Why Are Indians Facing More Fertility Problems Than Ever? | Dr. Sulbha Arora x Dr. Pal

Why Are Indians Facing More Fertility Problems Than Ever? | Dr. Sulbha Arora x Dr. Pal

Author Name:Dr Pal

Youtube Channel Url:https://www.youtube.com/@DrPal

Youtube Video URL:https://www.youtube.com/watch?v=_Zll6AOyoDs



Transcript:
(00:00) When we see western celebrities conceiving naturally in their 40s, there is a racial difference. We have an ovarian reserve 5 to 6 years less than the ovarian reserve of Caucasian women. So the chances they have of conceiving at 40, we have at 34. >> What are the other lifestyle thing that women should do? So there have actually been studies in late night shift workers and they found that the incidence of endometriosis, difficulty conceiving, miscarriages were higher in this category.
(00:36) >> Sometimes we have a condition called aospermia. >> The man doesn't have any sperm at all. >> No. In such cases we have to do something called the >> Hello guys welcome to another episode of our podcast series get feeling with Dr. Pal. In this video we talked with Dr. Schulba.
(00:57) She's an IVF specialist [music] at Nova IVF center an expert in reproductive physiology. In this podcast we discussed about what is the right time to get pregnant, what are all the infertility [music] issues and why is it increasingly common and what you can do about this. Let's dive deep into it. Thank you so much for being the podcast ma'am. Thank you so much for having me.
(01:14) It's a pleasure to be here. >> Thank you, ma'am. So, right off the bat, I want to ask you, fertility issues are becoming more common. >> Yes. >> Is it more common now because of whatever is happening in the last 10 years in the environment or is it that we are picking up a lot? >> It's both actually and it's multiffactorial.
(01:34) We are also picking it up more because people are now slowly getting over the stigma surrounding fertility issues and coming forward to get the help they much needed. Whereas back in the day it was more common for them to continue suffering in silence. But the incidence is also on the rise.
(01:53) The incidence is rising because of multiple reasons. But what I feel the commonest being lifestyle and environment >> with lifestyle you know the single most important determinant of a couple's chances of conceiving is the age of the female partner >> because when we are born unfortunately we are born with a limited number of eggs.
(02:14) >> So so you're saying age does matter. >> Of course it matters. It's the single most important thing that matters. When a woman is born, she's born with about 20 lakh eggs in both her ovaries combined and that's it. After that, she can't make a single new egg. In fact, it's like being born with a fully charged battery, a 100% charged battery, but the charger is not given to us.
(02:35) So, right from birth, that battery is going to start reducing. This is what happens to the quantity and quality of eggs. By the time the girl gets her first period from 20 lakhs, this is already down to four lakhs. >> 20 lakh eggs exist when they start manarchy. when they are born >> when they born >> when menarchy happens it's already reduced to four lakhs without getting a single period in the first 10 to 12 years of life it goes down from 20 lakhs to four lakhs when the girl is in her 20s 20 to 30 is the age of peak
(03:07) fertility because the quantity of eggs is good the quality of eggs is good chances of conceiving are high after 30 there is a more rapid decline so an accelerated decline starts in quantity and quality. As we are approaching near to 40, we are left with our last few eggs, most of which may be too weak to give rise to a pregnancy.
(03:29) That's why as we get older, our chances of conceiving keep dropping. Now, what happens is that you asked me the incidence is rising. If we ask our mothers how old they were when they had [clears throat] their first child, most are going to say 20, 21, 22. Back in the day, probably even 25 was considered too late.
(03:49) But nobody is getting married that early and having babies now. For the women of today, and maybe rightfully so, there are so many competing priorities. >> Education and career are just as important for the girls as they are for the boys. And sometimes you just haven't found the right partner yet. >> So those peak fertility years go by very quickly before you've even thought about starting a family.
(04:13) And now when people get married very often in the early 30s, sometimes late 30s, sometimes early 40s, the biological clock has already slowed down for the women. Say in one generation itself, we have gone from trying to conceive in the early 20s to trying to conceive now in the late 30s for most couples. But evolution doesn't change in one generation.
(04:34) It takes millions of years to realize that it needs to catch up. So we are still aging the way our mothers were aging but we're not conceiving at the time when they were planning their first child. So age is one of the most important factors why more and more couples are struggling to conceive. Now >> choosing the right partner is the problem here.
