More women are choosing motherhood on their own timelines, not the one mapped out for them decades ago. Across cities, more Indian women are delaying childbirth by choice, or circumstance. This quiet but definitive shift is reshaping the landscape of reproductive care. Fertility clinics are adapting. Insurance providers are taking notes. And employers are rethinking benefits.
However, as this shift gains momentum, it comes with its own economic and clinical calculus. Fertility preservation options like egg freezing are moving from luxury to necessity. Insurers are slowly being nudged toward revisiting their coverage criteria. And healthcare providers are rethinking risk profiling and prenatal care strategies. But the pace and consistency of this evolution remain open questions. Which brings us to the heart of the matter: Are India’s reproductive health and insurance systems keeping pace with the evolving realities of delayed motherhood.
The urban shift
Even as the idea of motherhood evolves across India’s urban centres, fertility specialists are observing a steady rise in women actively pursuing pregnancy in their mid-to-late thirties. For many, this is a conscious, informed decision shaped by career, financial independence, and better awareness of assisted reproduction.
“The social and healthcare advancements of today have contributed to the increased trend of women giving birth at the age of 35+,” says Dr Madhu Juneja, Director – OBGY and IVF, Sahyadri Hospitals Momstory.
According to her, this trend is especially pronounced in cities where awareness and affordability of fertility treatment is higher. “This trend is more common in cities where women are knowledgeable about the available fertility treatments and are more financially stable,” she adds. “Despite the change in societal norms, the realisation of the challenges that come with trying to conceive when older is more widely accepted.”
But the rise in delayed motherhood also underscores a growing; though uneven awareness of biological limits. “Certainly, the understanding of the decline of fertility with age seems to be growing, especially in metropolitan areas, where women are sequentially delaying marriage and childbirth for a myriad of professional and personal reasons,” notes Dr Juneja. “With the help of fertility clinics, social media campaigns, and doctors, women are increasingly realising the risks associated with postponing pregnancy and the value of maintaining fertility.”
As a result, many women in their 30s are turning to fertility and family planning services, such as egg freezing, driven by growing awareness of the reduced quantity and quality of eggs as they age. However, she cautions that this awareness is still largely an urban phenomenon. “There are still unfilled gaps of information, especially in rural regions where information such as this may not be easily accessible,” she states. “Deeply rooted cultural norms in several regions of India still place strong value on early marriage and childbirth, potentially obstructing discourse surrounding the decline of fertility with age. Comprehensive information, public and targeted, is imperative in both urban and rural India.”
In cities, however, patients are already taking a more proactive role in their fertility journey. Anjali Ajaikumar, Director at Milann Fertility & Birthing Hospital, says, “When observing trends around conception at 35 among Indian women, it’s clear that more couples are facing challenges in conceiving and are actively looking for the right place for their treatment. Women over 35, in particular, are doing their research to understand the best treatment options available and are specifically seeking centers that follow a holistic approach in their treatment protocols.”
She also observes a clear decision-making pattern among couples. “There’s a growing pattern where couples first attempt natural conception, and if that doesn’t work, they move to IUI, and then IVF as a next step. These women are also becoming more aware and informed—ensuring they get genetic testing done and that their partners are tested as well.”
Risk matrix
However as cultural acceptance of delayed motherhood grows, so does the need to navigate its medical realities with greater precision. Fertility experts and clinicians are now adapting their protocols to account for the evolving risk landscape that comes with age “Clinical risks increase significantly with advancing maternal age, particularly for women aged 35 and older, and these risks become even more pronounced for those above 40 years,” says Dr Kshitiz Murdia, CEO & Whole Time Director, Indira IVF.
The list of medical complications is wide-ranging.“Obstetric complications range from increased miscarriage and cervical insufficiency to placental abruption, higher rates of both planned and emergency C-sections, postpartum haemorrhage, and sepsis,” Dr Murdia adds.
With these risks now firmly acknowledged in clinical guidelines, the focus has shifted toward proactive management. “Traditional approaches to these issues have focused on risk management,” says Dr Juneja. “These methods have since changed to more vigilant tracking and personalised attention. New methods of genetic testing, like NIPT (noninvasive prenatal testing), help identify risks sooner, allowing parents to make timely decisions.”
One of the biggest shifts, both experts note, is the growing emphasis on preconception preparation. “Thorough health assessment is recommended before conception,” Dr Murdia explains. “This includes screening for hypertension, diabetes, thyroid disorders, and other chronic conditions. Emphasis is placed on optimising preconception health: achieving a healthy BMI, quitting smoking or alcohol, starting folic acid supplementation, and managing any comorbidities proactively.”
