Why Affordability Could Be the Biggest Fertility Issue Facing Patients

Written by Sophie Sulehria

When we talk about fertility treatment, the conversation is often dominated by scientific breakthroughs. New technologies. Better embryo selection. Artificial intelligence. Genetic screening. More personalised medicine. These advances are exciting, and they have the potential to improve outcomes for many patients.

But at this year's European Society of Human Reproduction and Embryology (ESHRE) Annual Meeting, one piece of research cut through all the discussions about innovation with a simple but uncomfortable truth.

For many people, the biggest barrier to having a baby isn't science, it’s money.

The treatment exists, it’s the access that doesn't.

Anyone who has been through fertility treatment knows the financial toll it can take.

One cycle of IVF often isn't enough. Add medication, genetic testing, donor treatment, embryo storage, travel costs and time away from work, and the bill can quickly reach tens of thousands of pounds.

For some, that's manageable. For many others, it simply isn't.

Patients often find themselves making impossible decisions. Should they remortgage their home? Empty their savings? Borrow from family? Give up after one unsuccessful cycle because there is no money left?

These are not medical decisions, they are financial ones.

The research

Researchers analysed fertility treatment, economic and demographic data from 22 countries and regions, representing more than 95% of global assisted reproductive technology (ART) activity.

They wanted to understand one simple question:

What determines whether people actually access fertility treatment?

The answer was striking. The affordability of treatment explained between 77% and 84% of the differences in ART use between countries.

In other words, cost was one of the strongest predictors of whether people received treatment at all.

Perhaps the most eye-catching finding was this:

The researchers estimated that halving patients' out-of-pocket costs could increase the number of babies born through fertility treatment by almost 2.7 times.

That's an extraordinary statistic. Not because it suggests a new medical breakthrough. But because it suggests that, for many people, the treatment already exists, they simply can't reach it.

A postcode lottery on a global scale

Across Europe and beyond, access to fertility treatment varies enormously. In some countries, publicly funded treatment is widely available. In others, patients are expected to pay most, or all of the costs themselves.

Even within the UK, access differs depending on where you live. Local funding criteria can vary significantly, meaning two people with the same medical diagnosis may be offered very different levels of NHS support.

That inequality has consequences. The study found that countries where patients paid less than half of the median household income for treatment consistently achieved much higher use of assisted reproduction.

By contrast, where treatment costs approached two or even three times a household's annual income, very few babies were born through ART.

The implication is difficult to ignore - becoming a parent should not depend so heavily on your bank balance.

Innovation without access isn't progress

One of the privileges of attending ESHRE was speaking to the organisation's Chair-elect, Professor Borut Kovacic, about the future of fertility care.

When we discussed emerging technologies such as artificial intelligence and personalised medicine, one point stood out above all others. Technology that only serves the wealthy is wrong. It's a simple statement, but one that captures a growing challenge in reproductive medicine.

Every year, fertility science advances. Clinics develop new techniques, researchers make exciting discoveries. But unless those innovations become accessible, they risk widening the gap between those who can afford cutting-edge treatment and those who cannot.

Scientific progress only becomes meaningful when patients can benefit from it.

Why patients travel abroad

The issue of affordability is also one reason why fertility treatment has become increasingly international. Patients often travel across borders in search of treatment that is less expensive, more readily available or legally accessible. This can create new opportunities, but it also raises important questions about consistency, regulation and patient safety.

Professor Kovacic believes organisations such as ESHRE have an important role to play in improving transparency and supporting high standards of care across Europe, helping patients make informed decisions wherever they receive treatment.

The emotional cost

The financial burden of fertility treatment is often discussed in terms of numbers. But behind every number is a person. It's the couple who stop after one IVF cycle because they cannot afford another. The individual who delays treatment while trying to save enough money. The family who remortgage their home. The person who wonders for years whether another cycle might have worked if only they had been able to pay for it.

Financial stress doesn't exist separately from infertility but sadly becomes a large part of the experience. It influences decisions, relationships, mental health and, ultimately, who gets the chance to continue treatment.

What needs to change?

No single policy will solve the affordability challenge. Healthcare systems differ, funding models vary, and resources are always limited. But the findings presented at ESHRE send a clear message. If we want more people to benefit from fertility treatment, improving access may have a greater impact than many of the scientific advances that dominate conference headlines.

Investment in fertility care isn't simply about funding IVF. It's about recognising infertility as a health condition that deserves equitable access to evidence-based treatment.

What this means for patients

For anyone currently navigating fertility treatment, these findings may feel both frustrating and validating. Frustrating because they highlight a barrier that so many people already know exists.

Validating because they confirm that struggling to access treatment is not a personal failure. It is a systemic issue affecting patients across the world. Fertility medicine is advancing at an extraordinary pace. But real progress won't be measured only by the technologies we develop. It will also be measured by how many people can actually benefit from them.

This article is part of our ESHRE 2026 series. Over the coming weeks we'll be exploring the latest research on lifestyle, IVF trends, pregnancy loss, male fertility and more.