Mumbai: With more than 50 percent of the country’s population falling under the working-age bracket, the aspirations of becoming better and bigger are fueled by euphoria stronger than ever before. Noticeably, some early reflections have already started to appear in various socio-demographic studies, irrespective of the geographic landscape.
However, the natural life cycle process will soon compel this phenomenon to confront the inevitability of demographic decline, where issues such as family planning and replacement rate will be exacerbated, leading to more complex challenges in the coming years.
To balance this equilibrium, medical advancements like advanced reproductive treatments such as IVF have offered some hope with their potential to ensure the continuity of life without hampering one’s choices.
Pioneering in this regard, the 5th edition of the ETHealthWorld Fertility Conclave delved into such topics and explored the latest breakthroughs, newer technologies, and emerging advancements—from assisted reproductive technologies (ART) to the evolving landscape of precision medicine and genetic screening—that are redefining the fertility and reproductive treatment paradigm, along with ethical dilemmas.
The summit commenced with a welcome address by Prathiba Raju, Senior Associate Editor, ETHealthWorld.
Following the opening remarks, Dr. Shivanand Bandekar, Dean, Goa Medical College, delivered the keynote address on ‘Expanding Access to IVF: Goa Medical College’s Role in Public Health and Fertility Care.’
In his address, Dr. Bandekar underlined that the cost of IVF procedures often acts as a roadblock for many couples. Addressing this challenge, the Goa state government has set up India’s first IVF treatment unit in a public healthcare institution (Goa Medical College), where the entire cost of the treatment, from tests to drugs, is borne by the government.
So far, the medical unit has performed 294 IUI (Intrauterine Insemination) procedures, including 68 IVF cycles. Of the total 14 pregnancies achieved through these procedures, the center has reported an overall success rate of around 71.4 percent (which reached the live birth stage).
As of now, the cost-free treatment is limited to state residents, and the expenditure is covered under the public insurance scheme run by the government.
After the keynote address, the conclave proceeded with its first panel discussion on ‘Mapping IVF Trends: Bridging Fertility Needs and Demographic Changes.’
The experts who shared their insights at the panel discussion included Dr. Kshitiz Murdia, Co-Founder and CEO, Indira IVF; Dr. Duru Shah, Director-Gynaecworld, Founder President-The PCOS Society; Dr. Manika Khanna, Founder, Chairperson & Managing Director, Gaudium IVF; and Dr. Kedar Padte, Director, Dr. Kedar’s Infertility and Research Centre. The discussion was moderated by Prathiba Raju, Senior Associate Editor, ETHealthWorld.
Initiating the discussion, Dr. Kshitiz Murdia, Co-Founder and CEO of India’s oldest IVF chain, Indira IVF, said, “Around 25-30 million people suffer from infertility, but only 2 percent come forward for treatment, reflecting a severe underpenetration of fertility treatment in the country.”
Underlining the need to raise awareness among patients, Dr. Murdia said, “Every IVF clinic is fighting for the same pie rather than expanding the market.”
Sharing several other insights, Dr. Manika Khanna, MD of Gaudium IVF, said, “Though metro cities have more opportunities, due to factors like congestion challenges and environmental unsustainability, we are witnessing a reverse migration where people are moving back to their Tier-2 and Tier-3 cities. The IVF industry needs to penetrate those regions.”
Adding to this, Dr. Khanna emphasized investing in hub-and-spoke models, which have the potential to address infrastructure and logistical challenges along with increasing access to fertility treatments, especially in rural pockets.
Contributing to the discussion, Dr. Kedar Padte stressed, “We may overlook the crisis, but the state of fertility health in India can be equated with what we witnessed during the COVID pandemic. The population explosion has come to an end, population growth is declining, and the TFR is expected to fall to 1.3. In several Western countries, it has already reached that.”
To address this challenge, Dr. Padte suggested leveraging digital solutions such as teleconsultations and mobile fertility clinics, along with increasing public funding and allocating more resources toward fertility care.
Extending to this, industry stalwart Dr. Duru Shah underlined that, with time, newer advancements may replace human interventions with robots, and the IVF procedure will become simpler and cheaper. “But that technology has to be domestically developed, and medical practitioners also need to trust it,” she added.
On the flip side, Dr. Shah also stressed that newer advancements will raise several ethical questions, where issues like birth determination, genetic testing, and gene editing may be exacerbated.
