Nearly 60 percent of couples faced catastrophic financial strain
Across India's fertility clinics, a quiet financial crisis unfolds in the shadow of a long-held assumption: that infertility is a woman's burden. A new multicentre study has revealed that treating male infertility costs nearly as much as treating endometriosis, the most expensive reproductive condition studied, yet it remains almost entirely absent from public health planning. With nearly 60 percent of couples spending catastrophically on care they must finance entirely themselves, the research asks a deeper question — not merely about money, but about which suffering a society chooses to see.
- Male infertility treatment costs ₹16,566 annually — just ₹377 less than endometriosis — yet it receives a fraction of the policy attention, exposing a profound blind spot in reproductive health discourse.
- Nearly 60% of couples cross the WHO threshold for catastrophic health spending, with lower-income households, those managing co-morbidities, and IVF patients facing the steepest financial cliffs.
- Men quietly absorb over 80% of lost wages across treatment centres, a hidden cost that researchers and policymakers have routinely failed to count in the true economic toll of infertility.
- Only 1% of infertility patients carry any insurance coverage, leaving the rest to borrow from relatives, take out loans, or face impoverishment — because the system has classified infertility as a private problem.
- Essential fertility medicines are frequently unavailable in public hospitals, and outpatient diagnostics fall outside flagship insurance schemes, forcing patients into a private market with no safety net.
- Researchers are now calling for insurance reform, public hospital medicine availability, and the integration of infertility care into mainstream health programmes before more families must choose between parenthood and financial survival.
In India's fertility clinics, the conversation around infertility has long centred on women. But a new multicentre study published in the Indian Journal of Medical Research has exposed a financial reality that quietly overturns this assumption: treating male infertility costs nearly as much as treating endometriosis, the most expensive reproductive condition examined, and it remains almost entirely invisible in public health planning.
Couples seeking treatment for male infertility spent a median of ₹16,566 out of pocket each year — trailing endometriosis by only ₹377. Diagnosis alone cost a median of ₹5,220, with medicines, travel, food, and lost wages adding thousands more. These costs accumulate in a system where infertility services exist almost entirely outside public provision. Men bore more than 80 percent of lost wages across all IVF centres studied, a burden routinely overlooked when policymakers estimate the true cost of care.
The scale of financial catastrophe is stark. Nearly 60 percent of couples spent more than 40 percent of their annual household non-food expenditure on treatment — meeting the WHO's definition of catastrophic health spending. The risk was highest for lower-income households and those managing conditions like diabetes or thyroid disorders. Only one percent of patients had any insurance coverage. The rest borrowed, took out loans, or faced impoverishment.
The structural gaps are significant. Essential fertility medicines are often unavailable in public hospitals, and outpatient diagnostic investigations fall outside reimbursement frameworks like Ayushman Bharat. Male factors contribute to roughly half of all infertility cases, yet the men experiencing them face costs that rival those borne by women with some of the most painful gynaecological conditions known. The invisibility reflects a persistent cultural assumption that infertility is fundamentally a woman's issue.
The study's authors called for stronger insurance coverage, better medicine availability in public hospitals, and the integration of infertility care into mainstream health programmes — arguing that until India's public health system treats infertility as a legitimate priority, couples will continue to choose between starting a family and financial ruin.
In India's fertility clinics, the conversation around infertility has long centered on women—endometriosis, polycystic ovary syndrome, blocked fallopian tubes. But a new multicentre study published in the Indian Journal of Medical Research has exposed a financial reality that upends this narrative: treating male infertility costs nearly as much as treating endometriosis, the most expensive reproductive condition examined, and it remains almost entirely invisible in public health planning.
Couples seeking treatment for male infertility spent a median of ₹16,566 out of pocket each year, according to the research conducted across five tertiary healthcare facilities. That figure trails endometriosis by only ₹377—a gap so narrow it suggests the two conditions impose comparable economic strain on families. Yet while endometriosis has gained visibility and advocacy, male infertility persists as an afterthought in discussions of reproductive health burden. The study found that diagnosis and treatment require extensive investigations and hormonal therapies: couples paid a median of ₹5,220 for diagnostic procedures alone, with another ₹1,166 going to medicines. Travel, food, and lost wages added ₹3,943 more. These costs accumulate in a healthcare system where infertility services exist almost entirely outside public provision, forcing patients to finance everything themselves.