Prevention, monitoring, and timely intervention now form the three pillars of clinical response. “There is also enhanced focus on the preconception health of the mother and counselling about lifestyle changes to decrease health risks prior to conception,” Dr Juneja adds. “There is also more focus on customised treatment approaches and greater use of ART in conjunction with more intensive observation for high-risk pregnancies.”
This transition is codified in both global and national guidelines, with Indian protocols designating all pregnancies in women aged 35 and above as “high-risk.” “AMA—advanced maternal age—is inherently considered a risk factor for adverse outcomes,” says Dr Murdia. “So these pregnancies are monitored as ‘high-risk’ by default in both global and Indian practice.”
National programs like the Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) play a crucial role in operationalising this classification. “Indian guidelines mandate enhanced surveillance through the PMSMA and related government initiatives. There is a strong focus on early detection, regular follow-up, and timely referral to tertiary care centres if complications arise,” he adds.
Monitoring protocols for older mothers include more frequent antenatal visits, first-trimester scans for viability, third-trimester assessments for fetal growth, and in many cases, early initiation of fetal surveillance. “Aneuploidy screening (noninvasive prenatal testing or detailed anomaly scans) is highly recommended and usually discussed as part of routine counselling,” Dr Murdia notes. “Fetal surveillance— like non-stress tests or biophysical profiles—is typically initiated earlier or performed more frequently in women aged 40 or above.”
Dr Juneja reinforces that Indian urban clinics are increasingly equipped to meet these challenges. “Indeed, older women (35+) have different treatment and monitoring requirements than younger women. Pregnancy complications are more likely to occur in older women, necessitating more frequent and thorough monitoring. To identify any possible issues early, this includes routine blood pressure checks, glucose tests, ultrasounds, and genetic screening.”
Preventive measures have also become more structured. “Low-dose aspirin is advised from the late first trimester for preeclampsia prevention in AMA women with one or more moderate or high-risk factors,” says Dr Murdia. Iron and folic acid supplementation remains a nationwide mandate, and decisions about delivery timing are also adjusted. “For women 40 years or older, induction of labour or elective caesarean at 39 weeks may be offered to reduce the risk of stillbirth.”
These decisions are often grounded in counselling that spans both medical and emotional readiness. “Detailed birth preparedness counselling is emphasised,” says Dr Murdia. “And postpartum monitoring is particularly crucial—for hemorrhage, infection, and delayed recovery.”
Still, gaps remain, especially when it comes to equitable access. “Fertility clinics in urban areas are prepared to provide cutting-edge treatment options, like IVF and egg freezing, as standard care for elderly women,” notes Dr Juneja. “But in rural areas, access to such advanced care may be limited, and the focus remains on managing high-risk pregnancies with basic monitoring and support.”
She adds that in India, treatment plans must account not just for medical risk, but also cultural context. “Additional social and cultural counselling is included, as older mothers may require support for mental health, birth spacing, and family planning.”
The rise in delayed pregnancies has thus transformed not only the risk matrix, but also the very nature of how reproductive care is designed, delivered, and adapted to India’s evolving maternal demographic.
Preserving possibility
As age-related risks grow more complex, many women are now choosing to plan ahead—long before pregnancy even begins. This shift has put fertility preservation and workplace wellness firmly in the spotlight. “Absolutely, there are significant developments happening both globally and in India when it comes to fertility preservation and workplace wellness,” says Ajaikumar. “Fertility preservation is becoming a less taboo topic, and more men and women are opting for it at a younger age so they can choose when to begin their conception journey.”
Dr Murdia, outlines how fertility preservation is being formalised into hospital care pathways. “Many medical centres are establishing specialised fertility preservation programs or units. These programs are designed with dedicated teams, including program directors, patient navigators, and multidisciplinary clinicians, who coordinate fertility risk assessment, counselling, and procedures for patients who may lose fertility due to medical treatments,” he explains.
Among the available options, egg freezing is just the beginning. “In addition to egg freezing, women in India have other options to preserve their fertility, such as embryo freezing, ovarian tissue freezing, ovarian suppression, and experimental artificial ovaries,” says Dr Ameet Soni, Associate Vice President, HoD – Medical Affairs, CORONA Remedies.
