The image of a woman as someone carved out of Adam’s rib is as extinct is that of her wearing a locked iron chastity belt or a housewife hidden behind yards of a saree toiling over a fire-spitting chullah. Enter the super woman: A super mom, an efficient and ambitious and upwardly climbing professional, a conscientious homemaker and a perfect partner. In her journey from the kitchen to the corporate world, her interests and responsibilities have increased manifold with a wide gamut of manifestations, but behind all the glamorous visible changes remains the woman’s neglect of her own well being. Today’s lifestyle has women facing demanding careers, ever growing responsibilities at home (with nuclear family sizes) and at work, with challenge at every step of her life. Senior gynaecologist Dr. Ranjit Chakraborti explains “lifestyle disease is the disease of the civilization that inevitably follows as countries tread the path of industrialization or globalization.” If health was never a priority then, it still has not made it to her priority list no matter whatever be the extent of the so called progress. When was the last time you scheduled or had a general gynaecological or annual medical check-up? Not many can answer this basic question. As rightly pointed out by Dr. Chakraborti, “Today our lives are fast paced with long working hours with high levels of stress and lack of time for oneself. For today’s women it’s a constant race against time. When she is at work, there are deadlines to be met and work related pressures to be dealt with and side by side she also needs to keep track of what is happening on the home front from her maid’s uncalled for absenteeism from duty to attending her child’s parents’ -teacher’s meeting. Once she reaches home, theres no question of putting her feet up for some much needed rest. Home chores beckon, plus there are children needs-food, homework, play, conversation and the list goes on and on. Come morning and theres challenge of getting everyone up and off on time. Most of these women do not even realize that they are stressed out because of the multifaceted roles they have to play.” This is the modern Indian woman constantly balancing between professional and personal fronts at the cost of her own well being and health. They seek medical help only when things are serious. Thus is explained the rising incidences of cancer, heart disease, diabetes, chronic liver disease, alzheimer’s and declining fertility. All these are co related in the sense that all these diseases are lifestyle related. A major concern is the sexual health of the women. Low sex drive and lack of desire are being experienced by increasing number of women. Either they are too exhausted or they do not have the time. As Dr. Chakraborti shares, " I have seen couples who come to me requesting for artificial insemination on the days when the wife will be fertile just because the husband is traveling. The boom in the BPO sector has made nocturnal work a routine affair much against the natural biological mechanism." Dr. Chakraborti states that the declining sexual health in women could be attributed to the following factors: " Environmental Pollutants " Low testoterone levels " Stress " Lack of sleep " Lack of exercise " Lifestyle " Excess alcohol and depression " Poor nutrition and obesity affecting energy levels, hormone imbalance " Emotional and psychological problems “Almost every woman whom I see are into jobs and we all know that jobs in private sectors are very demanding with long working hours and stressful. Work gets carried over within the confines of domesticity specially with the advent of mobile phones and office could be never switched off from the mind. This adds to the tension and the woman is never mentally relaxed. We thus see women having hypertension at a very young age. The pressure to excel and perform in both domestic and professional fronts take a toll. And this culminates to the fact that the modern woman is facing increasing difficulties in her way to start a family. Infertility has become the single largest disease in the age group of 20-40 years. Earlier it was more of a pathological problem. But now, it is deeply lifestyle related.” Infertility is the single largest disease that is affecting younger people in their peak years. It stands at an estimated 10 to 15% today. “In my chamber I meet three to four women every day who are from the software sector. It’s a classic case of mouse replacing the spouse. These young women are so busy pursuing their careers that they forget all about the reproductive cycle or biological clock. In my last five years of practice, I have seen that high-stress private sector jobs have caused havoc in these couples’ bedrooms. The result is increasing infertility. For these women sex takes a backseat because of odd working hours. The night shifts in call centers and BPOs are much against the body’s natural mechanism and negatively affects the body’s natural process. These employees working in nocturnal shifts suffer from hormonal disturbances caused by changing sleep rhythms and bio-cycles. Hormonal disturbances in women lead to disturbed egg release and ovulation and polycystic ovarian diseases. These aggravate infertility. Then the quality of time spent with spouse has diminished due to odd and long working hours.” Earlier it was seen that women were getting married at around 24-26 years. But now the scenario has changed completely. Women are not getting married before 30 years and are planning the child when they are at 33 years. “Medical wisdom dictates that women should finish having babies by the time they are 30, after which fertility levels begin to drop. At 33 to 35 years she is on the wrong side of the biological clock and she is faced with difficulties as well as complications. Even they respond badly to fertility treatments at this age. The ovarian response is poor and they sometime do not have the capacity to carry the pregnancy. The quality of eggs deteriorate and this affects the fertility outcome”, as emphasized by Dr. Chakranorti. According to Dr. Ranjit Chakraborti, the rising incidence of female infertility in case of the working women could be categorized into the following:
Polycystic Ovarian Disease: This disease is the most common cause of ovulation disorders in women and is characterized by the presence of many minute cysts in the ovaries, by excess production of androgens, and by infrequent periods or absent periods. The failure to ovulate is the most common cause of female infertility and can occur for no apparent reason or as the result of stress, hormonal imbalances, and various diseases and disorders of the reproductive system (some of which will be described below). PCOS affect a woman’s menstrual cycle, fertility, hormones, insulin production, heart, blood vessels, and appearance. An estimated five to 10 percent of women of childbearing age have PCOS. Weight reduction is the single most important lifestyle change which can help to restore and correct PCOD. Almost 60-70 % of PCOS women are obese. The earlier the weight is controlled, sooner the problem may be corrected. Dr. Chakraborti says, “Infertility in polycystic ovary syndrome is usually treated successfully by improving diet and exercise and weight reduction. If these measures are not successful, conception can usually be achieved by one or more of clomiphene citrate, gonadotropins, gonadotropin-releasing hormone analogues, laparoscopically applied therapies to the ovaries and assisted reproductive techniques.”
