Background: Infertility and Assisted Reproductive Technologies (ART) are growing components of reproductive healthcare, yet social stigma, misinformation, and limited awareness continue to affect help-seeking behavior, especially in culturally sensitive regions like Shimla. This study aimed to assess public understanding, attitudes, and misconceptions surrounding infertility and ART, with an emphasis on social stigma, gender dynamics, and readiness for medical intervention. Materials and Methods: A descriptive, cross-sectional online survey was conducted from February to March 2025, targeting adult residents (N=405) of Shimla district. Using a structured, bilingual questionnaire disseminated via digital platforms, data were collected on demographic details, awareness of infertility causes, familiarity with ART (e.g., IVF, IUI), stigma, and willingness to seek treatment. Descriptive statistics and chi-square analysis were performed using SPSS 26.0. Results: Participants demonstrated moderate awareness overall, with 73.8% recognizing that infertility affects men, and 70.9% aware of the 1-year guideline for seeking fertility help. However, only 56.3% correctly stated that ART does not guarantee success, and 52.3% knew about partial insurance coverage. Social stigma was notable, with just 55.6% willing to discuss ART openly. Knowledge score analysis revealed that 12.6% had 'Very Good' knowledge, while 38.0% had 'Fair' and 18.3% 'Poor' levels, indicating prevalent gaps in understanding. Conclusion: Although awareness of infertility and ART is improving in Shimla, persistent myths, financial misconceptions, and stigma continue to hinder informed reproductive decisions. Community education programs, policy advocacy, and culturally tailored outreach are essential to bridge knowledge gaps and normalize ART use across socio-economic and gender divides.
Infertility, defined as the inability to conceive after 12 months of regular, unprotected sexual intercourse, is a global reproductive health concern affecting millions of individuals and couples. In India, where societal norms often place a high premium on childbearing and motherhood, infertility remains a deeply stigmatized issue. Women in particular are disproportionately blamed, subjected to emotional distress, social exclusion, and even domestic violence. This stigma persists despite the well-documented medical fact that infertility can be attributed to male, female, or combined factors—and that effective medical treatments are now widely available through Assisted Reproductive Technologies (ARTs) [1-4].
ARTs such as In Vitro Fertilization (IVF), Intrauterine Insemination (IUI), donor egg or sperm treatments, and surrogacy have revolutionized fertility care. However, public awareness about these options remains limited, and misconceptions about their safety, morality, affordability, and success rates are widespread. Many perceive ART as a "last resort" or as unnatural, invasive, or religiously inappropriate. Misinformation also leads to delayed medical intervention and increased psychological burden for those facing fertility challenges [5-8].
Shimla, a district characterized by a mix of urban convenience and rural traditions, offers a compelling backdrop to explore public understanding and attitudes toward infertility and ART. While urban residents may have greater exposure to fertility clinics, advertisements, and media coverage, women and men in semi-urban and rural areas often rely on social hearsay, traditional beliefs, or spiritual remedies. In this context, both awareness and acceptance of medical fertility solutions vary widely and may be shaped by cultural silence, gender dynamics, and educational gaps.
This study aims to assess public awareness, attitudes, and beliefs surrounding infertility and assisted reproductive technologies in Shimla. It will examine how different segments of the population perceive infertility causes, whom they blame, where they seek help, and whether they are open to ART as a solution. The research also seeks to document stigma, emotional reactions, and levels of trust in modern reproductive science. The findings will serve as a foundation for designing targeted health education initiatives and policy interventions that promote equitable access to reproductive care, destigmatize ART, and empower individuals to make informed reproductive decisions.
This research employed a descriptive, cross-sectional online survey design to evaluate the awareness, perceptions, and social attitudes toward infertility and Assisted Reproductive Technologies (ART) among the adult population of Shimla. The digital format enabled widespread reach and anonymous participation across different socio-economic and geographic segments of the district.
The survey was conducted in Shimla district, Himachal Pradesh, including urban, semi-urban, and rural zones. The study targeted adult individuals (18 years and older), including both men and women, to gain a holistic view of societal perspectives. Participants were drawn from a variety of educational, marital, and occupational backgrounds to ensure diversity and representativeness.
Adults aged 18 years or older
Permanent residents of Shimla (minimum one year)
Comfortable reading and responding in Hindi or English
Access to an internet-enabled device (smartphone, tablet, or computer)
Willingness to provide informed digital consent
Fertility specialists, gynecologists, or ART practitioners (to avoid professional bias)
Individuals previously diagnosed with infertility and currently undergoing ART (if the aim is general public awareness)
The data collection phase spanned six weeks, from February 1 to March 15, 2025, intentionally timed with World Infertility Awareness Month to align the survey with ongoing public discourse and engagement opportunities.
