Secondary infertility, the inability to conceive again after an earlier pregnancy, has become more common in India. Analysis of National Family Health Survey (NFHS) data shows its prevalence rose from about 19.5% in the early 1990s to 28.6% by 2015-16. The main contributors named are delayed parenthood, age-related fertility decline, lifestyle disorders, reproductive health complications and male infertility.
Infertility is defined as the failure to achieve pregnancy after 12 months or more of regular unprotected intercourse. It is primary when no pregnancy has ever been achieved and secondary when at least one earlier pregnancy has occurred but the couple cannot conceive again. The World Health Organization (WHO) estimates that around one in six people of reproductive age experience infertility in their lifetime.
Career consolidation, urban migration and financial pressures have pushed the first birth into the early 30s. By the time couples plan a second child, women are often above 35, when diminished ovarian reserve and falling egg quality reduce the chances of conception. Advancing paternal age can also increase sperm DNA fragmentation.
Previous deliveries can change the reproductive environment. Rising Caesarean rates can cause pelvic adhesions or isthmocele, a uterine scar defect, which may interfere with implantation. Untreated postpartum infections can lead to pelvic inflammatory disease and blocked fallopian tubes. Endometriosis and uterine fibroids may develop or worsen between the first and second pregnancy.
Weight gain, sedentary habits and metabolic changes after childbirth can disrupt the hypothalamic-pituitary-ovarian axis and affect ovulation. Polycystic Ovary Syndrome (PCOS), which affects up to 20% of Indian women, may worsen with age, weight gain and insulin resistance. Postpartum thyroiditis and hypothyroidism can disrupt menstrual cycles in a similar way.
The male factor is often overlooked. Weight gain, smoking, alcohol, chronic occupational stress and metabolic disorders can reduce sperm concentration, motility and morphology after the first child. Prolonged exposure to pesticides, microplastics and industrial chemicals, which are endocrine-disrupting, can affect egg and sperm quality. Chronic exposure to PM2.5 and heavy metals can cause oxidative stress, which is linked to declining sperm parameters and impaired ovarian function.
Under the Surrogacy (Regulation) Act, 2021, married couples are barred from surrogacy if they already have a surviving child, whether biological, adopted or born through surrogacy. The exception is a child with a life-threatening disorder or a severe mental or physical disability. This restricts options for couples with medically diagnosed secondary infertility and has raised questions about reproductive autonomy under Article 21.
IVF and intracytoplasmic sperm injection (ICSI) cost Rs 1.5 to 2 lakh per cycle and are largely excluded from public insurance such as Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY). The RMNCH+A (Reproductive, Maternal, Newborn, Child, and Adolescent Health) framework gives priority to contraception and the reduction of maternal mortality, and infertility care is largely overlooked.
Assisted reproductive technology (ART) clinics are concentrated in the private sector and in Tier-1 and Tier-2 cities. District hospitals lack the embryology labs and endocrinologists needed to treat complex cases.
Because the couple already has a child, their distress is often minimised or dismissed, which leads to isolation and delays in seeking medical or psychiatric help. A widespread belief that a man who has fathered one child is permanently fertile means male partners often refuse or delay semen analysis, even though declining sperm quality is a major driver of secondary infertility.
The Assisted Reproductive Technology (Regulation) Act, 2021 was meant to regulate fertility clinics, but enforcement remains a challenge. Social media carries advertisements from unregulated clinics promising "100% IVF success in one cycle". Many couples in rural and semi-urban areas spend reproductive years on home remedies and alternative treatments before seeking evidence-based care. Women over 35, whose ovarian reserve drops rapidly, are particularly affected.
Besides the ART and Surrogacy Acts, a few schemes offer help. The Jiyo Parsi Scheme, run by the Ministry of Minority Affairs, is meant for the Parsi community. The Employees' State Insurance Corporation (ESIC) covers free IVF for eligible insured women, and the Central Government Health Scheme (CGHS) partly reimburses IVF for government employees. Together, ESIC and CGHS IVF coverage is limited to these groups. Goa, Tamil Nadu and Rajasthan have their own free or subsidised IVF schemes or ART policies.
With reference to infertility in India, consider the following statements:
Which of the statements given above are correct?
Consider the following statements:
Statement-I: Under the Surrogacy (Regulation) Act, 2021, couples with medically diagnosed secondary infertility have restricted access to surrogacy.
Statement-II: The Act bars married couples from surrogacy if they already have a surviving child, whether biological, adopted or born through surrogacy, except where the child has a life-threatening disorder or a severe mental or physical disability.
Which one of the following is correct in respect of the above statements?
Consider the following pairs:
Scheme/Body : Position on IVF support
How many of the above pairs are correctly matched?
