Explained: Causes Of The Rising Infertility Rates In Urban Indian Couples, According To Specialists

Urban India is witnessing a sharp shift in fertility patterns, as delayed parenthood, lifestyle changes, and health risks collide with biological reality. While awareness has improved, a critical gap between knowledge and timely action continues to impact outcomes. Under the Assisted Reproductive Technology (ART Regulation) Act, 2021, women are permitted to undergo assisted reproductive procedures such as IVF between the ages of 21 and 50. However, while the law defines an upper age limit, advancing maternal age is associated with increased risks, including pregnancy complications and lower success rates. Experts say that fertility decisions should be guided by health status, ovarian reserve, and overall clinical assessment, rather than age alone.

Lifestyle and Environmental Pressures

The shift in fertility patterns has become increasingly evident, driven largely by lifestyle changes. Dr. Vidya V. Bhat, Medical Director of Radhakrishna Multispeciality Hospital, Bengaluru noted, “Postponing pregnancy, often into the 30s when ovarian reserve is already declining, is a major factor. In urban India, lifestyle and environmental factors are increasingly impacting reproductive health for both men and women.”

She explains that a sedentary lifestyle, poor diet, chronic stress, smoking, alcohol use, and screen exposure are contributing to hormonal imbalances, ovulatory disorders like PCOS, and declining sperm quality; including lower counts, reduced motility, and abnormal morphology. Environmental exposures such as heat, pollution, and endocrine-disrupting chemicals further compound these effects. “In clinical practice, there is a marked increase in irregular cycles, anovulation, and unexplained infertility: issues that are now seen almost daily rather than occasionally,” she added.

Action Gap in Urban Couples

An embryologist and an IVF mother, Rishina Bansal, Clinical Embryologist and Co-founder of Archish Fertility emphasized that the focus must shift from crisis-driven decisions to timely action and awareness to informed, early-action planning. She told ETV Bharat's Anubha Jain, “Clinically, a large proportion of patients present only after years of trying, by which time biological factors have already shifted unfavourably. Fertility continues to be treated as an issue to address only when problems arise, rather than something to plan for proactively; an approach that ultimately limits success rates. Workplaces, too, have a critical role to play. Through fertility benefits, knowledge, and by fostering an environment where such conversations are free from stigma.”

With demanding careers becoming the norm, Bansal addressed how urban couples can balance professional ambitions with biological timelines and highlighted the biggest misconception surrounding delayed parenthood. She added that despite being informed, women often overestimate how much control they have over biological timelines. Ovarian reserve and egg quality decline silently, often narrowing the fertility window before visible signs appear. Balancing career and parenthood is entirely possible, but it requires early planning like assessing ovarian reserve in the early 30s and considering options like egg or embryo freezing, if pregnancy is likely to be delayed. A major misconception is the belief that conception can happen whenever one is ready, influenced by global narratives, or that reproductive timelines remain flexible indefinitely due to IVF.

Early Screening and Preconception Care Matter

With rising infertility, speaking on the importance of early screening and preventive care in identifying risks, Dr. Vidya V. Bhat said, “Timely evaluation is crucial yet often overlooked. Conditions such as hormonal imbalances and endometriosis may not show obvious symptoms initially, leading many women to ignore subtle signs like irregular periods, painful cycles, or persistent fatigue.” Timely detection allows for more effective intervention and can even prevent disease progression. Early management of PCOS can help restore ovulation and significantly improve fertility outcomes, while early diagnosis of endometriosis can protect reproductive health before it affects the ovaries or fallopian tubes. Preventive care and fertility discussions should begin in the late 20s or early 30s, especially for those delaying pregnancy.

On whether fertility testing and egg freezing should be discussed earlier, Dr. Bhat said, “While many women are well-informed about general health, understanding of fertility, especially concepts like ovarian reserve, remains limited and some still struggle to fully grasp these ideas. A common misconception is that regular periods equate good fertility, which is not always true. Ovarian reserve can decline silently without noticeable symptoms.”

Simple assessments, such as Anti-Müllerian Hormone (AMH) — a key marker of the number of eggs remaining in the ovaries — testing and ultrasound, can offer valuable insights into reproductive health. Egg freezing is a personal choice, but it should be introduced into the conversation sooner rather than later, as outcomes are closely linked to age.

The Overlooked Role of Male Fertility

While fertility discussions often focus on women, male infertility is equally significant and warrants much greater attention. Speaking on this, Clinical Embryologist Navin Desai noted, “Fertility planning often remains skewed toward women, delaying shared responsibility. Male fertility also declines with age (particularly sperm quality and DNA integrity) yet men rarely undergo early testing or factor fertility into life planning.”