The financial weight falls unevenly. Men bore the majority of the hidden costs—more than 80 percent of lost wages across all IVF centres studied came from husbands taking time away from work for treatment visits and procedures. This burden is routinely overlooked when researchers and policymakers estimate the true cost of infertility. Meanwhile, the geographic reality compounds the problem. Couples often travel long distances to reach specialised fertility services, and while public hospitals charged less for direct treatment, they generated higher travel and accommodation expenses because patients came from neighbouring districts or states.
The scale of financial catastrophe is staggering. Nearly 60 percent of couples undergoing infertility treatment spent more than 40 percent of their annual household non-food expenditure on care—meeting the World Health Organisation's definition of catastrophic health spending. The risk was significantly higher for lower-income households, for couples managing co-morbidities like diabetes or thyroid disorders, and for those pursuing intrauterine insemination. Only one percent of infertility patients had any insurance coverage. The rest borrowed from relatives, took out loans, or faced impoverishment to pay for treatment.
The structural gaps are deliberate, if unintentional. Although infertility is increasingly recognised as a significant reproductive health concern, it remains largely excluded from major public health programmes. Essential fertility medicines—letrozole, metformin, human chorionic gonadotropin—are often unavailable in public hospitals, forcing patients to purchase them privately at inflated prices. Other commonly used drugs, including clomifene citrate and follicle-stimulating hormone injections, do not appear on essential drug lists in many settings. Diagnostic investigations conducted on an outpatient basis fall outside reimbursement frameworks like Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana, the government's flagship health insurance scheme. The system, in effect, has decided that infertility is a private problem requiring private payment.
The researchers noted that male factors are solely responsible for about 20 percent of infertility cases and contribute to another 30 to 40 percent. Among men undergoing IVF, oligospermia—low sperm count—accounted for 36 percent of diagnoses, followed by asthenospermia at 22 percent and azoospermia at 17 percent. These are common, treatable conditions. Yet the men experiencing them face costs that rival those borne by women with one of the most painful gynaecological conditions known. The invisibility is not accidental. It reflects a persistent cultural assumption that infertility is fundamentally a woman's issue, a woman's failure, a woman's burden to solve.
The authors called for stronger insurance coverage, improved availability of medicines and diagnostic services in public hospitals, and greater integration of infertility care into mainstream health programmes. They noted that their findings mirror evidence from other low- and middle-income countries, where infertility treatment remains unaffordable for most households. Until India's public health system acknowledges infertility as a legitimate health priority—not a luxury concern—couples will continue to choose between starting a family and financial ruin.
Citações Notáveis
Male infertility contributes substantially to the infertility burden in India and often requires hormonal treatment and diagnostic evaluation, which increases the costs— Study authors in Indian Journal of Medical Research
Infertility care in India imposes a substantial financial burden on affected couples, with a high risk of catastrophic expenditure. Addressing these challenges requires strengthening health financing mechanisms, improving service delivery, and prioritising infertility care within the public health system— Study researchers
A Conversa do Hearth Outra perspectiva sobre a história
Why does male infertility cost so much when it's often just a diagnosis and some medication?
Because diagnosis itself is expensive. You're looking at ultrasounds, hormone tests, semen analyses—sometimes repeated multiple times. And the hormonal treatments aren't cheap. But the real cost driver is that none of this happens in public hospitals where it could be subsidised. It all happens privately.
The study says men lost more wages than women during treatment. How does that happen if women are the ones typically having procedures?
Men are taking time off to accompany their partners, to attend consultations, to be present for procedures. But also—and this matters—men's lost wages are being counted as part of the couple's burden, not as a separate issue. It's invisible labour, invisible cost.
Only one percent had insurance. That's almost nothing. Why is infertility so excluded from coverage?
Because it's not considered essential. Infertility isn't life-threatening in the way a heart attack is. Policymakers see it as elective, as a choice. But for couples, it's existential. And the financial pressure is real enough to push families into debt or worse.
The study mentions that public hospitals have lower direct costs but higher travel expenses. Why would someone travel farther for a cheaper option?
Because the cheaper option might be the only option in their region. If your state has one public fertility clinic and it's three hours away, you're paying for accommodation and transport. The private clinic down the street costs more per visit but less overall when you factor in travel.
What would actually change this?
Insurance coverage would be the fastest fix. But that requires treating infertility as a public health priority, not a private problem. It also requires stocking public hospitals with the medicines and equipment they need. Right now, the system is designed to push people toward private clinics.