Mumbai: India’s fertility landscape is changing in ways that are gradually becoming more visible in clinics, hospitals and policy discussions. While the country’s total fertility rate has fallen close to replacement levels, infertility continues to affect a significant share of couples. Estimates suggest that nearly 10–15 per cent of Indian couples experience infertility, and clinicians say the demand for assisted reproductive technologies such as in vitro fertilisation (IVF) is steadily increasing as more people delay marriage and parenthood.
These changing dynamics formed the backdrop of a panel discussion titled “IVF Unplugged – Where Science Meets Hope in Reproductive Care,” where Dr. Neeta Singh, Professor & Unit Chief, Division of Reproductive Medicine & Surgery, Dept of Obstetrics & Gynaecology, AIIMS Delhi, Dr. Tushar T Palve, Vice-Dean, Government Medical College (GMC) Mumbai, Dr. Manika Khanna, Founder, Chairperson & Managing Director, Gaudium IVF and Dr. Rekha Ambegaokar, Senior Director, Obstetrics & Gynaecology, Nanavati Max Super Speciality Hospital reflected on how reproductive care is evolving in India and what it will take to make fertility treatment more accessible and sustainable in the years ahead. The session was moderated by Prathiba Raju, Senior Assistant Editor at ETHealthworld, The Economic Times Group.
Opening the discussion, experts pointed to the growing trend of delayed parenthood as one of the most visible shifts shaping fertility care. Dr Singh noted that many couples today choose to focus on careers or financial stability before starting a family, but biological realities often make this decision more complicated than anticipated.
“When couples delay their parenting journey, infertility sometimes becomes an unintended consequence,” she said, explaining that what clinicians are increasingly witnessing is involuntary childlessness. As couples postpone childbearing, more of them eventually turn to fertility treatment, which partly explains the rapid expansion of IVF centres across the country.
From a public health perspective, the scale of the issue is difficult to ignore. Dr Palve pointed out that India may have close to 2.8 crore couples dealing with infertility. In a country where population numbers are always large, infertility too appears in large numbers in hospital records.
“In my hospital alone we see about sixty thousand patients every year, and nearly three to four thousand of them come with infertility issues,” he said, underlining that the numbers are substantial enough for the health system to take serious note.
Recognising the growing need, several state governments and public institutions have begun expanding fertility services. Maharashtra, for instance, has started IVF facilities in public hospitals and is planning to increase the number of centres across medical colleges. Newer AIIMS institutions are also establishing reproductive medicine facilities, guided by the experience of AIIMS New Delhi, which pioneered such services within the network nearly two decades ago.
While the demand for IVF has been steadily rising in metropolitan cities, experts said the growth of fertility services is no longer confined to urban centres. According to Dr Khanna, infertility is present across all geographies, including smaller towns and rural areas.
“We often assume infertility is an urban phenomenon, but that is not the case,” she said. “Even villages report infertility rates, though the numbers may be slightly lower than in cities.”
What has changed in recent years is the willingness of people in smaller cities to seek treatment. Rising disposable income, greater awareness about reproductive health, and changing social expectations have contributed to an increase in fertility consultations in tier two and tier three cities. At the same time, the spread of urban lifestyles, including irregular work hours, stress, smoking and alcohol consumption, has also begun influencing fertility patterns beyond major metropolitan areas.
However, Dr Khanna emphasised that expansion must be accompanied by a focus on quality care. Fertility treatment is unlike other medical services because it deals with the creation of life, which makes clinical standards particularly important.
“We are in the business of hope,” she said. “But hope must also be supported by quality.”
Clinicians say the profile of patients seeking fertility treatment has also evolved over the decades. Dr Ambegaokar, reflecting on more than forty years of clinical practice, observed that couples are now approaching fertility specialists much later in life than they once did.
“When I started my practice, most couples came in their late twenties after trying naturally for a few years,” she recalled. “Today, many couples arrive in their mid-thirties.”
Urban marriages often take place later than before, and many couples choose to spend the first few years focusing on careers or personal goals before considering children. As a result, fertility consultations often happen at a stage when biological fertility has already started declining.
Despite this shift, Dr.Ambegaokar noted one encouraging trend. More couples are now seeking preconception counselling before attempting pregnancy. This allows doctors to advise patients on lifestyle changes such as reducing weight, stopping smoking or improving metabolic health before they begin trying to conceive.
At the policy level, the question of whether fertility screening should become a routine part of reproductive healthcare is increasingly being discussed. Dr Neeta Singh cautioned against indiscriminate testing.
“I do not support universal hormonal screening for everyone who walks into a gynaecology clinic,” she said. “It can create unnecessary anxiety and also burden the healthcare system.”
Instead, she advocated a risk based approach. Women with conditions such as endometriosis, polycystic ovarian syndrome, obesity or previous pelvic surgeries should receive early counselling and targeted screening. She also stressed the need to pay greater attention to male infertility, which is often overlooked in fertility discussions that focus primarily on women.
Affordability remains another major concern in fertility care. In private centres, the cost of IVF treatment can range between one and a half lakh and three lakh rupees per cycle, and many couples require multiple cycles before achieving pregnancy. For many families, this makes treatment financially challenging.
Government hospitals have attempted to address this barrier by offering subsidised treatment. According to Dr Palve, patients below the poverty line may receive treatment at minimal cost in public hospitals because medicines and hormones are provided free of charge. Even for other patients, the cost in teaching hospitals may be significantly lower than in private clinics.
Beyond affordability, fertility specialists must also navigate the delicate task of managing expectations. IVF success rates generally range between thirty and forty per cent per cycle, depending on factors such as age and underlying medical conditions.
Dr.Ambegaokar said transparency is essential when counselling patients.
“Many patients ask if there is a hundred per cent guarantee,” she said. “But we must explain clearly that multiple attempts may be required and that success rates depend on many factors.”
For doctors, the role often extends beyond clinical treatment. Fertility care involves guiding patients through what can be a deeply emotional journey, requiring empathy as well as scientific clarity.
At the same time, India’s combination of clinical expertise and relatively lower costs has begun attracting international patients seeking fertility treatment. Dr Khanna believes the country is well positioned to become a global destination for IVF.
“A treatment that costs two to three lakh rupees in India may cost more than fifteen lakh rupees in the United States,” she noted. Even after accounting for travel and accommodation expenses, treatment in India can remain significantly cheaper for international patients.
As a result, several Indian fertility centres are already treating patients from dozens of countries. For clinicians working in the field, one observation stands out: the emotional burden of infertility is remarkably similar across cultures and nationalities.
Looking ahead, experts believe that expanding access to fertility care will require stronger public sector participation. Studies have suggested that IVF can be delivered at a relatively lower cost within government institutions, making it possible to scale services through medical colleges and public hospitals.
At the same time, awareness campaigns, early counselling and preventive health measures will be crucial in helping couples make informed decisions about fertility.
As the discussion concluded, panelists agreed that infertility is no longer a niche medical issue but an emerging public health concern that deserves greater attention from policymakers and healthcare providers alike.
Advances in reproductive medicine have made parenthood possible for many couples who once had limited options. The challenge now lies in ensuring that these scientific advances remain accessible, affordable and grounded in compassionate care for the millions of couples who continue to seek hope through fertility treatment.
