Why more Indian couples are being diagnosed with secondary infertility

A few weeks ago, a couple sat in my consulting room looking almost apologetic. They already had a bright six-year-old waiting at home. “We feel silly taking your time, doctor,” the mother said. “We have one child. Everyone keeps telling us to just be grateful.” And then, quietly, she started to cry.

I have heard that phrase — “at least you have one” — more times than I can count. It is almost always meant kindly. It almost always lands like a door being shut. And it is one of the reasons the couples I see struggling to conceive a second time carry their grief so silently.

Understanding the condition

The condition has a name: secondary infertility — the difficulty conceiving or carrying a pregnancy after you have already had a baby. For years it was brushed aside as a non-problem. The numbers say otherwise. Analyses of India’s National Family Health Survey data show secondary infertility rose from roughly 19.5% in the early 1990s to about 28.6% by 2015–16 — close to a doubling in a single generation. It is now one of the most common reasons a “previously fertile” couple walks in, bewildered. “We didn’t even try the first time,” they say. “Why is it so hard now?”

Part of the answer is the calendar. A generation ago, most couples finished their families in their twenties. Today a first baby often arrives at 31 or 32 — after the degree, the job, the EMI, the move to a rented flat in a city. By the time life finally feels “ready” for a second child, the mother may be 36 or 38, and fertility, unfairly, does not wait for our life plans. Egg numbers and quality fall with every passing year; clinics in cities like Delhi/NCR, Bengaluru, Mumbai and others, have reported a sharp rise in women seeking help only after 35.

But age is just one thread. In the years between the first and second child, bodies change. Weight creeps up. The thyroid quietly slips. As many as one in five Indian women now lives with PMOS, which tends to worsen with time. A Caesarean section may have left adhesions; an old, untreated infection may have scarred a fallopian tube. And — this matters — the problem is very often on the man’s side. Sperm counts fall with weight, stress, smoking and even the polluted air so many of us breathe. Yet in my experience, Indian men will wait years longer than their wives before agreeing to a simple semen test, convinced that “we already have a child, so it can’t be me.”

Layered over all of this is something newer: our phones. Social media has, in many ways, been a gift for fertility awareness. Couples now arrive far better informed than a decade ago; the taboo is finally cracking; brave women share IVF journeys that once would have been whispered about. But scroll through any feed and you also meet the other side — an unending stream of “Baby No. 2!” announcements, and picture-perfect siblings. For a woman in her fourth month of trying, or recovering from a second miscarriage, that scroll is a slow bruise. The comparison is relentless — and so is the family WhatsApp group where an aunt asks, yet again, when the “good news” is coming. I have also watched social media do harm the other way: glossy reels promising IVF “success in one cycle,” or home remedies that persuade a couple to delay proper testing by a year they cannot afford to lose.

Telling the truth

So what do I tell the couple crying in my room? First, that their pain is real and they are allowed to feel it. Wanting a sibling for the child you adore is not ingratitude; it is love asking for a little more room. Second, that this is a medical condition, not a moral verdict — not a punishment, not nazar, not something they did wrong. Third, that timing matters. If a woman is under 35 and has tried for a year, or over 35 and has tried for six months, both partners — together — should be evaluated. Do not let the calendar run, out of politeness.

And I tell them the truth about hope, honestly. Modern fertility care helps a great many couples in exactly this situation, and IVF succeeds for many even in their late thirties and forties. But I will never promise a guaranteed outcome, and I would gently warn anyone against a clinic that does. What I can promise is a clear answer and a plan.

If there is one thing I wish more of us understood, it is this: the woman who “already has one” may be quietly grieving a child who simply hasn’t arrived yet. She does not need to be reminded how lucky she is. She needs to be asked how she is. Often the most healing thing a family member, a friend — or a doctor — can do is stop offering gratitude as a cure, and simply listen.

(Dr. Richika Sahay Shukla is co-founder and medical director, India IVF Fertility. director@indiaivf.in)