IVF players on expansion mode in smaller towns as fertility rates go down

Major in-vitro fertilisation (IVF) chains are expanding into untapped Tier 2 and 3 cities, driven by improved healthcare infrastructure, growing acceptance of fertility treatments, and rising disposable incomes in smaller urban centres.
Birla Fertility and IVF, which currently operates around 30 centres in Tier 2 and 3 cities, plans to open at least 15 to 16 more centres in FY26, two-thirds of which will be in smaller towns. Nova IVF, which derives 40 per cent of its revenue from such cities, is exploring expansion in 15 locations including Haldwani, Jamnagar and Meerut. Indira IVF, the country's largest infertility chain, has also announced plans to enter over 25 Tier 3 cities by FY27.
Explaining the rationale, Shobhit Agarwal, Chief Executive Officer (CEO) of Nova IVF Fertility, said, 'With one in six couples experiencing infertility in India, there is a need for fertility chains to expand to cater to couples battling infertility.'
A recent United Nations Population Fund (UNFPA) report highlighted that India's total fertility rate (TFR) has fallen to 1.9 births per woman — below the replacement level of 2.1. The report echoes findings from the National Family Health Survey (NFHS)-5, which pegged India's TFR at 2.0 births per woman for 2019–21.
The NFHS-5 also found the fertility rate had declined more significantly in rural areas, where it stood at 2.1 — down from 3.7 in NFHS-1 (1992–93). In urban areas, it fell to 1.6 from 2.7 in the same period. While infertility is not the sole factor behind the falling TFR, experts suggest infertility cases are expected to rise beyond Tier 1 cities, fuelled by stress-related lifestyle diseases and climate change.
Industry insiders say IVF players are already witnessing increased demand for infertility treatment from Tier 2 and 3 cities.
Abhishek Aggrawal, CEO of Birla Fertility and IVF, told Business Standard that more than 50 per cent of the company's annual IVF cycles are conducted in cities such as Siliguri, Varanasi and Prayagraj. 'While there is a rising segment in metros, with IVF chains receiving queries from women for procedures like egg freezing to delay parenthood, Tier 2 cities are providing an opportunity to tap less penetrated, high-potential markets,' he said.
Agarwal added that many couples from Tier 2 regions find it difficult to travel to larger cities for fertility treatment, as the cost of travel, accommodation and lost wages makes the process financially burdensome. 'With expansion, we are bringing standardised fertility treatment to their home towns, with the best clinical acumen and embryologists,' he said. This model, he added, is affordable and avoids additional hassle.
India currently performs around 200,000 to 250,000 IVF cycles annually, and the market is projected to grow to 400,000 cycles by 2030, with smaller cities expected to account for a substantial share of this growth.
Aggrawal noted that to meet this growing demand, IVF chains are also focusing on building awareness to ensure fertility care is both accessible and better understood by those in need.

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