A growing global reproductive health concernSo what is Infertility?
South Asia: a region facing a rising burdenIn South Asia, the infertility rate has increased faster than the global average.
Between 1990 and 2023, South Asia saw its age-standardised infertility prevalence rate rise from 5,255 per 100,000 women to 6,322 per 100,000.
The annual increase in South Asia was 1.53 percent, compared with the global increase of 0.45 percent.
Research shows increased consumption of junk food can disturb metabolism, in turn affecting reproductive health in both women and men.
For decades, infertility was viewed as a private struggle faced by couples, while some got lucky after treatment and others spent years trying to conceive. The story seems to have changed now.
A new study, however, shows that delayed childbearing is driving a major public health challenge- rising infertility among women in their late 30s and 40s.
A study published in the Lancet Obstetrics, Gynecology and Women’s Health estimates that more than 53 million women aged 35-49 years worldwide were living with infertility in 2023. The researchers warn the number could rise by nearly 50 percent in another ten years, reaching 80 million by 2036.
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The study is being called one of the most comprehensive assessments of infertility trends, as it analysed data from 204 countries and territories between 1990 and 2023 as part of the Global Burden of Disease 2023 study.
A growing global reproductive health concern
So what is Infertility?
According to the World Health Organization (WHO), infertility is the failure to achieve a clinical pregnancy after 12 months of regular unprotected intercourse. This study, however, focuses on women aged 35-49, for whom age-related fertility decline is a key factor.
The Lancet analysis found that the global age-standardised infertility prevalence rate increased from 6,001 per 100,000 women in 1990 to 6,907 per 100,000 in 2023. The burden has increased steadily, with prevalence rising by about 0.45 percent every year over the three decades studied. The projections are more worrying, as this age group is likely to see a 50 percent increase in the coming decade.
Why are more women facing infertility?
One of the biggest drivers is a worldwide shift towards delayed parenthood.
“Women today are more conscious about themselves, spending more years in education, entering the workforce, and delaying marriage and pregnancy. Economic pressures, career goals, and changing social norms have transformed reproductive choices,” said Dr Geeta Chadha, renowned obstetrician and gynecologist at Indraprastha Apollo Hospitals, Delhi.
However, biology has not changed at the same pace.
“Women’s fertility declines with age, particularly after 35 years,” the study notes. Dr Chadha agreed, “With age-related changes, a woman’s ovarian reserve gets affected. So does egg quality and pregnancy outcomes.”
This delays conception and reduces the chances of a successful pregnancy. The risks of miscarriages also increase, and treatments become less successful.
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The increase in infertility rates, according to her, can also be linked to improved awareness, better diagnosis, and greater availability of assisted reproductive technologies (ART), which means more couples are seeking medical help than before. Dr Chadha adds that better awareness, improved diagnosis and wider availability of assisted reproductive technology (ART) have also contributed to the increase. More women are now seeking medical care and therefore being captured in health datasets, whereas many would previously have remained undiagnosed.
South Asia: a region facing a rising burden
In South Asia, the infertility rate has increased faster than the global average.
Between 1990 and 2023, South Asia saw its age-standardised infertility prevalence rate rise from 5,255 per 100,000 women to 6,322 per 100,000. Among world regions, South Asia recorded the second-highest infertility burden after East Asia.
The annual increase in South Asia was 1.53 percent, compared with the global increase of 0.45 percent.
Why India needs to pay attention
The Lancet study does not provide a separate estimate for India, but the country’s position within South Asia makes the findings highly relevant.
India is undergoing a demographic transition, with both birth and death rates declining. The region also presents a complex picture: while many women still struggle with limited access to reproductive healthcare, urban populations are increasingly seeing women enter higher education in larger numbers, participate more in the workforce, and delay marriage and childbirth.
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“A pregnancy in the late 30s is not impossible, but the biological window narrows. Many couples who postpone parenthood may discover fertility challenges at a stage when treatment options are more limited and expensive,” says Dr Sudha Prakash, former HOD, Department of Obstetrics and Gynecology, and a leading infertility expert.
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“The best chances are till 35 to 38 years of age. By the time many couples seek help, they may already have lost valuable reproductive time,” she says.
For India, unequal access to care is also a major issue. ART technologies such as IVF have expanded rapidly, but treatment remains expensive and is concentrated mainly in urban centres. While the expenses are out-of-pocket, many couples also face emotional and social pressure.
There is also a biological challenge.
“In the Indian scenario, we often see ovarian ageing occurring earlier compared with Western populations. In many Western women, we may still see a good egg reserve even in their mid-40s, but in Indian women, the decline can occur around five years earlier due to genetic and other factors. I have seen women as young as 38 years coming for IVF with a very low egg reserve, sometimes producing only one or two eggs,” Dr Prasad says.
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Dr Prasad highlights a few points affecting fertility, underscoring the need to pay attention to them.
Infertility is not only a female issue. Men report problems with sperm count, movement, and morphology.
Environmental factors, lifestyle changes, and exposure to pollutants affect fertility in both genders. Research shows increased consumption of junk food can disturb metabolism, in turn affecting reproductive health in both women and men. Sleep deprivation, night shifts, and chronic stress can affect hormones.
Increased smoking and alcohol use affect both egg quality and sperm health, reinforcing how fertility concerns extend beyond women alone.
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