Abstract

Background: Infertility has emerged as a significant reproductive health challenge in India, currently impacting an estimated 27.5 million couples. Despite its high prevalence, female infertility remains a "silent epidemic" characterized by profound social stigma, gender bias, and severe mental health implications. This study explores the shifting epidemiological landscape and multifactorial causes of female infertility in the Indian context. Objective: To analyze the prevalence, regional distribution, and primary clinical determinants of female infertility in India, utilizing recent national-level data. Methods: The study synthesized data from the National Family Health Survey-5 (NFHS-5, 2019–21) and existing literature. Clinical causes, including Polycystic Ovary Syndrome (PCOS) and Endometriosis, were examined alongside socio-demographic factors. Results: Analysis revealed a significant inverse correlation between marital duration and infertility prevalence. Regional disparities are prominent, with the highest burdens identified in Goa, Lakshadweep, and Chhattisgarh. Clinical drivers include a high prevalence of PCOS (affecting 1 in 5 women) and endometriosis (affecting ~10% of reproductive-age women), compounded by lifestyle factors, environmental toxins, and preventable reproductive tract infections (RTIs). Conclusion: The rising burden of female infertility in India, particularly in urban settings and specific sub-national regions, necessitates targeted public health interventions. Addressing the "silent epidemic" requires expanding access to reproductive care, mitigating social stigma, and implementing a national infertility surveillance system to support affected couples.