What does BMC's move to make IVF treatment affordable mean for Mumbaikars?

Pineapples confused Aarti Mehra Why is this fruit hailed as symbol of fertility on the Internet but Mehra was specifically told to avoid it when she started her in vitro fertilisation IVF treatment In contrast women on online infertility communities recommend consuming the fruit before their fertility doctorrsquos appointments to improve chances of conception and some even wear pineapple motifs as good luck charmsWhichever advice she ended up following the Goregaon resident is a rare success story having conceived her twins after the very first round of IVF ldquoI know I am one of the lucky women I have so many friends for whom the struggle to conceive is still onrdquo says MehraShe got lucky on another aspectmdashjust that one round of IVF alone would have cost Mehra anywhere between R4 and R8 lakh but as an advisor at an US bank luckily her work insurance scheme covered the costSmriti NotaniFor most others IVF can be a long painful and expensive process But Mumbaikars can take heart that at least one of those things is set to changemdashthe BMC on February 4 announced a huge investment push for IVF centres at three of its hospitals to make fertility treatment more affordable for all classes Out of a total health infrastructure budget of R738044 crore the civic body allocated Rs 245589 crore to King Edward Memorial KEM Hospital in Parel BYL Nair Charitable Hospital in Mumbai Central and Lokmanya Tilak Municipal General Hospital in Sion aka Sion hospital to expand their health services including IVFThis is a sizeable investment by the civic body accounting for over 33 per cent of its health budget but it remains unclear how much of the outlay will go towards IVF Amid unprecedented infertility rates IVF centres mushrooming overnight and the sheer number of desperate couples who are trying to conceive the BMCrsquos move feels like the first step to acknowledging growing infertility among cityrsquos residentsmdashmen and women Itrsquos also anticipated to destigmatise IVF and conversations around infertility among economically weak sectionsThe National Family Health Survey 201921 NFHS documented a fall in the national total fertility rate TFR to 20 or two children per woman In urban areas this number is even lowermdash16 While these statistics might sound like a womenrsquos fertility issue itrsquos important to note that they also include increasing infertility among menmdasha problem that remains taboo in IndiaGoregaon resident Aarti Mehra struggled getting pregnant through IVF treatment PicKirti Surve ParadeIn 2024 ResearchAndMarketscom released a 70page report on the Indian IVF industry value it at 16 billion or Rs 14000 crore in 2023 The report forecasted that this figure would grow to 182 billion or Rs 15000 crore by 2030 It makes sense then that both global and national healthcare chains want a slice of the pieAt eight months of pregnancy Smriti Notani admits she is ldquoready to poprdquo as she speaks to us over the phone Due for delivery next month Notani is grateful that IVF worked out for her in the first round but her treatment was not covered by her employerprovided insurance policyldquoI was lucky that it was successful in the first go So many women go through multiple rounds which leaves them drainedmdashnot just emotionally and physically but also financiallyrdquo says Notani a Khar residentApart from the lakhs spent on each IVF cycle most fertility clinics also charge a lump sum of R80000 annually to store the patientrsquos eggs or embryos This is hardly the kind of money that most working class families can afford But the BMCrsquos push to make IVF more affordable could now make the dream of having a child possible for many such couplesWhile Sion currently already offers free fertility assistance to underprivileged couples the eventual goal is to also offer subsidised IVF treatment for R25000 to R30000 per cycle with KEM Hospital serving as a model for other hospitals to follow One cycle takes about two to three months from medical tests and hormonal injections to transferring the fertilised embryos into the uterusldquoFertility treatment consists of two primary procedures IUI intrauterine insemination and IVF When couples visit us we first assess the underlying issue whether it lies with the woman or the man and proceed with the appropriate treatment accordinglyrdquo says Dr Mohan Joshi dean of Sion HospitalSmriti Notani is due to deliver her twins in MarchldquoWe initially explore natural methods to facilitate pregnancy before moving to medical interventions The first step is IUI which a relatively less invasive procedure If IUI fails we conduct further studies and if necessary opt for IVF IVF is a more complex process involving egg retrieval fertilisation in a laboratory and embryo transferrdquo he addsDiscussing the financial aspect of IVF treatment Dr Joshi says ldquoIn private hospitals IVF treatment costs several lakhs per cycle which can go even higher at highend hospitals However at Sion Hospital we provide this treatment completely free of cost Offering IVF services in civicrun hospitals will greatly benefit couples particularly those from lowerincome groupsrdquoItrsquos free but will it be effective BMC hospitals are often resourcechallenged but Sion hospital has been making waves with its IVF success rate having more than tripled since its IVF centrersquos launch last year ldquoOur success rate has significantly improved increasing from 23 successful cases initially to approximately 7080 nowrdquo Joshi says with prideKEM hospital will provide mandatory counselling to couples who visit for fertility treatmentOver at KEM Hospital the IVF centre is in its initial phase The hospital currently offers counselling services and an outpatient department OPD while civil work for the next phase is underwayDr Sangeeta Rawat Dean of KEM Hospital and GS Medical College confirmed that all logistical preparations are in place for phase two including the availability of an embryologist ldquoThe treatment will be provided based on a financial assessment by our medical social workers Depending on the couplersquos economic condition treatment will be either subsidised or completely free in genuine casesrdquo she