Fertility problems plague India’s young

India's fertility rate has been deteriorating, with the 2019-21 National Family Health Survey pegging it at all-time lows

More than four decades after the birth of India’s first test-tube baby, it’s millennials, especially those in their mid-to-late 20s and early 30s, who are driving the market for fertility treatments in the world’s second-most populous nation.

That is good news for fertility chains and hospitals offering medical procedures related to assisted reproductive technology such as in vitro fertilisation (IVF), intracytoplasmic sperm injection, freezing of reproductive cells and fertility medication at hefty prices, but a grim reminder of how unhealthy the country’s younger population is.

“70 per cent of my patients are younger ones like those in their late 20s. Only 30 per cent are above 35 years. This mix was the exact opposite, say five years back,” said Arunima Haldar, Consultant - IVF & Reproductive Medicine, Manipal Hospital in Whitefield.

The reasons for rising infertility among the young include obesity, lack of exercise and use of tobacco, alcohol and drugs, according to fertility experts. Some also blamed it on the frequent exposure to heat through prolonged use of gadgets.

India's fertility rate has been deteriorating, with the 2019-21 National Family Health Survey pegging it at an all-time low of 1.6 in the urban population and 2.1 in their rural counterparts. But that’s only half the story.

Indians have also become more receptive to fertility treatment in recent years and that has led to the mushrooming of chains offering such services across the country.

Consulting firm Alvarez & Marsal India sees the fertility market tripling to Rs 15,000 Cr in FY26 from Rs 5,500 Cr in FY20.

“There is no other single speciality that is growing at this pace,” Alvarez & Marsal India Managing Director Kaustav Ganguli told DH. “It has become a more mass segment in the last three years.”

The entry of new organised companies into the market made such services more affordable and accessible to the middle class, he added.

While services targeting women still account for the major chunk of the Indian fertility market, many young men are also seeking help to tackle fertility issues, setting the stage for a prolonged boom.

“Earlier mostly we were looking at women but now, a lot of cases we are looking at are related to male infertility,” said B Ramesh, founder and urology laboratory laparoscopic surgeon, Altius Hospital, Bengaluru.

Others agreed.

“At least 30 per cent cases are where the problem is with the men. In another 30 per cent cases, women have a problem and the rest is where both have some problem,” said Chandana Narayana, a gynaecologist and infertility specialist at Motherhood Hospitals, Sarjapur, Bengaluru.

In addition to those seeking fertility treatment, many are also choosing to freeze their reproductive cells or embryos in their 20s, further driving the growth of the market, said BS Ajaikumar, the chairman and chief executive officer of hospital chain HCG.

Ajaikumar expects a 15-20 per cent increase in patient volumes at its Milann fertility centres. In a recent conference call, HCG said year-to-date revenue at Milann was up 53.1 per cent. He sees Milann's earnings before interest, taxes, depreciation, and amortisation rising to 25 per cent from 20 per cent currently.

Apollo Hospitals’s maternity care and fertility business, which was once loss-making, has also turned profitable.

Fertility chains have people like 30-year-old Shriya (name changed) to thank.

The Hyderabad-based HR professional went to a fertility specialist five years back for the first time with the hope of getting some assistance to have a second child.

"My first pregnancy was unplanned. I was not able to shed all the weight I had gained after my first child. To add to it, was my PCOD. That is why me and my husband decided to consult a doctor. I was told hormone injections would help me conceive,” she told DH.

They did help her conceive but she ended up having miscarriages, four times in a row.

“After multiple miscarriages despite the treatment, I went into depression. I am drained emotionally, physically and monetarily now. Every week based on the follicular study report, they would give me injections. The treatment cost me a few lakh rupees. People think fertility treatment is easy but that's not true,” she lamented.

And it’s just not just India’s city dwellers like Shriya who are seeking fertility treatment.

Dr Santosh Gupta, a fertility consultant at Nova IVF in Koramangala, told DH that 50 per cent to 60 per cent of her patients were from a rural background.

A perfect storm of factors is setting the stage for the market to grow further.

"The optimistic growth outlook for the segment is based on the fact that India has a large population of young people, growing income levels and awareness in this population and the fact that fertility services are still under-penetrated, offering significant growth headroom," Ganguli said.

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