A single affordability measure explained up to 84% of the gap in ART use worldwide
Halving what patients pay out of pocket for fertility treatment was associated with a 2.67-fold increase in births through assisted reproductive technology (ART).
An international study presented at the 42nd Annual Meeting of the European Society of Human Reproduction and Embryology (ESHRE) reported the finding.
Researchers analyzed ART registry, economic and demographic data from 22 countries and regions between 2021 and 2023, covering more than 95 percent of global ART activity, to gauge how affordability varies internationally.
To compare countries on a common basis, the team built a "cost-to-baby" measure estimating what it costs to achieve one live birth through ART.
Researchers calculated a gross figure from average per-cycle treatment costs, including embryo transfer, preimplantation genetic testing where used and medications, together with the age-weighted number of cycles needed for a live birth.
A net out-of-pocket figure then factored in reimbursement programs, subsidies and tax benefits in each region.
Both were expressed as a percentage of median after-tax household income.
Affordability varied widely.
Countries where gross cost-to-baby fell below 100 percent and net out-of-pocket cost stayed under 50 percent of median household income recorded the highest ART use, the authors reported, including South Korea at 11.8 percent of births, Spain at 11.7 percent and Japan at 9.3 percent.
Where costs reached two or three times annual median household income, as in Brazil, India and Southeast Asia, ART births fell to between 0.2 percent and 0.4 percent.
Lead author Stephanie Kuku of Conceivable Life Sciences said the single affordability measure explained between 77 percent and 84 percent of the variation in ART use across the countries studied.
The relationship followed a power-law rather than a linear pattern, she added, meaning cost reductions could produce disproportionately large gains in access, with the biggest effects where affordability barriers are highest.
The findings point to specific policy levers, according to Kuku.
"Perhaps the most straightforward answer is that insurance mandates and public funding programmes need to cover multiple complete treatment cycles, not just one," she said.
Her analysis centred on cost-to-baby rather than cost-per-cycle because that is what patients face, she noted, and the data show countries funding multiple cycles reach higher use.
Kuku also pointed to tax policy, citing South Korea's 30 percent income tax credit for fertility treatment, and to workforce licensing reform that could expand clinical capacity and lower gross treatment costs.
Industry could improve affordability through workflow optimization, standardization and automation, she said.
The analysis did not capture chronically underserved communities defined by race, geography or socioeconomic status, Kuku said, and future work would examine how to reach patients who need ART rather than only those who can currently access it.
The study abstract will appear in the journal Human Reproduction.
