When parenthood is an expectation but remains out of reach, the consequences extend far beyond the clinic walls.
In a country known for its billion-strong population, a silent struggle affects millions of couples who find themselves unable to conceive. While India's population continues to grow, with fertility rates declining to near-replacement levels (1.9 in 2025 according to UN estimates), the painful reality of infertility remains largely overlooked in public health discourse and policy 9 .
Imagine the pressure faced by approximately 22-23 million Indian couples who are unable to conceive despite their efforts—a number highlighted by the Indian Council of Medical Research 4 . In a society where motherhood is often equated with womanhood and cultural expectations prioritize procreation, the consequences of infertility extend far beyond biological factors, creating ripple effects across mental health, marital stability, and social standing.
Couples Affected
Secondary Infertility Rate
ART Centers
When a woman has never conceived despite regular unprotected intercourse for at least 12 months.
When a woman cannot conceive after having previously carried a pregnancy to term.
| State/Region | Total Fertility Rate (2022) | Infertility Pattern |
|---|---|---|
| Bihar | 3.0 | High fertility, but rising secondary infertility |
| Uttar Pradesh | 2.6 | Similar to lower middle-income countries |
| Southern States | 1.3-1.6 | Very low fertility, varied infertility issues |
| Tamil Nadu | 1.3 | Matches Japan's fertility rate |
Data from Registrar General of India's 2022 report and analysis of NFHS data 7 9
A clear inverse relationship exists between a woman's education level and her fertility outcomes. In Chhattisgarh, for instance, illiterate women have a TFR of 3.9, while those with graduate degrees or above have a TFR of 1.9. Similar patterns are observed across states, highlighting how educational empowerment changes reproductive outcomes 9 .
The psychological impact of infertility in India is profound, with women disproportionately affected. A 2023 study conducted at a tertiary healthcare hospital in Delhi examined couples seeking infertility treatment and revealed striking findings:
| Psychological State | Prevalence in Wives | Prevalence in Husbands | Statistical Significance |
|---|---|---|---|
| Depression | Significantly Higher | Lower | P < 0.1 |
| Anxiety | Significantly Higher | Lower | P < 0.1 |
| Stress | Significantly Higher | Lower | P < 0.1 |
| Primary Infertility Impact | More severe psychological impact | Less pronounced impact | Significant for wives' depression (P < 0.05) |
Data from hospital-based study using DASS-21 questionnaire 2
The research found that wives consistently showed higher levels of depression, anxiety, and stress compared to their husbands. Those experiencing primary infertility (never having conceived) suffered more severe psychological consequences than those with secondary infertility 2 .
In the Indian context, where cultural narratives strongly link womanhood with motherhood, infertility carries significant social stigma that extends beyond individual psychology:
A systematic review of social determinants of mental health among infertile women found that factors like higher education, employment, and stronger social support correlated with better mental health outcomes. Unfortunately, these protective factors are not equally accessible to all Indian women .
India has emerged as a significant player in assisted reproductive technology (ART) since the birth of the country's first IVF baby in 1978. The sector has expanded dramatically, from approximately 500 ART centers in 2010 to over 1,500 in 2019 4 .
Birth of India's first IVF baby
Approximately 500 ART centers across India
Over 1,500 ART centers operating in the country
ART (Regulation) Act passed to establish clearer guidelines
This growth, however, has faced challenges in standardization and regulation. As one study notes, "There is no standardization of protocols and reporting is very inadequate. Furthermore, there are only ART guidelines and no law still exists" 3 . The recent ART (Regulation) Act of 2021 aims to address these concerns by establishing clearer guidelines for clinics and procedures.
Perhaps the most significant barrier to infertility treatment in India is its cost:
| ART Service | Extent of Utility | Affordability & Access |
|---|---|---|
| ICSI-ET | High | Mostly private sector, costly |
| Conventional IVF-ET | Medium | Limited to those who can afford |
| Donor Oocyte/Donor Sperm | Medium-High | Available but expensive |
| Frozen Embryo Transfer | Medium-High | Increasingly available |
| Fertility Preservation | Medium | Limited to urban centers |
| Surrogacy | Medium | Now restricted to altruistic surrogacy |
Data on ART service utility adapted from current review of fertility care 4
ART services in India are predominantly offered through the private sector, with limited government support. The high cost of treatment cycles and lack of insurance coverage create significant barriers for many couples 4 . This creates a troubling equity gap where biological parenthood becomes a privilege largely accessible only to those with sufficient financial means.
Based on the current evidence, several critical areas demand attention from social science researchers:
Future research must examine how economic status, gender, education, and social status (caste or tribe) interact to shape infertility experiences and access to treatment. The CSDH (Commission on Social Determinants of Health) framework provides a useful model for understanding these interrelationships 1 .
Developing culturally appropriate counseling and support mechanisms for infertile couples, particularly women, represents an urgent priority. Research should explore how traditional family structures and community resources can be mobilized to provide support.
With the recent passage of the ART Regulation Act and surrogacy legislation, research must track how these policies are implemented and their impact on treatment access, safety, and affordability across different socioeconomic groups.
The near-exclusive focus on women in infertility research needs correction. Studies must actively include male experiences and perspectives to develop a complete understanding of infertility's psychological and social impacts.
Social science research on infertility requires specialized methodological approaches:
Combining quantitative surveys with in-depth qualitative interviews
Tracking couples over time to understand evolving experiences
Examining differences across India's diverse regions
Involving people experiencing infertility in research design
Evaluating policies for their equity implications
Infertility in India represents more than just a medical condition—it is a complex socio-cultural phenomenon with far-reaching consequences for individuals, relationships, and communities. As India continues its demographic transition, with declining fertility rates nationwide, the needs of those unable to conceive must not be forgotten.
Addressing infertility requires a multidisciplinary approach that brings together medical specialists, mental health professionals, social scientists, policymakers, and community leaders. Only through such collaborative effort can we develop comprehensive solutions that address both the biological and social dimensions of infertility.
The time has come to recognize infertility as a significant public health issue in India—one that deserves research funding, policy attention, and societal awareness comparable to other reproductive health concerns. By bringing this hidden struggle into the open, we can begin to build a more supportive and inclusive society for the millions of Indians navigating the challenging path of infertility.