Infertility in India: Prevalence, Costs & New Regulations | IVF & ART Updates

Infertility is a growing public health concern in India, affecting an estimated 15-20% of couples – roughly 30 million people – according to recent data. While traditionally considered a women’s issue, current understanding recognizes that male factors contribute to nearly 40-50% of cases. This shift in perspective, coupled with increasing awareness of the impact of psychological stress on reproductive health, is reshaping the conversation around infertility in the country.

The World Health Organization (WHO) estimates that approximately 1 in 6 adults globally experience infertility. Within India, prevalence rates vary geographically, with urban areas reporting higher rates of primary infertility (never having conceived) and rural areas experiencing more secondary infertility (difficulty conceiving after a previous pregnancy, often linked to untreated infections). The national Total Fertility Rate (TFR) has also fallen to 1.9, below the replacement level of 2.1, driven by both intentional delays in childbearing and involuntary infertility.

The financial burden of infertility treatment is substantial for Indian families. The Health Technology Assessment India (HTAIn) Resource Hub at the ICMR-National Institute for Research in Reproductive and Child Health recently estimated the costs associated with Assisted Reproductive Technology (ART), including In-vitro Fertilisation (IVF). A single IVF cycle can cost approximately ₹1.10 lakh at public hospitals and ₹2.30 lakh at private facilities. Beyond IVF, general infertility care – including consultations, investigations, medications, and monitoring – incurs median out-of-pocket expenses of around ₹7,340 in public hospitals and ₹11,834 in private hospitals.

Recognizing the financial strain, the government’s Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) scheme provides health coverage of up to ₹5 lakhs per family per year for secondary and tertiary care hospitalisation. The latest Health Benefit Package (HBP 2022) offers cashless healthcare services for 1,961 procedures across 27 medical specialties. However, a significant challenge remains, as over 90% of Indian insurance policies currently exclude infertility coverage.

Several factors are contributing to the rising rates of infertility in India. Delayed parenthood, driven by career aspirations and financial considerations, is a key contributor, with more women seeking fertility treatments after the age of 35. Declining sperm quality, linked to environmental toxins and stress, is increasingly recognized as a significant factor in male infertility. A study conducted in central India reported a prevalence of infertility at 8.9%, while a 2020 study by Purkayastha et al., comparing data from four rounds of the National Family Health Survey (NFHS), revealed a notable increase in infertility prevalence between 2015-2016, particularly in southern states.

To address the challenges and ensure ethical practices, the Indian government has introduced the Assisted Reproductive Technology (Regulation) Act, 2021 and the Surrogacy (Regulation) Act, 2021. These acts aim to regulate ART clinics, banks, and surrogacy clinics, promoting safe and ethical practices within the field of reproductive medicine.

The Indian IVF market is experiencing substantial growth, projected to double from $900 million in 2024 to $1.8 billion by 2029, reflecting increased demand for medical assistance. However, access to ART centers remains limited, and social stigmas surrounding infertility contribute to underreporting and low utilization of available services. Addressing these barriers through increased awareness campaigns and integration of infertility care into primary healthcare settings is crucial to improving access and quality of treatment.

The evolving understanding of infertility in India highlights the need for a comprehensive approach that addresses not only the medical aspects of treatment but also the psychological and social factors that contribute to the problem. Recognizing male infertility as a significant component and acknowledging the impact of stress on reproductive health are essential steps towards providing holistic and effective care for couples struggling with infertility.