Written By: Longjam Dineshwori | Updated : February 15, 2023 10:29 AM IST
Image credits by: Anaemias due to iron deficiencies were seen in a vast percentage of paediatric (50.08%) and adolescent (34.85%) populations putting them at considerable risk in the growing years, especially women during reproductive years and later.
The Indian government is determined to eliminate Sickle Cell Anaemia by 2047. The Centre is coming up with an ambitious nationwide mission to achieve the target, as announced by Finance Minister Nirmala Sitharaman during the Union Budget 2023-24 presentation. She elaborated that the programme would include awareness creation, universal screening of seven crore people in 0-40 years age group in affected tribal areas, and counselling through collaborative efforts of central ministries and state governments.
Did you know that Sickle Cell Anaemia can affect fertility in both men and women?
In an exclusive interaction with TheHealthSite, Dr Kshitiz Murdia, CEO and Co-Founder of Indira IVF, explains the relationship between sickle cell anaemia and reproductive issues. He also suggests some measures that can be included under the proposed mission to eliminate this inherited blood disorder.
Sickle cell anaemia is an inherited condition, an autosomal recessive disorder, that is, two faulty genes called haemoglobin S gene are inherited from both parents. This results in sickle-shaped RBCs instead of the biconcave shape due to which organs receive inadequate amounts of blood and oxygen resulting in fatal conditions.
It has been found that 1 in 86 births among the tribal community in India is afflicted with sickle cell anaemia. In fact, India is thought to have the second-highest incidences of the disease in the world.
Iron deficiency anaemia and sickle cell anaemia can impact fertility in both men and women by impacting oocyte quality, affecting endometrial receptivity, sperm abnormalities, erectile dysfunction, etc.
Sickle cell anaemia is a congenital disorder which results when two mutated genes called haemoglobin S are inherited from both parents. As such, a person who is born with the disorder has to live with it and will only be able to control or avoid complications associated with it. Certain preventative steps can include taking folic acid supplements to maintain normal iron levels, keeping oneself hydrated, avoiding extreme temperatures, exercising adequately, avoiding tobacco and alcohol consumption, as well as consulting with one's doctor before taking any medication.
For persons with sickle cell anaemia or those who have the trait (at least one faulty haemoglobin S gene) who seek to become parents, it becomes imperative to visit a genetic counsellor who can highlight the possibility of having a child with sickle cell anaemia. They can also explain the preventive measures, treatment possible, and reproductive options. As per genetics, when both parents have sickle cell anaemia, the offspring will also get the disorder; when one of the parents have the faulty gene, there is a 50 per cent chance of the child to also become a carrier of the disorder; when both parents are carriers of the disorder, there is a 25 per cent chance that the offspring will be born with sickle cell anaemia whereas there is a 50 per cent probability that the offspring will be a carrier with one faulty gene.
Recently, experimental gene therapy has found to have some success in this matter. However, these are still in their trial stages and more research is required to further prove its efficacy.
The Sickle Cell Anaemia Elimination Mission taken up by the Union Budget is a commendable step by the government. Although a herculean task, when implemented strategically, it can take us leaps in our journey to eliminate the disorder by the 100th year of India's independence.
Identification of high-risk communities: A primary step of note here is the identification of key locations and geographies where sickle cell anaemia is highly prevalent in (or high-risk communities), to begin with. The government has currently identified 200 districts to kick off the mission.
Creating public awareness: Holding awareness camps would be a pivotal step in this matter and just as imperative would be to incentivise individuals to attend such educational gatherings.
Screeningall individuals of high-risk communities: Following this, all individuals of the community will have to be screened for the presence of the gene whether they are carriers, that is, with one faulty gene but not with the disorder or whether they are living with the disorder, that is, with both the sickle cell anaemia-causing faulty genes. These individuals will then have to be educated on the possibility of passing on the disorder to their children in a customised manner and be provided with health identification cards. These steps will have to be taken in a phased-out manner to ensure that the at-risk and high-risk communities are checked.
Preimplantation genetic testing (PGT): Another key step that the government can include in this mission is preimplantation genetic testing (PGT). According to the Assisted Reproductive Technology (Regulation) Act, 2021 couples whose first child is born with a genetic disorder such as sickle cell anaemia and would like to ensure that their second child does not have the disorder can opt for PGT before conceiving. In fact, in cases, a saviour sibling can also be brought into the world who can be a bone marrow donor for the elder child. It has been made possible by advancements in the field of genetic testing that carriers of the disorder can avoid passing it on to their children.
Such couples can utilise assisted reproductive technology such as in vitro fertilisation followed by PGT that can determine if the embryos formed have both the recessive genes. Thus, embryos that do not have the condition can be implanted inside the uterus, resulting in children without sickle cell anaemia.
The health budget this year has focused on a few niche, however, crucial areas of healthcare. This has brought to the forefront increasing access to training, addressing the challenges associated with sickle-cell anaemia, encouraging public-private partnership, and futuristic developments in medical technology, especially of that in artificial intelligence.
We support the government's new mission to eliminate Sickle-Cell Anaemia by 2047. The condition direly requires attention with the help of government-aided missions, primarily in the tier II and rural belts of India. Awareness creation, setting up camps, and screening individuals for the disease would form a strong foundation for the Sickle-Cell Anaemia Elimination Mission 2047. This will help highlight the severity of this condition which has long remained unknown and ignored.
As a leader of infertility treatments in India, another condition that is increasing on rapid scale, affecting one in six couples, we understand the impact of anaemia on a person's general health and infertility. Iron deficiency plays a critical role in human infertility, oocyte quality and even impacts endometrial receptivity. By correcting iron deficiency in women, pregnancy rate improves hence, contributing to the country's total fertility rate as well, which has now reached a below-replacement threshold as per the latest National Family Health Survey.
Disclaimer: The content on TheHealthSite.com is only for informational purposes. It is not at all professional medical advice. Always consult your doctor or a healthcare specialist for any questions regarding your health or a medical condition.
