A new global analysis has delivered a stark, quantifiable message: the price patients pay for fertility treatment is not just a financial burden but the single most powerful predictor of whether they will ever hold a baby. Presenting at the 42nd Annual Meeting of the European Society of Human Reproduction and Embryology, researchers showed that halving out-of-pocket costs for assisted reproductive technology was associated with a remarkable 2.67-fold increase in births achieved through ART. The study, spanning 22 countries and regions that together account for more than 95% of all global ART activity, introduces a novel ‘cost-to-baby’ affordability metric that is reshaping how policymakers and clinicians think about access to reproductive medicine.
To build a consistent international comparison, the team first calculated a gross cost-to-baby by combining average per-cycle treatment expenses—including embryo transfer, preimplantation genetic testing where used, and medications—with the age-weighted number of cycles statistically required to achieve a single live birth. This age weighting is crucial because ovarian ageing means that a woman starting treatment at 38 may need twice as many stimulated cycles as one at 32 to have the same cumulative chance of a child. The researchers then derived a net out-of-pocket cost-to-baby by subtracting all public reimbursements, private insurance payouts, and tax relief mechanisms applicable in each jurisdiction. Both figures were expressed as a percentage of median after-tax household income, producing a ratio that directly reflects the economic strain on a typical family.
The disparities that emerged are extraordinary. Gross cost-to-baby ranged from 66% of median household income in Israel to 833% in sub-Saharan Africa (excluding Egypt, Tunisia, and South Africa), a more than twelve-fold spread. When accounting for funding support systems, net out-of-pocket costs varied from just 13% in Israel to a crushing 825% in the same African region. The consequences for actual utilization were dramatic. Nations where gross cost-to-baby fell below one full year’s median income and net out-of-pocket cost stayed under 50% of that income consistently topped global birth-share charts: South Korea saw 11.8% of all births occurring via ART, Spain 11.7%, and Japan 9.3%. In stark contrast, countries such as Brazil, India, and much of southeast Asia, where the net cost approaches two or three times annual median household earnings, registered ART birth proportions as low as 0.2% to 0.4%.
Perhaps the most striking analytical finding is that the relationship between affordability and utilization follows a power-law distribution rather than a straight line. In practical terms, this means that cost reductions yield disproportionately large gains in access, with the most explosive increases concentrated in the very settings where affordability barriers are currently highest. Lead author Dr Stephanie Kuku of Conceivable Life Sciences noted, “Our models explained between 77% and 84% of the variation in ART utilisation. It was genuinely striking to see how much of the variation in access between countries and regions could be explained by a single affordability metric.” The power-law pattern implies that a marginal improvement in funding schemes in a highly cost-burdened country could trigger a surge in treatment uptake, far beyond what simple linear projections would anticipate.
The analysis points to a concrete affordability benchmark: keeping net out-of-pocket cost-to-baby below 50% of median household income. Dr Kuku emphasized that this is not a theoretical construct but “a grounded observation of what top-performing nations have achieved.” The 50% threshold reflects a patient-centric reality—what a typical household actually earns versus what it must genuinely spend to have a child through ART. Crucially, the entire conceptual framework shifts the conversation away from per-cycle pricing toward the outcome that matters to families. The cost-per-cycle lens, researchers argue, fundamentally misrepresents the financial journey of infertility patients, who often need multiple stimulated cycles across many months.
What clears the path to this threshold? The data unambiguously point to insurance mandates and public funding programmes that reimburse multiple complete treatment cycles, not just a single attempt. South Korea’s 30% income tax credit for fertility treatment, alongside workforce licensing reforms that expand clinical capacity, provides a potent example of how fiscal policy can lower net cost. Industry also plays a role: workflow automation, standardization of laboratory protocols, and AI-driven embryo selection systems are beginning to reduce gross treatment expenses at the laboratory level. Dr Kuku suggested that such technical innovations could eventually help bend the cost curve downward, particularly in settings where clinician-dependent manual procedures still dominate.
Despite the study’s sweeping scope, the authors are careful to highlight its limitations. Chronically underserved communities—those defined by race, geography within countries, or extreme socioeconomic deprivation—do not surface in national registry averages. Dr Kuku indicated that future research will drill down into these populations, aiming to measure not just who currently accesses ART but who needs it and cannot. As she concluded, “We now have a clear starting point. Affordability is a measurable constraint on access and the data show where some of the greatest opportunities to improve access may exist.” ESHRE Chair Professor Anis Feki added that the study puts numbers behind what patients already feel viscerally: that affordability is not a secondary concern but a primary gatekeeper to the family-building futures millions envision.
Subject of Research: The relationship between out-of-pocket ART costs (expressed as a percentage of median household income) and population-level access to assisted reproductive technology.
Article Title: Cost-to-baby as a percentage of median household income predicts population-level access to assisted reproductive technology (ART): a global health economics analysis of affordability.
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References: Kuku, S., et al. (2026). Cost-to-baby as a percentage of median household income predicts population-level access to assisted reproductive technology (ART): a global health economics analysis of affordability. Human Reproduction.
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Keywords: In vitro fertilization, Human reproduction, Pregnancy, Infertility, Economics, Medical economics, Health equity, Health care policy, Birth rates
