The Silent Crisis : Understanding infertility in a changing world
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Boro Laipubam
Infertility was once whispered about in the shadows — a myth cloaked in shame, misattributed to fate, and unfairly heaped upon women alone. Today, however, the medical commu- nity speaks with clarity. Infertility is a global health crisis of mounting proportion, one that transcends biology, culture, and even species.
Our understanding of infertility must evolve just as boldly.
What Is Infertility — And Who Does It Affect?
Clinically defined by the World Health Organization (WHO), infertility is the inability of a couple to achieve pregnancy after 12 months of regular, unprotected intercourse or after just six months when the woman is 35 or older, roughly 1 in 6 people globally experience infertility at some point in their lives, making it a major and often under acknowledged public health challenge.
Infertility is not a woman’s burden alone simul- taneous evaluation of both partners, Studies and WHO data confirm that male factors contribute to nearly half of all infertility cases (app. 40-50%).
Three principal forms of Infertility
Primary infertility— where conception has never occurred despite regular unprotected intercourse for 12 months (or 6 months if the woman is 35+).
Secondary infertility— where a prior successful pregnancy exists but subsequent conception repeatedly fails.
Unexplained infertility — where all clinical investigations return inconclusive results, leaving couples in a medical grey zone as emotionally devastating as it is diagnostically frustrating.
The Causes: A Modern Epidemic with Modern Roots
Scientists and clinicians today navigate an increasingly complex web of infertility and has multiple causes, including:
Lifestyle and Environmental Factors: Sedentary lifestyles, obesity, poor diet, smoking, alcohol and drug use, chronic stress, sleep disruption, and exposure to environmental pollutants.
Physiological Causes: In women, conditions such as polyendocrine metabolic ovarian syndrome (PMOS), endometriosis, blocked fallopian tubes, fibroids, and diminished ovarian reserve; in men, low sperm count, poor motility, abnormal morphology, hormonal imbalances, and varicocele.
Other Factors: Age-related fertility decline, sexually transmitted infections, delayed childbearing, cancer treatments, and auto-immune disorders.
Fertility Rates, Replacement Levels & Global Context
The replacement fertility rate is 2.1 births per woman. Many developed countries, including South Korea and Japan, are below this level, while countries such as Niger, Mali, and Chad have some of the highest fertility rates.
India’s fertility rate has declined to around 2.0, with several states already below replacement level.
In Manipur, the fertility rate has declined steadily, some regional studies have suggested comparatively high rates of secondary infertility in Manipur, although further population-level research is needed to clarify the magnitude and causes. Influenced by delayed marriages, nutritional deficiencies, limited access to specialist reproductive care, and rising socio-economic pressures on young couples.
Treatment: From Laboratory Bench to Delivery Room
Modern reproductive medicine offers a range of treatments tailored to each individual’s diagnosis, age, and reproductive profile.
IUI (Intrauterine Insemination): A minimally invasive procedure in which prepared sperm is placed directly into the uterus during ovulation.
IVF — In Vitro Fertilisation
The cornerstone of assisted reproduction, a technique involving egg retrieval, laboratory fertilisa- tion, embryo culture, and embryo transfer, with options such as embryo freezing, genetic testing and assisted hatching.
ICSI — Intracytoplasmic Sperm Injection
A specialised form of IVF where a single healthy sperm is directly injected into an egg. Used in severe male-factor infertility, previous IVF failure, or where sperm is retrieved surgically (TESA/PESA). ICSI has significantly improved fertility outcomes for men once considered untreatable.
Surrogacy: A Pathway to Parenthood Under the Law
For individuals or couples unable to carry a pregnancy due to health condition or medically certified conditions, surrogacy may provide a lawful pathway to parenthood. In India, the Surrogacy (Regulation) Act, 2021 and the ART (Regulation) Act, 2021 regulate the process to ensure ethical practices and protect the rights of all parties involved.
Cost of Infertility Treatment in India
India is a leading destination for fertility treatment due to its lower costs and advanced reproductive technologies. Costs vary across cities, & some insurance policies now cover IUI and IVF. Patients should obtain a clear breakdown of all treatment-related expenses before starting care.
Infertility treatment success varies by treatment type, age, and underlying cause. Women under 35 generally have higher IVF live-birth rates than women over 40 due to age-related declines in egg quality and ovarian reserve.
The Future of Fertility: IVG and Beyond
In Vitro Gametogenesis (IVG) aims to create eggs and sperm from induced pluripotent stem cells (iPSCs), potentially enabling single individuals and same-sex couples to have genetically related children. While proof-of-concept has been demonstrated in mice and early human studies are underway, significant scientific, ethical, and regulatory challenges remain.
Artificial Intelligence is also reshaping embryology byAI-assisted embryo assessment is being integrated into fertility laboratories, though its long-term impact on live-birth rates remains under active investigation.
Choosing the Right Treatment and the Right Centre
Choosing the right fertility centre is essential. Patients should look for accredited centres with experienced multi-disciplinary teams, transparent success rates, advanced laboratory facilities, and comprehensive support services, including clear communication, counselling, and personalized care.
Infertility is not a failing of character, willpower, or worth. It is a medical conditionfully deserving of science, compassion, equity, and societal support. The era of silence is over. The era of informed, accessible, and advanced reproductive care must now begin in earnest.
