Srinagar: Rihana (name changed) from Pulwama slipped into depression when she did not conceive after her marriage.
The 25-year-old woman saw several gynecologists, but nothing was effective. A doctor’s recommendation for In Vitro Fertilization (IVF) gave her a glimmer of hope.
IVF, or in vitro fertilization, is a process that helps a woman to conceive. During the process, mature eggs are removed from ovaries and fertilized in a lab by sperm. Subsequently, an embryo is created by implanting one or more of the fertilized eggs into the uterus, the organ in which babies develop. One full cycle of IVF takes about 2 to 3 weeks.
“Rihana came for treatment because she was unable to handle the stress. During our medical visits, she used to assure me that when she became a mother, her depression would go away and she wouldn’t need any medicine. I discontinued her medicine when she told me that she was considering IVF,” said her doctor.
Little did Rihana know that her happiness would be short-lived and her IVF attempt would ultimately fail. “She suffered from severe depression following the failure of the IVF treatment. She used to isolate herself and avoided social gatherings because people used to ask her when is she conceiving. What happened to IVF? Is she not consulting any doctors? The consistent judging exacerbated her depression”, said her doctor.
As per the National Family Health Survey (NFHS) for 2019-21, there has been a sharp fall in the total fertility rate (TFR) in UT. The fertility rate has come down from two to 1.4, far below the national average of two since 2015-16.
Dr. Fazl E Rouf, a psychiatrist at IMHANS told The Kashmir Monitor that infertility affects the couple as a whole, not just the husband or wife. He said people should refrain from questioning coupled because it could lead to depression. “They are already going through difficult times that only they are aware of,” he said.
He said that not only women but men are also facing serious mental health issues because of infertility which can lead to severe depression. “I have seen cases of depression in both men and women who are experiencing infertility, but women experience more stress owing to societal stigma and the concerns that society poses to them”, he said.
Sample this: 32-year-old Rakib (name changed) also endured severe stress since his low sperm count prevented him from becoming a father.
“Rakib was experiencing problems with his wife because he was unable to accept the fact that he would never be a father. His wife decided to file for divorce after three years of waiting. Her wife also attended our sessions,” his doctor said.
According to his doctor, Rakib was traumatized by his divorce. “He used to visit the hospital for his treatment, but all of a sudden he stopped coming,” he said.
Preliminary findings of research titled `Prevalence and Pattern of Psychiatric Morbidity in Couples Seeking Treatment for Infertility in a Tertiary Care Hospital’ at LD Hospital, Srinagar, found that 120 couples are suffering from depression due to infertility.
Dr. Nighat Akhbar, a 2nd-year resident in the department of psychiatry at IMHANS, who is leading the research told The Kashmir Monitor that most of the depression due to infertility is seen in women as they are more pressurized by society for pregnancy. “Women appear to be more likely to be perceived as depressed since they don’t always seem to receive the emotional support they require,” she said.
The study found that primary infertility, in which a couple has not conceived at all, is more common than secondary infertility, in which a couple is unable to conceive after having one child. “A couple’s finances are depleted when they undergo an IVF process, and their stress level increases if the procedure fails. Stress has an impact on both male and female hormones, which can lead to infertility”, said Dr. Nighat.
“My thesis states that infertility is not just a problem for older adults; it also affects couples in their 20s and 30s,” she added.
Medical experts say that in females the major cause of infertility is Polycystic Ovarian Syndrome (PCOS) and Premature Ovarian Failure (POF) and in males, the major causes of infertility are Azoospermia and Oligospermia.
Dr. Tanzeela, Associate Professor and Gynecologist at Government Medical College Anantnag told The Kashmir Monitor that the number of cases of infertility in both men and women is increasing daily. “One of the main causes of infertility is late marriage. The age range over thirty is where I have observed the most cases of infertility. As people age, the quantity of reserved ovaries in women decreases, and men’s semen quality deteriorates as well,” she said.
Dr. Tanzeela said that one of the causes of fertility problems females face is also the MPT kits they take after one delivery to terminate the pregnancy. “In Kashmir, it has become an epidemic. Because there is less time between a first and second pregnancy, women are taking abortion pills without understanding their side effects and other consequences. I have seen a lot of females who come to me saying they are having trouble becoming pregnant because they used MPT kits incorrectly.”, she said.
“In my opinion, males and females should get married in their early 20s to avoid issues related to infertility”, she added.
Senior Endocrinologist at Sher-I-Kashmir Institute of Medical Sciences Soura, Srinagar, Dr. Shariq Masoodi told The Kashmir Monitor that an unhealthy lifestyle is problematic for both males and females. “These factors increase the risk of infertility: obesity, unhealthy diets, smoking, and little exercise. Exercise and get a full eight hours of sleep,” he said.
Additionally, Dr. Shariq suggested keeping an eye on any bodily changes. “Women who experience irregular menstrual cycles, acne, or unusual hair growth on the face or body should pay attention to these symptoms and not ignore them,” he said.
He also suggested men to lead healthy lifestyles. “Males should refrain from using tobacco products, wearing tight clothing, and using other drugs as they may damage their sperm”, he said.
“Support from healthcare professionals, mental health experts, support groups, and a supportive community can significantly mitigate these challenges,” said Dr. Nighat.