(04:54) >> Yes, >> in many cases you know people say arranged marriages were better uh but not anymore right? You know we are thinking that there's a lot of school of thought is that um it's better to have the right partner rather than having a family with a wrong partner. >> Absolutely. >> So it is difficult to choose the right partner in the first 20 to 25 years of age or even 25 to 30.
(05:20) >> Yes. >> And then when the let's say they find the right partner and then they go into 32. Can you tell me in numbers in terms of how many eggs they may have and what is the risk that they are taking if that is what they want to do? >> So what we say in scientific terms and then let me explain that to you in simple terms as well is that the rate of usite apoptosis varies between individuals.
(05:47) >> Usite is the egg. >> Egg. >> Apoptosis is disintegration. >> Yes. So the biological age does not always correlate with the chronological age. >> Now to put this simply, what this means is that some girls in the late 20s or early 30s itself could have a very low ovarian reserve because their ovaries have aged faster >> and some in the late 30s can still have a larger ovarian reserve.
(06:17) So sometimes when girls come to me and I check their ovarian reserve and I find that it is low, they may be surprised that I'm only 28 or I'm only 31. How can I already have a low AMH or a low ovarian reserve? >> What I explain to them is that this is an aspect of aging >> and just like any other aspect of aging, it differs from person to person.
(06:42) M >> for example white hair it's a part of the aging process >> but some people have white hair as young as 30 35 some don't have any white hair till 45 50 correct >> because it's different for everyone >> so similarly though the ovarian reserve by 32 should still be you know reasonably good but in a lot of cases that is not the case.
(07:06) >> So you mentioned about AMH. >> Yes. >> Is that a blood test? It is a blood test >> which can give you a sign of the ovarian reserve. >> Yes. So there are two main tests for ovarian reserve. One is the serum AMH antimarian hormone. >> This is a blood test. >> It tells us if the value is two or more nanog per ml that is considered a good value.
(07:32) Less than two means now it has started rapidly declining. Very low values less than 0.5 usually in uh indicate a severely diminished reserve. AMH is not the only test we go by. We also do something called an antal follicle count which we check on transvaginal ultrasound scan. So we take a look at the ovaries and we count how many follicles we can see.
(07:56) >> And how what do you mean by follicles? >> Yeah. Coming to that. So follicles are eggs which are present on the surface of the ovaries. You can't see the whole reserve but each month from the reserve our body recruits a group of eggs and brings them to the surface. These can be seen and these can be counted and these are called your antal follicles.
(08:18) >> So as the reserve inside shrinks the number visible on the surface keeps reducing. When we see a total anthropolicical count of 10 or 12 or more, we are happy. It indicates a good reserve. When this number starts dropping to below 10, we have entered the stage now where the reserve is rapidly reducing.
(08:40) So apart from AMH, this is the other test that we do. Important to keep in mind is that any test you do is a test for quantity. Unfortunately, there are no reliable tests for the quality of eggs and that also declines as we get older. So, two things happen at the quality level. One is usite senence. That means aging eggs. It's like you can expect a 25 year old to run a marathon, but a 90 year old won't have that kind of energy.
(09:11) So eggs uh from women who are in their 20s are much more likely to lead to healthy embryos and live births. But the eggs from women who are in their late 30s or early 40s may not have that much energy. >> The other thing which is even more significant is something called anuploloy. That means chromosomeal abnormalities.
(09:33) >> Not every human egg is chromosomally normal. Some human eggs have chromosomal defects. When we are in our 20s, the majority of eggs are uploid. That means chromosomally normal eggs. In the 30s, this ratio starts increasing. By the time we are reaching 40 out of every 10 eggs coming out of our ovaries, in all likelihood, seven or eight have chromosomal defects.
(09:59) So even the percentage of chromosomally abnormal eggs increases. So even if you see a 38 or a 40year-old who has a good amh or a good entrle count, how many of these eggs would actually be able to give rise to a live birth? If the egg has a chromosomal defect, four things may happen. One, because it is chromosomally abnormal, it may not fertilize with the sperm and become an embryo at all.
(10:24) Two, it may become an embryo and then fail to implant, so fail to give rise to a pregnancy. Three, it might implant. So, a pregnancy may take place, but then it ends in an early miscarriage. So, the commonest cause of people not conceiving or having early miscarriages, especially as we grow older, is the increasing incidence of chromosomal abnormalities in the eggs.
