As she was being wheeled inside a room at a Sion hospital in Mumbai over two months ago, the woman, 34, felt anxious. Realising that the fertility procedure was her last shot at motherhood after years of failing to conceive, she went ahead with the treatment.
Eleven weeks and hundreds of prayers later, the parenthood dream of the couple from Dharavi, Asia’s largest slum, came true.
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Parenthood is set to become a reality for more underprivileged couples struggling with infertility, thanks to the Brihanmumbai Municipal Corporation (BMC)-run hospital’s pioneering OPD. The Fertility OPD, which was launched by the civic body at the Sion hospital in October 2023, is authorised to offer free assisted reproductive technologies (ART) level-1 fertility treatments.
Clutching her husband’s hand, the teary-eyed expectant mother told The Indian Express, “I am a domestic help and my husband is an auto-rickshaw driver. We knew we could never afford fertility treatments at private hospitals, where one round of Intrauterine Insemination (IUI or insemination of concentrated sperm into the uterus) costs over Rs 10,000 excluding doctors’ fee and medicines.”
Doctors say that despite hesitancy among underprivileged couples in approaching them for fertility issues, the OPD has received a positive response. It has treated 133 infertile couples and 18 of them have conceived successfully in nearly four months since its launch.
Dr Archana Bhosale (middle in front row) with her unit. (Special Arrangement)
According to doctors, another woman from Dharavi suffered from polycystic ovary syndrome (PCOS), a hormonal disorder that causes enlarged ovaries, irregular menstrual cycles and fertility issues. Talking about her fertility struggles, the woman said, “Our luck changed when we discovered that the Sion hospital offered IUI free of cost.”
The cost of IUI at private hospitals varies between Rs 10,000 to Rs 30,000, depending on the woman’s age, menstrual cycle, medication and location. Given that this procedure has a success rate of 15 to 20 per cent, multiple cycles may be required, making the overall treatment cost run into a few lakhs.
Like the Dharavi couples, a couple from Sion Koliwada who are daily-wage labourers also struggled with infertility for nearly a decade due to the husband’s low sperm count. This woman, 32, who also underwent IUI at the Fertility OPD, is now 10 weeks pregnant.
Expressing her joy, she remarked, “We were waiting for this day for years. The clinic made it possible for us.”
On why the Fertility OPD was opened, Dr Mohan Joshi, the dean of the Sion hospital, said, “We have observed that women from rural Maharashtra and slums have been struggling to conceive. Following numerous queries on fertility treatments, we decided to initiate the OPD to provide treatment, which exceeds Rs1 lakh, for free to economically disadvantaged couples in Mumbai.”
The OPD proposal was initiated by Dr Sudhakar Shinde, the Additional Commissioner of BMC.
Doctors say fertility issues are not confined to just rich couples. The National Family Health Survey (NFHS) has indicated a worrisome decline in Maharashtra’s Total Fertility Rate (TFR), which measures average children per woman — the TFR has dropped from 1.9 in NFHS-4 to 1.7 in NFHS-5, below the national average of TFR of 2. Phase two of NFHS-5 by the Union Health Ministry shows a nationwide TFR decrease from 2.2 to 2.0, with a TFR of 1.6 in urban areas and 2.1 in rural areas.
A Mumbai civic hospital helps poor couples become parentsBesides IUI, ART level-1 fertility treatments available at the Sion hospital include ovulation induction (to stimulate ovaries with medications), fertility medicines (prescribed to regulate ovulation), cycle monitoring (regular tracking of menstrual cycle via ultrasounds or blood tests) and cervical mucus monitoring (observing changes to determine the fertile window). Advanced tools like an ultrasound machine help the hospital determine the precise timing for IUI, thus enhancing the likelihood of success.
The hospital has plans to offer more advanced ART procedures, specifically those that fall under ART level-2.
Dr Archana Bhosale, associate professor and head of the unit, said, “With approval of ART-2 level from the Heath Department, we aim to offer in vitro fertilisation (IVF), a procedure where eggs are retrieved from the ovaries and fertilised with sperm in a laboratory dish. The resulting embryos are then implanted in the uterus. This advanced treatment has the potential to help more women become pregnant. We hope to offer this procedure soon.”
According to the Indian Council of Medical Research (ICMR) and the National Academy of Medical Sciences (NAMS), nearly 8 per cent of all infertile couples across India require advanced ART methods, like IVF to conceive.Despite this, fertility treatments remain expensive for most. In fact, these treatments are not covered by insurance in India. Studies here have revealed that financial constraints substantially elevate anxiety levels among men and women undergoing infertility treatment.
A 2020 study by Mumbai’s International Institute for Population Sciences, which surveyed 150 men undergoing infertility treatment, revealed that the average cost of fertility treatment exceeded Rs 3 lakh. Of the total, 129 respondents answered a question on how they funded their treatment: 50 per cent had sufficient funds, 50 per cent used personal savings, 8 per cent borrowed from family and 2 per cent took a bank loan.
Besides a shot at motherhood, expectant mothers said the Fertility OPD has also helped them cope with the discrimination they faced due to their struggles with fertility. Many said they were discouraged from seeking medical help to conceive.
The second woman from Dharavi had experienced two miscarriages and struggled with conception for four years before conceiving successfully with help of IUI. “Our families taunted and discouraged us from seeking medical help. But I persisted despite the weekly injections (to trigger ovulation) as part of the fertility treatment for over five years,” she said.
The doctor also outlined the importance of counselling for couples undergoing fertility treatment. “Fertility treatment is a complex process, particularly for patients from economically disadvantaged backgrounds. To ensure adherence, we explain each step to them. Unlike other health disciplines, this treatment entails more emotional involvement,” Dr Bhosale said.
She added, “In the end, patients often leave our OPD in tears — tears of joy.”