Infertility can be defined as the inability to conceive after 12 months of regular unprotected intercourse and is estimated to affect 10–15% of couples worldwide.
“Starting a family is a deeply meaningful milestone, yet an increasing number of couples are finding it harder to conceive than expected,” says Dr Sreevani Kotha, Director and Head of Department, 9M Fertility by Ankura Hospital, Hyderabad.
Women are born with a certain number of eggs, and as they get older, the number and quality of these eggs decrease with age. A large portion of her ovarian reserve may have already been diminished by the time a woman is in her mid-30s. By the time a woman is 40, the loss is even more noticeable. This loss isn’t just about numbers; older eggs are more likely to have chromosomal abnormalities, leading to miscarriages and reducing the chances of successful pregnancy.
Dr. Sreevani Kotha explains, “Fertility does not always align with personal life goals. When pregnancy is planned later in life, particularly in the mid-30s and beyond, the natural decrease in egg quality becomes an important factor that couples should take into account.”
Research reviews show that older paternal age is associated with lower sperm quality, changes in DNA structure, and less favourable reproductive results. While the decline in male fertility is not as rapid as in women, its effects become more noticeable after 40.
Age, environment, and lifestyle all play a role in fertility. Several scientific studies show that being overweight, stressed, smoking, drinking alcohol, and being around environmental pollutants can all make it harder for both men and women to get pregnant.
In women, a higher body mass index (BMI) is linked to ovulatory dysfunction and a lower probability of conception. Men who smoke, consume excessive alcohol, or are overweight are more likely to have reduced sperm concentration, motility, and morphology. Population studies indicate a decline in sperm counts across various regions over the last few decades, raising public health concern.
Reproductive disorders like polycystic ovary syndrome (PCOS), which affects 15 to 20% of women in their reproductive years and is caused by hormonal imbalances, are closely linked to irregular ovulation and reduced fertility. Other conditions that can affect fertility and may often require specialised medical evaluation include endometriosis, uterine abnormalities, thyroid problems, and male-related issues like varicocele.
Dr. Sreevani Kotha says, “Many couples think that having a baby later is just a matter of timing, but underlying health issues can often affect fertility.”
“Early evaluation, including hormone level checks, tests to assess ovarian reserve, and semen analysis, helps couples gain a clear understanding of their fertility situation instead of relying on luck.”
A common concern among specialists is delayed medical consultation. What may appear to be a normal delay in conception could signal underlying factors that benefit from early intervention. Global health authorities, including the World Health Organization (WHO), emphasise that timely fertility evaluation and awareness can improve outcomes and reduce emotional distress.
Couples are generally advised to seek medical guidance if pregnancy has not occurred within 12 months of regular attempts—or within six months if the woman is over 35.
Lifestyle modifications such as maintaining a healthy weight, managing stress, avoiding tobacco, limiting alcohol, and ensuring balanced nutrition are evidence-based measures that support reproductive health. While assisted reproductive technologies have advanced significantly, age remains one of the most critical determinants of success.
Dr Sreevani Kotha concludes, “Fertility planning requires a blend of scientific insight and informed personal choices. Understanding how age, health, and lifestyle interact empowers couples to make proactive decisions. While delayed pregnancy is increasingly common, awareness and timely evaluation can significantly improve the chances of a successful outcome.”
