Infertility

What is Infertility?

Infertility is defined as the inability to conceive after 12 months of unprotected intercourse. It may involve problems with ovulation, the fallopian tubes, uterus, sperm production, sperm movement, ejaculation or hormonal function. Infertility affects couples across socioeconomic classes.

Primary infertility means that a pregnancy has never occurred. Secondary infertility means that a person has previously achieved at least one pregnancy but is unable to conceive again. Both partners are usually evaluated, as either or both may contribute.

Types of Infertility

Types of infertility include:

How Common is Infertility in India?

According to a systematic review of 2026, infertility affects around 8% of Indian women aged 15 - 49, although prevalence differs across regions and study populations. Around 27.5 million couples in India are facing infertility issues, and this figure is anticipated to increase.Millions of Indian couples struggle with infertility, which causes a great deal of social, financial and emotional strain.

Infertility rates are continuously rising in both urban and rural areas as a result of underlying medical issues, environmental difficulties and lifestyle modifications.

What are the Symptoms of Infertility?

The primary sign of infertility is the inability to conceive. You may not be ovulating if your menstrual cycle is excessively lengthy (35 days or longer), too short (less than 21 days), irregular, or nonexistent. There may be no other symptoms or indicators.

Possible early warning indicators of infertility and when a medical evaluation may be necessary are given in the table below:

Diseases Similar to Infertility

A few other conditions may also cause pregnancy-related problems, and are easy to confuse with infertility. However, their treatment approach and outcomes are distinct. The table below lists such conditions along with their critical features for your understanding:

Infertility Vs. Sterility Vs. Recurrent Pregnancy Loss

What Causes Infertility?

Infertility may result from female factors, male factors, combined factors or an unexplained cause. These can be:

What are the Complications of Infertility?

Infertility usually does not directly cause physical complications. However, it may have significant emotional, social, relationship and financial effects. Fertility treatments may also involve certain medical risks. These are:

• Ovarian Hyperstimulation Syndrome: Fertility medicines may cause the ovaries to become enlarged and painful. Severe cases may cause fluid accumulation, breathing difficulty or blood clots.

• Multiple Pregnancy: Ovulation-induction treatment or transferring multiple embryos may result in twins or higher-order pregnancies. This increases the risk of premature birth, low birth weight, gestational diabetes and high blood pressure during pregnancy.

• Ectopic Pregnancy: Fertility treatment may slightly increase the possibility of a pregnancy developing outside the uterus, usually in a fallopian tube.

• Procedure-Related Complications: Egg retrieval or fertility surgery may rarely cause bleeding, infection or complications related to anaesthesia.

• Unsuccessful Treatment Cycles: IUI or IVF may not result in pregnancy, and some couples may require repeated cycles, adding emotional and financial strain.

Careful monitoring, individualised medicine doses and appropriate embryo transfer practices can help reduce treatment-related risks.

When Should I See a Healthcare Provider?

Depending on your age, you may need to ask for assistance if you are unable to get pregnant. Below are the typical situations in which you should see a healthcare provider for infertility:

• After 12 months of regular, unprotected intercourse when the female partner is younger than 35.

• After six months, when the female partner is older than 35.

• Without delay, when the female partner is over 40.

• Earlier, when periods are absent or is very irregular or unusually painful.

• When endometriosis, pelvic infection or blocked fallopian tubes are suspected.

• After chemotherapy, radiotherapy or reproductive surgery.

• When there is known testicular disease, low sperm count or ejaculatory difficulty.

• After repeated miscarriages or a previous ectopic pregnancy.

It is recommended that both partners attend the assessment.

How is Infertility Diagnosed?

Infertility assessment usually begins with both partners, as male and female factors may occur separately or together. These tests can include:

Diagnostic Overview Table

How is Infertility Treated?

Treatment depends on the cause, duration of infertility, age of the female partner, ovarian reserve, semen findings, previous treatment and the couple's preferences. The treatment approaches often implemented for infertility are listed below:

• Treating Underlying Conditions: Thyroid disorders, raised prolactin, genital infections, diabetes and other contributing conditions may require appropriate medical treatment.

• Medication: Women who do not ovulate regularly may receive medicines that stimulate ovulation. Ultrasound monitoring may be required to assess follicle development and reduce the risk of multiple pregnancy.

• Surgery: Selected uterine polyps, cavity-distorting fibroids, adhesions, tubal conditions, endometriosis or male reproductive tract obstructions may be treated surgically.

• Intrauterine Insemination (IUI): During IUI, prepared sperm is placed inside the uterus near the time of ovulation. It may be considered for selected cases of unexplained infertility, ovulation problems or mild male-factor infertility.

• In-Vitro Fertilisation (IVF): During IVF, eggs are collected and fertilised in a laboratory before an embryo is transferred to the uterus. It may be recommended for blocked fallopian tubes, severe male-factor infertility, reduced ovarian reserve or unsuccessful simpler treatment.