Pelvic Inflammatory Disease: This infection of the reproductive tract can lead to blocked or damaged fallopian tubes and is usually caused by sexually transmitted disease, miscarriages, abortions, childbirth, or an intrauterine device.
Endometriosis: This disorder occurs when the tissue which lines the uterus (the endometrium) grows into growths or lesions outside of the uterus (usually on the ovaries, fallopian tubes, and ligaments that support the uterus; the area between the vagina and the rectum; the outer surface of the uterus; the lining of the pelvic cavity; the bladder, bowel, vagina, cervix, vulva, and in abdominal surgical scars). In sync with the menstrual cycle, this tissue builds up, breaks down, and sheds each month; but unfortunately, it has no way of leaving the body. As a result it causes internal bleeding, breakdown of blood and tissue from the lesions, and most often inflammation which can cause pain, infertility, scar tissue formation, adhesions, and bowel problems. Even the men are also at risk. Men who smoke needs to know that it affects the sperm concentration and can induce DNA damage in the sperm."These young couples must remember that too much mental stress leads to erectile dysfunction, lack of libido and impotence-all three contributing to the rising incidence of infertility these days. “To sum it up, I can say late marriage of women coupled with the complexities of modern city life, high-stress jobs, lack of a support system are making their marks felt with growing number of women facing difficulties while conceiving”, as said by Dr. Chakraborti. Case Study 1 Arup and Shreya. Both are working software professionals. They are 30 and 27 years old married for the last two years. They travel a lot as the job demands. Even when they are in the city, they work for more than 12 hours daily and at times on Sundays also. They are ambitious and both are equally engrossed in their professions. They are trying to go the family way for the last 5 months. Now Arup has to travel to UK for 8-10 months for an assignment. Shreya cannot accompany as she has her work here. So both came to consult Dr. Ranjit Chakraborti. According to him, “they are wanting to store Arup’s sperm and go for artificial insemination as they hardly spend time together or even if they are together, they are too stressed out. So both want to opt for this method.” Case Study 2 Vedant and Rashmi are married for a little more than a year. They are 34 and 33 years old. Vedant works in a multinational bank, while Rashmi is in a BPO unit. They meet each other properly only during weekends and that too if each does not have a pressing professional committment, which Vedant mostly has. Morning sees Vedant hurrying for office, while Rashmi comes back absolutely exhausted after working whole night. When they met Dr. Chakraborti, their main problem is that they just don’t feel like getting into the physical relationship as they are too tired or fatigued after a tiring week. They are lacking the sexual urge and yet both desire to laed a normal life and plan a family at a later stage. Case Study 3 Siddharth, 35 years, and his wife Priyanjana, 33 years, are both young upcoming management professionals who have just come back after their education abroad. They are married for the last three years and now that they are back in home town, they are wanting to go the family way. However they are losing hope as they are failing. However, accordng to Dr. Chakraborti, they still have chance to conceive naturally but they are impatient and are too much taken up in their respective careers. They hardly spend any quality time and are expecting results overnight. Case Study 4 Shayan, 32 years and Tanuja, 25 years are married for alomost four years now. Shayan is working in a multinational software company and Tanuja in a leading call centre. Both have underewnt numerous consultations with several doctors for their desire to have a child. They were pointed out that they are very stressed out and so lack the basic urge to go for sexual intercourse. When they came to see Dr. Chakraborti, they were tensed, shattered and stressed out after trying and failing and also going from one doctor to another. He first explained to them the fertility period and advised them to relax. Then they were counseled continuously. Tanuja conceived naturally within the next 4 momths. In the opinion of Dr. Chakraborti, “we have seen that the common factor in all of the above cases is demanding professional life with odd working hours and a highly stressful life. In today’s times couples are all so ambitious and career oriented that they hardly spend quality time with each other. In some cases we see them just pressing the panic button when things are not so serious. So many times we counsel them to try naturally to conceive except in cases where there is some complication. I have come across so many couples who just dont have the sexual urge due to burn outs. In certain cases we see couples to come with odd requests asking for artificial insemination when they are not infertile. It is just that they dont have the time and wants everything planned like clockwork precision. Overall there is lack of proper sex education as they know things superficially and so they easily lose hope whe it isnot the end of the road. They need counseling and with that results could be seen in quite a few cases.”