Medically Reviewed
By Dr. Puneet Rana Arora : Founder & Director, CIFAR — Centre for Infertility & Assisted Reproduction, Gurugram FRCOG (Royal College of Obstetricians & Gynaecologists, UK) | MSc Reproduction & Development, University of Bristol, UK
Last Review Date : 14 August, 2026
Insights from Dr. Puneet Rana Arora, Gynecologist & Reproductive Medicine Specialist, CIFAR Gurgaon
Fertility care in India is undergoing a quiet but significant transformation. More couples are seeking help, they’re seeking it earlier, and the reasons they need it have shifted dramatically over the past three decades. To understand what’s really happening on the ground, we spoke with Dr. Puneet Rana Arora, a gynecologist and reproductive medicine specialist practicing at CIFAR, Gurgaon, in a candid conversation at the 7th IBF Awards session, powered by IHW Council.
Infertility Is Rising — And So Is the Age of Patients
According to Dr. Arora, the numbers speak for themselves: the incidence of infertility in India is climbing, and so is the average age of couples walking into fertility clinics. Male fertility isn’t immune either — she has observed a steady decline in semen parameters among male partners over the years.
“There’s a lot of shift towards infertility — the number of patients we see, and the age at which we see them, has increased,” she noted.
The Root Causes Have Changed
Three decades ago, blocked fallopian tubes caused by infections were among the most common culprits behind infertility. That picture looks very different today.
Modern causes are far more closely tied to delayed childbearing, declining ovarian reserve, and lifestyle factors. Because women are born with a fixed number of eggs, Anti-Müllerian Hormone (AMH) levels — a key marker of ovarian reserve — naturally decline with age. Add to that chronic workplace stress and inadequate sleep, both of which affect egg and sperm quality, and the causal landscape of infertility has been rewritten. Infections, once the leading cause, have taken a back seat to ovarian reserve and semen quality as the dominant factors today.
Fertility Preservation is Gaining Ground — Even in Tier 2 Cities
One of the more encouraging trends Dr. Arora highlighted is the rising awareness around Fertility preservation, or egg freezing, even in Tier 2 cities. Thanks to greater visibility through platforms and public conversations, more women are proactively freezing their eggs well before they plan a pregnancy.
Interestingly, she pointed out a kind of split pattern: while some patients in these cities are freezing eggs for the future, others are simultaneously seeking treatment to use their gametes now. It’s a sign that awareness — and access — is expanding on both ends of the fertility spectrum.
Busting the Big Myths
Dr. Arora addressed some of the most persistent misconceptions she encounters in her practice:
- “IVF guarantees pregnancy.” It doesn’t. IVF is science, not certainty — every individual has their own success probability, and outcomes cannot be generalized.
- “An IVF baby is somehow different.” It isn’t. The only difference lies in how conception is achieved; the embryo and the resulting child are no different from a naturally conceived one.
- “Waiting a little longer with home remedies will work.” Perhaps the most damaging myth: many couples try alternative therapies for years before seeking professional help, unaware that the odds of natural conception drop sharply after two years of trying.
When Should Couples Actually Seek Help?
Timing, Dr. Arora emphasized, should be guided primarily by the woman’s age:
- Under 3 years: Trying for up to one to two years before seeking evaluation is reasonable.
- More than 35 years: Six months of trying without success warrants a consultation.
- Above 40 years: Even three to four months is enough reason to seek guidance — not necessarily to jump straight to IVF, but to get expert advice on improving the odds, including naturally.
Why Personalized Treatment Matters More Than Ever
With rising exposure to smoking, pollution, and other environmental disruptors, Dr. Arora stressed that fertility treatment today is far from one-size-fits-all. Every couple’s probability of success — whether 30%, 40%, or 60% — depends on a unique combination of factors: sperm parameters, egg quality, uterine architecture, and endometrial health.
At CIFAR, she explained, every couple receives an individualized success rate after thorough assessment, and treatment protocols are tailored accordingly rather than applied as a blanket approach — a philosophy she credits for the clinic’s stronger outcomes.
From Counseling to Cutting-Edge Technology
Perhaps the most striking shift Dr. Arora described is how fertility care, not just fertility treatment, has evolved. Recognizing how mentally taxing failed cycles can be, clinics like CIFAR now integrate dedicated psychological counselors into the patient journey to help couples navigate the process in a less stressful environment.
On the technology side, advances have been just as significant:
- IVF labs now operate under triple-filtration systems and strict quality-control accreditations, given the sensitivity of embryo development.
- Advanced sperm-selection techniques like Zymot and PICSI, along with genetic analysis of embryos and endometrial receptivity assessments (ERA), are now used to address repeated failures far earlier than before.
The result: clinics rarely see couples with ten failed cycles anymore. Intervention with advanced technology typically begins after just one or two failures, significantly reducing the overall time to pregnancy.
The Barrier That Remains: Cost
Despite the scientific progress, Dr. Arora was direct about the biggest obstacle still facing Indian couples — the financial burden of fertility treatment. Multiple cycles, especially when combined with advanced technologies, can quickly become expensive.
She pointed to models in some Western countries, where governments subsidize one or two IVF cycles, as a possible direction for India. “We are very advanced in our technology, we are very advanced in our science,” she said, “but the financial barrier remains the biggest challenge right now.”
The Takeaway
India’s fertility landscape is shifting — from reactive treatment to proactive preservation, from generic protocols to personalized care, and from purely clinical intervention to holistic, counseling-supported journeys. As Dr. Puneet Rana Arora’s insights make clear, the science has advanced considerably. What remains is making that science more accessible, affordable, and timely for the couples who need it most.
This article is based on an interview conducted at the 7th IBF Awards, powered by IHW Council.
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