From AMH to sperm health: How work culture is impacting fertility

Imagine if everyone treated fertility the way they do heart health: checking it regularly, interpreting data early and taking simple steps decades before problems arise. You would not wait until a heart attack to measure cholesterol so why wait for infertility to strike before you test your fertility?

That is the message a growing number of reproductive health experts are sounding in India where fertility rates in several states have dipped below replacement levels and a silent crisis of late-stage infertility is emerging. Couples increasingly arrive at clinics only after years of trying to conceive, often with diminished ovarian reserve in women or poor sperm quality in men, conditions that might have been detected and addressed much earlier with basic screening.




With delayed marriage, long careers, lifestyle stressors and environmental toxins all adding fuel to the fire, experts say that a prevention-focused approach to reproductive health, including routine fertility testing and workplace support, is no longer a luxury but an essential.

What science says about fertility awareness and early testing

Fertility decline with age is real and predictable. According to a 2020 study published in Fertility and Sterility, “Ovarian reserve and oocyte quality decline with age, leading to reduced fertility and increased time to pregnancy… reproductive aging is a major determinant of fertility potential.” This widely cited review confirms what clinicians see every day: fertility is time-sensitive. Unlike heart health markers that decline gradually, reproductive potential especially in women follows a steep curve, with significant reductions after the age of 35. Early awareness of ovarian reserve can give couples more options and better outcomes.

Early fertility testing improves family planning decisions. A 2021 study in Human Reproduction found, “Women who underwent routine assessments of ovarian reserve and reproductive hormones were more informed about their reproductive timelines and made earlier family planning decisions than those who did not.” This study highlighted how proactive screening, rather than reactive care, empowers individuals. Knowledge of AMH levels, antral follicle counts or sperm parameters early in the reproductive window can help couples make intentional decisions including timing, fertility preservation or lifestyle adjustments, instead of reacting only when conception fails.

Male fertility also declines with age and lifestyle factors. As per a 2017 study in Asian Journal of Andrology, “Advancing male age is associated with reduced semen volume, sperm motility and morphology, along with increased DNA fragmentation… age-related decline in male fertility should be considered in family planning.” While much public focus centers on women’s reproductive ageing, this research underscores that men’s fertility also declines with age and environmental factors. For couples, early semen analysis can reveal modifiable issues — like oxidative stress, smoking or toxin exposure — long before a fertility crisis strikes.

Why you must view fertility health through a preventive lens

In an interview with the Times of India, Shobhit Agarwal, CEO and Dr Rohit Gutgutia, Medical Director at Nova IVF Fertility, talked about why routine fertility awareness is a public health priority and shared -

• Falling Fertility, Rising Blind Spots: Often, couples walk into clinics many years after attempting to conceive, even when the window of conception is already considerably narrow. Women who present with diminished ovarian reserve, or men who present with dismal sperm quality, often receive their diagnosis much too late, when there is much less they can do, with only one option left to undergo advanced fertility treatments. Not only the issue of timing but also the cultural lifestyles of later marriages, delayed childbearing, increasing stress, overweight and exposure to environmental toxins further increase fertility challenges.
• The Biological Clock Gap: A few decades ago, heart health was at this stage, where there was a lack of awareness on preventing heart diseases. In this sense, infertility is being treated like a “post-mortem” diagnosis, something evaluated only when conception fails. Just as we now encourage young adults to monitor blood pressure, cholesterol, and glucose levels as preventive care, fertility testing must become part of routine health check-ups among the reproductive age group of the population, irrespective of their marital status. Most Indians still are not aware that fertility health can be assessed before planning for conception. Reproductive potential declines steadily with age, even in healthy individuals. Without proactive fertility testing, couples are left blindsided and in great shock when fertility specialists present them with a diagnosis of low egg reserve and poor sperm quality.

Plan rather than panic

Shobhit Agarwal and Dr Rohit Gutgutia asserted, “Routine fertility screening is not about instilling fear; it’s about creating preparedness. Basic tests - AMH for women, sperm analysis for men, thyroid and hormone profiles for both - can identify risk factors for fertility well in advance of the family planning process. Risk factors and sub-fertility patterns, including polycystic ovarian syndrome (PCOS), thyroid dysregulation, low ovarian reserve, tubal blocks, genetic factors and male factor infertility, can all be discovered years before family planning.”

They added, “Identification of these risk factors and/ or sub-fertility will cost much less emotionally and financially than waiting for the diagnosis and then acting. For several couples, by the time they escalate their care to a fertility clinic, they have limited options, often requiring advanced fertility treatment, which leads to disappointment, frustration, fear, and stigma. In some cases, donor eggs and donor sperm will be used.”

Workplace health benefits have traditionally focused on heart health check-ups, eye checks, cancer screenings or stress management. Most of the employees in corporate India are in the reproductive age group yet fertility health has been left out of the preventive healthcare conversation. This is slowly changing as several progressive companies are now including fertility tests and even egg-freezing as part of their benefits.

Agarwal and Dr Gutgutia suggested, “For India’s young workforce, where delayed marriage is common, egg-freezing can serve as a practical preventive measure. By covering fertility assessments and preservation, corporate India can support employees in balancing career goals with future family plans. Government support is equally critical, as the conversation on NCDs has largely driven awareness on the subject. Along with fertility, there should be a larger conversation on preconception and premarital health tests, which can help in identifying if parents are carriers of any genetic conditions, such as Thalassemia, Muscular Dystrophy, etc.”

Countries like Saudi Arabia have made Thalassemia testing a part of the mandatory premarital health test to prevent this inherited condition. In India, 1.5 lakh children are reportedly born with thalassemia major and over 40 million carriers are born annually. Yet there is very low awareness of testing for Thalassemia, which can be determined through a simple blood test. Subsidizing such tests or integrating them into public health packages could shift the focus from crisis management to prevention, thereby shifting the discussion to healthier babies. Fertility health should be woven into reproductive health programs.

Highlighting that the cost of waiting is too long, Agarwal and Dr Gutgutia said, “The expenses and emotional burden of infertility can be overwhelming. Preventive fertility screening is a small cost in relation to the advanced fertility treatments, and it gives couples some time to plan, preserve fertility, or undergo medical interventions before things get worse.”

A preventive mindset is the way forward

Both the experts stressed that the strategy towards fertility needs to be like heart health. In our current time, no one questions whether cholesterol levels should be regularly tested, blood pressure should be often examined to assess risk for stroke/heart failure, or whether individuals should be screened for diabetes. These are seen as preventive measures towards investing in one's overall health for the long term. Fertility should be as noticeable as heart health.

India can move from crisis to preparedness stage by normalising the discussion around fertility check-ups, encouraging the workplace to support, creating access through the government and educating the public about preconception counselling and even predisposition to infertility.

Note: The information provided in this article is for educational purposes only and is not intended as medical advice. Always consult with a qualified healthcare professional before starting any new medication or treatment and before changing your diet or supplement regimen.