(10:52) This is a protective mechanism that nature has in place because it will try its level best to stop an abnormal embryo from becoming an abnormal baby. So either it doesn't lead to a pregnancy or even after conceiving it doesn't grow. >> A person listening to this podcast let's say they are in 32 years old. Yeah. >> And then they are listening to this let's say they want to check their ovarian reserve.
(11:16) >> They go to an gynecologist and then get their blood test. they have a serum AMH and then they get an ultrasound of the ovaries and then count the number of follicles and let's say that they are good okay but still they need some more time to settle down is there where the egg freezing technique comes in and what is your opinion on that >> uh yes depends on how much more time they want if they are reasonably sure that in spite of having a good ovarian reserve ve at least for the next couple of years they are not going to be
(11:52) planning a pregnancy. Then by the age of 30 or 32 maximum is the ideal time to consider fertility preservation though it can be done sooner or later as well. For Indian women the average age of menopause is now 46.1 and an accelerated atresia or decline in the eggs is said to start 13 years prior to menopause which for Indian women is around 33.
(12:22) M >> also interesting to know is that we have an ovarian reserve 5 to 6 years less than the ovarian reserve of Caucasian women. So the chances they have of conceiving at 40, we have at 34. >> So when we see western celebrities conceiving so easily naturally in their 40s, >> it's not necessary that we have the same capacity. It's different for us.
(12:48) There is a racial difference. Mhm. >> So coming to your 32 year old, if she's not yet going to be planning at least for a couple of years, yes, she can consider fertility preservation. For single girls, it's egg freezing. For married couples, they have the option. Embryo freezing is preferred. Embryos are sturdier. Uh survival.
(13:12) >> So So egg freezing is aspirating that egg from the uh women and then freeze it. freezing it. >> Nothing happens in the quality. >> Nothing happens in the quality because the newer vitrification techniques are very very efficient. >> See the egg cell is the largest cell in the human body because of which it has a large amount of water content.
(13:37) Earlier about 10 or 15 years back uh the new vitrification techniques didn't exist. We had something called slow freezing. Because of slow freezing to go from room temperature to the ideal freezing temperature of minus 196° the embryo or the egg had to spend a very long time in the chilling zone where ice crystal formation occurs and damages the cell.
(14:03) >> With the new vitrification technique, it goes from room temperature to minus 196 in a fraction of a second. So it doesn't get time for ice crystal formation or damage to occur. >> So when you freeze the egg, it's basically it's in a refrigerate kind of >> kind of analogy. >> Yes. >> And then you can take it how long? 5 years, 10 years after.
(14:26) >> Well, the law currently allows up to 10 years for eggs or embryos to be frozen. >> Law in India. >> Yes, the law in India. But uh medically speaking there is no a there's no deadline to how long it can be kept frozen. So a person listening to this podcast let's say they are 23 year old or 25 year old can they freeze it at that age and then don't worry about at all >> they can if they wish to >> uh what the trend that I'm seeing is that about 10 years back I mostly had women in the 40s coming to me for egg freezing but it is too late
(15:02) >> too late >> but now we do have a lot of awareness and the average age group coming to me now is 28 to 32 >> sorry for interrupting the podcast flow but let me take one minute to tell you about something I have passionately put together. The Numi Lifestyle Medicine Clinic. If you're struggling with diabetes, hypertension, fatty liver, obesity, or any other chronic lifestyle conditions, Numei Lifestyle Medicine is designed to help you build longlasting habits and not just give you another diet chart, a detailed evaluation with a
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(16:12) If that sounds like the support you need, visit drpmnew.com and check out the program link in the description. >> See, I had a psychologist of the podcast and then what she is saying is that you know I think it is high time that you trust your partner, you take time to choose the partner, you know, we don't want any broken marriages because that is going to give a strain on the kids.