A non-probability convenience sampling method was used. The survey link was shared widely via:
WhatsApp and Facebook groups focused on women’s health, parenting, and local communities
Online bulletin boards of schools, colleges, and workgroups
Digital platforms of NGOs and health awareness organizations
Community health worker networks and village-level SHGs (Self-Help Groups)
A target of 400 complete responses was set to ensure statistical reliability and allow for subgroup comparisons (e.g., urban vs. rural, male vs. female).
The study utilized a structured, bilingual (Hindi and English), pre-validated online questionnaire built on Google Forms. The tool was developed in consultation with reproductive health experts, sociologists, and public health professionals. It included five sections:
Demographics – Age, gender, marital status, education level, occupation, and area of residence.
General Awareness of Infertility – Understanding of biological causes, myths, preventability, male and female contributions, and the normal duration before seeking help.
Awareness of ART – Knowledge about IVF, IUI, donor eggs/sperm, surrogacy, treatment costs, and perceived safety and effectiveness.
Stigma and Social Attitudes – Perceptions about the shame, blame, secrecy, and emotional toll associated with infertility and ART use.
Health-Seeking Behavior and Media Influence – Willingness to consult fertility specialists, openness to ART, sources of reproductive health information (TV, doctors, social media, peers), and trust in medical advice.
The questionnaire underwent pilot testing with 30 individuals, whose feedback helped refine phrasing, improve flow, and eliminate ambiguity. Pilot responses were excluded from final data analysis.
The survey included an introductory cover page detailing the purpose, voluntary nature, data confidentiality, and e-consent process. Participation was anonymous and one-time only (per device). No personal identifiers were collected. The survey was mobile-optimized to facilitate ease of response, especially in rural areas where smartphones are more prevalent than laptops.
Data were exported into Microsoft Excel and analyzed using SPSS Version 26.0. Descriptive statistics (frequencies, means, percentages) were used to summarize awareness levels and attitudes.
All participants provided informed electronic consent before taking the survey. Data were stored securely and analyzed anonymously. The study followed national ethical guidelines for online public health research
A total of 405 participants completed the online survey. The majority were aged 25–34 years (36.0%), followed by 35–44 years (25.2%). Women represented 57.5% of the sample. Most respondents were married (58.8%) and had a graduate or higher degree (67.4%). Urban and semi-urban participants made up 65.9% of the responses. Employment status varied, with 48.9% employed and 25.2% identifying as homemakers. This distribution reflects a diverse demographic sample suitable for analyzing awareness and attitudes toward infertility and ART.
Participants were assessed on 20 questions related to causes of infertility, stigma, misconceptions, and understanding of ART such as IVF and IUI. While awareness of infertility affecting both genders was fairly high (72.3%), misconceptions remained: 61.7% wrongly believed infertility was rare, and only 56.3% knew IVF does not always guarantee success. Encouragingly, 73.8% recognized that male infertility exists, yet only 45.2% felt comfortable discussing ART openly. The responses
highlight a mix of knowledge and prevailing social discomfort surrounding the topic.
Participants’ total correct answers were used to categorize awareness levels. The highest proportion (38.0%) fell into the 'Fair' category (8–11 correct answers), followed by 'Good' (31.1%). Only 12.6% demonstrated 'Very Good' awareness (≥16 correct), while 18.3% had poor understanding. This highlights a general familiarity with infertility and ART terminology but persistent misconceptions and social hesitance.
Variable | Category | Frequency (n) | Percentage |
Age Group | 18–24 | 85 | 21.0 |
25–34 | 146 | 36.0 | |
35–44 | 102 | 25.2 | |
45–54 | 48 | 11.9 | |
55+ | 24 | 5.9 | |
Gender | Male | 172 | 42.5 |
Female | 233 | 57.5 | |
Marital Status | Unmarried | 141 | 34.8 |
Married | 238 | 58.8 | |
Divorced/Widowed | 26 | 6.4 | |
Education Level | Up to Secondary | 132 | 32.6 |
Graduate | 168 | 41.5 | |
Postgraduate & Above | 105 | 25.9 | |
Residence Area | Urban/Semi-Urban | 267 | 65.9 |
Rural | 138 | 34.1 | |
Occupation | Employed | 198 | 48.9 |
Homemaker | 102 | 25.2 | |
Student | 61 | 15.1 | |
Unemployed | 34 | 8.4 | |
Other | 10 | 2.5 |
Question | Options | Correct (n) | % |
What is infertility? | a) Pregnancy after 1 year, b) No pregnancy after 1 year, c) Late periods, d) Frequent miscarriage | 282 | 69.6 |
Can infertility affect men too? | a) No, b) Only older men, c) Yes, d) Only if injured | 299 | 73.8 |
Is infertility always a woman's fault? | a) No, b) Yes, c) Usually, d) Depends on age | 320 | 79.0 |
