Latest news with #MannanGupta
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First Post
26-07-2025
- Health
- First Post
Dr explains: How air pollution, stress and late pregnancies are fuelling India's fertility crisis
Infertility affects 10–15% of Indian couples. Firstpost brings out expert views on India's growing infertility crisis, examining how lifestyle, pollution, and delayed parenthood are affecting reproductive health, IVF success rates and access to fertility care in urban and tier-2 and tier-3 cities. read more Infertility is emerging as a pressing public health concern in India, affecting an estimated 10–15% of couples according to studies published in The Lancet and other medical journals. The issue has been further spotlighted by government data and clinical observations pointing to a surge in conditions like PCOS, endometriosis and declining sperm quality, particularly in urban centres. Environmental stressors such as air pollution and exposure to endocrine-disrupting chemicals, combined with sedentary lifestyles and delayed family planning, are compounding the crisis. The Indian Council of Medical Research and the Ministry of Health have taken regulatory steps with the Assisted Reproductive Technology (Regulation) Act to ensure standardised fertility care but challenges around accessibility, affordability and awareness persist—especially in tier-2 and tier-3 cities. STORY CONTINUES BELOW THIS AD Firstpost talked to Dr. Mannan Gupta, Chairman & HOD, Obstetrics & Gynaecology & IVF, Elantis Healthcare (New Delhi) to understand the underlying medical and environmental factors behind India's infertility burden, how air pollution and lifestyle are affecting IVF outcomes, and the current state of ART practices across the country. What are the main medical and environmental factors behind the rising burden of infertility in India? Dr Mannan: Infertility now affects nearly 10–15% of couples in India, and the trend is steadily increasing. Medically, rising cases of Polycystic Ovary Syndrome (PCOS), endometriosis, thyroid disorders, diabetes, and obesity in women are significant contributors. In men, conditions like varicocele, hormonal imbalances, and poor sperm parameters are commonly seen. Environmentally, increasing exposure to endocrine-disrupting chemicals (EDCs), air pollution, and unhealthy lifestyle habits—such as poor diet, lack of exercise, smoking, alcohol consumption, and chronic stress—are worsening reproductive health. Additionally, delayed marriages and late pregnancy planning have become major socio-cultural factors contributing to declining fertility. How are declining sperm quality and ovarian reserve due to air pollution and sedentary lifestyles impacting IVF outcomes, especially in urban India? Dr Mannan: In urban settings, declining sperm counts and ovarian reserves have become major challenges for successful conception—both naturally and via assisted reproduction. Studies show increasing DNA fragmentation in sperm and diminished anti-Müllerian hormone (AMH) levels in women exposed to high-pollution environments. These directly reduce embryo quality and negatively impact IVF success rates. Sedentary habits, obesity, and poor sleep hygiene further impair hormonal health. As a result, we often require multiple IVF cycles and personalised stimulation protocols to achieve a viable pregnancy, especially in metropolitan cities. How accessible and affordable is IVF treatment across India, particularly in tier-2 and tier-3 cities? Dr Mannan: While IVF is gaining popularity and acceptance, affordability and access remain significant hurdles outside metro cities. In tier-2 and tier-3 areas, there is limited availability of advanced infrastructure, skilled embryologists, and fertility specialists. Many couples are forced to travel to metro cities, which increases emotional and financial burdens. Moreover, infertility is still considered taboo in several regions, leading to delayed medical intervention. Although some states are considering subsidised treatment or insurance coverage for infertility, there is still a long way to go in terms of accessibility and affordability at the national level. STORY CONTINUES BELOW THIS AD What realistic expectations should couples, especially those over 35, have when starting IVF? Dr Mannan: IVF success rates typically range from 30% to 50%, depending on factors like the woman's age, the cause of infertility, and the clinic's expertise. For women above 35, success rates start to decline due to reduced ovarian reserve and egg quality. It is crucial for couples to understand that IVF is not a guarantee of pregnancy in the first cycle. It may require two or more attempts, and in some cases, advanced techniques like donor eggs or preimplantation genetic testing (PGT) may be recommended. Emotional and psychological support also plays a big role during this journey. Since the implementation of ICMR guidelines and ART legislation, how have clinical practices, patient safety, and ethical standards changed? Dr Mannan: The Assisted Reproductive Technology (Regulation) Act and ICMR guidelines have brought much-needed standardisation to IVF practices across India. Clinics now require mandatory registration, ensuring quality control and accountability. There are clear protocols for consent, gamete donation, surrogacy, and embryo storage. This has significantly improved patient safety, reduced unethical practices, and built greater transparency in treatment. While compliance can sometimes increase operational costs, it ultimately enhances trust between patients and healthcare providers. STORY CONTINUES BELOW THIS AD Are clinics in India adopting single embryo transfer more frequently to