(16:34) Okay. And now you are coming and saying oh that's a wonderful opportunity that if you are thinking along those lines why don't you freeze the eggs yeah at 25 >> for me it sounds like a no-brainer to me >> it is because the process is simple and straightforward it is uh it's very safe >> but as a consumer I may what if it increases the risk of chromosomal abnormalities or babies born from this kind of technique will have the same lifestyle or >> yeah but it has not been shown to increase that risk We have enough number
(17:06) of years of data. Now >> see IVF as such also the first IVF baby was born in 1978. These procedures are not new. We've been doing them from almost half a century now. >> And she's grown up and had naturally conceived children of her own. So in all these so many years and how many millions of babies have born through IVF across the world, we have enough data that has put our minds at ease as far as outcomes are concerned.
(17:37) Babies born through IVF are no different than babies who were conceived naturally. It hasn't though theoretically we had that speculation but the what the studies have shown in practice is that there is no difference. there is no higher risk of any sort to the babies conceived through IVF. >> So is the awareness about egg freezing is there or seeing more now? >> It is increasing.
(18:00) We are happy to see that. What has helped is that celebrities who have gone through it are now coming up and speaking about it. >> As long as there was silence around this, people were reluctant. They were hesitant. the any celebrity that you know >> or can you say this? Uh have they openly said that we have done this? >> A lot of them have in my clinic as well.
(18:23) Just uh a month back I had one of the celebrities who came to me word of mouth and she asked me even before coming is it okay with you if I bring my camera crew along I would like to document this. M >> and I was very happy when she said that because I said it would be wonderful because it would create so much awareness >> of course >> it would inspire other young girls when they see you and she's decided to do a vlog about this.
(18:52) So as she's going through the journey, she's just yesterday she's put up the first YouTube link of the very first consultation she had with me, her antal follicle count. How she >> Oh, it's in the YouTube already. >> Yes, yesterday. >> Oh, then you could say the name. What's the name of the celebrity then? >> Urfi Javeed. >> Ufi Javat.
(19:08) >> Yeah, >> you should go and check out that blog, >> right? >> Yeah, you should because she has spoken about it very well. >> Wow. She has even spoken about the fact that whatever lifestyle choices she had in the past that she realized may not be great for her general or her reproductive health. >> What changes she made and what remarkable changes she has made as far as sleeping on time is concerned >> as far as you know consumption of she's absolutely not consuming alcohol, not smoking and we can clearly see it in her
(19:43) results. So, she's spoken about it very candidly >> and I'm glad she did it because this kind of awareness is what we require. >> Correct. Correct. >> She's 30. She's turned 30 this year and this is why she's decided to do it now. And she speaks in the video and says that uh well, what she says is I don't trust men.
(20:03) I might as well do something for myself, you know. >> So, yeah, because it is an easy process fairly. It's not complicated. What it does is that it takes the pressure off. It gives you more autonomy over your life's choices. Otherwise, the way we've been biologically designed, it's the woman who needs to compromise either on the career front or on the childbearing front.
(20:28) >> In this time, besides age, what are the other lifestyle thing that a women should do or a couple should do in case they're going through infertility issues? So there is a huge impact of environment and lifestyle on our general as well as reproductive health for both partners. Actually [clears throat] fertility is not just a female issue.
(20:51) >> In almost 50% of cases there is a sperm factor involved as well. >> 50%. Wow. >> Which they may not be aware about. >> But usually women are being blamed a lot more. Correct. In your practice. >> Yes. Yes. That's sadly what is still happening. Men are sometimes reluctant even to get a semen analysis done.
(21:10) But we are seeing that changing now. >> There are times when we've even had men, single men come and say, "I'm about to get married. I'd like to check my semen quality first." >> Huh. >> Yeah. That's refreshing to see that kind of a Is it right? >> It is right. Yeah. >> So they want to >> Oh, so so we can assess the quality of the semen as well.
(21:31) >> Yeah. We can do a semen analysis for them. >> So instead of astrology, they should do this before marriage. >> They should They really should >> they should check the ovarian reserve. They should check the chamber analysis. >> There are so many tests that they should be doing well astrology.
(21:44) I'm not going to dismiss it completely. But this is equally important as well >> and we'll come to the genetic issues uh in a bit. >> But yes, we're talking about the lifestyle and the environment. First of all, what I feel unfortunately obesity is becoming like a pandemic. >> So obesity plays a role in infertility. It plays a very big role when the BMI is too low or too high.
(22:09) Too high is what we find more commonly. Too low is a little rare. >> Uh it impacts egg quality and sperm quality. It reduces the chances of implantation. It creates hormonal imbalances. So it's very important to try and achieve a normal BMI which is between 20 and 25 kilograms per meter squared. It's not always possible to achieve that, especially for people who have a very high BMI.
