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Childless couples from semi-urban and lower middle-class backgrounds are boldly breaching cultural and financial hurdles to undergo expensive assisted reproduction techniques for the joy of holding their child in their arms.
Strapped to a hospital bed and covered in a gown, Savita Samant lies calm amid the casual flutter of doctors and technicians running around in green scrubs. Her husband is by her side, uneasily watching an injection with a transparent fluid being thrust into her. In the next room lies Pragya, similarly strapped. Having failed to conceive naturally, both Savita and Pragya had decided to go in for assisted reproduction. But that's as far as similarities between the two go.
Savita, 27, a homemaker from Nagpur, landed up at the hospital after she realised that her husband's semen did not have adequate sperm - a condition called azoospermia - to impregnate her. She has studied only till Class 10 and says she remains busy through the day doing household chores and attending to her mother-in-law. Thirty-one-year-old Pragya, on the other hand, an operations manager in a leading IT company in Mumbai, chose IUI (intra-uterine insemination) after being diagnosed with polycystic ovarian syndrome.
Opting for assisted reproduction is a tough choice. Not only do you need to have an abiding faith in your doctor, you also need to give up all your inhibitions - even the most forward-looking of women squirm at the thought. For someone like Savita it's a gigantic leap of courage to let a male doctor peep - clinically, of course - into her vagina and inject some fluid into her system.
A decade ago, the Samants would have given up. Their socio-cultural background would not have allowed them to discuss their 'personal' problems with a doctor. Back then, infertility mostly meant childlessness or discreet visits to shady godmen and tantrics without much result. But the times have changed. The couple had heard about artificial insemination and knew that their medical condition was not irreversible. So they readily approached an in-vitro fertilisation (IVF) clinic, even if it meant emptying their purses and staying bankrupt for a while.
Artificial insemination and the range of infertility treatments grouped under the ever-expanding umbrella of assisted reproductive techniques (ART) have not just revolutionised the realm of reproductive sciences but also initiated attitudinal shifts in society, be it in the general perception of childlessness or the receptivity of different sections of society to these techniques. When it comes to seeking treatment for infertility, the class ceilings are fast cracking up.
Doctors these days often talk - quite happily - about the changing profile of the average couple seeking infertility treatment, and its widening reach. Increasingly, lower middle-class couples and non-urban families are shoring up, egged on by the growing credibility of IVF and access to new-age media like the internet. The small-town family that opted for time-honoured customs like keeping mannat, or appeasing a deity, is now resolutely pitching tents outside infertility clinics even if it costs them a fortune.
A single IVF cycle can set you back by Rs 1 lakh or more, depending on the injections and screening required to go with it. And it usually takes quite a few cycles before you get lucky. "Many wives take up a job for a few months prior to starting treatment. Sometimes husbands take up additional assignment to earn extra money, " says Firuza Parikh, infertility specialist at Mumbai's Jaslok hospital and author of the recently-released book The Complete Guide to Becoming Pregnant.
But for many middle-class couples, especially in semi-urban and rural areas, the psychological scarring and social stigma are an inevitable part of the infertility baggage. As authors Marcia Claire Inhorn and Frank van Balen observe in their book Infertility around the globe: New thinking on childlessness, gender and reproductive technologies: "While delay may be tolerated, women are ultimately expected to marry and reproduce. " And, thanks to regular media exposure, word-of-mouth publicity and a growing openness to science, medical intervention is an approved option. Out of an infertility factor of 10 to 15 per cent among couples, an increasing number is going in for medical resolution. Around 50 to 60 per cent of those who do are successful in conceiving through artificial means.
In the past five years alone one of the first 'budget' IVF clinics to open in India, Deccan Fertility Clinic, has seen a jump in the middle-class and lower-middle class clientele. Dr Gautam Allahabadia, who started it, says: "Till 2005, these categories accounted for 0. 1 per cent of the patients. Today, I'd say more than two in 10 are from far-off areas and of modest means. "
Like Manju Shah, a 31-year-old-housewife from Dhule in Maharashtra. She and her husband have put all their faith in IVF and she is undergoing treatment in Mumbai. Their savings are not enough but she is scrounging and praying. They stay at a relative's place every time she's called to Mumbai for treatment. Already, the first two cycles have failed. "I can hold out for six more months. After that, we will have to rethink our strategy, " he says.
There are others who are putting in everything they have and banking on their hopes. Shabnam, 29, has not only quit her job as a school teacher to make time for the treatment but has also sold all her jewellery and taken loans to generate the Rs 2. 3 lakh required to get pregnant. The chances of her conceiving appear remote, given her complicated history of fibroids, endometriosis and blocked tubes. But she is not giving up in a hurry. "I will try till I am 40. If all fails, then I will consider adoption. "
Shabnam and her husband took time to think their options through. "We have no family backing, but when my gynaecologist advised advanced treatment, we decided to go for it. I'd heard about it and felt comfortable and confident after surfing the internet, " she says.
Apart from endowing couples with muchcoveted parenthood, these treatments have impacted our world view and gently influenced the societal take on infertility. Science has helped, and how. Name a problem and doctors show you a way out. Blocked fallopian tubes? Extract the eggs from the ovaries. Poor quality eggs? Use donor eggs. No ovaries? Use donor eggs. No uterus? Hire a womb. Poor quality sperm? Find, treat and inject the good ones. No sperm? Extract some from the epididymis or the testes. No sperm in testes? Use a donor's. The petridish has replaced prayers for parenthood.
Of course, there are areas where technology too throws up its hands (see Where there's a wish, there's a way). Dr Duru Shah, who runs infertility clinic Gynaec World in Mumbai, says, "After we use the best options available, including surrogacy, around five to 10 women in 100 will still remain childless. " As film director Farah Khan, who showed the way to many women by getting pregnant through IVF at the age of 42, says, "There are pills for contraception but none for conception. " So, keep the faith.
(Names of patients changed on request)
WHERE THERE'S A WISH, THERE'S A WAY
Technology has limits. Assisted reproduction techniques fail when the woman has no uterus or its lining is affected due to genital tuberculosis. Or when the man has no sperm due to incurable genetic defects or Sertoli-Cell-Only syndrome or cryptorchid testes (small non-functional testes located in the abdomen instead of the scrotum). But doctors maintain all is not lost. In the first case, the woman can opt for surrogacy - pay another woman to bear her child with her or a third woman's eggs - to ensure the child has her partner's sperm at least. In the case of missing sperm, the man can settle for donor sperm to artificially impregnate his wife in order to beget a child with his wife's genes.
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