The growing demand for IVF and reproductive care in Tier 2 and Tier 3 India

A few years ago, if a couple from Moradabad or Anantnag needed IVF, the journey usually began with a train ticket. They would travel to Delhi, sit in an unfamiliar waiting room, spend money on hotels and lost wages, and carry the entire weight of the experience alone — because back home, nobody could know. I remember couples who told relatives they were going to the capital for “a wedding” or “some paperwork.” That was the reality of fertility care in smaller India: available only to those who could afford the travel, the treatment, and the secrecy.

That picture is changing faster than most people in our industry predicted. Today, some of the most informed, most determined patients I meet come from Tier 2 and Tier 3 cities. They walk in having already read about AMH levels and blastocyst transfers. They ask sharper questions than many metro patients did a decade ago. And increasingly, they don’t have to travel hundreds of kilometres to ask them.

The demand was always there. The access wasn’t.

It is tempting to describe what’s happening as a “rise in demand” for fertility care in smaller cities. I would put it differently: the need was always there — what’s rising is the willingness to act on it, and the infrastructure to act on it locally.

India is now estimated to have one in six couples experiencing infertility, and the country’s total fertility rate has slipped to around 1.9, below replacement level. Lifestyle shifts that we once associated with metros — delayed marriage, high stress, sedentary work, rising PCOS and obesity, declining sperm parameters — have travelled down the highway to every district headquarters. A software employee working remotely from Meerut has the same lifestyle risk profile as her colleague in Gurugram.

What has changed is the silence around it. Social media, vernacular health content, and frankly, sheer word of mouth from couples who succeeded, have made infertility discussable. When a couple in a small town knows three other families who had IVF babies, the stigma loses its grip. At our monthly outreach camps in places like Meerut, Aligarh, Moradabad, and Anantnag and Shopian in Kashmir, I’ve watched the conversation shift over the years — from whispered questions at the end of the camp to mothers-in-law sitting in the front row, asking when their daughter-in-law should get her tests done. That, to me, is the single biggest driver of this market: permission.

What the numbers say

The business case mirrors what we see clinically. India’s IVF services market crossed roughly a billion dollars in 2025 and is projected to grow at about 14–15 per cent annually over the next decade — with virtually every major chain pointing to Tier 2 and Tier 3 cities as the engine of that growth. Several national players now report a third to half of their cycles coming from non-metro centres, and treatment costs in smaller cities typically run 25–30 per cent lower than metros, which widens the funnel of families who can consider treatment at all.

The ART (Regulation) Act has quietly helped too. By mandating registration and standards, it has begun separating credible clinics from the unregulated setups that once flourished in smaller towns and damaged patient trust. For organised, accredited players, regulation is not a burden — it is the foundation on which non-metro patients can finally trust local care.

The challenges nobody should gloss over

Having said all this, I want to be honest about what still goes wrong, because the patients pay the price for our industry’s blind spots.

The first is delayed diagnosis. By the time many couples from smaller towns reach a fertility specialist, they have spent three to five years cycling through general practitioners, gynaecologists without ART training, and unfortunately, unverified local remedies. Conditions like endometriosis, low ovarian reserve, or male-factor infertility — which accounts for nearly half of all cases — get picked up years late. Men, especially, delay testing because of misplaced shame; I still meet husbands who have never been tested even after years of treatment focused entirely on the wife.

The second is affordability. An IVF cycle still costs ₹1.5–3 lakh, and the overwhelming majority of insurance policies in India exclude infertility treatment. For a family in a Tier 3 city, that is not a medical expense — it is a life decision. This is why financing models like zero-cost EMIs and outcome-linked insurance products matter so much in smaller markets; at India IVF Fertility we have seen them turn “impossible” into “let’s plan for it.”

The third is the specialist gap. Embryologists and trained fertility specialists remain concentrated in metros. You cannot solve this by simply opening centres; you solve it with a hub-and-spoke model — where advanced laboratories, technology like AI-assisted embryo selection and robotic ICSI, and senior clinical oversight sit at the hub, while consultations, monitoring, and follow-up happen close to the patient’s home. Telemedicine has made this genuinely workable: a patient in Srinagar can be reviewed by the same clinical team and protocols as a patient in Delhi, travelling only for the procedures that truly require it. When we opened our centre in Srinagar — the first IVF centre in Jammu & Kashmir — the lesson was humbling: the demand was not created by the centre; it was waiting for it.

What the next phase looks like

I believe the next five years of Indian fertility care will be written outside the metros. The chains that win there will not be the ones that simply transplant a metro clinic into a smaller city, but the ones that adapt — pricing honestly, counselling in the patient’s language, involving families rather than fighting them, and holding the same clinical standards in Gwalior as in Gurugram.

There is also a deeper shift underway: fertility care in India is moving from being a luxury service to being understood as essential healthcare. Smaller cities are where that transition will actually happen, because that is where most of India lives.

Every week now, I meet couples who didn’t need a train ticket and a cover story to seek help — just a short drive and a little courage. As an industry, our job is to make sure that courage is met with science, transparency, and care worthy of it.