(22:36) But at least they need to make a start somewhere. >> Even if they lose 5 to 10% of their current body weight, it it shows a significant improvement in their chances. So sometimes what we do with couples who are of a very high BMI and we know the clock is ticking, we tell them, do the embryo freezing, focus on your weight loss, and then do the embryo transfer.
(22:59) So you're at least conceiving at a time when you are in a much healthier state. >> And then we always try to emphasize that this normal BMI they have to try and achieve with the help of both exercise and diet. Exercise is so lacking in our generation. A lot of the health problems are due to what we call a sedentary lifestyle. Right? >> What makes it worse is the misconception that couples have that when they are trying to conceive they should not be working out. They just stop working out.
(23:27) Women just stop working out. >> Oh, because it may interfere with >> they quit their jobs. They start sitting at home, they start taking bed rest, but they're reducing their physical activity even further. >> What I tell them is that if you see our grandparents generation, >> they were so much more physically active than us.
(23:45) >> Most of them stayed in rural areas. They went walking. They did everything manually, washing clothes, filling water from wells. So in our grandparents' generation, it was very common to have large families. Four children, six children, some had eight. >> In our parents' generation, my mother is 73.
(24:06) She goes grocery shopping, walking every day. She goes to the dry cleaner, walking every day. She doesn't miss her morning walk, evening walk. So our parents' generation was fairly active as well. They also conceived without much difficulty. Two or three kids, most of them had. We blink it. We don't even go. We don't go anywhere.
(24:27) We sit in our chair and we take an app, swiggy or blinket and we order our groceries. Our day-to-day activity has become so limited that what nature designed our bodies for, the level of physical activity that we were designed for, we're not even doing a small fraction of it. >> That's why it's very important to in your day-to-day activity, if you can increase, you know, your step count, etc., it's great. But also work out.
(24:53) It's very important to work out. You cannot skip exercising. Even if your BMI is normal, you should not skip exercising. >> Even if you look if you look normal. >> Even if you look normal. >> How does exercise helps in IVF outcomes. >> First of all, exercise is the most underrated stress buster. >> It releases endorphins.
(25:16) It makes you feel good. It gives you a sense of accomplishment. You start your day with a good 1-hour workout. It sets the pace for your day. And we know that stress levels are high. That's another factor that's contributing to couples having difficulty conceiving. >> So exercise is great for your general physical health and your mental health both.
(25:37) So even people who have a normal BMI should still be exercising. >> So but what is happening right now? It's a vicious cycle where the couple is having infertility issues. They are stressed out and for stress they are staying at home thinking that the infertility will get better if they don't do any any workout or also actual work and then they end up eating more.
(25:57) Then they put on more weight. It's a vicious cycle. >> It is a vicious cycle. So exercise is one aspect, diet is the other. And typically when people are stressed out they reach for comfort foods. M >> when you're stressed out, you're not going to think, okay, let me have a salad.
(26:13) When you're stressed out, you want to have your French fries or your parathas or, you know, whatever gives you >> happiness, >> happiness, which is okay sometimes. But if your lifestyle contains mostly food which is not giving you proper nutrition, is adding empty calories, then the food becomes a factor as well. And not just that because a lot of people are now working late nights, >> eating at erratic hours, >> the circadian rhythm is disrupted which is another very big factor.
(26:43) >> So sleeping for 7 to 8 hours is very important. But from the correct time to the correct time, sleeping at 3:00 a.m. and waking up at 11:00 a.m. doesn't count as good sleep hygiene. >> So I'm a big promoter of circadian rhythm. I say eat by 7:00 p.m. sleep by 10 p.m. >> But can you tell me how the circadian rhythm, sleep, exercise, stress is affecting the actual ovarian pathophysiology.
(27:08) >> So maybe if I can explain that to the layman person, then maybe they'll be able to connect both together. >> Yeah. Because our hormones respond to the circardian rhythm. So the >> estrogen, progesterone, >> melatonin, >> melatonin. So there have actually been studies in late night shift workers which included cabin crew on long haul flights and nurses doing night duties.
