For Indian American couples facing infertility, getting fertility treatment can mean navigating a complicated U.S. healthcare system, significant out-of-pocket costs, insurance limitations and long waits before treatment even begins.
For some, the answer is increasingly closer to home, but not necessarily in the United States.
Indian Americans living in the U.S. are traveling to India for fertility treatment, combining access to fertility specialists with something that can be difficult to replicate in America: having parents, siblings and extended family nearby during an emotionally and physically demanding process.
The trend is not entirely new. But fertility specialists say more diaspora couples are now considering India not simply because treatment can cost less, but because the clinical gap between the two countries has narrowed and families are looking for more continuity of care.
Speaking exclusively with The American Bazaar, Dr. Rohit Gutgutia, co-founder and medical director of London-based fertility guidance platform Ikivana, and Megha Agarwal, co-founder of Ikivana, discussed what Indian American couples should know before making that decision.
Gutgutia, who has more than 20 years of experience in IVF, and Agarwal work with fertility specialists and treatment partners across India and the UAE.
For a couple living in the United States, starting IVF can involve more than finding a fertility clinic. Gutgutia said the process in the U.S. can involve significant delays because of the workup and insurance authorization process.
“In the United States most clinics work on a co-pay or self-pay basis, so what delays a couple is rarely the clinic itself. It is the workup, and then the authorisation sitting on top of it. In my experience couples describe weeks turning into months before they actually begin, and the variation between one clinic and the next is wide.”
India, meanwhile, can offer shorter waiting times and substantially lower treatment costs, he said.
“In India the wait is materially shorter and the cost, which we will come to, is a fraction of it. The clinical toolkit itself is much the same. IVF is a standardized field, and the laboratory techniques used in a good Indian clinic are the techniques used anywhere else.”
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For Indian Americans, however, the decision can involve something beyond the medical and financial calculations.
“This is not new. Non-resident Indians have always come home for fertility treatment. What has changed is the scale.”
“Cost is the obvious driver. But the reason couples give me most often is family. IVF is demanding and often lonely, and going through it with your mother or your sister nearby, in a house you know, changes the experience entirely.”
He also pointed to the narrowing difference in clinical capabilities between the two countries.
“The third factor is that the gap in quality has closed. Indian laboratories, embryologists and equipment are current, and a patient is no longer choosing between a good outcome and an affordable one.”
Agarwal said Indian Americans have often relied on family recommendations when seeking fertility treatment in India, but traveling without adequate planning can create another layer of stress.
“What we see at Ikivana is that people were already going. They were booking flights on the strength of a cousin’s recommendation, with no plan, no vetted clinic and nobody to call when something went wrong. The trend is not new. Doing it properly is.”
For diaspora patients, continuity of care can be particularly important when treatment begins in India but follow-up eventually takes place in the United States.
Agarwal said patients in India can often have more continuity with their fertility specialist.
“We believe in continuity of care, and that is what our patients talk about most. It is not clinical, it is attention. In India they tend to see the same consultant throughout, and that same doctor usually carries out the procedures too, the egg retrieval and the embryo transfer, rather than handing them to whoever is on the rota that day. Appointments are not rationed in the same way either. When you are three weeks into a cycle and something does not feel right, being able to reach the doctor who already knows your case, rather than explaining yourself from the beginning to whoever is on duty, matters more than any brochure comparison of success rates.”
Cost is one of the clearest reasons an Indian American couple might consider treatment in India.
Gutgutia estimates that a standard IVF cycle in the United States runs between $18,000 and $25,000, compared with around $4,200 for a standard cycle at Ikivana’s partner clinics in India.
“The part couples get caught out by is the add-ons. Very often a couple will ask for embryo screening through PGT-A, or an additional laboratory procedure such as microfluidics, and in most cases that adds a further four hundred to eight hundred dollars. These are not hidden charges, but they are often raised late, once a couple is already committed and least able to weigh them calmly.”
His advice to patients is to ask for a complete cost breakdown before treatment begins.
“My strong advice is to insist that the add-ons and the base cycle cost are laid out together on the first day of counseling, in writing. A clinic that will not do that is telling you something.”
Agarwal said Ikivana’s package is around $4,200, while optional procedures are priced separately.
“This is why we price it the way we do. Our package is around four thousand two hundred dollars and covers everything a standard cycle needs, with the optional extras Dr Rohit mentions, PGT-A and microfluidics, priced separately and quoted before anyone commits rather than added along the way. A couple should know what they are paying at the start, not work it out looking back.”
For Indian Americans, however, the real cost calculation goes beyond the medical bill.
“Then there are the costs no invoice shows. Flights, accommodation, and above all time away from work, since a cycle does not bend around a calendar. Some US employers now reimburse fertility treatment abroad through their benefits provider, so it is worth asking your HR team rather than assuming the answer is no.”
Another concern for an Indian American couple considering treatment in India is what happens after they return to the United States.
Gutgutia said patients should leave India with detailed documentation of their treatment.
“IVF is a standardized medical procedure and its processes are much the same worldwide, so patients move between countries more smoothly than they expect. In every case the patient leaves with a detailed treatment note setting out what was done, what was used and what we recommend next, before they travel.”
For patients returning to the United States after treatment, he said specialist follow-up is important.
“Where a patient returns to the United States, we insist they move to a high-risk obstetric service rather than a general one, so that the pregnancy is monitored by a specialist team from the outset.”
Agarwal said the challenge is making sure the transition between the two healthcare systems is planned rather than improvised.
“The advantage is the one couples underestimate. Treatment is demanding, and going through it in your own family’s home, with your mother cooking and a family member with you at appointments, is worth more than any brochure suggests.”
