IVF in India Has Changed Dramatically: Dr Hrishikesh Pai on Rising Fertility Challenges

In an exclusive interview with Dr Hrishikesh Pai, Consultant Gynaecologist and IVF Specialist with over four decades of experience, we explore how fertility care in India has transformed from a stigma-laden subject to a science-driven, patient-centric discipline.

Drawing on his extensive expertise in reproductive medicine, Dr Pai sheds light on the rising influence of lifestyle factors, the growing role of genetic testing, and the increasing recognition of male infertility.

He also addresses the emotional and medical complexities behind repeated IVF failures, the promise of fertility preservation, and the integration of advanced technologies like AI in treatment protocols. Offering a balanced perspective, he emphasizes the importance of personalized care, early intervention, and busting long-standing myths making this conversation both insightful and essential for today’s evolving fertility landscape.

1. With over four decades of experience in IVF and reproductive medicine, how have you seen fertility challenges evolve among Indian couples?

Over the past four decades, the landscape of fertility in India has undergone a significant shift. Earlier, infertility was largely attributed to clear medical conditions such as tubal blockages or infections. Today, we see a rise in lifestyle-driven factors, delayed marriages, increasing stress levels, sedentary habits, obesity, and environmental pollutants all contributing to declining fertility. Additionally, there is a noticeable increase in conditions like PCOS, endometriosis, and diminished ovarian reserve among younger women. Male infertility, once under-recognized, is now a growing concern. Importantly, awareness has improved, and couples are more open to seeking timely medical intervention, which is a positive change.

2. Many couples today face repeated IVF failures—what are the most overlooked factors that impact success rates?

Repeated IVF failures can be emotionally and physically exhausting, and often the underlying causes are multifactorial. Some of the most overlooked factors include poor embryo quality due to genetic abnormalities, undiagnosed uterine issues such as chronic endometritis, and immunological factors. Lifestyle aspects such as smoking, alcohol consumption, poor nutrition, and stress also play a critical role but are frequently underestimated. Additionally, improper timing of embryo transfer and lack of individualized treatment protocols can impact outcomes. A comprehensive evaluation and a personalized approach are essential rather than repeating the same protocol.

3. How is genetic testing changing the way IVF treatments are planned and executed today?

Genetic testing, particularly Preimplantation Genetic Testing (PGT), has revolutionized IVF by allowing us to identify chromosomally normal embryos before implantation. This significantly improves implantation rates, reduces the risk of miscarriage, and increases the chances of a healthy pregnancy. It is especially beneficial for older women, couples with recurrent IVF failures, or those with a history of genetic disorders. Genetic insights also help in tailoring treatment plans more precisely, making IVF not just more effective, but also safer and more predictable.

4. Fertility preservation is gaining traction—what should individuals in their late 20s or early 30s know before considering options like egg freezing?

Fertility preservation, especially egg freezing, is an empowering option for individuals who wish to delay parenthood for personal or professional reasons. However, timing is crucial—egg quality and quantity decline with age, so the late 20s to early 30s is considered an optimal window. It’s important to understand that egg freezing is not a guarantee of future pregnancy but a proactive step to improve the chances. Individuals should undergo a proper fertility assessment, including ovarian reserve testing, before making a decision. Equally important is choosing a clinic with strong laboratory standards and expertise.

5. Male infertility is often under-discussed—what key shifts are needed in awareness and diagnosis?

Male infertility contributes to nearly 40–50% of infertility cases, yet it remains stigmatized and under-discussed in India. There is a need for a cultural shift where fertility is seen as a shared responsibility. Early screening for men, including semen analysis and advanced diagnostic tests like DNA fragmentation index (DFI), should become routine. Lifestyle modifications—such as reducing smoking, alcohol intake, and managing stress—are equally important. Increased awareness, open conversations, and inclusion of men in fertility consultations are critical steps toward better outcomes.

6. With advanced technologies like Embryoscope and AI in IVF, how do you balance technology with personalized patient care?

Technological advancements like time-lapse imaging (Embryoscope) and AI-driven embryo selection have enhanced precision in IVF, allowing us to select the most viable embryos with greater accuracy. However, technology should complement—not replace—clinical judgment. Every patient’s biology, medical history, and emotional journey are unique. The key lies in integrating data-driven insights with personalized care, ensuring that treatment protocols are tailored to individual needs. Empathy, clear communication, and patient-centric decision-making remain at the heart of successful fertility care.

7. What are the biggest myths around IVF that still persist among patients in India?

Several myths around IVF continue to create confusion and anxiety. One common misconception is that IVF guarantees pregnancy, whereas success rates vary based on age, medical history, and other factors. Another myth is that IVF always results in multiple pregnancies, which is no longer true with advancements like single embryo transfer. Many also believe IVF is only for women, ignoring the role of male infertility. Additionally, there is a perception that IVF babies are somehow less healthy, which is not supported by scientific evidence. Addressing these myths through education and transparent communication is essential to help patients make informed decisions.