What is IVF? | a) Natural therapy, b) Lab fertilization, c) Fertility massage, d) Hormonal yoga | 273 | 67.4 |
Is IVF the only ART available? | a) Yes, b) No, c) Only in big cities, d) Not clear | 262 | 64.7 |
How long should couples try before seeking help? | a) 6 months, b) 2 years, c) 1 year, d) No timeline | 287 | 70.9 |
Can stress alone cause infertility? | a) Yes, b) No, c) Always, d) Only women | 244 | 60.2 |
Is infertility rare? | a) No, b) Yes, c) Very rare, d) Happens after 40 | 238 | 58.8 |
Are donor eggs or sperm legal in India? | a) No, b) Yes, c) Only for rich, d) Only abroad | 267 | 65.9 |
Is ART treatment covered under insurance in India? | a) Always, b) Sometimes, c) Never, d) Only for men | 212 | 52.3 |
Do people using ART face social stigma? | a) No, b) Yes, c) Not known, d) Only if unmarried | 283 | 69.9 |
Can ART guarantee 100% pregnancy success? | a) Yes, b) Usually, c) No, d) Depends on doctor | 228 | 56.3 |
Should ART be a private family decision? | a) Yes, b) No, c) Only in rural areas, d) Needs society’s approval | 318 | 78.5 |
Are infertility treatments only for the rich? | a) No, b) Yes, c) Mostly yes, d) Not for women | 265 | 65.4 |
Is surrogacy allowed in India? | a) No, b) Only abroad, c) Yes, under legal guidelines, d) For foreigners only | 247 | 61.0 |
Can herbal medicine treat infertility? | a) Yes, always, b) Yes with IVF, c) No, not reliably, d) Depends on religion | 224 | 55.3 |
Are people open to discussing infertility? | a) No, b) Yes, c) Sometimes, d) Only online | 225 | 55.6 |
Should men also get tested for infertility? | a) No, b) Yes, c) Only married men, d) Not necessary | 309 | 76.3 |
Is adoption a good alternative to ART? | a) No, b) Yes, c) Only for women, d) Only if rich | 289 | 71.4 |
Would you support a friend seeking IVF? | a) Yes, b) No, c) Depends, d) Only if married | 261 | 64.4 |
Knowledge Category | Score Range (%) | Frequency (n) | Percentage (%) |
Very Good | ≥ 80 | 51 | 12.6 |
Good | 60 – 79 | 126 | 31.1 |
Fair | 40 – 59 | 154 | 38.0 |
Poor | < 40 | 74 | 18.3 |
This study offers critical insight into the awareness and attitudes of the Shimla population toward infertility and Assisted Reproductive Technologies (ART). Despite growing global normalization of fertility treatments, the findings suggest that misconceptions, stigma, and discomfort around the topic remain prominent in this region. While most participants correctly understood that infertility can affect both men and women (73.8%) and that medical intervention is appropriate after 12 months of unsuccessful conception (70.9%), persistent myths—such as infertility being rare (only 58.8% answered correctly) or ART guaranteeing success (only 56.3% knew it doesn't)—reflect the need for enhanced public education.
The gender-based perception of blame also surfaced, with encouraging signs: 79.0% recognized that infertility is not always a woman’s fault, highlighting gradual change in traditional mindsets. Yet, social stigma continues to surround ART use, as shown by the fact that only 55.6% reported openness to discussing infertility publicly. This cultural silence poses significant emotional burdens for those undergoing fertility struggles and can delay timely healthcare-seeking behavior.
Legal and ethical awareness about ART also showed gaps. Although a majority knew that donor treatments and surrogacy are legal in India, only 52.3% understood the partial insurance coverage of such procedures—suggesting that financial misconceptions could prevent people from exploring available options. Furthermore, only 65.4% rejected the idea that fertility treatment is only for the wealthy, underscoring the need for policy-level support and better financial counseling.
The knowledge score classification reiterates the findings: only 12.6% of participants demonstrated 'Very Good' awareness, while 38.0% fell into the 'Fair' category and 18.3% had 'Poor' awareness. This uneven distribution indicates that although there is growing familiarity with the concept of ART, deeper understanding—especially around processes, legality, and emotional consequences—remains superficial or incomplete. These insights emphasize the urgent need for targeted community-based awareness campaigns, integration of fertility education into broader reproductive health curricula, and improved communication between healthcare professionals and patients in both rural and urban contexts.
This study underscores that while foundational awareness of infertility and ART exists among the population of Shimla, significant knowledge gaps and attitudinal barriers persist. Despite encouraging shifts toward gender-inclusive understanding, misconceptions about treatment accessibility, legal rights, and societal acceptance remain widespread. To foster reproductive equity and emotional support, it is imperative to destigmatize infertility through culturally sensitive public health education, promote accurate media representation, and improve access to affordable fertility care across diverse socio-demographic groups.
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