Every week, I meet couples who have spent months, sometimes years, navigating uncertainty and misinformation before walking through our doors. They are not unusual cases. They represent a vast, underserved population that India’s health care system is now beginning to address more seriously.
Karnataka’s decision to include Assisted Reproductive Technology (ART) under its public health scheme is a meaningful step forward. It reflects an official acknowledgement that infertility is a medical condition deserving a structured public response and places fertility care within the broader architecture of state healthcare planning.
Infertility affects millions of couples in India, with research showing notable increases in reproductive challenges over recent decades. This is not a niche medical issue. It sits alongside other chronic conditions in terms of prevalence and impact on quality of life. Yet for decades, infertility received relatively little attention in public health policy.
This gap has had real consequences. Misinformation fills the space where clear clinical guidance should exist. Many couples delay consultation, often arriving at specialist clinics after years of waiting, with fewer options available. The science and clinical capability exist in India to help far more people than currently receive timely care. The opportunity now is to build the policy infrastructure around that capability.
When a government includes a condition within its public health framework, the effects extend beyond budgetary allocation. It signals to families and communities that the condition is understood and deserving of medical attention.
In practical terms, public coverage reduces the most significant barrier for many families: cost. Fertility treatment has long been perceived as accessible only to higher income households. When cost becomes less prohibitive, couples consider seeking help earlier. Earlier consultation generally leads to better clinical outcomes and that builds wider confidence in the system.
There is also a social dimension worth noting. In many households, hesitation around fertility treatment is not only financial. Families wonder whether seeking help is appropriate or how it will be perceived. A government health scheme provides institutional clarity. It signals that this is a recognised medical pathway governed by standards and oversight. That kind of legitimacy matters in communities where social perception continues to shape health care decisions.
The World Health Organization (WHO) has underscored this point in its first global guideline on infertility, published in November 2025. For the first time, WHO has offered comprehensive, evidence-based recommendations on the prevention, diagnosis and treatment of infertility, urging countries to integrate fertility care into national health systems. This guideline frames infertility not as a lifestyle concern but as a public health issue that belongs within universal health coverage and reproductive health planning.
Expanding access is an important goal, and with it comes an equally important responsibility. As more couples enter the formal fertility treatment ecosystem, clinical standards, ethical practice, and transparent outcomes reporting become even more critical.
ART is a field where outcomes are deeply personal. As coverage broadens the emphasis on evidence-based medicine, laboratory quality, and patient-centred care must keep pace. Accessibility and quality are not competing priorities. They are interdependent. One without the other undermines the trust that both policy and practice are trying to build.
The private sector shares in this responsibility. Advocating for wider access means committing to the same rigorous standards expected of any medical discipline, including consistent reporting, ethical counselling, and care that genuinely prioritises patient wellbeing.
This policy shift comes at a relevant moment. India is urbanising rapidly. Lifestyle related conditions that affect reproductive health are becoming more common. The average age of family formation is rising, particularly in cities, which has a direct bearing on fertility outcomes.
Reproductive health policy that focuses only on maternal care no longer reflects the full picture. Integrating ART within state health care planning is an acknowledgement that the field of reproductive health is broader and that public systems need to reflect that reality.
Public health progress is gradual. Each policy decision that expands the definition of what the system covers reflects a deeper understanding of what populations need.
Karnataka’s inclusion of ART in its health scheme establishes an important principle: That difficulty conceiving is a medical matter deserving a medical response. As other states consider similar steps and as the healthcare system continues to evolve, decisions like this one provide a foundation to build on.
For the couples who navigate these challenges every day, that progress is not abstract. It is the difference between a system that sees them and one that does not.
This article is authored by Abhishek Aggrawal, CEO, Birla Fertility and IVF.