He emphasized that couples must approach fertility as a joint decision, aligning career goals with biological realities. Men can contribute by opting for early assessments, maintaining a healthy lifestyle, and being preventive rather than reactive. A key misconception, he added, is that medical technology can compensate for any delay. While IVF is advanced, it cannot fully overcome age-related changes in egg or sperm quality; biology ultimately sets the baseline.

Echoing this, Dr. Bhat noted, “Male factors contribute to nearly 40–50% of infertility cases, yet they remain under-discussed and frequently overlooked. In urban India, there is a clear decline in sperm quality, including lower sperm counts, reduced motility, and abnormal morphology. It is essential to view infertility as a shared concern rather than solely a woman’s issue. Early evaluation of both partners can save time, reduce emotional stress, and lead to more effective treatment and better outcomes.”

Delayed Parenthood and Its Impact on Pregnancy Outcomes

Replying to how later age conception in urban India is affecting pregnancy outcomes, and the most common risks associated with it, Dr. Kavitha Kovi, Head of Department - Obstetrics & Gynaecology at Aster Whitefield Hospitals, said, “In urban India, pushing pregnancy to later years is linked to negative outcomes. Advanced maternal age increases risks of congenital abnormalities, gestational diabetes, hypertension, preterm birth, and cesarean delivery. Biologically, ovarian reserve declines with age; reflected by falling AMH levels.”

Lower AMH not only indicates reduced fertility but also increases the likelihood of requiring assisted reproductive techniques. Urban lifestyle factors such as stress, low physical activity, and exposure to endocrine disruptors further compound these risks, and medical advances cannot fully offset age-related biological decline.

Rishina Bansal said there is a clear shift: patients are seeking care later, often presenting with more complex fertility profiles. Delayed parenthood, stress, poor sleep, sedentary lifestyles, and metabolic disorders are directly affecting both egg and sperm quality, increasingly reflected in clinical outcomes. As a result, the demand for assisted reproductive technologies like IVF has steadily increased. However, a positive trend is that conversations around fertility are becoming more open, and patients are beginning to seek help earlier than before, which is gradually translating into improved outcomes.

Speaking on how steep the decline in fertility rates in urban India is compared to earlier decades, Dr. Kovi said that urban fertility in India has declined sharply compared to earlier decades and remains lower than in rural areas. “A key driver is the trend toward later parenthood, with many women postponing pregnancy into their 30s, when fertility is already declining. While about 90% of women can conceive naturally in their 20s, this drops significantly with age,” she explained. She added that the biggest concern is the gap between biological fertility and social/career timelines, often without adequate fertility awareness. Combined with stress and environmental factors, this may lead to higher infertility rates, increased reliance on assisted reproductive technologies, and greater pregnancy-related risks.

Dr. Kovi highlighted that many urban women miss early warning signs of declining fertility, as the changes are often subtle. “Indicators like falling AMH levels or menstrual irregularities are frequently overlooked or detected too late. There is also a common misconception that fertility issues can always be resolved later through technology, which is not always the case,” she said. Preconception care remains underutilised, with most women seeking medical help only after facing difficulty in conceiving. Fertility understanding and planning should be part of routine check-ups, not delayed intervention.

Reactive Treatment To Proactive Planning

On the challenges of affordability, awareness, and stigma in timely intervention, Bansal noted that the biggest issue is not lack of awareness, but delayed action. Many couples understand fertility decline but postpone seeking help due to cost concerns or social stigma. By then, ovarian reserve and sperm parameters are often significantly compromised, limiting treatment options and reducing success rates.

In addition, expanding insurance coverage and normalising fertility conversations (particularly around male infertility) can support earlier intervention and lead to more consistent and predictable outcomes. There is a need to shift from reactive treatment to proactive fertility planning, recognising reproductive health not as a last resort but as an essential part of preventive care.

Also read:

1. Pollution Bias In India Emerging As Key Factor To Male Infertility, Linked To 11% Sperm DNA Damage: Study
2. Can Sexual Dysfunction In Men Affect Their Chances Of Having A Baby? We Asked A Fertility Specialist
3. Reports Are Normal But Still Not Getting Pregnant? Ob/Gyn Explains Why “Normal” Tests Don’t Always Mean A Couple Is Fertility-Ready
4. The Calendar App vs. The Biological Clock: How Urban Work-Life Rhythms Are Rewriting Fertility Timelines