From delayed pregnancy to PMOS: Navigating the infertility burden in women

Because the desire for a biological child is tied to deep emotional expectations and familial pressure, many women find themselves trapped in a cycle of repeated IVF attempts.

“If you [insert diet/supplement], you will get pregnant right away.” “Just relax, go for a vacation” “When will we get to play with our grandchild?” Unwanted suggestions and subtle taunts drain a woman. 

Infertility carries deep social stigma, and more often than not, women are blamed for the inability to start a family. While traditionally considered a woman’s problem, infertility affects both men and women equally, particularly driven by a poor lifestyle in both. 

Over the last few decades, there has been a noticeable increase in infertility cases in both men and women. It has therefore increased in IVF consultations and treatments too, despite being an expensive procedure, particularly in urban centres, Dr Manisha Singh, a gynaecologist and sub-specialist in reproductive medicine and surgery at Fortis Hospital, Bengaluru, says. 

Several couples continue repeated IVF cycles because of emotional expectations, family pressure, social stigma around childlessness, or personal hope. In some cases, Dr Singh says, it leads to emotional burnout, financial strain, and psychological stress. 

The shift to delayed pregnancy

Over the last few decades, urban centres have seen a noticeable spike in infertility cases. This has naturally led to a surge in IVF consultations, despite the procedures being notably expensive.

Dr Manisha Singh, a gynaecologist and sub-specialist in reproductive medicine and surgery at Fortis Hospital, Bengaluru, explains that many couples now wait until their late 30s to try for a baby. "Couples are focused on establishing their careers, budgeting for the future, or securing a specific lifestyle," Dr Singh says. However, because a woman’s ability to conceive naturally diminishes with age, delaying conception has become a primary driver for fertility interventions.

Beyond age, modern life itself is throwing hormones out of balance. Dr Singh notes that high stress, poor sleep patterns, smoking, alcohol consumption, thyroid imbalances, and conditions like Polycystic Ovary Syndrome (PCOS) are collectively causing a decline in fertility across the board.

Major causes of infertility 

Infertility is rarely a straightforward issue in women; common causes include Polyendocrine Metabolic Ovarian Syndrome (PMOS), endometriosis, blocked fallopian tubes, reduced ovarian reserve, hormonal imbalance, thyroid disorders, and delayed conception due to age-related decline in fertility. Dr Anita David, infertility specialist, Hosmat Hospital, Bengaluru, says, PMOS is one of the leading causes of infertility in most women. 

Historically, the prevalence of Polycystic Ovarian Syndrome (PCOS), recently changed to PMOS, was estimated at 8.4 per cent. However, studies have noted that recent assessments indicate that the actual prevalence is much higher. 

Dr David notes that stress and lifestyle issues are the common denominators today, "From academic pressure to the relentless hustle at work, everyone seems to be affected, regardless of gender."

The Toll of the IVF Journey

Because the desire for a biological child is tied to deep emotional expectations and familial pressure, many couples find themselves trapped in a cycle of repeated IVF attempts. Dr Singh warns that this can quickly spiral into severe emotional burnout, financial strain, and psychological stress, making psychological counselling and realistic expectation-setting an absolute necessity during treatment. 

Undergoing IVF treatments can take a severe toll on a woman’s mental health. No two IVF treatments are the same. Each person involved experiences various physical, mental, and emotional effects that differ from others. Choosing to undergo IVF treatment is in itself a big decision. Beyond that the two-week waiting period inducing uncertainty of results, and experiencing a failed treatment can cause a significant mental health effect. 

Experts explain that an IVF cycle does not give a 100 per cent chance of a successful conception and hence requires multiple attempts for some couples. The chance of having a baby through IVF depends on various factors, such as age, egg quality, sperm quality, underlying medical conditions, and embryo quality. In general, younger women tend to have better success rates compared to women above 35–40 years. Live birth rate is considered the most meaningful outcome rather than only a positive pregnancy test.

Furthermore, the medical process itself carries specific risks for women with PCOS, they face a higher risk of Ovarian Hyperstimulation Syndrome (OHSS)—an exaggerated response to the fertility drugs used to stimulate egg production.

"Patients with PCOS have a higher average number of follicles present in their ovaries," explains Dr Rekha Venugopal, a gynaecologist at Bridge Health. "Their ovaries are highly sensitive to the hormones used during the cycle, which increases the risk of OHSS." While the incidence varies between 20% to 30%, Dr Venugopal reassures that it is manageable. High-risk women are carefully monitored and given lower, tailored doses of hormone stimulation.

Do not lose hope or panic

Dr Venugopal says, most women with PMOS can conceive naturally. She recommends simple changes like avoiding eating at erratic hours, ensuring good sleeping patterns, while maintaining a worklife balance can be greatly beneficial.  “Even five to ten per cent of weight loss can result in improving hormonal and metabolic reset, regularity of menstrual cycles and thereby restoring ovulation.”

Ultimately, navigating infertility requires more than just medical science; it needs a shift in societal empathy. By breaking the stigma, addressing lifestyle stressors early, and centering mental healthcare alongside clinical treatments, couples can be better supported through one of the most challenging journeys of their lives.