minimise complications from multiple pregnancies? Dr Mannan: Yes, there is a growing shift towards single embryo transfer (SET), especially in younger women with good-quality embryos. While earlier practices often involved transferring two or more embryos to boost chances, we now understand that multiple pregnancies increase maternal risks such as hypertension, preterm birth, and NICU admissions. With improved embryo culture systems, blastocyst transfers, and technologies like vitrification (rapid freezing), SET has become a safe and effective option. However, adoption still varies across clinics and regions based on patient preference, cost considerations, and expectations. What does current evidence suggest about egg freezing and fertility preservation in working women and cancer patients? Dr Mannan: Egg freezing has emerged as a valuable tool for fertility preservation. For working women who wish to delay childbearing, freezing eggs before the age of 35 offers the best chance of future success. In cancer patients, fertility preservation before undergoing chemotherapy or radiotherapy is becoming standard practice. Evidence shows that frozen eggs, when used within 5–10 years, can lead to pregnancy rates comparable to fresh eggs—provided they were retrieved at an optimal age and under proper protocols. The key is early counselling and timely decision-making. STORY CONTINUES BELOW THIS AD How widely are advanced technologies like AI and time-lapse imaging being adopted in Indian IVF clinics, and do they improve outcomes? Dr Mannan: Advanced technologies such as AI-based embryo selection and time-lapse imaging (like EmbryoScope) are being increasingly integrated into top-tier IVF centres in India. These tools offer real-time monitoring of embryo development and help identify embryos with the best implantation potential. AI algorithms analyse thousands of data points to assist embryologists in decision-making. While the evidence is promising—especially in reducing subjectivity and improving selection accuracy—more long-term data is needed to confirm significant improvements in live birth rates. Cost is another limiting factor, making these technologies less accessible in smaller cities.
Indian Express
03-07-2025
- Health
- Indian Express
Do IVF babies have more health problems? Gynaecologist clears the air
Written by Dr Mannan Gupta Many couples who come to me for in-vitro fertilisation (IVF), which entails fertilisation of an egg by a sperm in a laboratory and subsequent implantation of the embryo into the woman's uterus, ask me one question: Will the baby born to them be healthy or be more susceptible to infection? As an assisted reproductive technology (ART), most people assume that IVF children are somehow unnatural and hence vulnerable to illnesses. This presumption, however, is misplaced. Studies show that the vast majority of IVF-conceived children develop normally and achieve milestones as well as naturally conceived children. They go to regular schools, live ordinary lives and enjoy similar long-term health outcomes. Some findings do indicate that IVF babies tend to have a slightly increased risk of low birth weight, premature birth or being small for gestational age. But such a risk is most frequently associated with circumstances such as multiple conception like twins or triplets, older age of the mother or underlying infertility but not IVF. Also premature or low birth weight babies do not develop significant illness later in life. That largely depends on factors such as the health of the parents, the quality of the embryo and the expertise of the fertility clinic providing the treatment. Notably, as IVF technology improves, through single embryo transfer, freezing technology, and improved embryo testing, risks have diminished considerably. Opt for single embryo transfer instead of multiple embryos to reduce the risk of multiple pregnancies, which are associated with higher health risks for both babies and mothers. Preimplantation Genetic Testing (PGT) can be performed on embryos before they are implanted. This can help identify and select embryos without chromosomal abnormalities, reducing the risk of birth defects. Ensure the health of the mother before and during pregnancy is optimum. This includes a lifestyle discipline, managing pre-existing health conditions and addressing any potential risks that may affect pregnancy. Couples need to be counselled so that they can make informed decisions based on their specific circumstances. Regular monitoring and follow-ups during pregnancy can help both the mother and the developing foetus last out the full term. Science has revolutionized IVF to the extent that it is not only effective but also safe for mothers and babies alike. Couples considering IVF ought to see fertility specialists, adhere to set guidelines and not be discouraged by myths. (The author is Chairman & HOD, Obstetrics & Gynaecology, Elantis Healthcare, New Delhi)
The Hindu
20-05-2025
- Health
- The Hindu
Early medical care for pelvic organ prolapse symptoms can improve women's quality of life, experts say