explainsHowever despite excitement bubbling among both patients and the hospital management government action seems to be slow Both KEM and Sion hospitals are yet to receive phase one approval from the government despite applying six months ago reveals Dr Sangeeta RawatAnjali Jha With Son Ivaan And Husband Kumar ShekharDr Niranjan Maydeo Head of the Obstetrics and Gynaecology Department at KEM noted that while the plan has been commissioned and inspected state government approval is still pending Meanwhile preparations for the second phase including laboratory and operation theatre setup are ongoingKEMrsquos IVF centre has been funded by infertility expertturnedangel investor Dr Aniruddh Malpani under whose initiative the first 100 IVF cycles at the clinic will be provided free of cost on a firstcomefirstserve basis ldquoAs the centre expands we will explore ways to sustain and grow the initiativerdquo adds Dr MaydeoWhile the hopes of countless couples ride on the BMCrsquos IVF programme it remains to be seen how effective it really is on the ground But we can look to a similar scheme in Delhi for an indication of potential problemsWhen freelance journalist Anjali Jha moved from Mumbai to the national capital seven years ago she explored the Delhi governmentrsquos fertility treatment options but found them wanting ldquoAfter one very painful miscarriage and no success in natural conception I went to a goverment hospital to get some initial tests done Since my husband is a central government employee we knew our treatment would be subsidised and extremely affordable But I did not go ahead with my IVF there because we realised that there were too many patients waiting for treatment and there was a huge delay in getting appointmentsrdquo she recallsldquoIn December 2022 my husband was asked to get some tests done but when we tried to schedule an appointment the only slot available was in February 2023rdquo she tells us One can only imagine how many more months it would take to jump the rest of the hoops before their IVF procedure could even beginThey switched to a private centre and ldquoby February I was already midIVFrdquo says Jha adding that she skipped IUI treatment altogether because she considered it ldquoa waste of time and moneyrdquo apart from also being ldquobrutal on the bodyrdquo Not all women have the same kind of health literacy or financial power to make a similar decision thoughldquoAt the government hospital I realised women from economically weaker sections had been doing IUI for two years or more They were either not aware or being told to move forward to IVF It was heartbreaking to watch these women go month after month to get the IUI treatmentrdquo she addsJha also observes that there was little to no counselling provided to the women who were often accompanied by their mothersinlaw This is a worrying gap that Mumbairsquos administration would do well to prevent especially when it comes to a sensitive topic such as infertility issuesGoregaonresident Mehra recalls how while she was undergoing multiple rounds of IUI in early 2021 she felt shame for her body ldquonot doing the most natural thing it was supposed to domdashconceiverdquoIn 2022 she switched to IVF and went on to conceive and deliver her twin daughters in December that yearldquoYou have to go through a lot of fertility tests that involve poking and prodding in your vagina It is very difficult physically and emotionally Your mind is filled with anxious thoughts like lsquoWhat if I canrsquot conceive because therersquos something wrong with mersquordquo Mehra recallsShe faced another mental health crisis when halfway through the course of hormone injections she suffered a dog bite and had to take the antirabies vaccine ldquoIt was a freak accident Since I was more than halfway through the hormone injections I decided that I would take both injections hormone and antirabies but couldnrsquot take anything for the pain because it would have risked my IVF treatment But no one tells you it gets this difficultrdquo adds MehraA freelance content writer Notani has always been a big proponent of therapy but it took on even greater significance during her IVF therapy ldquoI was constantly in touch with my therapist But I also understand that this is a privilege and I was lucky to have it I do think that this is a vital tool to have in your arsenal as wellrdquo she saysFortunately this is something our civic hospitals are prepared for Couples that opt for IVF treatment at KEM will also be provided pretreatment counselling at the hospitalrsquos psychiatry department says Dr Maydeo adding ldquoIt is crucial for patients to understand that IVF does not guarantee success and counselling helps them prepare for potential challengesrdquoAt Sion hospital counselling and mental health support will be provided throughout treatment all the way until the childrsquos birth says Dr JoshiThere are plenty of issues to iron out and it remains to be seen how the BMC will tackle infertility stigma among the economically weaker sections as well as handle the huge caseload that is expected once the scheme is formally launched But for now we have hopeMehra on learning about BMCrsquos IVF initiative says ldquoMy domestic workerrsquos daughter has been having problems conceiving I will tell her to go and enquire at BMC hospitals I think everyone who wants a baby should have a fair chance to have one no matter what their financial standing might be This is really good newshelliprdquoRs 48 lakhCost of each IVF round at private centresRs 80KAnnual charge for pvt storage of eggs or embryosRs 035KPromised cost of each round at BMC hospitalsMore agency for womenFor some IVF can serve as a sureshot way to time their pregnancy to fit the timeline they want giving women more agency over their bodies Swati Babel 38 a financial analyst opted for IVF after during the pandemic when she was working from home in Navi MumbaildquoI had no pressure to have kids and both my husband and I had no fertility issues but we knew we had only until the pandemic ended for me to have a child and be able to take care of them since we were all working from homerdquo she tells us over the phone from Dubai where she has since moved Babelrsquos strategy worked and she delivered twin girls in 2022