For millions of Indians trying to conceive, the challenge is not necessarily the absence of medical technology. In many cases, the bigger question is whether a person can reach the right specialist at the right time, understand what is happening, undergo the right diagnostic evaluation, and receive care that is appropriate for their individual needs.
This is where I believe the conversation around fertility care in India needs to evolve.
We often speak about IVF, advanced laboratories and new technologies, but fertility care is much bigger than that. It is about access to care, awareness, timely diagnosis, clinical expertise, appropriate technology and, importantly, informed decision-making.
Infertility is a significant healthcare concern. The World Health Organization estimates that approximately one in six people of reproductive age experience infertility during their lifetime. It may involve male factors, female factors, both partners, or sometimes no immediately identifiable cause. Whatever the diagnosis, timely evaluation and the right medical guidance can make an important difference in determining the next step.
India has made substantial progress in assisted reproductive technology. Fertility specialists, embryologists and laboratories today have access to diagnostic systems and techniques that were not available a few decades ago. But advanced treatment alone cannot address every fertility concern.
The questions we need to ask are fairly simple.
{{/usCountry}}The questions we need to ask are fairly simple.
{{/usCountry}}Can a patient reach the right specialist in time? Can the underlying concern be identified accurately? Does the couple have access to the right diagnostic systems and clinical expertise before making a treatment decision? These questions matter because good fertility care is not about doing more. It is about doing what is right for the individual patient, at the right time.
For someone living in a smaller town or rural area, accessing specialised fertility care can mean travelling to a major city. And fertility treatment is rarely limited to one consultation. There can be investigations, monitoring, procedures and follow-up visits, sometimes over a considerable period of time.
This is why India needs stronger referral networks and wider access to reproductive-health services beyond major urban centres. Public-private partnerships can play a role in taking specialized services closer to people through secondary and tertiary health care facilities. Primary healthcare centres, too, can have a much stronger role in recognising concerns early and referring patients to the right level of care.
At the same time, we need to remember that fertility care should begin with the simplest and most appropriate clinical pathway.
Natural conception should remain the first level of care wherever clinically appropriate. Not every patient needs IVF or another assisted reproductive technique. Some may benefit from medical treatment, surgery, counselling, lifestyle guidance or simply a better understanding of when it is the right time to seek specialist advice.
The objective should be timely and evidence-based evaluation, rather than automatically moving every patient towards advanced treatment.
A tiered approach can help people receive the right care at the right stage. It can also reduce delays, unnecessary investigations and the confusion that often comes from misinformation.
Fertility care has changed significantly over the years. We have better diagnostic systems, improved laboratory technology and greater clinical expertise than ever before. A comprehensive evaluation can help identify factors that may influence conception, including menstrual and ovulatory disorders, endometriosis, polycystic ovary syndrome, tubal factors and male-factor infertility.
This is why the quality of the initial assessment matters so much.
The right diagnosis can help determine whether a couple needs medical management, surgery, fertility counselling, timed conception or assisted reproductive treatment. Fertility treatment is also not simply about having access to a machine or a laboratory. It depends on trained clinicians, skilled embryologists, specialised laboratories and strong safety and quality systems.
Advanced technology must therefore go hand in hand with clinical expertise, appropriate counselling, transparent processes and robust quality standards. Technology should support clinical decision-making, not replace it.
At the centre of all of this has to be the individual patient — understanding their situation, their medical history and their needs, and then choosing the intervention that is medically appropriate for them.
One of the challenges we continue to see is that many people wait for years before seeking medical advice. Some rely on information they find online. Others continue trying to conceive without understanding the possible role of age, menstrual disorders, endometriosis, polycystic ovary syndrome, male-factor infertility, or other medical conditions.
There is also a larger conversation we need to have around how we look at infertility.
Infertility is not primarily a woman’s problem. Fertility is a shared reproductive-health issue, and both partners should be encouraged to undergo appropriate evaluation from the beginning. The male partner should not be tested only after female factors have been ruled out.
Awareness should also not begin only when someone starts trying to conceive. Reproductive-health education needs to help people understand fertility, menstrual health, sexually transmitted infections, lifestyle factors and when medical advice may be appropriate.
But this information needs to be communicated responsibly.
The purpose of awareness should be to help people make informed decisions — not to create fear, unrealistic expectations or pressure to undergo unnecessary tests and procedures. People should also understand that seeking medical advice does not automatically mean undergoing assisted reproductive treatment. Sometimes, the most important intervention is simply understanding what is happening and knowing what the next appropriate step is.
The World Health Organization’s first global guideline on the prevention, diagnosis and treatment of infertility, issued in November 2025, highlights the need for fertility care that is safer, more accessible and better integrated into health systems. For India, this is an opportunity to strengthen the entire pathway through which people enter fertility care. That means building effective referral networks, improving diagnostic and clinical capabilities, strengthening counselling and ensuring continuity of care across different levels of the healthcare system. It also means collecting better data.
We need to understand who is accessing fertility services, where the gaps exist, and which interventions are providing the greatest clinical benefit. A stronger fertility-care ecosystem cannot be built only by increasing the number of advanced treatments centres. It requires greater awareness at the primary-care level, better coordination between healthcare providers, and timely access to specialists when they are needed.
As fertility-care providers, our responsibility is not limited to offering advanced treatment. It is also about helping people reach the right care sooner, understand their options clearly, and make decisions based on sound medical advice. India’s progress in fertility care should not be measured only by the number of IVF centres or procedures performed.
We should also ask: Are patients being evaluated early enough? Are underlying concerns being diagnosed effectively? Are people receiving the right care at the right stage?
These are equally important measures of how our fertility-care system is evolving.
Fertility care needs to continue becoming a more integrated part of mainstream healthcare. Timely information, advanced diagnostic systems, clinical expertise and appropriate medical support can help people make better-informed decisions about their reproductive health. And wherever clinically appropriate, natural conception should remain the first level of care, with advanced fertility treatments considered when they are medically indicated.
Ultimately, the goal should be simple: A fertility-care system where people can identify concerns early, reach the right expertise and receive the appropriate care without unnecessary delays.
(The views expressed are personal)
This article is authored by Anjali Ajaikumar, director, Milann Fertility and Birthing Hospital.