Regarding the impending challenge of falling total fertility rate, Dr. Murdia underlined that only 2-3 percent of total live births take place through the IVF process. “So even if they increase by 2x, the country’s total fertility rate will not increase unless there is an expansion in the base group who is seeking or willing to explore fertility treatment,” he noted.
Following the panel discussion, Dr. Banusri Velpandian, Senior Specialist, Law Division & Research and Networking Division, NITI Aayog, delivered a special address on ‘ART and Surrogacy Laws: Impact on India’s Fertility Industry.’
Dr. Velpandian, in her address, voiced that moving forward, IVF regulations will move towards matching global standards to facilitate patient reliance on the process. Considering cost advantages, such regulatory measures will support the growth of foreign patients.
After the special address, Dr. Gunjan Gupta, Founder and Director, Gunjan IVF World, shared her insights through a presentation on ‘Low Eggs or No Eggs: All Is Not Lost!’
Following the presentation, the conclave proceeded with a panel discussion on ‘Does the Centre’s ART Bill Address State Needs and Incorporate Global Insights?’
The panelists for the session included Dr. Sunita Tandulwadkar, President-FOGSI, HOD-ObGyn & Chief, IVF and Endoscopy Centre, Ruby Hall Clinic; Dr. Jaydeep Tank, Obstetrician & Gynaecologist, IVF Consultant, Ashwini Maternity and Surgical Hospital; Dr. Muriel Cardoso, Professor and Head, Obstetrics and Gynaecology, Goa Medical College; and Dr. Sulbha Arora, Clinical Director and IVF Specialist, Nova IVF Fertility. The session was moderated by Dr. Hrishikesh D. Pai, Founder and Director, Bloom IVF Group.
After the panel discussion on the Centre’s ART Bill, there was a discussion on ‘Ethics Meets Science: Designer Babies and IVF Technology – The Intersection of Innovation and Morality.’
The panelists for the session included Nitiz Murdia, Co-Founder & Managing Director, Indira IVF Hospital Limited; Anubhav Prashant, Chief Operating Officer, Apollo Cradle and Apollo Fertility; Javier Herrero, IVF/Embryology Advisor and Clinical Embryologist; Dr. Shipra Thukral, Country General Manager, CooperSurgical India; and Dr. Prateek Makwana, Director, Vasundhara Hospital Ltd., Consultant Embryologist. The discussion was moderated by Prathiba Raju, Senior Associate Editor, ETHealthWorld.
Anubhav Prashant, Chief Operating Officer of Apollo Fertility, said, “Newer innovations like gene editing, which have raised several ethical concerns, are still under investigation and are being tested across different populations. Initial results are exciting, but many other data points need to be validated before they enter contemporary operations and services from a commercial standpoint.”
“The Indian IVF industry is still deliberating between the pre- and post-ART period (government regulation), and the ethical boundaries set by the law are still finding their feet. With time, as in the case of Western nations, some of these ethical equations will evolve,” he added.
Sharing his views on other under-trial subjects like artificial wombs, lamb-grown embryos, and the ethical challenges associated with them, Nitiz Murdia, Co-Founder of Indira IVF Hospital, highlighted that, “These innovations will be highly useful for couples facing fertility and reproductive challenges. The only ethical issue that comes with such technologies is their misuse by those who do not necessarily need them. A fine line needs to be drawn to ensure that these technologies are meant only for those who have a medical necessity rather than being used based on choice or personal preference.”
Contending this argument, Dr. Prateek Makwana voiced that, “Earlier, when egg freezing was introduced, it was meant for cancer patients, but it later entered the broader landscape. If the option had been restricted to only medically indicated patients, the burden of having an early pregnancy would have increased. Medical technologies exist to make things easier rather than discriminate against those who express an interest in them.”
Reflecting on the scientific aspect, Javier Herrero, a Clinical Embryologist, emphasized that ethics come into play when regulations are unclear or not properly enforced. “All of these technologies will help many couples, but as of now, artificial wombs are not designed to create babies. Instead, they assist premature babies in completing their final stage of development. However, if we don’t draw clear lines and allow such advancements without the necessary ethical frameworks, it will become difficult to control them in the future.”
