IVF affordability predicts resulting births

Halving what patients pay for fertility treatment could more than double uptake, according to research presented at the 42nd Annual Meeting of the European Society of Human Reproduction and Embryology (ESHRE) in London.

The study compared average out-of-pocket costs to have a baby through fertility treatment with median household incomes across 22 countries and regions. They found that uptake of fertility services was highest in areas where it was most affordable, particularly where the cost was less than 50 percent of annual income.

'While it is already understood that cost influences patient decisions, 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,' said Dr Stephanie Kuku from Conceivable Life Sciences, who presented the research. 'Our entire analysis is built around cost-to-baby, not cost-per-cycle, because that is what matters to patients.'

The net 'cost-to-baby' was calculated using local pricing for IVF cycles and transfers, multiplied by the expected number of treatments to achieve a birth, and minus any reimbursement or subsidies. This figure was then expressed as a percentage of the local median income.

The calculation produced a wide range of figures, from Israel, where the average cost was around 13 percent of median income, to parts of Africa where the cost was 825 percent – over eight years' earnings for an average person.

Although the prevalence of infertility is the same across the world, countries where the net cost was below 50 percent of average income had the highest proportions of children born through IVF, such as South Korea and Spain, where nearly 12 percent of births are the result of fertility treatment. This compares to fewer than 0.5 percent in countries like Brazil or India, where the cost is over twice the median income.

When looking at the relationship between the proportion of births resulting from fertility treatment and the net cost as a percentage of income, they found a power relationship, indicating that for every ten percent reduction in net patient cost, the number of IVF births per 1000 women of reproductive age increases by approximately 14 percent. From this, they concluded that reducing the cost burden by half could result in a 2.6-fold increase.

'In practical terms, this means that reducing costs could produce disproportionately large increases in utilisation, with the greatest gains seen in countries and regions where affordability barriers are highest,' said Dr Kuku.

'This study puts numbers behind what many patients experience: affordability is not a secondary issue, but a major determinant of access to fertility care,' said Professor Dr Anis Feki, chair of ESHRE. 'While solutions must be adapted to each healthcare system, the data offer a clear and hopeful message: policies that reduce the real cost to patients can meaningfully improve access to [fertility treatment].'