What No One Tells You About Fertility: Why IVF Is on the Rise

Infertility is more complex than many people realise, involving Reproductive Health, age, medical conditions and emotional well-being. Dr. Sankalp Jain explains why couples should seek an individual Fertility assessment before deciding whether in vitro fertilisation (IVF) is the right treatment.

For many couples, the journey towards parenthood begins with an expectation that pregnancy will happen naturally. When months pass without a positive test, however, hope can gradually give way to anxiety, questions and pressure from family or society. What initially feels like a private experience can become an increasingly difficult emotional and medical challenge.

The growing visibility of fertility treatments has made IVF a more familiar option for people experiencing difficulties conceiving. Yet greater awareness does not always translate into a clearer understanding of infertility, its possible causes or the treatments available.

In a discussion on reproductive health, Dr. Sankalp Jain, MBBS, FNR, PGDID (Australia), PGD in Sexology and Psychosexual Therapy, The American College of Sexologists (USA), highlights an important distinction: IVF can be an effective route to parenthood, but it is not automatically the right first step for every couple.

His perspective places individual medical assessment, the involvement of both partners and emotional well-being at the centre of fertility care. It also challenges a long-standing social assumption that difficulties conceiving are primarily a woman’s responsibility.

Understanding these issues can help couples make more informed decisions, avoid unnecessary assumptions and approach fertility treatment with realistic expectations.

Why Is IVF Becoming a More Visible Fertility Option?

In vitro fertilisation, commonly known as IVF, involves fertilising eggs with sperm in a laboratory and transferring an embryo into the uterus. It is an established form of assisted reproductive technology used in the treatment of certain fertility problems.

For couples who have struggled to conceive, IVF can offer an important opportunity to pursue pregnancy. However, its increasing visibility in public conversations can sometimes create the impression that it is the inevitable next step whenever conception takes longer than expected.

The reality is more complicated.

Infertility can result from male reproductive factors, female reproductive factors, a combination of both or causes that remain unexplained even after investigation. Treatment therefore needs to reflect the medical circumstances of the individuals involved.

The World Health Organization has estimated that approximately one in six people worldwide experience infertility during their lifetime. This highlights the scale of the issue and the importance of making appropriate fertility care accessible.

Greater awareness of IVF is valuable because it can encourage people to seek help rather than suffer in silence. However, awareness should also include an understanding of the diagnostic process, the alternatives to IVF where appropriate and the limitations of available tests.

The important question is not simply whether IVF is available. It is whether it is suitable for a particular patient’s circumstances.

IVF Is an Option, Not Always the First Step

One of the central messages in Dr. Jain’s discussion is that fertility treatment should begin with an assessment rather than an assumption.

A couple experiencing difficulty conceiving may have an underlying condition that requires specific investigation or treatment. For example, blocked fallopian tubes can interfere with the movement of an egg towards the uterus, while endometriosis may affect reproductive function in some patients.

Other cases may involve problems with ovulation, sperm production or sperm quality. Some couples may have more than one contributing factor.

These differences matter because the same treatment approach cannot be expected to suit everyone.

A fertility specialist may recommend further testing, treatment for an identified condition, carefully monitored attempts at natural conception or assisted reproductive technology, depending on the findings.

IVF may be appropriate when particular reproductive barriers make other approaches unsuitable or less effective. In other circumstances, a different intervention may be considered first.

This does not mean that couples should avoid IVF or postpone treatment without reason. Delaying appropriate care can be counterproductive, particularly when age or a known medical condition makes time an important consideration.

Instead, the objective is to establish a clear diagnosis where possible, understand the available options and discuss the likely benefits, limitations, costs and risks of each approach.

An individual assessment helps make that decision more informed.

Infertility Is a Shared Medical Concern, Not Just a Woman’s Problem

The tendency to blame women when a couple cannot conceive remains one of the most damaging misconceptions surrounding fertility.

In many families, the woman is expected to undergo repeated investigations and explain why pregnancy has not occurred, while the man’s reproductive health receives comparatively little attention.