Adding to this, Dr. Shipra Thukral said that, “Before the adoption of such technologies, adequate clinical trial data and validation are required, followed by the establishment of a regulatory framework and guidelines that are up to date with such advancements.”
“From a patient’s perspective, it should be a prerequisite to counsel them and convey the potential outcomes associated with adopting such artificial reproductive measures rather than just presenting a rosy picture,” she added.
Upon the completion of the panel discussions, the conclave proceeded towards a partner session where Dr. Jyothi C. Budi, Medical Director of Ferty9 Fertility Center, made a presentation on ‘Crafting the Journey to the Best IVF Outcomes.’
Following this, the conclave moved to another panel discussion on ‘FOGSI’s Blueprint for Advancing Pre-Conceptional Care and Fertility for Optimal Pregnancy Outcomes.’
The panelists for the discussion included Dr. Santhosh Kumar Kraleti, Senior Public Health Specialist, Founder and General Secretary, Sushena Health Foundation, Associate Dean, School of Healthcare, Rishihood University; Dr. Parag Bhamre, Country Lead, Maternal and Newborn Health, Jhpiego; Lekha Nirmal Tandulwadkar, Director, PMECH Consultant and PMECH Technologies. The discussion was moderated by Dr. Sunita Tandulwadkar, President of FOGSI, HOD (ObGyn), and Chief of IVF and Endoscopy Centre, Ruby Hall Clinic.
Following the panel discussion on FOGSI’s Blueprint for Advancing Pre-Conceptional Care and Fertility for Optimal Pregnancy Outcomes, the conclave moved to its last panel discussion, themed ‘Rising Costs and Sustaining Success Rates: Navigating the High Costs, Risks, and Insurance Scope in IVF.’
The experts who shared their views on the panel included Vinesh Gadhia, Executive Director and Chief Executive Officer, Ferty9 Fertility Center; Dr. Nikita Lad Patel, Chief IVF Specialist, Apollo Fertility; Dr. Ashwini Kale, Joint Secretary of FOGSI and Director, Asha Kiran Hospital; Chetan Raj Singh, President, Business, Advy Chemical Pvt Ltd.; and Vikas Anand, Founder & CEO, Safetree. The discussion was moderated by Dr. Keshav Malhotra, Director, ART Rainbow IVF.
Initiating the discussion, Vinesh Gadhia, CEO of Ferty9 Fertility Center, shared that, “With investment in technology, standardization, and safety standards, we have significantly improved the number of successful clinical outcomes compared to ten years ago. Earlier, the cost of setting up one IVF clinic was around ₹3-4 crore, but it has now come down to around ₹60-70 lakh.”
“The cost to patients has increased much less than the investment, and the profitability of the IVF business has declined in India. Despite this, the quality of services is better than in any of the neighboring regions and is even comparable to U.S. and European standards,” Gadhia added.
Dr. Ashwini Kale said, “A large chunk of the investment goes into consumables, followed by gonadotropins (used to stimulate ovulation in women and promote spermatogenesis in men), which are primarily sourced from international markets. This is coupled with the substantial cost of maintaining the cold chain.”
Addressing the cost burden on patients who undergo multiple cycles, Dr. Nikita Lad Patel shared that, “As people are getting married later in life, couples experience diminishing ovarian reserves and poor-quality oocytes. This compels clinicians to advise two to three cycles or embryo pooling, where the success rate is just 15-20 percent. The remaining 80 percent of patients end up paying a huge cost.”
Vikas Anand, CEO of Safetree, said, “Currently, 98-99 percent of the cycle cost is paid by individuals. Meanwhile, in corporate healthcare, a major chunk of revenue comes from insurance. Insurance coverage offers the possibility of increasing IVF access, but most health insurers across the globe do not recognize infertility as a disease. However, some progressive corporations like Google (globally) and ONGC (in India) have started covering two to three cycles for their employees. Moving forward, more collaboration is required between insurers and corporate entities.”
Contributing to the panel, Chetan Raj Singh stated that AI-driven innovations are helping improve decision-making. Further advancements in diagnostics, such as DNA Fragmentation Index (DFI) testing, have helped determine the type of sperm strand (single or double), which plays a crucial role in treatment.
Upon the completion of the panel discussions, the annual conclave concluded with the announcement of the ETHealthworld National Fertility Awards, celebrating excellence and innovation in the field of reproductive health and fertility treatment.
