In vitro fertilization (IVF) has played a vital role in reproductive medicine, and has offered a ray of hope to couples struggling with infertility.

Infertility is a major public health problem in India and around the world. According to the World Health Organization (WHO), infertility is a disease of the male or female reproductive system, defined by the failure to conceive after 12 months or more of regular unprotected sexual intercourse.

What is IVF?

IVF involves retrieving eggs from the female partner and fertilizing them with sperm in the laboratory. When male infertility is a factor, ICSI (intracytoplasmic sperm injection) is used, in which a healthy sperm is injected directly into the egg, increasing the chances of fertilization.

This technique overcomes many of the obstacles faced by sperm in natural conception, such as traveling through the female reproductive tract to reach the egg.

Why are male infertility rates so high?

Although female infertility has long received attention in reproductive health, the rate of male infertility has seen a significant increase in the past few years.

The rising rates of male infertility due to low sperm count, poor sperm motility, or abnormal sperm morphology are linked more to environmental and lifestyle factors than genetic factors.

Dr Duru Shah, director of Gynecworld and consultant at Breach Candy and Jaslok Hospitals, said smoking, alcohol consumption, obesity and old age are the major causes.

“Cigarette smoking is a known hazard that affects sperm motility, count and morphology. Chronic alcohol consumption disrupts normal sperm development and also increases the risk of sexual dysfunction,” Dr Shah told IndiaToday.in.

Dr KD Nair, chief consultant and head of department, Akanksha IVF Centre, said the male factor has increased to 50%, making fertility a major problem among couples.

Environmental factors include exposure to toxins, pesticides, and heavy metals, which are known to inhibit spermatogenesis.
Research shows that men exposed to high levels of environmental pollution have significantly reduced sperm quality and higher rates of infertility.

Studies have shown that stress due to heat can cause a temporary decrease in sperm count and motility.

Dr Archana Dhawan Bajaj, gynaecologist and IVF specialist at Nurture IVF Clinic, New Delhi, said, “When treating male infertility, IVF is sometimes the best solution. If a semen test shows that there are very few normal sperms present, IVF is recommended to deal with infertility in men.”

The expert highlighted the efficacy of IVF, especially in cases where multiple fertility issues are present, such as a low sperm count as well as blocked tubes, ovulation difficulties, or older maternal age.

“Through IVF, eggs can be fertilised with sperm with low motility. Fertilisation can be controlled in the laboratory by placing the sperm and egg close together in a petri dish, reducing the distance that the insufficiently motile sperm has to travel to reach the egg,” said Dr Bajaj.

How can IVF help?

IVF allows the use of sperm obtained by a variety of methods, including testicular sperm extraction (TESE), where sperm is obtained directly from the testes in cases of azoospermia (absence of sperm in the ejaculate).

Dr Shah emphasised the transformative impact of IVF and ICSI on male infertility. He said, “With IVF, fertilisation could be achieved in a petri dish, with one ovum (egg) left to be fertilised with about 50,000 sperms. But with the discovery of ICSI in 1992, even severe forms of male infertility can now be successfully treated.”

According to the expert, the success rate of IVF or ICSI is around 40-50%, depending on the high-risk factors of both.
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Furthermore, Dr. Shah stressed the importance of understanding the mental and emotional factors of men when facing infertility problems.

Dr Shah added, “We must also consider the fact that men are at risk when they are diagnosed with infertility. Understanding their mental and emotional factors during their infertility journey is also something that should not be overlooked.”

Challenges of IVF in India

Although IVF offers hope, a number of challenges in India make its accessibility and affordability a significant barrier, making it a difficult fertility option for many couples.

Dr Shah said although urban areas are “full of fertility clinics”, rural areas still struggle to have easy access to fertility treatments.

“The stigma associated with infertility contributes to depression, anxiety, and failed relationships,” Dr. Shah said.

Dr Nair said that since IVF costs between Rs 80,000 and Rs 2.5 lakh, the procedure has become quite inaccessible and expensive for most couples, especially given India’s low per capita income. Introducing IVF in medical colleges in India could help increase access, she said.

Both Dr. Nair and Dr. Shah also advocated for insurance coverage and urged better government regulation and standardization of IVF clinics.

By facilitating fertilization, IVF addresses the problem of high infertility rates in men, and provides a viable route to parenthood, and reduces the emotional and social burden associated with infertility, if the challenges are addressed promptly.