High cost of infertility treatments puts financial strain on couples: ICMR-NIRRCH study

Though a regulatory framework exists in India for advanced infertility treatments such as In vitro Fertilisation (IVF), the cost of the procedures remains unregulated, placing immense financial strain on couples, a study has said. The study was aimed at estimating “the cost of diagnosis of infertility and its management, including IVF and quality of life, among infertile couples’’.

In India, several patients who participated in the study conducted by the Indian Council of Medical Research-National Institute for Research in Reproductive and Child Health (ICMR-NIRRCH) were found to incur high expenditure. According to the study, average out-of-pocket expenditure for one IVF cycle was upward of ₹1 lakh in both private and public hospitals. 

Out-of-pocket expenses are payments made from one’s own resources, not from a third party such as like insurance.

What the study found

For the study, researchers identified three public and two private tertiary health facilities willing to participate. Primary data was collected from 30 patients undergoing IVF treatment and 100 patients undergoing infertility treatment (particularly diagnosed with single causes such as PCOS, endometriosis, tubal factor, uterine factor and male infertility) at each site, along with health system costing. 

In India, Female factors contributed to 46% of infertility cases, while male factors contributed to 20% and 10% of infertile couples had both male and female contributory factors. The remaining couples had either idiopathic infertility or multiple factors contributing to infertility and were not included in the study. The study found thatAmong couples undergoing IVF treatment, oligospermia and tubal factor infertility were the leading cause of infertility. Of the couples in the study, about 8% of infertile couples required advanced treatments like IVF, which were expensive and technically demanding.

“Among couples undergoing infertility treatment, Polycystic Ovary Syndrome (PCOS), a hormonal disorder in women of reproductive age, is the most common factor of infertility among the five factors considered,’’ added the study.

Experts said there was no fixed number of IVF cycles that guaranteed success and outcomes varied for each individual. Most women have a good chance of success after three stimulated cycles, and cumulative success rates increase with each attempt, they said. 

Out-of-pocket expenditure

IVF involves several steps, including ovarian stimulation, egg retrieval, fertilization, embryo transfer, and monitoring for pregnancy. Stating that median out-of-pocket expenditure for infertility treatment was ₹11,317, the study said direct medical costs for medicines and investigations were high in private facilities while the non-medical and indirect costs were higher among those seeking infertility services from public facilities. 

“Patients with uterine factor infertility and endometriosis had the lowest health-related quality of life. Pain/discomfort and anxiety/depression were the dimensions contributing most to the poor quality of life of the patients. The health system cost of infertility management for one year in the public facilities ranged between ₹6,822 to ₹11,075 which was found to be higher in the private than public facilities,’’ the study noted.

Fertility in India

“Every one in six couples in India suffer from infertility issues. With India’s fertility rate declining, it becomes even more critical to integrate fertility-related healthcare into the larger health insurance framework. The recent national report has emphasised that infertility care should be a core part of public health systems so that all couples have access to fertility treatment. Infertility is not just an urban India phenomenon, even the couples in tier 2 and tier 3 regions also have been impacted. Fertility care must be accessible, coupled with transparent pricing. By including fertility treatments in PM-JAY [Pradhan Mantri Jan Arogya Yojana] more families can access necessary treatments, reducing the emotional and financial burden of infertility. Addressing fertility issues as part of the health insurance framework supports population health management, ensuring a balanced demographic dividend, and can reduce the risks associated with declining fertility rates,” said Shobhit Agarwal, CEO, Nova IVF Fertility. 

ART service delivery

Currently, very few public facilities provide ART services. The rising demand is thus met by an expanding private sector for these services. Although the ART rules regulate these private providers, their prices remain uncontrolled. There is a lack of scientific data to suggest the cost of providing these services in India. This results in huge out-of-pocket expenditure and financial burden on infertile couples.

As per a systemic review of financial costs of assisted reproductive technology for patients in low- and middle-income countries, medical costs of one ART cycle are significantly higher (166.4%) than patients’ average annual income in India. Regulatory framework for ART services in India currently includes Assisted Reproductive Technology (Regulation) Act, 2021 and ART rules notified under the act. This framework regulates the practice of ART by laying down rules on egg and sperm donation, cryopreservation, registration of ART clinics and sets different criteria for different types of ART clinics.

Currently, the Central Government Health Scheme (CGHS) reimburses a one-time cost of ₹65,000 or the actual cost, whichever is lower, incurred for three fresh cycles of IVF as per a government memorandum if the woman/couples fulfil specific criteria. With the ART Act, 2021, there is a growing demand to assess if IVF services could be included in the Ayushman Bharat- Pradhan Mantri- Jan Arogya Yojana (AB-PM-JAY) package. Currently, the PM-JAY scheme includes medical and hospitalization expenses for almost all secondary care and most tertiary care procedures. However, certain conditions are exempted under this scheme. Fertility treatment is one among them.

In view of the rising demand and high financial burden of IVF in India, there was a request from the Health Ministry to Health Technology Assessment in India (HTAIn), Department of Health Research (DHR) to estimate treatment cost of IVF for inclusion in PM-JAY. The HTA Resource Hub at Indian Council of Medical Research- National Institute for Research in Reproductive and Child Health (ICMR- NIRRCH), Mumbai had been allocated this research question. This study was conducted to address this research question.

The report has recommended coverage of IVF under PM-JAY at ₹81,332 for one IVF cycle. It said that currently, outpatient department (OPD) expenses were not covered under PM-JAY and a majority of the expenditure for infertility treatment, including IVF, was OPD based. This needs to be considered for including IVF in PM-JAY package, the study said.

Published – December 05, 2025 10:45 pm IST