Dr. Hrishikesh Pai is one of India’s leading gynaecologists. Dr. Pai is also the pioneer in the field of Infertility and IVF since 1991. He is presently the Medical Director of Bloom IVF Group. He is the first IVF doctor in India to introduce numerous innovations in medical fields such as assisted laser hatching, spindle view, ovarian tissue freezing for cancer patients, oocyte freezing by vitrification, IMSI and embryoscope. 

Dr. Pai has a vision to make India’s healthcare affordable for the 1 billion people of the country who cannot afford it. 

When did Bloom IVF Group start?

Dr. Hrishikesh Pai has extensive experience of 35 years in the IVF industry. He stepped in the IVF industry with his first venture, Babies & Us Fertility & IVF India Pvt. Ltd., which is the parent company of Bloom IVF, in the year 1995 with his partner Dr. Nandita Palshetkar. Bloom IVF currently operates seven IVF Centers and two Fertility Centers in India including Lilavati Hospital in Mumbai and Fortis Hospitals in New Delhi, Gurugram, Faridabad, Mohali and D. Y. Patil Medical College, Navi Mumbai. 

How does Bloom IVF distinguish itself?

India has a very few IVF chains which are not funded by the private equity investors and are completely owned by doctors. Bloom IVF chain is one such independent IVF chain in India which is not commercially driven but is primarily driven by their ethical practices and patients’ benefits. This is why Bloom IVF centers are consistently ranked amongst India’s leading fertility clinics.  

Bloom IVF has not only managed to survive but it has thrived in the last 3 decades since its inception.   

How has the acceptability and affordability been in India?

In the last decade, acceptability towards Artificial Reproductive Techniques has seen a huge jump but the challenge here remains accessibility in terms of affordability. India has approximately 300 million couples who are ready for parenthood but out of these, 10% i.e. 30 million of them are infertile. Out of these 30 million infertile couples, only a mere 2,50,000 couples seek help from IVF specialists. The biggest obstacle couples face in availing IVF treatments is the cost of each cycle. 

How is Bloom IVF helping masses with affordability?

IVF treatment by private clinics in India may burn a hole in the patients’ pockets by setting them back by a whopping INR 1,00,000 – 1,50,000 on average. With the onset of Government schemes like CGHS etc and the inception of IVF treatments in Government hospitals like AIIMS, the affordability has increased dramatically as compared to the private IVF clinics. The cost of a cycle in AIIMS is close to INR 50,000 including medicines.

Bloom IVF is striving to be similar to AIIMS in terms of costing, making IVF treatment affordable in India under their new budget IVF venture, Venus IVF Clinics. Their new budget IVF centers cost around INR 70,000 including medicines per cycle. Dr. Pai has classified people who qualify for the budget treatment through their annual family income. If the annual family income is below INR 2,50,000, the couple qualifies for the budget IVF treatment under Dr. Pai. He even suggests that bringing IVF under the Pradhan Mantri Ayushman Bharat Scheme for one cycle will drastically change the IVF affordability scenario in India. Though there are loan schemes available for the treatment, but most of the patients do not qualify for the loans. Hence Dr. Pai is taking a step further in increasing the affordability for the masses by providing the patients to pay in easy instalments over a period of 10 months.

What is the ratio of female to male infertility?

As mentioned before, the population of couples in reproductive age group in India is 300 million, out of which 10% are infertile. In those 30 million infertile couples, only 3 million need IVF and the rest can conceive with the help of proper medications and treatments. Out of the 3 million infertile couples who need IVF, only 1,200,000 couples (40% middle class) may be able to afford IVF treatment. Coming to the comparison of male & female infertility – both stand equally at 30% each; in 30% both male and female factor is present; and the rest 10% is unexplainable. Male fertility is fairly easy to check with just a semen inspection but female infertility evaluation needs more detailed tests such as hormonal tests, ultrasounds, tubal patncy test (HSG / laparoscopy). The first thing doctors do, is to investigate the semen sample of the male to rule out the probability of the male being infertile. If this is normal, then they proceed further with the treatment of the female.

Is delay in marriage an important factor in IVF? 

The Indian population can easily be divided into two groups, one is the well of section of the population i.e. 200 million and other is the economically disadvantaged section of the population. The health experts and Government has been trying to make the latter people aware of importance of getting married at a later age and importance of spacing between pregnancies. This is done with the help of media advocacy and Asha workers. These patients are facing problems such as genital tuberculosis which damages the ovaries and fallopian tubes. 

The well off section of the society is delaying getting married because of issues related to career or inability to find the most suitable partner. This problem can be surmounted by preserving their fertility by freezing their eggs at a younger age. Dr. Pai along with his partner Dr. Nandita Palshetkar, were the pioneers in freezing eggs by vitrification in India in the year 2007. Diana Hayden was one of the first parents in India to conceive with eggs which were frozen 10 years back by her.

This process of Fertility Preservation can also be used by women who are going to start surgery or chemotherapy/radiation therapy due to cancer. Cancer treatment regimens can have a detrimental effect on female fertility, due to the removal of reproductive organs or the use of radiation therapy and cytotoxic agents. These women can freeze their eggs or ovarian tissue prior to starting their treatment. In this way their fertility can be preserved.

How does age affect infertility treatment?

The success rate of IVF is best before the female reaches the age of 35. After 35 years of age, the chances of pregnancy declines. The average rate of success is 35% in IVF treatments. For every 10 women going for IVF, who are younger than the age of 35, 3 will get pregnant and have a live birth in the first attempt, the other 5 or 6 females may get pregnant in the second or third attempt. However, the remaining 1 or 2 women will not have a live birth and they are classified as repeated IVF or recurrent implantation failure. They are further treated with advanced clinical methods. If they still don’t get pregnant, they are counselled to opt for adoption. There are third party options as well like egg donation, sperm donation or surrogacy which can be offered to these patients. However, there is a possibility that new Bills like Assisted Reproductive Technology (Regulation) Bill and Surrogacy (Regulation) Bill may get passed by the Indian Parliament in near future.

Is there any regulatory body for the IVF Industry ?

The IVF industry currently follows the guidelines prescribed by the Government of India. These guidelines will be legally binding when Assisted Reproductive Technology (Regulation) Bill and Surrogacy (Regulation) Bill passes in the Indian Parliament. The IVF Clinics also need to register under the Pre-Conception and Pre-Natal Diagnostic Techniques Act, 1994 and the Nursing Home Act 2010. 

How can one decide to go for  IVF treatment?

Normally, a couple is expected to achieve pregnancy within a year’s time after getting married. If they do not conceive, then the couple can visit a general gynaecologist and get treated there. If they still do not achieve pregnancy within a year’s time, then they can be referred to the ART / IVF Clinic for further treatment.

Do the government policies make an impact on the IVF industry?

The Government can make a huge impact on the IVF industry by utilising the pre-existing infrastructure of the industry for the poor and underprivileged society. Dr. Pai suggests that the Government should provide a subsidy for pre-existing fertility/IVF clinics under the Ayushman Bharat Scheme. This will not only solve the problem of affordability/accessibility for the masses but will also bring more patients to fertility clinics which is a win-win solution for the patients, Government and the doctors.

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