Reducing patient out-of-pocket fertility treatment costs by half could increase births achieved through assisted reproductive technology (ART) by more than two-fold, according to research presented at the 42nd Annual Meeting of the European Society of Human Reproduction and Embryology (ESHRE).

The international study analysed ART registry, economic and demographic data from 22 countries and regions between 2021 and 2023, representing more than 95% of global ART activity. Researchers examined how treatment affordability influences the use of ART and the number of babies born through fertility treatment.

The analysis found that halving patient out-of-pocket costs was associated with a 2.67-fold increase in births achieved through ART, highlighting the impact that financial barriers can have on access to fertility care.

To compare countries and regions consistently, researchers developed a “cost-to-baby” affordability metric, estimating the cost required to achieve one live birth through ART.

The calculation combined average treatment costs per cycle, including embryo transfer, medications and preimplantation genetic testing where applicable, with the average number of treatment cycles needed to achieve a live birth based on patient age. Researchers then adjusted those figures to account for reimbursement programmes, government subsidies and tax benefits before expressing the overall cost as a percentage of median household income.

The findings revealed wide differences in affordability across countries and regions.

Gross cost-to-baby ranged from 66% of median household income in Israel to 833% across Africa, excluding Egypt, Tunisia and South Africa. After accounting for reimbursement and other financial support, net out-of-pocket costs ranged from 13% in Israel to 825% across the same African regions.

Countries where treatment costs represented less than 100% of median household income, and where patients paid less than 50% of that cost themselves, consistently reported the highest use of ART. South Korea recorded 11.8% of births through ART, followed by Spain at 11.7% and Japan at 9.3%.

In contrast, countries and regions including Brazil, India and South-east Asia, where treatment costs can reach two to three times annual median household income, recorded between 0.2% and 0.4% of births through ART.

Dr Stephanie Kuku, lead author of the study, said: “It was genuinely striking to see how much of the variation could be explained by a single affordability metric. Our models explained between 77% and 84% of the variation in ART utilisation.”

The researchers believe the findings provide a practical benchmark for policymakers looking to improve access to fertility treatment through funding and reimbursement programmes.

Dr Kuku said: “Our analysis is fundamentally patient-centric: it asks what a typical household actually earns and what they would actually have to spend to have a baby through ART. The 50% threshold isn’t a theoretical construct; it’s a grounded observation of what top-performing nations have achieved.”

The findings were presented during the 42nd Annual Meeting of ESHRE, where researchers highlighted affordability as one of the strongest predictors of access to fertility treatment across different healthcare systems. The analysis suggests that reducing financial barriers could substantially increase access to ART in countries where treatment costs remain beyond the reach of many households.