Infertility in India: bringing mental health to the forefront

Is womanhood synonymous with motherhood? This question has lingered in the Indian social imagination for generations. The country’s fertility landscape remains firmly anchored in a patriarchal narrative, where a woman’s worth, identity, and social legitimacy are overwhelmingly tied to her ability to bear children.

Despite the biological fact that conception requires both a man and a woman, the moral burden of infertility is placed almost exclusively on women. Women without children, frequently branded as maladi (pejorative Tamil term for female infertility) are openly discouraged from attending weddings, baby showers, or religious ceremonies. Such exclusions deepen feelings of shame, isolation, embarrassment, identity fragmentation, and perceived moral failure.

Infertility, though a medical condition like any other, is frequently subjected to moral scrutiny. Even when medical evaluations clearly identify male‑factor issues—such as low sperm counts or unexplained infertility—the cultural script continues to place blame squarely on women. This persistent assumption reinforces a deeply entrenched gender bias that distorts both responsibility and compassion.

Men’s mental health

What often goes unacknowledged in these conversations is that male infertility itself is deeply intertwined with mental health, and that psychological distress can directly impair sperm quality. This is well‑established in contemporary reproductive science. A 2024 original research article in Frontiers in Endocrinology found that depression is significantly associated with decreased semen quality, including reduced sperm concentration and motility (Zhang et al., 2024). This means that the very men who are culturally insulated from blame may themselves be experiencing psychological states that biologically diminish fertility potential.

Further evidence comes from a 2025 open‑access study in Reproductive Biology and Endocrinology, which demonstrates that depression, anxiety, and stress impair sperm quality through dysregulation of the mitochondrial PDK–PDC axis, a pathway essential for healthy sperm metabolism (Wang et al., 2025). This mechanistic insight reinforces that mental health is not merely an emotional overlay, but a physiological determinant of reproductive function.

Ironically, the very patriarchal norms that so swiftly assign fault to women also conspire to keep men silent about their own psychological distress. This enforced quietude does more than perpetuate stigma—it may be actively undermining fertility itself. Observations from clinical reviews indicate that chronic psychological stress triggers activation of the hypothalamic–pituitary–adrenal (HPA) axis, driving up cortisol levels and destabilising the hormonal milieu essential for healthy spermatogenesis.

What emerges from this body of research is a striking paradox: while women absorb the social, emotional, and reputational costs of infertility, men’s unaddressed mental health burdens may be biologically fuelling the very condition for which women are castigated. Acknowledging this dual reality is not merely a matter of fairness or empathy—it is central to improving reproductive outcomes.

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Women’s mental health

If the silence around men’s mental health obscures its biological consequences, the emotional landscape for women is even more fraught—and the science here is equally unambiguous. Mental health challenges do not merely accompany infertility; they can actively impair reproductive function. A landmark study in Human Reproduction found that women experiencing high levels of psychological stress had significantly lower probabilities of conception during each menstrual cycle, with elevated salivary alpha‑amylase—a biomarker of stress—correlating with reduced fecundability (Lynch et al., 2014). In other words, stress is not just a by‑product of infertility; it can be a precursor.

Depression and anxiety also exert their own reproductive toll. Findings from a number of studies underscore that emotional distress is not simply “in the mind”—it is inscribed in the endocrine system.

Taken together, the evidence paints a sobering picture: women are not only socially penalised for infertility but may also be physiologically disadvantaged by the very emotional burdens that stigma imposes. It is a cruel feedback loop—one in which social pressure becomes a biological impediment, and biology becomes further ammunition for social blame.

Recognising this interplay is essential. Mental health is not a peripheral concern in fertility care; it is a central determinant of reproductive health. Until emotional well‑being is treated with the same seriousness as hormonal assays and ultrasound scans, the gap between what science knows and what society believes will continue to widen, to the detriment of the very people seeking to build families.

ART and mental health

The consequences of this emotional burden extend even further when couples enter the realm of infertility treatment. Assisted reproductive technologies are often portrayed as purely biomedical solutions, yet their success is intimately tied to psychological wellbeing. Chronic stress—fuelled by stigma, family pressure, financial strain, and the relentless expectation to conceive—can disrupt hormonal regulation, impair ovulation, and interfere with the body’s responsiveness to treatment protocols.

Research consistently shows that heightened anxiety and depressive symptoms are associated with lower success rates in procedures such as IVF. The monthly cycle of hope, hyper‑vigilance, and disappointment compounds this stress, creating a physiological environment that is less conducive to conception.

The pressures of infertility treatment also reshape the most intimate dimensions of a couple’s relationship. What is ordinarily an expression of desire, connection, or spontaneity can become tightly choreographed around ovulation windows, clinic schedules, and medical directives. Many couples describe sex during treatment as increasingly mechanical—an obligation rather than an act of intimacy. This shift can erode relational closeness. . Over time, the emotional strain can dampen libido, heighten anxiety, and create a sense of detachment between partners. Ironically, the very effort to conceive can undermine the relational and psychological conditions that support healthy sexual functioning.

Recognising this dynamic is crucial. Fertility treatment is not only a medical journey but a relational one: without compassionate support that acknowledges the toll on intimacy, couples may find themselves navigating not only the challenges of infertility but also the quiet erosion of the connection that once anchored their partnership.

The path forward

India stands at a crossroads. The science is clear, the human cost undeniable, and yet our cultural narratives remain stubbornly unchanged.

The first step forward is cultural honesty. We must finally sever the idea that womanhood is validated through motherhood. As long as society treats fertility as a measure of virtue, women will continue to pay with their dignity, their mental health, and in many cases, their biological chances of conceiving. Equally urgent is the need to bring men into the centre of the conversation. The data shows that male mental health directly affects fertility, yet patriarchal norms keep men silent, unexamined, and emotionally unsupported. This silence is not strength—it is sabotage. A fertility system that ignores half the equation cannot claim to be scientific.

Clinics, too, must evolve. Mental health support cannot remain a decorative add‑on to reproductive care. It must be embedded into every stage of assessment and treatment. Screening for anxiety, depression, and relational strain should be as routine as semen analysis or hormone testing. When emotional wellbeing is treated as essential, outcomes improve—not just medically, but humanely.

Finally, couples need support that protects their relationships from the corrosive pressures of treatment. Infertility should not be allowed to hollow out intimacy or turn partnership into performance. Protecting the emotional core of a relationship is not a luxury; it is a form of care.

The way forward is not complicated—it is simply long overdue. We must replace stigma with science, silence with dialogue, and blame with compassion. Only then can fertility care in India move from being a site of quiet suffering to one of dignity, equity, and genuine healing.

(Rashikkha Ra. Iyer is a multidisciplinary clinician working in the U.K., specialising in the delivery of clinical interventions in forensic settings. Rashikkha.RaIyer@outlook.com)