Presented today at the 42nd Annual Meeting of the European Society of Human Reproduction and Embryology (ESHRE), the 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, to assess international variations in affordability.
To compare countries/regions consistently, researchers developed a ‘cost-to-baby’ affordability metric estimating the cost required to achieve one live birth through assisted reproductive technology (ART).
Gross cost-to-baby was calculated using average per-cycle treatment costs, including embryo transfer, preimplantation genetic testing where used, and medications, alongside the age-weighted number of cycles required to achieve a live birth. Net out-of-pocket cost-to-baby then accounted for reimbursement programmes, subsidies and tax benefits applicable to each region or country. Both gross and net costs were expressed as a percentage of median after-tax household income.
The results revealed significant international differences in affordability. Gross cost-to-baby varied more than 12-fold across countries and regions, ranging from 66% of median household income in Israel to 833% in Africa (excluding Egypt, Tunisia and South Africa), while net out-of-pocket cost-to-baby ranged from 13% in Israel to 825% in Africa.
Countries with gross cost-to-baby below 100% and net out-of-pocket cost-to-baby below 50% of median household income consistently achieved the highest levels of ART utilisation, including South Korea (11.8% of births via ART), Spain (11.7%) and Japan (9.3%).
Conversely, in countries and regions such as Brazil, India and South-east Asia, where costs approach two or three times the annual median household income, the proportion of ART births plummeted to between 0.2% and 0.4%.
Lead author Dr Stephanie Kuku of Conceivable Life Sciences said, “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. Our models explained between 77% and 84% of the variation in ART utilisation.”
“We also found that the relationship followed a power-law pattern rather than a simple linear one. 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,” she added.
Looking ahead, Dr Kuku said that the findings provide a clear and measurable benchmark for improving access to fertility treatment. “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.”
While policies to improve access to fertility care will depend on regional healthcare systems and economic contexts, Dr Kuku said the findings pointed to several clear areas for action. “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. “Our entire analysis is built around cost-to-baby, not cost-per-cycle, because that is what matters to patients. The data are unambiguous that countries funding multiple cycles achieve higher utilisation.”
Dr Kuku also highlighted the importance of tax policy, pointing to South Korea’s 30% income tax credit for fertility treatment, alongside workforce licensing reform that could expand clinical capacity and reduce gross treatment costs. She added that industry also has a role to play in improving affordability through workflow optimisation, standardisation and automation.
Discussing the next steps for research, Dr Kuku said, “Chronically underserved communities, whether defined by race, geography or socioeconomic status, are not captured in this analysis. Future work will focus on how to serve those who need ART, not just describe who can currently access it.”
“However, 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,” Dr Kuku concluded.
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The study abstract will be published today in Human Reproduction, one of the world’s leading reproductive medicine journals.
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Notes to editors:
A reference to the ESHRE Annual Meeting must be included in all coverage and/or articles associated with this study.
For more information or to arrange an expert interview, please contact the ESHRE Press Office at: press@eshre.eu
Countries/regions included in the study:
Africa*
AUS & NZ
Brazil
Canada
China
East Europe
Egypt
India
Israel
Japan
Latin America†
Mexico
Middle East‡
SE Asia
South Africa
South Korea
Spain
Taiwan, China
Tunisia
UK
USA
West Europe§
* Excluding Egypt, Tunisia, South Africa.
† Excluding Mexico and Brazil.
‡ Excluding Turkey, Israel, Egypt.
§ Excluding Spain, UK.
About the author:
Dr Stephanie Kuku serves as the Chief Regulatory & Scientific Affairs Officer at Conceivable Life Sciences, where she leads strategic development including scientific affairs and IP strategy. She is a member of the Royal College of Obstetricians & Gynaecologists in the UK and holds an MD in Clinical Research from UCL, where she also serves as Honorary Senior Research Fellow. Dr Kuku is a Senior Adviser to the WHO on Clinical AI and Data Governance and currently serves as a Board Trustee of The King’s Fund.
About Conceivable Life Sciences:
Conceivable Life Sciences is pioneering physical AI in the life sciences, bringing to the IVF laboratory a system that can perceive and execute. The company’s AURA platform sits at the convergence of robotics, optics, software, and reproductive medicine. It replaces hundreds of operator-dependent manual steps with machine precision and improves through a cloud-based machine learning system that captures thousands of data points across every cycle.
Website: https://www.conceivable.life/
About the European Society of Human Reproduction and Embryology:
The main aim of ESHRE is to promote interest in infertility care and to aim for a holistic understanding of reproductive biology and medicine.
ESHRE collaborates world-wide and advocates universal improvements in scientific research, encourages and evaluates new developments in the field, and fosters harmonisation in clinical practice. It also provides guidance to enhance effectiveness, safety and quality assurance in clinical and laboratory procedures, psychosocial care, and promotes ethical practice. ESHRE also fosters prevention of infertility and related educational programmes and promotes reproductive rights regardless of the individual’s background. ESHRE’s activities include teaching, training, professional accreditations, mentoring and career planning for junior professionals, as well as developing and maintaining data registries. It also facilitates and disseminates research in human reproduction and embryology to the general public, scientists, clinicians, allied personnel and patient associations.
Website: https://www.eshre.eu/
About Human Reproduction:
Human Reproduction is a monthly journal of ESHRE and is one of the top three journals in the world in the field of reproductive biology, obstetrics and gynaecology. It is published by Oxford Journals, a division of Oxford University Press.
References:
[1] 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.