Pelvic organ prolapse (POP) is far more common in India than most realise. Some research studies have found that up to 21% of women may experience clinically relevant POP. While nulliparous prolapse (in women who haven't given birth) accounts for just 1.5–2% of genital prolapse cases, the incidence jumps to 5–8% in women who have had one or two children -- among the highest globally. Although literature reports that 50% of women are affected by POP in their lifetime, doctors say the real number may be closer to 70–80%, with most cases going unreported due to stigma or lack of awareness. According to the World Health Organization (WHO), POP occurs when one or more pelvic organs -- such as the bladder, rectum, or uterus -- descend from their normal positions into or through the vaginal canal, due to the weakening of the pelvic floor muscles and connective tissue. It is a condition that impacts the lives of thousands of Indian women, particularly in their postmenopausal years. Lack of awareness leading to late detection Though POP has been recorded as early as 2000 BC in ancient texts, it remains misunderstood and underdiagnosed, especially in India. Many women accept the symptoms as a natural part of aging or womanhood. Shame, silence, and cultural stigma often prevent them from seeking timely help. Only a small percentage of women undergo treatment, despite its major impact on quality of life. Medical experts say early detection and intervention can drastically reduce the physical, emotional, and social toll POP takes on women. While a large percentage of women experience some degree of prolapse, only a subset develop symptoms significant enough to seek treatment. Even then, many remain undiagnosed. Sapna Raina, senior consultant at Narayana Health City, Bengaluru, explains, 'Pelvic organ prolapse primarily happens because of the weakening of pelvic floor and gluteal muscles. Multiple vaginal deliveries, prolonged labor, use of forceps during childbirth, poor antenatal or postnatal care, chronic constipation or cough, menopause, lifting heavy weights, smoking, and obesity—all contribute to this weakening.' She emphasises that menopause plays a critical role due to the natural drop in estrogen, which compromises the strength and elasticity of pelvic tissues. She also notes that poor lifestyle practices and delayed care further worsen the condition. Importance of seeking care early POP often begins subtly. Early signs include urinary leakage when coughing or sneezing. As it progresses, women may experience a dragging sensation in the lower abdomen, difficulty urinating or passing stool, or a visible bulge at the vaginal opening. In advanced cases, symptoms can include repeated infections, foul-smelling discharge, chronic back pain, and significant discomfort while walking or sitting. Mannan Gupta, chairman and HOD of obstetrics and gynaecology at Elantis Healthcare, New Delhi, says, 'It's very common in older women who've had multiple normal vaginal deliveries. The uterus, rectum, and bladder can descend, and in severe cases, even protrude through the vaginal canal. Treatment at that stage often requires surgery.' He adds that awareness remains low, particularly among elderly women, many of whom endured childbirth in the 1980s and 1990s under limited medical supervision. These women now present in their later years with advanced POP. Jaishree Gajaraj, head of obstetrics and gynaecology at MGM Healthcare, Chennai,says, 'Many women live with this for years, thinking it's just a part of growing old. But those who undergo treatment --whether non-invasive or surgical --often feel like they've regained their life.' Non-surgical and surgical management Early diagnosis can prevent progression. Mild prolapse can be managed with pelvic floor physiotherapy, including Kegel exercises and strengthening of the core and gluteal muscles. Preventive care also includes addressing chronic constipation, avoiding heavy lifting, managing weight, and ensuring good antenatal/postnatal care. 'Regular exercise and timely medical attention are key,' says Dr. Raina. 'In the early stages, prolapse can often be corrected without surgery. 'However, when the condition advances, surgical intervention may be necessary. Dr. Gupta adds, 'Delaying care means patients may require surgery under general anesthesia, which is riskier for elderly women or those with co-morbidities.' Surgical options such as laparoscopic repairs or mesh implants are available for more severe cases. Dr. Gajaraj elaborates on the surgical process, 'When the uterus descends, it pulls the bladder in front and the rectum behind. Surgery typically involves removing the uterus, repositioning the bladder and rectum, and tightening the vaginal wall to restore pelvic support.' Post-surgery, most women report relief from symptoms such as urinary incontinence and pelvic discomfort. Many regain their mobility, independence, and confidence within a few weeks. Call for awareness, better programmes and timely action Despite POP's widespread impact, it remains absent from national health conversations. Dr. Gupta remarks, 'There are campaigns for conditions like anaemia and diabetes, but nothing specifically for pelvic organ prolapse.' He calls for awareness programmes, particularly in rural and semi-urban regions where symptoms are often normalised or ignored. Dr. Raina confirms that there are currently no dedicated government programmes for prolapse, though it may be loosely addressed under general maternal and reproductive health schemes. 'Honestly, we don't have standalone programs for this. Some degree of prolapse is seen in 70–80% of women, but symptomatic full-blown cases are still under 5%,' she says. Most women don't even know their suffering is due to a treatable condition,' says Dr. Gajaraj, emphasising the need to normalise conversations around pelvic health, while acknowledging initiatives like the Society of Vaginal Surgeons of India, where she was formerly the director, and stressing that both awareness and access to care must improve. Experts stress that POP should not be accepted as an inevitable consequence of childbirth or ageing. With better education, early detection, lifestyle changes, and appropriate medical interventions, women can reclaim not only their health, but also enjoy a better quality of life.