(27:33) >> And they found that the incidence of irregular periods, PCOS, endometriosis, difficulty conceiving, miscarriages were higher in this category. >> So of course there is an impact. In some professions maybe there isn't much that they can do about it but at least for people who don't have those kind of work commitments where they have to work all night they if they can try and reduce too many late nights and like you said eat on time sleep on time >> there's a >> so so you're saying when you do this when you aligning with them the quality
(28:08) of the hormones are much better >> is hormones are more balanced >> balanced >> and uh >> because infertility is a hormonal issue >> it Everything is a hormonal issue as far as fertility is concerned. If your hormones are balanced, it's like an orchestra, you know, with >> with so many different hormones that play.
(28:28) >> It's a symphony. >> It's a symphony. Yes. >> It's multiple microolecules are being engaged. >> Yes. >> And every molecule has its own circadian rhythm. That's the beauty of it. >> Yes. Yes. And what is good is that the awareness of the impact of all these lifestyle factors amongst medical practitioners is increasing.
(28:47) And so we are able to educate our patients better about it as well. >> It's not just take this tablet or take this injection. It starts with lifestyle modification. You cannot skip that. >> So we talk a lot about stress. So stress increases cortisol. Cortisol decreases the quality of estrogen and progesterone through this multiple interactions.
(29:06) And that hormone needs the ovaries to produce this good quality or it is not there infertility stress again which is like >> yes so stress plays a role in many indirect ways as well >> the direct connection in fact has not scientifically been conclusively proven but when couples are stressed out you just imagine a couple that has got a you know very uh difficult job high stress levels >> a lot of times They're not even able to have relations at the time of ovulation.
(29:40) They're just too tired or one is tired, one is not. Their marital life is taking >> it becomes a chore. >> It becomes a chore. And as I mentioned, when they are stressed out, they are more likely to eat at erratic hours, eat the wrong things and also reach out for that extra cup of coffee, for that, you know, one glass of whiskey or alcohol just to calm them down smoking.
(30:05) So which then again comes down to our lifestyle factors where all these things are concerned. Smoking even one cigarette is going to hamper your egg quality and your sperm quality. Everyone knows smoking causes cancer. How many people know that it causes reduced egg quality, reduced sperm quality, increased incidence of IUGR babies, miscarriages? >> Impotence.
(30:27) >> Impotence. Alcohol in moderation doesn't have as much of an impact as smoking does but in moderation. In excess of course it will. Similarly, caffeine in moderation is not harmful but everything has to be in moderation. Smoking has to be not at all. >> Smoking in your practice as women is also involved. >> Absolutely.
(30:49) >> Is that right? That's something new because I went to US in 2006. At that point of time women smoking was not common. It is becoming common now because of you know the corporate offices. The men step down for a cigarette break. The women step down with them as well. So it just it's not necessarily only the men anymore.
(31:10) There's an equal number of women smokers. Depends also where you practice. Where I practice in Mumbai and Andhiri it's fairly common to see both men and women smoking. >> So after listening to this podcast let's say that people understand. Okay. So lifestyle plays a role in your infertility treatment. So I'm going to sleep on time, eat on time, I'll do meditation, I'll do stress relaxation techniques, I'll do physical activity, I'll work on it.
(31:36) Uh I'm saying this so frequently because this is what I tell in my online new me clinic [laughter] repeatedly on daily basis. But as as a matter of fact, any patients with infertility when when I treat them with a lifestyle, the outcome is significant. >> Of course, because the impact is significant. significant significant it's very clear very clear it takes time >> it takes 6 weeks to 3 months >> but it's not going to be overnight >> but it's a step in the right direction >> when they quit smoking in the next one year the adverse effects of smoking have
(32:06) been reversed already so it takes time but then they need >> so one year no smoking reversed almost yes almost reverses >> and then there's the environment as well because unfortunately we now live in an environment where we are exposed to more than 20,000 chemicals on a daily basis. 800 of which have been proven to be toxic and we can do nothing about it.
(32:29) But it is so, you know, it it's so ingrained that people don't realize what kind of toxins they are exposed to. Everything is a chemical. Your toothpaste, your soap, your shampoo, they're all chemicals, your detergents, your floor disinfectants. And as if that isn't enough, if you see the way food is being prepared nowadays, agriculture, there is such rampant pesticide use.