• Intracytoplasmic Sperm Injection (ICSI): ICSI involves injecting a single sperm into an egg. It is commonly used for severe sperm abnormalities or when surgically retrieved sperm is required.

• Sperm Retrieval and Donor Treatment: Surgical sperm retrieval, donor sperm, donor eggs or donor embryos may be considered in selected cases after counselling and established clinical guidelines.

Common Medicines Used to Treat Infertility

The following generic medicines are often prescribed by doctors during infertility treatment:

• Letrozole: Commonly used as first-line ovulation induction for women with anovulatory infertility due to PCOS.

• Clomiphene Citrate: An alternative oral medicine that stimulates ovulation when clinically appropriate.

• Gonadotropins: Injectable FSH or related hormones may stimulate follicle development during ovulation induction, IUI or IVF.

• Human Chorionic Gonadotropin: May be used to trigger final egg maturation or treat selected men with a confirmed hormonal deficiency.

• Metformin: May be used in women with PCOS and insulin resistance, usually as metabolic treatment or alongside ovulation-induction therapy.

• Cabergoline or Bromocriptine: May restore ovulation when infertility is associated with abnormally high prolactin.

• Levothyroxine: This may be prescribed when hypothyroidism contributes to menstrual or ovulation problems.

• Progesterone: May provide luteal-phase support during selected fertility treatment cycles.

• Antibiotics: Used only when a bacterial reproductive tract infection is confirmed.

Note: Medicines depend on the identified cause and require specialist supervision. They should not be taken without a fertility assessment and monitoring.

Living With Infertility: Challenges and Patient Well-Being

Living with infertility can affect emotional health, relationships, daily routines and finances. Support from partners, family members and healthcare professionals can help individuals cope with fertility testing and treatment.

What is the Prognosis of Infertility?

Many causes of infertility can be treated or managed, but no single success rate applies to every couple. Outcomes depend on the female partner's age, ovarian reserve, infertility cause, semen quality, treatment type, duration of infertility and previous treatment response.

Some couples conceive after treating an underlying condition or using ovulation induction or IUI. Others may require IVF, ICSI, donor treatment or surgical sperm retrieval. Treatment does not guarantee pregnancy, and more than one cycle may be needed.

How Can I Prevent Infertility?

It may not be possible to prevent every cause of infertility. Genetic conditions, age-related changes, congenital abnormalities and some reproductive disorders may occur despite healthy habits. However, certain measures may protect reproductive health or support earlier diagnosis:

• Avoid smoking, tobacco, recreational drugs and anabolic steroids.

• Limit excessive alcohol intake.

• Maintain a healthy weight and remain physically active.

• Seek timely treatment for sexually transmitted and reproductive tract infections.

• Use protective equipment when working with radiation, pesticides or industrial chemicals.

• Avoid unnecessary exposure of the testes to prolonged high temperatures.

• Discuss fertility preservation before chemotherapy, radiotherapy or reproductive surgery.

• Seek timely fertility counselling when age or a medical condition may affect reproductive plans.

• Manage diabetes, thyroid disease and other chronic conditions appropriately.

Infertility Treatment Cost In India

Infertility treatment costs in India vary according to the cause, required tests, medicines, hospital type, city and whether IUI, IVF or ICSI is needed. A single IVF cycle in India can cost anywhere from ₹1,00,000 to ₹3,00,000 or more. Besides, more than one treatment cycle may be required.

A brief overview of infertility treatment components and their associated costs is given in the table below:

Note: Treatment costs can vary depending on city, hospital, medicines prescribed and the patient's existing conditions and requirements. For more accurate estimates, consult a qualified healthcare provider.

Does Health Insurance Cover Infertility?

Yes, several health insurance policies in India provide coverage for infertility treatment. The costs of assisted reproductive treatment (ART), including in vitro fertilisation (IVF) are usually covered by medical insurance plans. However, regular consultations, diagnostic tests, drugs and outpatient treatments are covered with the OPD benefit. The exact scope of coverage may vary from one health policy to another.

However, there can be a waiting period of 2 to 3 years for infertility treatment coverage, depending on the policy.

How Much Health Insurance Coverage is Needed for Infertility?

Treatment for infertility like IVF is expensive. Hence, medical insurance has become increasingly important for people pursuing ART (Assisted Reproductive Treatment), particularly those considering IVF as a potential remedy for their infertility issues.

The required coverage depends on whether the policy explicitly includes infertility or assisted reproductive treatment. A mediclaim policy with a sum insured of ₹10 to 15 lakh should be sufficient, provided it comes with an infertility cover. Thus, it is essential to check whether the plan includes doctor consultations, diagnostic tests, fertility medicines, IUI, IVF, ICSI and embryo-related procedures before purchasing.