“I have never seen two pink lines (in the pregnancy test kit) in my life and I’ve started feeling something is wrong with me though all medical reports are clear with both of us,” says 33 year old Sahana*, trying to conceive for five years.

“Every transfer and every egg collection, we get emotionally invested into the process on top of the financial strain,” says Jhansi (35)*. “We talk to our embryos, put their pictures around the house. We give them names. We cry when we watch the videos of them developing... but when another IVF failed, I cried…”

These emotional whiplashes sit at the heart of India’s booming IVF industry, where couples grapple with hope and disappointment, and no guaranteed outcomes.

India has 2,616 registered IVF clinics as of Dec 13, 2025, according to the National ART & Surrogacy Registry. Less than ten are government-run centres – that are priced lower or free. Tamil Nadu, with one of India’s lowest Total fertility Rate (at 1.3, below the replacement rate of 2.1), has 669 clinics, followed by Gujarat (357) and Telangana (276).

In fact, private IVF chains are expanding aggressively across smaller towns – from Hosur to Erode to Gorakhpur, often marketed with glossy promises — AI-driven embryo selection, home-based IVF cycles, “needle-free” injections, etc.

“A lot of what is portrayed as innovation — home IVF, boutique packages — is really just tailoring according to what patient wants,” says Dr Shery Angel, obstetrician and gynaecologist at Chettinad Hospital and Research Institute.

The core procedure however, remains the same, she explains: stimulate ovaries, retrieve eggs, fertilise them in the lab, grow the embryos for a few days and transfer few into the uterus.

Pushed by stigma and lack of awareness about assisted reproductive methods, many couples reach this stage late when simpler interventions such as follicular stimulation, lifestyle changes or Intrauterine Insemination (IUI) might once have worked.

For many hopeful of having a baby, the financial stress comes long before the psychological toll of waiting. Doctors say ₹1.5–3 lakh is charged per IVF cycle and most couples go through 2-3 cycles or more. Medicines, add-ons or any abnormalities push costs up by few more lakhs.

Negotiating insurance

Insurance brokers say nearly 90 percent of couples undergoing IVF face ‘catastrophic’ expenditure. “India performs roughly 2–2.5 lakh IVF cycles a year,” says Narendra Bharindwal, President of the Insurance Brokers Association of India. “But only about 5 per cent have any insurance support, and even that is restrictive.”

The IVF market grows at 15-20 percent annually, he says, and demand for coverage is “small but clearly rising,” especially in sectors like IT, consulting, GCCs. And yet, he adds, “IVF is high-ticket, procedure-based and time-bound, so actuarial pricing and anti-selection concerns are sharper. That is why we are seeing cautious, capped benefits.”

In this vacuum, clinics now sell their own quasi-insurance products. In Yellow IVF’s Yellow Contract, couples booking two IVF cycles for ₹2.1 lakh are assured that if both cycles are unsuccessful, they will pay only ₹50,000 from the third cycle, regardless of actual cost.

While financial innovations seem reassuring, they exist almost entirely outside the Assisted Reproductive Technology (Regulation) Act, 2021, (ART Act), say industry experts.

Going rural

Dr Gauri Agarwal, founder, Seeds of Innocens IVF, which launched a home-based IVF model recently, says, they are seeing growing demand from smaller towns and rural areas where their model is helping overcome barriers of distance and stigma.

But the burgeoning industry comes with some concerns - including the sensitive gender question. Some couples recount hearsay of acquaintances “trying for a boy” through IVF, and published research from countries such as China, Australia and New Zealand has documented male-skewed IVF births.

“Scientifically, sex can be known at the embryo stage during PGT (Pre-implantation genetic testing), but in India it is completely illegal except for rare genetic reasons — where a couple carries a disease that affects only one sex. Only in those cases do we look at gender. Otherwise, it is not allowed,” says Dr Shery.

Existing regulatory frameworks offer little oversight in terms of tracking IVF sex ratios, success rates, costly add-ons and insurance coverage as the industry grows, observe industry-watchers.

Bharindwal calls for targeted policy – where the insurance regulator, for example, could issue guidelines on infertility and ART coverage (what can be covered / excluded, number of cycles, packages with out-patient components and minimum quality standards for empanelled clinics in line with the ART Act) – providing some cushion for couples.

The fertility factor

The fertility factor also often plays into the discussion on ART.

In developed western countries, economists attribute the fall in fertility rate to the lost opportunity costs for women who temporarily or permanently have to withdraw from the workforce to have children..

In India, though, the factors are varied and complex, say observers.

“Lack of proper diet, increase in stress, no proper workout or sleep are the main culprits. These cause blocks in fallopian tubes and increasing cases of resistant varieties of polycystic ovaries that don’t respond to treatment. All these pushes people to IVF,” says Dr Shery, giving a medical explanation to the growing reliance on IVF.

In fact, according to a recent analysis by Data for India, India’s female labour force participation rate is abysmally low at 31.58 per cent (Vietnam 75.74 per cent). Meaning, most adult women in India don’t work for pay outside the home, while most women in East Asia or Europe do. Yet, birth rates in India (1.99) are comparable to those in Vietnam (1.93) now, for example - indicating that a fertility rate that is stabilising in India has an explanation beyond growing career opportunities.

In After the Spike: Population, Progress and the Case for People, economists Dean Spears and Michael Geruso argue that fertility is falling not only because of economic pressures but because life itself has improved. As living standards rise, people place greater value on time, leisure and personal well-being. As these “nice things” expand, so does the opportunity cost of giving them up.

*(names changed to protect the identity of the individuals)

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Published on December 15, 2025