The total fertility rate, children per woman, in the country has reached 2.0 in 2019-21, compared to 2.2 in 2015-16, according to the National Family Health Survey.

This means women are giving a lesser number of births in their reproductive period. The Total Fertility Rate in the country has reached the replacement level of fertility which is the number of children needed to replace the parents, after accounting for fatalities, skewed sex ratio, infant mortality, etc. The population starts falling below this level.

The population replacement rate, which is the fertility rate needed to maintain a society's population size, is 2.1 children per woman. Countries with a fertility rate below this number may experience an overall older demographic and a decrease in population size over time. According to World Bank data, the global fertility rate was 2.4 children per woman in 2019.

This rate is approximately half of what it was in 1950 (4.7), and more economically developed countries such as Australia, most of Europe, and South Korea, tend to have lower rates than do less-developed or low-income countries.

Talking to IANS, Dr Neeta Singh, Professor, Department of Obst & Gynae, AIIMS, says that the urban fertility rate has reached the minimum level of 1.6 which is a major concern, however, the rural fertile rate is 2.0 and the overall fertility rate is 2.0. But, for a developing nation to keep a balance with the death ratio and new population, we need a 2.3 fertility rate, she warns. Dr Singh reasons late marriage trends in urban areas as a prime factor for the declining level of fertility.

"A woman gets married generally after 27-28, then needs time for settle down in life and then tries for child and after one or two years they visit doctors if she does not conceive", says Dr Singh adding that in between they cross the peak period of fertility which is 20 to 25 years. She argues that after this period, fertility remains in plateau condition to 30 years and starts declining after 30 years. After 35 years, female fertility declines faster, she says.

Infertility is "a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse, defines WHO. There are two kinds of infertility - primary and secondary. Primary infertility means that the couple has never conceived. Secondary infertility means that the couple has experienced pregnancy before and failed to conceive later. Globally, most infertile couples suffer from primary infertility, as per WHO.

In males also, fertility begins declining after 40 years. "This is just a myth that a male can remain fertile till 60 years", she told IANS. Most of the couple visits doctors when their fertility rate already starts declining, Dr Singh says.

"Research has found that the ovarian ageing of Indian women is around 5 years advance in comparison to the US and the UK which is a major concern. It means that if a woman can produce a child at the age of 40 in the US and the UK, in India the age will be only 35 years. However, whether the demographic condition or climate or race is responsible for this is not known yet," she told.

Talking about male infertility, Dr Singh said that it is also increasing with speed due to rising stress, food alterations, sedentary lifestyles, irregular working styles and others. "Every second or third male is infertile or sub-fertile in India. We rarely find 20 million sperm count in any male, which used to be around 50 to 100 million earlier. If we find even 15 million sperm count in a male, we consider it okay. Sperm dying is the main cause for male infertility", Dr Singh added.

On being asked about whether IVF is the solution to this rising infertility, she clearly rejected it and said that if eggs are not being produced, how can IVF work. Fertile eggs and healthy sperm can only make IVF successful, opined Dr Singh. However, Delhi based IVF specialist Dr Archna Dhawan Bajaj said that the cumulative success rate for IVF is around 45 per cent only. Talking about the causes of infertility, Dr Bajaj said that nearly 40 per cent of males, 40 per cent of females and 20 per cent of both couples contribute to infertility.