“The disadvantage is simply distance. Care that begins in one country and continues in another needs somebody holding the thread, and Ikivana was built for exactly that, to make fertility advice and treatment more accessible, practical, timely and trustworthy for people facing high costs, long wait times and fragmented advice. In practice it means the notes reach the next doctor before the patient does, and a couple knows who picks up their care when they land rather than working it out after they get home.”
While the price difference may make India attractive, Gutgutia cautioned against treating IVF as the default solution.
“IVF is the tip of the iceberg, and I wish that were better understood.”
He said many couples can conceive with less intensive interventions, including medication to induce ovulation and appropriate timing, while others may benefit from surgical correction.
“Most couples struggling to conceive do not need it. The commonest intervention is medication to ensure ovulation is happening, combined with proper timing, which sounds almost too simple but resolves a great many cases. Others benefit from a straightforward surgical correction.”
Gutgutia said IVF becomes more appropriate when simpler interventions have been exhausted or when blocked or damaged fallopian tubes prevent the egg and sperm from meeting.
“IVF becomes the right answer in two clear situations. The first is when the natural process has not worked over a long period and simpler interventions have been exhausted. The second is when the fallopian tubes are blocked or damaged, so that egg and sperm cannot meet at all, in which case there is no purpose in working through the intermediate steps.”
He added a warning for patients considering fertility clinics in either country.
“Any clinic that recommends IVF at the first consultation, before establishing why a couple is not conceiving, is not doing its job properly.”
For Indian American couples who may be quietly struggling with infertility, Gutgutia said waiting too long can also be a mistake.
“The standard we work to is straightforward. A woman who is ovulating regularly, in a relationship with regular unprotected intercourse, would be expected to conceive within a year. If that has not happened, it is time to see a gynaecologist rather than wait another year hoping.”
He said certain couples should seek an assessment earlier, including those with a history of pelvic surgery, a previous sexually transmitted infection or an inability to conceive in a previous relationship.
“There are also circumstances where waiting a full year is the wrong advice. A history of pelvic surgery in either partner, a previous sexually transmitted infection, or an inability to conceive in a previous relationship are all reasons to be assessed early. So is age. The older a woman is, the less sense it makes to wait and see.”
He said one of the most common patterns he encounters is couples who suspected something was wrong long before seeking professional advice.
“The most common thing I see is a couple who suspected something was wrong two or three years before they walked through the door. Those are years nobody can give back to them.”
For Indian American couples, fertility treatment can also mean confronting attitudes within their own families.
Gutgutia said the stigma surrounding infertility has declined, including in traditional Indian households.
“A great deal of that stigma has lifted, and faster than people outside the field realize.”
“The background matters. We are a young society with a strong emphasis on childbearing, and for generations most families had children early. What is new is women stepping out of the home, building careers, and deliberately delaying having children. That is a recent shift, and families have needed time to adjust to it.”
“At the same time more couples are coming forward, and treatment is discussed openly in a way it was not ten years ago. The result is that it is no longer a novelty even in traditional Indian homes. Most extended families now know someone who has been through it.”
His message to families is direct.
“What I would ask families to understand is simple. This is a medical condition, not a moral failing, and not a verdict on anyone’s worth.”
Agarwal said one perception remains particularly difficult.
“I would add one thing. It is still treated as a woman’s problem in a great many families, and it is not. That assumption does real damage, and it is the part that has changed least.”
For diaspora couples considering fertility treatment in India, preparation should begin well before they board a flight.
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Gutgutia said medical records can be sent electronically to the treating clinic in advance.
“Records are simpler than people fear. Previous medical records can be summarized electronically and sent to the treating clinic in advance, and reviewed before anyone gets on a plane. There is no need to carry files.”
He also highlighted the need to arrange the appropriate visa.
“The one thing that does need attention is the visa. Traveling for treatment means a medical visa rather than a tourist visa, and requirements change, so it should be checked and arranged before anything else is booked.”
Agarwal said couples should plan their trip around the fertility cycle.
“Plan the trip around the cycle rather than the other way round. Know roughly how long you are likely to be in India, who is travelling with you, and what happens if the cycle is postponed, because cycles can be postponed.”
For an Indian American couple balancing a job, healthcare, travel and family commitments across two countries, the logistics can become overwhelming.
“The admin around all this is heavier than people expect: the visa letter from the clinic, records sent ahead and acknowledged, appointments sequenced so you are not losing days between them, and the follow-up arranged before you fly. At Ikivana we take that off the couple. We hold the hotel and travel arrangements alongside the clinic appointments so the two are planned as one thing, and we build support around the treatment itself, wellness stays, nutrition guidance and emotional support, because the weeks between stimulation and a result are long and people are rarely prepared for how they feel in them.
“Somebody going through IVF is carrying enough physically and emotionally without also running a logistics project. That part is ours to carry, not theirs.”
For Gutgutia, the biggest message to Indian Americans considering treatment in India is that they should approach IVF with realistic expectations.
“That IVF in India is safe and well run, and that we look after our patients the way we would look after our own families.”
But he stressed that IVF should never be presented as a guarantee.
“The one thing I would want understood is that IVF is not a guarantee. In many cases more than one attempt is needed before a child is born, and a couple who begins expecting success on the first cycle is set up for a fall that is avoidable. The techniques keep improving, and more couples are reaching parenthood through assisted reproduction than ever before. But honesty about the odds is part of good care, and a clinic that will not give you that honestly at the start is not a clinic to trust.”
For Agarwal, the issue she would most like to see change among Indian American families is not necessarily where couples receive treatment, but how openly they talk about infertility.
“If I could change one thing, it would be the silence. Couples go through years of this without telling their closest friends, and then discover that three people they see every week have been through exactly the same. The treatment is not the hardest part. Doing it alone is.”