Why infertility is a public health crisis

This article is authored by Abhishek Aggrawal, CEO, Birla Fertility & IVF.

Public health conversations usually focus on diabetes, cancer, air pollution or mental health. Infertility rarely enters that list even though it affects more people than many conditions we routinely recognise as health crises. According to the World Health Organization (WHO), one in six people worldwide experiences infertility at some point in life. That is about 17.5% of the global population and far too significant to ignore.

Reasons behind infertility issues (Image by jcomp on Freepik)

The comparison with other conditions is revealing. Type 2 diabetes affects around one in ten adults globally and receives consistent policy attention and investment. Infertility affects even more people, yet it remains missing from national health plans in most countries. This gap between the scale of the problem and the response to it is exactly why infertility must be recognised as a public health priority.

WHO recognises infertility as a disease of the reproductive system. The global burden is substantial. About 186 million people live with infertility. India alone accounts for an estimated 27.5 million couples affected, nearly a quarter of the global total.

Access to diagnosis and treatment remains limited. Fertility care is largely paid out of pocket and is often financially overwhelming. In many countries, the cost of one IVF cycle exceeds the average family’s annual income. Studies show that 70% of women who undergo IVF take on debt, and nearly one third stop treatment because they cannot afford to continue. Where insurance coverage exists, continuity and outcomes improve significantly, which shows how central affordability is to care.

The emotional burden is equally serious. Anxiety, stress, stigma and isolation are common among people facing infertility. Women often face disproportionate blame even though male factor infertility contributes to nearly half of all cases. Mental health support is rarely integrated into fertility care despite a clear need for it.

Infertility rates are rising due to factors that go beyond age. Lifestyle changes, environmental stress and occupational exposures all play a role. Evidence linking air pollution, untreated sexually transmitted infections and endocrine-disrupting chemicals to infertility has strengthened. Awareness has increased, but action has not kept pace.

WHO recently released its first global guideline on infertility, offering 40 recommendations that cover prevention, diagnosis, treatment pathways and psychosocial support. It signals rising global recognition, but its value depends entirely on how countries act on it.

Infertility is shaped by environmental, biological and social realities. Air pollution, pesticides, heavy metals and endocrine-disrupting chemicals all affect reproductive health. Nearly 20% of Indian women of reproductive age live with Polycystic Ovary Syndrome (PCOS), a metabolic disorder strongly linked to lifestyle and a major contributor to infertility.

Male infertility also requires more attention. Around half of all infertility cases involve male factors. Exposure to high heat in industrial jobs, chemical contact, long sedentary work hours, excessive exercise and unregulated supplement use all affect male reproductive health. The lack of conversation around male infertility delays diagnosis and increases stigma.

These are not isolated medical issues. They are systemic public health challenges. Addressing them requires regulation, workplace protections, environmental safeguards and early education, not just clinical treatment.

Infertility must be integrated into national health strategies with clear goals and measurable progress. For India, several steps are essential.

• Policy integration: Include infertility within national reproductive health goals and track outcomes.
• Financial protection: Introduce insurance coverage for basic fertility assessments and first-line treatments. Cost is the biggest barrier to care.
• Better data: Systematic data collection on prevalence, causes and treatment outcomes is essential for targeted policy action.
• Fertility education: Provide accurate information on how age, lifestyle and health conditions affect fertility. Education must begin early.
• Prevention at scale: Many causes are preventable. In developing countries, untreated sexually transmitted infections account for nearly 70% of pelvic inflammatory disease cases that often lead to tubal damage.
• Private sector role: Clinics must contribute through awareness building, transparent pricing, ethical practice and adoption of advanced technologies.

WHO’s leadership on this issue is clear. As Dr Pascale Allotey has stated, the prevention and treatment of infertility must be grounded in gender equality and reproductive rights. Supporting people to make informed choices is both a health imperative and a matter of social justice.

The forces driving infertility today are not individual shortcomings. They are systemic failures. Pollution, high-risk workplaces, lack of early information, unaffordable care and persistent gender biases all contribute to a burden that continues to grow. These challenges must be recognised and addressed at the national level.

If infertility continues to be treated as a private struggle, millions will remain without support. Global recommendations exist, but real progress will come from local implementation, accountability and collaboration among government, medical societies and patient groups.

The move from silence to open discussion, from stigma to support and from individual burden to shared responsibility will show how seriously we value reproductive health. For the 27.5 million couples in India and the 186 million people worldwide living with infertility, the need for action is immediate. Infertility is a public health issue and must be treated as one.

This article is authored by Abhishek Aggrawal, CEO, Birla Fertility & IVF.