Financial Barriers Top Obstacles to Infertility Care for Iranian Women, Survey Finds

Infertile women in Tehran report their steepest obstacles to infertility treatment in the domain of financial affordability, according to a cross-sectional survey published in BMC Health Services Research. The study, led by Maryam Tajvar and colleagues, surveyed 450 women with primary or secondary infertility who were seeking care at five large public and private infertility treatment centers in Tehran in 2023. Using a structured questionnaire built mainly on Saurman's conceptual model of healthcare access and on a questionnaire from a prior study by Hosseini Esfidarjani, the researchers measured barriers across two dimensions, access to services and utilization of services, and analyzed the results with descriptive statistics, Spearman's correlation, ANOVA and a logistic regression model.

The authors report that in both dimensions, monthly income showed a negative correlation with barriers, meaning that women with lower monthly incomes tended to report greater difficulty reaching and using infertility treatment services. The bivariate analysis revealed a set of social and economic factors statistically associated with these barriers. According to the Spearman's correlation and ANOVA tests, access barriers were significantly associated with the type of insurance a woman held, her spouse's employment status, her ethnicity, her place of residence, whether a gap had formed between diagnosis and the start of treatment, and whether she had changed treatment centers at some point.

Utilization barriers were significantly associated with insurance type, the employment status of the couple, and the presence of a gap between diagnosis and treatment. These are correlations observed within this sample of 450 women, not demonstrated causal pathways. When the researchers moved from these bivariate tests to a logistic regression model, most of the associations did not remain significant.

In that multivariable analysis, only the medical center where the infertility treatment services were provided remained significantly related to both access and utilization barriers. One additional factor survived for access specifically: place of residence, with a coefficient of −2.26 and a p-value of 0.038. The authors report that women living in rural areas faced more access barriers than their urban counterparts.

The study's framing places infertility within a public health context. The authors describe infertility as a critical public health issue that reduces quality of life for many women and note that its prevalence among Iranian couples has increased in recent years. Their conclusion emphasizes that access to and use of infertility treatment services among infertile women is strongly influenced by affordability, by health system factors such as accommodation and service quality, and by cultural and socioeconomic factors.

As a response, they point to the development of policies and support mechanisms by the government, continuous education and support of patients, and the provision of a culturally safe environment as routes toward improving access and utilization. Several features of the study design shape how these findings should be read. The cross-sectional design captures associations rather than causal effects, and the reported links between insurance type, employment, ethnicity and barriers reflect correlation within this sample.

The logistic regression results, in which most factors lost significance once the treating center was accounted for, indicate that the facility where care was provided absorbed much of the variation in the barriers women reported in this model. Within the limits of the design, the pattern that emerges is consistent with the study's conceptual model. Financial affordability topping the access barriers, personal and cognitive issues topping the utilization barriers, and income correlating negatively with both dimensions together describe the barrier profile reported by this group of women.

The reported associations with a gap between diagnosis and treatment, and with a history of changing treatment centers, add a temporal dimension: in this sample, barriers were associated not only with entry into care but also with interruptions and redirections in the treatment journey itself. For policy, the authors' proposed measures follow from their findings. Because affordability and integration dominate the access dimension, and service quality and personal and cognitive issues dominate the utilization dimension, they argue that interventions would need to operate on financing, on health system organization, and on patient education and support at the same time.

The rural-urban difference identified in the regression adds a spatial dimension to the access findings as reported.

Subject of Research: Barriers to accessing and utilizing infertility treatment services among infertile women in Tehran, Iran

Article Title: Barriers to access and utilization of infertility treatment services among Iranian infertile women: a cross-sectional study

Article References: Tajvar, M., Saberpour, D., Atashbahar, O., Shakibazadeh, E., Oliyaeemanesh, A., & Khaledian, Z. (2026). Barriers to access and utilization of infertility treatment services among Iranian infertile women: a cross-sectional study. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15454-6

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15454-6

Keywords: infertility, healthcare access, Iran, cross-sectional study, health services research, financial barriers, women's health, Tehran, service utilization, health equity, Saurman model, Barriers