Infertility was once whispered about in the shadows — a myth cloaked in shame, misattributed to fate, and unfairly heaped upon women alone. Today, however, the medical commu- nity speaks with clarity. Infertility is a global health crisis of mounting proportion, one that transcends biology, culture, and even species.
Our understanding of infertility must evolve just as boldly.
What Is Infertility — And Who Does It Affect?
Clinically defined by the World Health Organization (WHO), infertility is the inability of a couple to achieve pregnancy after 12 months of regular, unprotected intercourse or after just six months when the woman is 35 or older, roughly 1 in 6 people globally experience infertility at some point in their lives, making it a major and often under acknowledged public health challenge.
Infertility is not a woman’s burden alone simul- taneous evaluation of both partners, Studies and WHO data confirm that male factors contribute to nearly half of all infertility cases (app. 40-50%).
Three principal forms of Infertility
Primary infertility— where conception has never occurred despite regular unprotected intercourse for 12 months (or 6 months if the woman is 35+).
Secondary infertility— where a prior successful pregnancy exists but subsequent conception repeatedly fails.
Unexplained infertility — where all clinical investigations return inconclusive results, leaving couples in a medical grey zone as emotionally devastating as it is diagnostically frustrating.
The Causes: A Modern Epidemic with Modern Roots
Scientists and clinicians today navigate an increasingly complex web of infertility and has multiple causes, including:
Lifestyle and Environmental Factors: Sedentary lifestyles, obesity, poor diet, smoking, alcohol and drug use, chronic stress, sleep disruption, and exposure to environmental pollutants.
Physiological Causes: In women, conditions such as polyendocrine metabolic ovarian syndrome (PMOS), endometriosis, blocked fallopian tubes, fibroids, and diminished ovarian reserve; in men, low sperm count, poor motility, abnormal morphology, hormonal imbalances, and varicocele.
Other Factors: Age-related fertility decline, sexually transmitted infections, delayed childbearing, cancer treatments, and auto-immune disorders.
Fertility Rates, Replacement Levels & Global Context
The replacement fertility rate is 2.1 births per woman. Many developed countries, including South Korea and Japan, are below this level, while countries such as Niger, Mali, and Chad have some of the highest fertility rates.
India’s fertility rate has declined to around 2.0, with several states already below replacement level.
In Manipur, the fertility rate has declined steadily, some regional studies have suggested comparatively high rates of secondary infertility in Manipur, although further population-level research is needed to clarify the magnitude and causes. Influenced by delayed marriages, nutritional deficiencies, limited access to specialist reproductive care, and rising socio-economic pressures on young couples.
Treatment: From Laboratory Bench to Delivery Room
Modern reproductive medicine offers a range of treatments tailored to each individual’s diagnosis, age, and reproductive profile.
IUI (Intrauterine Insemination): A minimally invasive procedure in which prepared sperm is placed directly into the uterus during ovulation.
IVF — In Vitro Fertilisation
The cornerstone of assisted reproduction, a technique involving egg retrieval, laboratory fertilisa- tion, embryo culture, and embryo transfer, with options such as embryo freezing, genetic testing and assisted hatching.
ICSI — Intracytoplasmic Sperm Injection
A specialised form of IVF where a single healthy sperm is directly injected into an egg. Used in severe male-factor infertility, previous IVF failure, or where sperm is retrieved surgically (TESA/PESA). ICSI has significantly improved fertility outcomes for men once considered untreatable.
Surrogacy: A Pathway to Parenthood Under the Law
For individuals or couples unable to carry a pregnancy due to health condition or medically certified conditions, surrogacy may provide a lawful pathway to parenthood. In India, the Surrogacy (Regulation) Act, 2021 and the ART (Regulation) Act, 2021 regulate the process to ensure ethical practices and protect the rights of all parties involved.
Cost of Infertility Treatment in India
India is a leading destination for fertility treatment due to its lower costs and advanced reproductive technologies. Costs vary across cities, & some insurance policies now cover IUI and IVF. Patients should obtain a clear breakdown of all treatment-related expenses before starting care.
Infertility treatment success varies by treatment type, age, and underlying cause. Women under 35 generally have higher IVF live-birth rates than women over 40 due to age-related declines in egg quality and ovarian reserve.
The Future of Fertility: IVG and Beyond
In Vitro Gametogenesis (IVG) aims to create eggs and sperm from induced pluripotent stem cells (iPSCs), potentially enabling single individuals and same-sex couples to have genetically related children. While proof-of-concept has been demonstrated in mice and early human studies are underway, significant scientific, ethical, and regulatory challenges remain.
Artificial Intelligence is also reshaping embryology byAI-assisted embryo assessment is being integrated into fertility laboratories, though its long-term impact on live-birth rates remains under active investigation.
Choosing the Right Treatment and the Right Centre
Choosing the right fertility centre is essential. Patients should look for accredited centres with experienced multi-disciplinary teams, transparent success rates, advanced laboratory facilities, and comprehensive support services, including clear communication, counselling, and personalized care.
Infertility is not a failing of character, willpower, or worth. It is a medical conditionfully deserving of science, compassion, equity, and societal support. The era of silence is over. The era of informed, accessible, and advanced reproductive care must now begin in earnest.