This approach is medically incomplete.

Male fertility depends on several factors, including sperm production, sperm movement, sperm shape and the functioning of the reproductive system. Hormonal conditions, certain illnesses, medications and other health-related factors may also contribute to difficulties conceiving.

Female reproductive health can involve ovulation, ovarian function, the uterus, fallopian tubes and other medical considerations.

In some couples, the difficulty may involve both partners. In others, testing may not reveal a clear explanation.

Professional guidance from the American Society for Reproductive Medicine recommends evaluating both partners concurrently when applicable, including semen analysis as part of the initial assessment of male fertility.

Dr. Jain’s emphasis on shared responsibility is therefore important beyond the medical setting.

When both partners participate in the assessment, the process can become less about assigning blame and more about identifying the relevant health factors. It can also help couples approach difficult decisions as a team.

Infertility should never be treated as a measure of a person’s worth, masculinity or femininity.

Age Matters, but It Does Not Tell the Whole Story

Age is among the most important considerations in fertility planning, particularly for women.

Female fertility generally declines with age as the number and quality of available eggs change. Increasing age is also associated with a greater likelihood of certain pregnancy complications and miscarriage.

Male reproductive ageing follows a different pattern, but age-related changes in reproductive health can occur in men as well.

These realities make it important to approach fertility planning with accurate information rather than relying on celebrity pregnancy stories or the experiences of friends and relatives.

Someone who conceives naturally at a later age cannot predict the reproductive outcome for another person of the same age. Individual medical histories, reproductive conditions and other factors differ.

At the same time, age alone does not establish whether natural conception is possible.

Tests such as anti-Müllerian hormone (AMH) assessment and antral follicle count can help clinicians evaluate ovarian reserve in appropriate circumstances. However, ovarian reserve tests have limitations and should not be interpreted as definitive predictions of natural conception.

The American Society for Reproductive Medicine describes female age as a particularly important predictor of fertility and advises that ovarian reserve testing should complement, rather than replace, clinical assessment and counselling.

For people considering pregnancy later in life, an early consultation can help clarify their options and whether further evaluation is appropriate.

Lifestyle, Metabolic Health and Fertility: What Couples Should Know

Fertility is closely connected to overall health, although lifestyle should not be treated as the sole explanation for infertility.

Factors such as smoking, obesity and certain substance exposures can affect reproductive health. Medical conditions that influence hormonal function or metabolism may also be relevant to conception.

For example, insulin resistance and associated metabolic conditions can be linked to hormonal and ovulatory difficulties in some women. Smoking can adversely affect reproductive health, while anabolic steroid use can interfere with normal reproductive hormone function and sperm production in men.

Dr. Jain also raises concerns about highly processed diets, stress and air pollution. These subjects warrant careful consideration, but their effects are not identical, and they should not automatically be blamed for an individual’s difficulty conceiving.

The practical approach is to focus on established, manageable steps.

Couples planning pregnancy can discuss existing medical conditions and medications with their healthcare professionals, avoid smoking and non-prescribed anabolic steroids, maintain a balanced diet and work towards sustainable habits that support general health.

Where excess weight or a metabolic condition is a concern, a clinician can help determine whether and how treatment may benefit reproductive health.

However, no particular diet, exercise routine or supplement guarantees pregnancy. Equally, a couple should not be made to feel responsible for infertility simply because they have a particular body weight or lifestyle history.

Lifestyle improvements can support health, but they do not replace appropriate fertility investigations.

The Emotional Side of Trying to Conceive

Fertility conversations often focus on medical procedures and test results, leaving the emotional experience of trying to conceive largely unaddressed.

For some couples, the process can change the way they experience intimacy. Intercourse may become organised around the fertile window, while each menstrual cycle brings a new period of anticipation and uncertainty.

Repeated disappointment can affect confidence, communication and emotional well-being.