(32:54) We're the only species that sprays our crops with poison so that other species don't eat it and then we eat it. And nowadays, as you know, this mango season was going on, rampant use of carbide injections to cause early ripening of mangoes that we don't realize when we are consuming. the pesticides also spraying them wasn't enough.
(33:16) Now we've heard reports of them being injected into the roots. So even if you try to correct your lifestyle, but what do we do about this toxic environment? It's in everything we breathe, drink, and eat. There's a very interesting book called Our Stolen Future. >> Our stolen future. >> It's our stolen future.
(33:35) Because of our own activities, we are heading towards our own extinction. M >> the book tells but it was written in the 1970s or 80s but it's a very eyeopening book. It's not a medical textbook. It's for anyone to read. >> It tells you about everything in our environment. The endocrine disruptors. the fact that plastics and certain other chemicals mimic estrogen and that's another reason why male babies right from the time when they are in the womb in utro are exposed to chemicals that mimic hormones and could be part of the
(34:10) reason why we are seeing an increased incidence of male infertility. That book is very interesting. It says that in all the parts of the ocean where the industrial toxins are dumped, the whales have cancer. If this is what we're doing to them, isn't this why don't you feel that the incidence of cancer is higher than it was 40 years back? 40 years back the average sperm count across the world was 100 million.
(34:34) Today the average sperm count across the world is 37 million. Even the WH criteria for a normal sperm uh parameters they have had to keep revising and reducing because it is reducing. Another culprit is plastic which for so many decades the you know the impact wasn't so well known but now microlastics have been found in breast milk.
(34:59) Microplastics are found in follicular fluid in the ovaries. There was a study I read recently where they compared the placenta of women who had preterm deliveries with the placenta of women who delivered at the full nine months. the pre-term deliveries, the placenta had a higher concentration of microplastics. >> So at least that awareness is coming in.
(35:22) If you go to most of the restaurants and hotels now, they have replaced plastic mineral water bottles with glass bottles. >> Correct. >> And this is something I encourage a lot of couples to do in their homes as well. >> A lot of people have already when I tell them they say, "Yes, doctor, we we don't use plastic bottles anymore.
(35:40) We use steel or we use glass." So people are also becoming aware about this. >> Wow. So I'm going to show you a real and then I want you to react to it. >> Sure. >> Okay. >> Yeah. >> Right. What do you think? So I'll tell you uh it's not just about them uh being scared to give a sperm sample but sometimes we have a condition called aospermia >> where there is a zero sperm count in the ejaculate >> that the man doesn't have any sperm at all.
(36:16) >> No. And many of these cases >> but they can still ejaculate. >> They can ejaculate but it's it's blank. There's no sperms in it. In many of these cases, the testes are actually producing sperm, but they're not coming out. In such cases, we have to do something called a tissa, a testicular sperm retrieval to be able to get the sperm directly from the testes.
(36:42) Most of the times the husbands get so terrified when they hear this that they are just so reluctant, not willing to do it. and the reel that you just showed me with the size of the needle that aspirates the oides. >> That is when I tell them this is the size of the needle that's going into your wife's ovaries through her vagina.
(37:04) For a testicular aspiration, it's a small 26 gauge needle. Even if something more is required, it's a small 18 gauge. Only the ones used for blood collection and they are so tiny >> and they don't even go all the way into the abdomen. So we do explain to them that the needle used for egg pickup is much larger and longer than the one we will use for a tissa.
(37:28) That's a very tiny needle. Uh but yes we do. >> You see I I I know that you know women were blamed and you know men were always patriarchal but now it is changing correct many people are even considering that you know we are also involved. How much is a change in your practice? >> Uh quite a lot. Although we do still have that small percentage of couples where they come and tell us the husband is not willing for the semen analysis.
(37:56) >> It's interesting to see the demographics, the socioeconomic backgrounds of such couples because usually the more educated ones are more willing to get their semen analysis done. We still find that in the lower socioeconomic sta with the less education or the slightly more underprivileged where they have a stigma even getting a semen test done.
(38:23) M hopefully with these podcast with these awareness maybe they'll be open uh to the idea that you know 50% >> of >> which is the reason we try and come on these platforms and talk about this because there is such a huge need to create an awareness >> to put reliable information out there >> to encourage people first of all to start the conversation >> it all begins with that if they are not going to be able to even speak about it how are we going to help them Crime.