Meanwhile, workplace culture is also catching up. Fertility support is becoming a key part of corporate wellness policies—not just as a perk but as a legitimate health benefit. “Women, especially employees of some major firms, are now able to access late motherhood due to changes in childcare policies,” says Dr Soni. “Additionally, wellness units are being established by some fertility clinics which extend their services beyond fertility treatment. These units offer services such as lifestyle counselling, stress management, and counselling ahead of conception. These growing shifts in policy signal the increasing recognition of the importance of fertility preservation as part of overall workplace wellness.”
Dr Murdia concurs, highlighting broader workplace and public health integrations: “Forward-thinking organisations are recognising the importance of comprehensive fertility benefits as part of their employee wellness strategies.” “Partnerships between public health departments and employers have been established to expand worksite wellness efforts—improving program reach and effectiveness through shared resources and expertise,” he concludes.
Insuring the future
As conversations around fertility preservation and workplace wellness grow louder, a natural next question emerges: is the insurance ecosystem keeping pace? While reproductive choices expand and more women opt for motherhood on their own timelines, insurers are beginning to respond – albeit cautiously.
According to Siddharth Singhal, Head – Health Insurance at Policybazaar.com, “Treatments like IVF and IUI, once seen as outside the ambit of health insurance, are now being included in select health plans, particularly in group policies and some premium retail offerings.” Most such plans come with waiting periods (typically nine months or more) and often cover diagnostics, medication, and a limited number of treatment cycles. While this inclusion remains nascent, it reflects a growing shift toward normalising fertility care within mainstream health coverage.
However, as Priya Deshmukh, Head – Health Products, Operations & Services, ICICI Lombard notes, this progress is largely limited to corporate group plans and riders. “Fertility treatments, especially elective ones, are still largely excluded under standard policies,” she says, though insurers are beginning to explore modular riders for diagnostics, counselling, and partial procedure coverage.
When it comes to pregnancies at 35 years and above, insurers are treading carefully. Structural aspects like sub-limits and waiting periods remain common, but product design is slowly evolving. “The increased risk associated with advanced maternal age, coupled with rising awareness around comprehensive maternal care, is driving demand for higher maternity sum insured,” says Deshmukh.
Both experts agree that urban demand is fuelling interest in long-term fertility planning—such as egg freezing and extended postnatal support— but actuarial challenges persist. Limited claims data, uncertain outcomes, and the high costs of elective care make broad inclusion complex. For now, most insurers are approaching these benefits conservatively, often through optional group riders that combine maternal health with services like physiotherapy, lactation, and mental health support.
Indeed, more couples are opting to start families later in life—either by choice or due to circumstance—which in turn increases reliance on medical support to conceive. Fertility clinics are now seeing a more diverse demographic, and technological breakthroughs are helping meet that growing demand. “From genetic testing and embryo freezing to AI-based embryo selection, new tools are improving success rates and patient satisfaction,” Dr. Murdia adds. “Automation and telemedicine are also helping clinics reach and maximise their operations, making IVF accessible to patients worldwide.”
This combination of accessibility and innovation is fueling long-term growth. According to IMARC Group, the global fertility services market—valued at USD 46.1 billion in 2024—is expected to triple by 2033, reaching USD 142.0 billion. India, following global trends, is expected to play a major role in this surge. However, growth is only part of the story. “I see tremendous potential for business growth in this space over the next five to ten years,” notes Anjali Ajaikumar. “However, especially in urban metros, there’s also a noticeable surge in competition—with many single-center or unorganised market players entering the field.”
She believes the sector is entering a crucial phase of consolidation. “While the barriers to entry have been relatively low, maintaining consistently high-quality standards that drive better outcomes requires a more streamlined and structured approach,” she says. The challenge, therefore, lies not just in expanding reach—but in ensuring that expansion is sustainable, standardised, and centred on patient well-being.
Fertility preservation, in particular, is emerging as a strong growth segment. “Fertility preservation has great business potential over the next 5 to 10 years,” says Dr Ameet Soni. “As more women choose to delay childbearing for personal or professional reasons, the demand for services like egg freezing and embryo freezing is expected to rise.” This shift is not just consumer-led. “Corporate wellness programs that offer these services as benefits are also likely to grow, providing a new market for fertility clinics,” he adds.
Conclusion
As delayed motherhood becomes a conscious and common choice, the fertility sector in India is poised for significant expansion. But to truly capitalise on this momentum, healthcare providers, insurers, and employers must accelerate innovation, improve access, and build systems that can sustain the realities.
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