Although there is a regulatory framework for advanced infertility treatments such as in vitro fertilization (IVF) in India, the costs of the procedures remain unregulated, putting enormous financial pressure on couples, a study said. The study aimed to estimate “costs of infertility diagnosis and management, including IVF and quality of life, in infertile couples”.
In India, several patients who participated in a study conducted by the Indian Council of Medical Research – National Institute of Research for Reproductive and Child Health (ICMR-NIRRCH) were found to have high expenses. According to the study, the average out-of-pocket expenditure per IVF cycle was higher by ₹ 1 lakh in both private and public hospitals.
Out-of-pocket payments are payments made out of your own resources, not from a third party such as insurance.
What the study found
For the study, researchers identified three public and two private tertiary care facilities willing to participate. Primary data were collected from 30 patients undergoing IVF treatment and 100 patients undergoing infertility treatment (mainly 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 factors. The remaining couples had either idiopathic infertility or multiple factors contributing to infertility and were not included in the study. The study found that among couples undergoing IVF treatment, oligospermia and tubal infertility were the leading causes of infertility. Of the couples in the study, about 8% of infertile couples required advanced treatments such as IVF, which were expensive and technically demanding.
“Among couples undergoing fertility treatment, polycystic ovary syndrome (PCOS), a hormonal disorder in women of reproductive age, is the most common cause of infertility of the five factors considered,” the study added.
Experts said there is no fixed number of IVF cycles that guarantee success and results vary from individual to individual. Most women have a good chance of success after three stimulated cycles, and the cumulative success rate increases with each attempt, they said.
Out of pocket expenses
IVF involves several steps, including ovarian stimulation, egg retrieval, fertilization, embryo transfer, and pregnancy monitoring. Stating that the median out-of-pocket expenditure on infertility treatment was ₹11,317, the study said that direct medical costs for drugs and investigations were high in private facilities, while non-medical and indirect costs were higher for those who sought infertility services in 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 that contributed most to patients’ poor quality of life. Costs to the health system for treating infertility over one year in public facilities ranged from ₹ 6,822 to ₹,’11,075, which was found in the study to be no higher in private facilities.”
Fertility in India
“One in six couples in India suffer from infertility problems. With India’s declining fertility rate, it becomes even more important to integrate fertility-related health care into the broader health insurance framework. A recent national report emphasized that infertility care should be an essential part of public health systems so that all couples have access to fertility treatment. Infertility is not just a phenomenon of urban couples in India, even in areas with higher fertility3, even in areas with higher fertility 2. Fertility care must be accessible along with transparent pricing By including infertility treatment in PM-JAY (Pradhan Mantri Jan Arogya Yojana), more families have access to necessary treatments, which reduces the emotional and financial burden of infertility Addressing fertility issues as part of the health insurance framework, ensures balanced demographic rates, CEO of Acligerning, IV.
Delivery service ART
Currently, very few public facilities provide ART services. The growing demand for these services is being met by the expanding private sector. Although ART rules regulate these private providers, their prices remain unchecked. There is a lack of scientific data to indicate the cost of providing these services in India. This results in a huge pocket and financial burden on infertile couples.
According to a systematic review of financial costs of assisted reproductive technology for patients in low- and middle-income countries, the cost of one cycle of ART is significantly higher (166.4%) than the average annual income of patients in India.
The regulatory framework for ART services in India currently includes the Assisted Reproductive Technology (Regulation) Act, 2021 and the ART Rules notified under the Act. This framework regulates the practice of ART by setting rules for 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 new IVF cycles as per the government memorandum, if the woman/couples meet specific criteria. With the ART Act 2021, there is a growing demand to assess whether IVF services could be included in the Ayushman Bharat- Pradhan Mantri- Jan Arogya Yojana (AB-PM-JAY) package. Currently, the PM-JAY scheme covers medical and hospitalization expenses for almost all secondary care procedures and most tertiary care procedures. However, certain conditions are exempted under this regime. Treatment of infertility is one of them.
Due to the growing demand and high financial burden of IVF in India, there was a request from the Ministry of Health for Health Technology Assessment of India (HTAIn), Department of Health Research (DHR) to estimate the cost of IVF treatment for inclusion in PM-JAY. This research question was assigned to the HTA Resource Hub at the Indian Council of Medical Research – National Institute for Research in Reproductive and Child Health (ICMR-NIRRCH), Mumbai. This study was conducted to address this research question.
The report recommends IVF coverage under PM-JAY at ₹ 81,332 per IVF cycle. She said that at present Out-Patient Department (OPD) expenses are not reimbursed from PM-JAY and most of the infertility treatment expenses, including IVF, were based on OPD. This needs to be taken into account for the inclusion of IVF in the PM-JAY package, the study said.
Published – 5 Dec 2025 22:45 IST
