Infertility in India: Challenges and New Hope Ahead

In an interaction with Thiruamuthan, Correspondent, India Pharma Outlook, Anjali Ajaikumar, Director, Milann Fertility & Birthing Hospital, discusses the rising infertility challenge, evolving fertility treatments, and innovations shaping personalized patient care in India. Anjali Ajaikumar is a healthcare leader with 15+ years in hospital administration, fertility care, and strategic growth. She is recognized for patient-first leadership, healthcare innovation, mentoring startups, and driving impactful social initiatives across India.

With infertility rates in India recently crossing alarming levels, how are changing urban lifestyles and delayed parenthood shaping this growing health crisis?

There are multiple factors at play when it comes to how urban lifestyles are shaping infertility trends. As couples achieve higher incomes, the natural tendency is to have fewer children, often just one, or at most two. This pattern is visible not only in India but globally as well. Delayed parenthood is another critical factor. We’re now seeing infertility rates rising in both men and women. When parenthood is postponed without adequate planning, for instance, without interventions like egg or sperm freezing, the likelihood of having fewer children, or in some cases none, becomes much higher. Urban lifestyle choices also play a role.

Many people today consciously prioritize career growth, travel, and personal pursuits, with children being seen as just one among several life options. This shift in priorities mirrors trends observed across the world. That said, India has already introduced certain measures to help address and manage these challenges, though the impact will take time to fully unfold.

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With late parenthood now a clear demographic shift in urban India, how directly is age contributing to rising infertility compared to biology?

Age is definitely a contributing factor. Once a woman crosses 35, she is automatically considered high-risk, with reduced chances of conception, and the decline becomes sharper with every passing year. The same trend is now being seen in men as well, especially beyond the age of 45. For Indian women, the challenge is compounded by biology.

Studies show that Indian women have nearly six years shorter reproductive span compared to Caucasian women, which further reduces their chances of conceiving as they grow older. If we look at global patterns in Japan, South Korea, much of Europe, and even the US, we see that as countries become more developed, fertility rates drop. India too is moving in that direction.

With improved infrastructure and changing lifestyles, family sizes have naturally reduced. Unlike earlier generations, our parents or grandparents, often engaged in agriculture, had large families, sometimes 8 to 11 children today it’s rare to see even three. Most families stop at one or two. This demographic shift is reflected in recent statistics: India’s fertility rate currently stands at 1.98, which is below the replacement level of 2.1.

In addition to age and socio-economic changes, other factors are also fueling infertility. Genital infections linked to reduced hygiene, high levels of stress, and unhealthy lifestyle habits all play a role in lowering fertility potential. So, age combined with biological limitations, lifestyle factors, and broader social changes is clearly driving the rise in infertility across India.

Recent studies link air pollution to declining sperm quality. How seriously is India addressing environmental factors fueling its infertility challenge?

Air pollution is a major issue when it comes to health challenges in India. Poor air quality doesn’t just affect the lungs, it is linked to higher cancer rates, more heart attacks, and countless other health issues. In fact, millions of deaths every year in India are attributed directly to air pollution. Fertility is no exception.

Studies now show that air pollution, combined with excessive use of technology, high stress levels from demanding work environments, and urban lifestyles, is contributing significantly to declining sperm quality. While India has taken some steps to address environmental factors, the efforts are not yet as focused or aggressive as what we’ve seen in countries that have successfully reversed severe pollution. For instance, if we compare Beijing and Delhi, a decade ago, both cities had extremely poor air quality, with Beijing often worse than Delhi.

Today, however, Beijing has drastically improved its air quality index, which can be as low as 18, while Delhi continues to hover much higher, often five times worse. This contrast shows that serious measures better city planning, stronger infrastructure, large-scale afforestation, and stricter pollution control are essential if India is to effectively reduce the environmental burden fueling its infertility crisis.

Despite government regulation of IVF clinics in recent years, why does affordability remain the biggest barrier for middle-class couples seeking treatment?

I don’t believe affordability is the biggest barrier for middle-class couples when it comes to fertility treatment. What matters more is the quality of care and being an active participant in the process. India is already 15–20 times more affordable than many other countries. But behind every successful IVF cycle, there are at least seven specialists and support staff working to ensure the best possible outcomes. That level of expertise cannot be compromised for the sake of cost alone. Rather than focusing only on affordability, couples should focus on choosing the right clinic and getting the right medical opinions. In the past, treatment often depended on one doctor and one opinion. Today, things have evolved.

At Milann, for example, our advanced clinic model was recently relaunched to cater to patients who had multiple failed IVF or IUI attempts elsewhere.

Government regulations are important, of course—they ensure clinics follow rules and maintain standards. However, affordability and regulation are not directly linked. Ultimately, it comes down to whether patients are asking the right questions: Is the clinic looking at my entire fertility journey? Are they considering natural conception or IUI before suggesting IVF as a last option? For every patient, the key is to go to the right place where quality, transparency, and individualized care are prioritized.

With India emerging as a hub for fertility tourism, how are ethical practices and regulatory oversight being balanced against aggressive commercialization pressures?

This is an important and complex question. In the more formal and structured parts of fertility care, we are beginning to see stronger government regulations, periodic inspections, and clearer frameworks for how clinics should operate. Ethical practices and regulatory oversight, however, still have scope for significant improvement. One of the biggest hurdles is corruption, which can undermine the very regulations meant to protect patients. Removing such barriers is critical.

Accreditations such as NABH are important strides in the right direction, helping ensure clinics are adhering to ethical standards and focusing on the right treatments for patients. At the same time, ethics in fertility care goes beyond compliance. It requires a culture of transparency and responsibility. Patients, too, play a role; they must ask the right questions, do their research, and ensure they trust the clinicians, the care team, and the brand they are choosing.

Ensuring ethical balance against commercialization requires multiple layers: accreditation and regulatory frameworks, strong clinical audits, regular outcome reviews, and a team-based approach to patient care. Only then can India’s fertility sector grow responsibly while maintaining the trust of patients from both within the country and abroad.

As stem-cell therapies and AI-driven fertility diagnostics gain momentum globally, what breakthroughs could realistically redefine infertility care pathways in India’s future?

There are several exciting breakthroughs on the horizon that could redefine infertility care in India. Globally, we are seeing a surge of new technologies, therapies, and diagnostic tools, many of which are going through clinical trials and validation. The advantage for India is that it is an open and rapidly adapting market, which means these innovations are both emerging locally and being introduced through international startups and collaborations.

For example, at Milann, we have already implemented an AI-driven embryology tool to support incubating eggs and improving embryo selection. This kind of technology enhances precision in treatment and directly improves outcomes. Stem-cell therapies are another promising area. Today, we are using two to three different approaches with stem cells in IVF, which have shown encouraging results in improving implantation rates, supporting positive beta-hCG outcomes, and ultimately leading to higher pregnancy success.

This also has benefits in improving sperm parameters, including in some cases of azoospermia. Equally important is the progress in diagnosing and treating male infertility. In the past, sperm with low motility or quality were often set aside. Now, with advanced technologies, we are able to better analyze sperm health, select viable sperm, and optimize chances for fertilization.

Together, AI-driven diagnostics, stem-cell therapies, and continuous innovations in fertility science are not just improving success rates; they are reshaping how we think about infertility care, making pathways more precise, personalized, and hopeful for couples in India.