Women may experience pressure from relatives who expect them to become pregnant, while men may feel that their ability to father a child is being questioned. Both partners can experience anxiety, grief or frustration, even if they express those feelings differently.

Over time, the relationship itself can become overshadowed by the goal of conception.

Dr. Jain’s discussion highlights the importance of recognising this emotional burden rather than treating fertility as a purely physical issue.

It is important, however, not to confuse the effects of stress on well-being with the claim that stress alone causes infertility. Telling someone to relax or stop worrying is not a substitute for medical evaluation.

Open communication, mutual support and professional counselling can help couples navigate the experience. Psychological support may be particularly valuable when treatment becomes prolonged, financially demanding or emotionally exhausting.

Seeking help is not a sign of weakness. It is one way to protect individual well-being and the relationship during an uncertain period.

Why Fertility Tests Need to Be Interpreted Carefully

Medical investigations are essential to understanding many fertility problems, but the number of tests available can also create confusion.

Couples may encounter recommendations for hormone panels, ovarian reserve tests, ultrasound examinations and semen analysis. Online information can make it difficult to distinguish essential investigations from tests that may not be necessary in a particular case.

A fertility evaluation should be guided by a qualified clinician and tailored to the patient’s age, symptoms, medical history and duration of attempts to conceive.

Depending on the circumstances, the assessment may include a review of menstrual patterns and ovulation, evaluation of the uterus and fallopian tubes, and semen analysis for the male partner.

AMH testing can provide information about ovarian reserve, particularly when planning certain fertility treatments. It does not independently establish whether a woman can conceive naturally or guarantee the success of IVF.

Similarly, an abnormal semen analysis may require further assessment, while a single result should not automatically be treated as a complete explanation of a couple’s fertility difficulties.

The objective is to interpret findings together rather than make major decisions based on an isolated number.

Couples should also be cautious about starting fertility supplements or undergoing extensive testing without understanding the clinical purpose.

A useful consultation should explain what each recommended test is intended to establish, how the result could influence treatment and whether additional investigation is necessary.

When Should Couples Seek a Fertility Assessment?

Waiting too long to seek advice can delay the identification of treatable reproductive conditions. Yet couples do not need to assume that every unsuccessful cycle indicates a medical problem requiring IVF.

A widely used clinical guideline recommends a fertility evaluation after 12 months of regular, unprotected intercourse without conception when the female partner is younger than 35. For women aged 35 and older, evaluation is generally recommended after six months.

For women over 40, more immediate assessment may be appropriate. Couples should also seek earlier medical advice when either partner has a known condition or history that could affect fertility.

Reasons to consider an earlier consultation include irregular or absent menstrual periods, suspected endometriosis, known reproductive tract conditions, previous cancer treatment or a suspected male fertility problem.

These timeframes are general clinical guidance, not a reason to delay care when there are existing concerns.

An initial consultation does not commit a couple to IVF. It provides an opportunity to understand their reproductive health, identify possible causes and decide on appropriate next steps with a qualified professional.

The Way Forward: Individualised Fertility Care

The growing visibility of IVF has opened up important conversations about infertility and the possibilities offered by modern reproductive medicine.

But greater awareness should also encourage a more balanced understanding of what fertility treatment involves.

As Dr. Sankalp Jain’s discussion highlights, the most useful starting point is not the assumption that every couple needs IVF. It is an individual assessment that considers both partners, their medical histories, reproductive health and emotional circumstances.

For some, IVF may be the most appropriate option. Others may benefit from different treatments, further investigations or a carefully planned approach based on their clinical findings.

The decision should be informed by medical evidence, realistic expectations and an open discussion of the available choices.

Just as importantly, couples should be able to pursue fertility care without blame, shame or pressure to compare their experiences with someone else’s.

Infertility is a medical concern, not a personal failure. Understanding its possible causes, seeking timely advice and involving both partners can help people make decisions with greater clarity and confidence.

The goal is not simply to choose a treatment. It is to choose the approach that best reflects the individual’s circumstances, medical needs and informed preferences.