For decades, infertility has long carried the weight of silence and stigma in India, especially in towns and cities beyond the metros. For many couples, the struggle was not limited to medical, as taboos and misconceptions made seeking help even harder. While infertility affects nearly 2.5–3 crore couples, access to advanced fertility treatments like in vitro fertilisation (IVF) is still largely confined to metropolitan cities. However, the story is changing now. 

Changing scenario of fertility treatment beyond metros

With rising awareness, social acceptance, and rapid advances in medical technology, advanced fertility treatment is slowly reaching Tier-II and Tier-III cities. Economic growth in these cities has created a new class of consumers with the means and motivation to pursue fertility treatments. The social stigma surrounding infertility is gradually diminishing outside metropolitan areas. This shift in mindset, combined with greater awareness about reproductive health, is creating demand for fertility services in previously underserved markets.

The expansion of IVF services to smaller cities represents one of the most compelling healthcare opportunities in contemporary India. The scale of untapped demand is staggering, with fertility services remaining largely absent or limited in most Tier-II and Tier-III cities, creating a vast underserved market. IVF treatments in smaller cities can be delivered at 25–30% lower costs compared to metropolitan centres, making them more accessible to middle-class families who might otherwise opt out of fertility care. Rather than travelling hundreds of kilometres to metros, couples from rural and semi-urban areas are now accessing fertility treatment in nearby Tier-II cities.

Technology emerges as a powerful enabler in this expansion. Digital health platforms and teleconsultations can effectively bridge the expertise gap, allowing patients in smaller cities to access consultations with leading IVF specialists based in metros. Artificial intelligence and big data tools are enhancing success rates by enabling predictive care and smarter decision-making. Cloud-based lab monitoring allows metro-based experts to remotely oversee facilities in smaller towns. Meanwhile, telemedicine is bridging the distance between doctors and patients, enabling ongoing consultations, follow-ups, and much-needed emotional support. Government initiatives further strengthen the foundation for this expansion. Programs like Ayushman Bharat, coupled with policy incentives for maternal health, create supportive ecosystems.

Barriers in the path of parenthood 

Despite these opportunities, expanding fertility care beyond metros presents significant challenges that require thoughtful solutions. Cultural barriers remain perhaps the most formidable obstacle. In many smaller towns and cities, infertility continues to be viewed as a social taboo, particularly for women. This stigma often delays seeking treatment and creates psychological barriers that can impact treatment success.

Infrastructure limitations pose another critical challenge. Advanced fertility care requires sophisticated embryology laboratories, cryopreservation facilities, and specialised equipment that are scarce outside metropolitan areas. The technical complexity of maintaining these facilities, coupled with the need for uninterrupted power supply and climate control, makes infrastructure development a significant investment barrier. The shortage of specialised professionals compounds these infrastructure challenges. Reproductive endocrinologists, embryologists, and trained IVF nurses are concentrated in major cities, and few are willing to relocate to smaller towns. 

The fertility care sector has witnessed the emergence of unregulated clinics that may compromise treatment standards and patient safety. Ensuring adherence to Indian Council of Medical Research (ICMR) guidelines and Assisted Reproductive Technology (ART) Act standards becomes more challenging as services expand to areas with limited regulatory oversight.

Patients in Tier-II and Tier-III cities expect lower costs, but IVF inherently requires substantial investment in infrastructure, technology, and expertise. Balancing these competing demands while maintaining treatment efficacy represents a fundamental challenge for service providers.

Putting patients at the heart of care

Beyond infrastructure and innovation, the true measure of fertility care lies in empathy. Couples in smaller towns often face an added emotional burden, as stigma and silence intensify the challenges of infertility. Clinics must therefore focus on patient-centric approaches with counselling services, women’s healthcare camps, and community education initiatives that normalise conversations around infertility. Building trust and breaking social barriers is just as important as providing cutting-edge medical care.

Also read: Building Gender Diversity beyond the Desk: Women in Labs, Plants & Leadership

What’s next

The future of IVF in the Indian hinterland lies in creating a connected and collaborative ecosystem. Hub-and-spoke models can extend the expertise of metro-based centres to satellite clinics in smaller towns, ensuring high-quality care while sparing patients the burden of long-distance travel. Public-private partnerships can amplify government-led initiatives on fertility awareness and maternal health, while collaborations with local gynaecologists can build trust within communities and encourage early intervention.

By 2030, India’s fertility industry is projected to grow into a $3–4 billion market, with Tier-II and Tier-III cities leading this expansion. But sustainable progress will depend on finding the right balance between affordability, accessibility, and accountability. Expanding IVF beyond metros is more than a business opportunity; it is a social responsibility to democratise the dream of parenthood. 

Views expressed by: Ambika Bhaik, CEO, Yellow Fertility

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Disclaimer: The views and opinions expressed in this article are solely those of the author and do not necessarily reflect the official policy or views of any organisation. The content is intended for informational and educational purposes only and should not be construed as medical advice.

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