of hope. Simple measures include lifestyle modification (eating, drinking, working out and timed intercourse) and medication (selenium to improve sperm profiles for men, chlomid to help women ovulate). Even complex cases like azoospermia (the lack of sperms) can be helped by procedures like IVF ICSI that retrieves a single sperm, which is then directly injected into an egg.
There are also two macro-issues that worry leading specialists in India—the lack of support groups and the refusal of insurance coverage for infertility treatment. The first is a perfect solution for patients who feel isolated in their treatment. These groups can also band together to lobby for a larger cause, namely insurance. Policies don't recognise infertility as a medical problem. "The public perception is that infertility does not need insurance, only cancer does, when infertility actually causes more lifelong stress and enormous mental and physical agony," says Dr Kochar.
Perhaps the worst toll of childlessness is on the bank account where costs rack up to as much as a lakh plus per IVF with a 30 per cent success rate. There are some rays of hope though. Telco in Pune has made a beginning by funding employees undergoing treatment. In Nikhil and Rashmi's case, their families have offered to pay for two cycles of IVF, while honouring their plea of "no questions please". Raghav and Dipali are carefully storing bills and submitting them as medical expenses, which are tax deductible. But that's still cold comfort for couples caught in the throes of Mission Conception, wondering whether they are doomed to being babyless forever.
(Some names have been changed to protect identities.)
Pramila N. Phatarphekar with Harsh Kabra in Pune, S. Anand in Chennai and B.R. Srikanth in Bangalore