In small towns, web and word of mouth help infertile couples

Rising incomes, changing attitudes, and a virtuous cycle of successful outcomes at regional clinics are making IVF popular outside the metros.

Late last year, while reading a Hindi daily, Bishan Dev came across what seemed like one last chance at fatherhood.

Kamla and Bishan Dev with Dr Latika Agarwal at her IVF centre in Bareilly, Uttar Pradesh. The Devs are sugarcane farmers from a nearby village.(Rohit Umrao / HT Photo)

The 39-year-old sugarcane farmer in Uttar Pradesh pored over the advertisement for an IVF centre in Bareilly, about 25 km from his village. Over eight years, he and his wife Kamla had already spent over ₹3 lakh on Unani and Ayurvedic treatment options, and on travelling to multiple shrines across the country, all in the hopes of bearing a child.

A neighbour had once talked about IVF, then Bishan saw the ad, and the couple decided to give it a try. “Everyone is getting it done,” he says. “I have read all the details on the internet. I could now guide other people about the procedure.” Kamla is now in the fourth month of her pregnancy. The procedure has cost them about ₹1.25 lakh.

The Devs are among a growing community of people driving the proliferation of assisted reproduction clinics in Tier 2 cities and small towns.

Of the 18 clinics in Uttar Pradesh, for instance, 8 are in Tier 2 cities such as Meerut, Agra, Bareilly, Hapur and Muzaffarnagar, according to the National Registry of ART Clinics and Banks in India.

Factors driving this growth include rising incomes and the falling cost of the procedure, changing attitudes to fertility treatments, and a virtuous cycle where successful outcomes at regional clinics encourage others seeking children to give it a shot.

“A common notion among people was that a test tube baby would not be their biological child. I remember telling couples that they could get DNA tests done if they had any doubts, and I would pay for the test.”

“Until 10-15 years ago, the common perception among the less educated was that IVF was some kind of operation and should be the last resort. Now I get patients who have been married for two years. They don’t want to waste time on other procedures,” says Dr Latika Agarwal, medical director of the Sarthak Test Tube Baby Centre in Bareilly, which Bishan Dev and his wife have been visiting since December.

Dr Agarwal’s centre is 15 years old, and in that time she says the number of patients she sees a month has risen from 2 to 20.

With three other IVF centres in Bareilly now, the city has become a magnet for people living in nearby towns such as Pilibhit, Badaun and Shajahanpur too. Even in areas with literacy rates far below the national average (Bareilly’s is 60% against a national average of 74%), superstition has given way to hope.

How IVF works, and why it is necessary

In in-vitro fertilisation, eggs are harvested and fertilised in a laboratory and then implanted in the uterus of the woman who will carry the foetus to term.

An IVF cycle takes four to six weeks and costs between ₹60,000 and ₹2 lakh in India.

IVF is used when couples are unable to conceive the conventional way.

The IVF cycle starts on the first day of the natural menstrual cycle, when the ovaries normally produce their one egg.

For the first 8 to 14 days of the cycle, women are injected with hormones to produce multiple eggs and give the procedure a better chance.

Mature eggs are harvested trans-vaginally in a daycare procedure under anaesthesia. Fresh, frozen or donor sperms are used to fertilise the eggs with, in a petri dish.

After incubating for five to six days, the healthiest embryos are implanted into the uterus in a 10-minute procedure without anaesthesia.

Multiple embryos are implanted to increase the chances of success. This is why quite a few IVF procedures result in multiple births — twins, triplets, and more.

After a two-week wait, a blood test is done to confirm pregnancy.

“A common notion among people used to be that a test tube baby would not be their biological child,” says Dr Agarwal. “I remember telling couples that they could get DNA tests done if they had any doubts, and I would pay for the test.”

There’s another interesting angle to the growing number of takers for IVF — delayed motherhood in working women, and the rise of nuclear families.

“Over the years, I have seen women becoming more career-oriented,” says Dr Neera Agarwal, Consultant Obstetrician & Gynecologist at Bareilly’s Manas Clinic and Infertility Centre. “This is a good trend and should be encouraged. One of the consequences is that they have less fertile cells by the time they are ready to start a family.”

As for the nuclear family effect, one of Dr Neera’s clients explains, “In my father and grandfather’s time, people would adopt a child from within the clan. Any decision had to be vetted by elders,” says a 36-year-old construction worker waiting his turn at Dr Neera’s clinic. “Things have changed now. I have two brothers. We all live separately. When and how I plan a family is nobody’s business.”

(With inputs from Chandan Kumar)