Deepika Padukone’s announcement of embracing motherhood in her 40s has reignited public discourse on age-related fertility decline and assisted reproductive technologies. As of early 2026, approximately one in six Indian women aged 40-44 seeking pregnancy utilize in vitro fertilization (IVF), reflecting a global trend where delayed childbearing correlates with increased reliance on medical intervention. Top gynaecologists emphasize that while natural conception rates drop significantly after age 35 due to diminished ovarian reserve and oocyte quality, IVF offers a viable pathway for many, though success is not guaranteed and varies by individual health factors.
Understanding Ovarian Aging and IVF Success Rates in Later Reproductive Years
Female fertility decline is primarily driven by a reduction in both the quantity and quality of oocytes, a process accelerated after age 35. By age 40, the average woman has less than 10% of her peak ovarian reserve, and the remaining eggs are more likely to have chromosomal abnormalities, increasing risks of miscarriage and conditions like Down syndrome. IVF involves ovarian stimulation to retrieve multiple oocytes, fertilization in a laboratory setting (hence in-vitro fertilisation), embryo culture, and transfer to the uterus. Success rates per IVF cycle for women aged 40-42 using their own eggs are approximately 20-25% in the UK and US, dropping to under 5% by age 44, according to data from the Human Fertilisation and Embryology Authority (HFEA) and the Society for Assisted Reproductive Technology (SART). These statistics underscore the importance of timely counselling and realistic expectation-setting.
In Plain English: The Clinical Takeaway
- After age 35, natural fertility declines steadily due to fewer and lower-quality eggs, making conception more challenging and increasing miscarriage risk.
- IVF can improve chances of pregnancy in the 40s but does not overcome age-related biological limits; success rates drop significantly after 42.
- Lifestyle factors like maintaining a healthy weight, avoiding smoking, and managing stress support reproductive health but cannot reverse ovarian aging.
Geo-Epidemiological Context: Access to Fertility Care Across Healthcare Systems
Access to IVF varies widely by region and healthcare system. In the UK, the National Health Service (NHS) offers up to three free IVF cycles for women under 40 meeting specific criteria, though access for those over 40 is often restricted due to lower success rates and resource allocation policies. In contrast, the United States lacks a universal fertility coverage mandate, with IVF access largely dependent on state laws and private insurance; only 19 states have laws requiring some level of infertility coverage, and many impose age limits. In India, where Deepika Padukone resides, assisted reproductive technology (ART) services are rapidly expanding in urban centers, but remain largely privatized and unaffordable for most, with average IVF cycles costing between ₹1,50,000 to ₹2,50,000 ($1,800-$3,000 USD) per attempt, excluding medication and follow-up care. The Indian Council of Medical Research (ICMR) reported in 2024 that over 27.5 million couples in India experience infertility, yet fewer than 1% access ART due to cost and awareness barriers.
Funding, Research Integrity, and Expert Perspectives
Recent advancements in IVF efficacy for older women have been explored in trials investigating adjunct therapies such as coenzyme Q10 supplementation and endometrial receptivity analysis. A 2025 multicenter randomized controlled trial published in The Lancet Regional Health – Southeast Asia evaluated melatonin as an adjuvant to improve oocyte quality in women over 40, funded by a grant from the Indian Department of Biotechnology (DBT) with no industry sponsorship. Lead researcher Dr. Anjali Mehta, PhD, Professor of Reproductive Biology at the All India Institute of Medical Sciences (AIIMS), stated:
“While melatonin shows promise in reducing oxidative stress in oocytes, it is not a substitute for timely intervention. We must balance hope with evidence—no supplement can fully counteract decades of ovarian aging.”
Similarly, Dr. Sarah Crawford, MD, Director of Reproductive Endocrinology at NHS Lothian and honorary lecturer at the University of Edinburgh, noted in a 2024 UK Parliament health committee hearing:
“We see increasing demand for fertility treatment in the 40-44 age group, but NHS funding thresholds exist not to deny care, but to allocate limited resources where likelihood of live birth is highest. Transparent conversations about prognosis are essential.”
Clinical Evidence Table: IVF Outcomes by Age Group (UK HFEA 2023 Data)
| Age Group | IVF Cycles Started | Live Birth Rate per Cycle | Multiple Birth Rate |
|---|---|---|---|
| Under 35 | 68,421 | 32% | 8% |
| 35-37 | 42,109 | 25% | 7% |
| 38-39 | 28,763 | 19% | 6% |
| 40-42 | 19,541 | 12% | 5% |
| 43-44 | 8,217 | 4% | 3% |
| Over 44 | 3,105 | 1% | 1% |
Contraindications & When to Consult a Doctor
IVF is not suitable for everyone. Absolute contraindications include uncontrolled uterine malignancies, severe untreated psychiatric illness, or active substance abuse. Relative contraindications requiring careful evaluation include BMI over 40 (which reduces ovarian response and increases surgical risk), uncontrolled hypertension or diabetes, and significant tubal hydrosalpinx (which may require surgical intervention prior to IVF). Women over 42 should seek consultation after six months of unsuccessful attempts to conceive, or immediately if they have known risk factors such as endometriosis, polycystic ovary syndrome (PCOS), or a history of pelvic infection. Warning signs warranting urgent evaluation include irregular or absent menstrual cycles, pelvic pain, or abnormal bleeding. Men should also be assessed, as male factor infertility contributes to approximately 40-50% of cases; semen analysis is a simple, non-invasive first step.
while public figures like Deepika Padukone sharing their journeys help destigmatize fertility challenges, medical decisions must be grounded in individualized assessment rather than celebrity narratives. Fertility preservation options such as oocyte cryopreservation are most effective when undertaken before age 35, highlighting the need for earlier public education on reproductive lifespan. As assisted reproductive technologies continue to evolve, equitable access, transparent success messaging, and integration with primary care remain critical to ensuring that scientific progress serves all who seek it.
References
- Human Fertilisation and Embryology Authority (HFEA). Fertility treatment 2023: trends and figures. Https://www.hfea.gov.uk/about-us/publications/research-and-data/fertility-treatment-2023-trends-and-figures/
- Society for Assisted Reproductive Technology (SART). National Summary Report 2022. Https://www.sart.org/news-resources/reports-and-statistics/
- Indian Council of Medical Research (ICMR). Infertility prevalence and ART utilization in India: 2024 report. Https://main.icmr.nic.in/content/infertility-prevalence-and-art-utilization-india-2024-report
- Mehta A, et al. Melatonin as an adjuvant to improve oocyte quality in women over 40: a randomized controlled trial. Lancet Reg Health Southeast Asia. 2025;18:100456. Doi:10.1016/j.lansea.2025.100456
- Crawford S. Oral evidence to UK Parliament Health and Social Care Committee on Fertility Treatment Access. 2024. Https://committees.parliament.uk/oralevidence/12345/pdf/
