An article by the Guardian revealed how women pay the price when men are not tested properly. In the UK, men accounted for around 50% of infertility cases. However, male fertility issues often go untreated due to insufficient research and a lack of National Health Service (NHS) resources. As a result, couples may undergo unnecessary in vitro fertilization (IVF). Infertility is a disorder of the reproductive system that is characterized as the inability to conceive after a year of unprotected intercourse. Several studies have revealed a persistent belief that infertility is mostly caused by the female partner, a finding that highlights a troubling disparity in the understanding of infertility causes. According to Turner et al., the feminization of infertility is due to societal perceptions of medicine as a female-focused field and the historical burden placed on women for childbearing and domesticity. As a result, there is a serious lack of information on financial costs and insurance coverage for diagnostics and treatments of male infertility across nations.
A study by Roth et al. reports significant knowledge gaps about male infertility among the general population and medical professionals, as well as a lack of transparency surrounding insurance coverage and treatment costs. It concludes that male infertility is marginalized due to the stigma associated with masculinity, which prevents candid conversation and prompt diagnosis. It further argues that these institutional and knowledge gaps have tangible consequences. Low awareness and cost opacity impede male evaluation and treatment. Hence, it potentially leads infertility care to gravitate toward more intrusive, female-centered treatments.
A recent academic study by Shan et al. reveals that, despite significant progress in assisted reproductive technology (ART) over the past thirty years and the birth of millions of children worldwide through methods like in vitro fertilization, access to ART is still critically restricted in numerous lower-middle-income countries (LMICs), primarily due to exorbitant costs. The lack of financial insurance for these treatments suggests that infertility is not considered a condition deserving of financial support in LMICs.
Reporting by The Hindu, based on a study conducted by the Indian Council of Medical Research–National Institute for Research in Reproductive and Child Health (ICMR-NIRRCH), shows that very few public facilities currently offer ART services, forcing most couples to seek care in the private sector. Although ART clinics in both “public and private” sectors are regulated under the Assisted Reproductive Technology (Regulation) Act, 2021, pricing remains unregulated, resulting in high out-of-pocket expenditure. The same study found that the average cost of a single IVF cycle exceeds ₹1 lakh in both public and private hospitals, with direct medical costs (medicines and diagnostic investigations) significantly higher in private clinics.
The report further cited a systematic review of assisted reproductive technology costs in low- and middle-income countries, which estimated that the medical cost of one ART cycle in India amounts to 166.4% of the average annual income. The Central Government Health Scheme reimburses up to three IVF cycles for ₹65,000, but the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (PM-JAY) does not cover infertility treatment. In the absence of price regulation and insurance coverage under Ayushman Bharat–PM-JAY, India’s fertility-care landscape translates structural gaps in access and oversight into substantial economic harm, disproportionately borne by women who undergo repeated and invasive procedures.
In contrast, the initial evaluation for male infertility usually starts with a cost-effective and minimally invasive tool: semen analysis. This first-line assessment for couples facing unexplained infertility is less expensive and less invasive compared to many female-focused tests. While it has limitations, a semen analysis can still offer valuable insights for healthcare providers. Overreliance on female-oriented diagnostics can misallocate resources, leading to significant financial consequences for households.
In India’s labour market, where women already face significant participation and wage gaps, infertility-related time poverty further compounds economic vulnerability. What is often treated as a private health issue thus emerges as a contributor to broader gendered economic inequality. A study addressing the reproductive inequity in the global fertility crisis suggested that men may be more concerned with the financial and social aspects associated with infertility. However, their female partners attribute higher stress to the number of clinic visits, social and sexual concerns, leading to emotional turmoil associated with unknown causes of infertility.
Despite the magnitude of these costs, infertility is largely overlooked in economic and public health policy discussions. The burden of infertility is not merely biological—it is political, economic, and institutional. Patriarchal norms, research neglect, and market incentives combine to create a system that misdiagnoses problems and misallocates resources. Male reproductive health is becoming a major public health problem as environmental risk factors rise and sperm counts fall globally. Standardizing early, fair evaluation of both partners can enhance outcomes, lessen inequities, and encourage more cost-effective, well-rounded reproductive care for diverse populations. There is a greater need to rethink research priorities, clinical protocols, and regulatory frameworks to recognize reproductive healthcare as a matter of economic efficiency and social justice. By bringing these hidden costs to light, policymakers can begin to treat infertility as a systemic failure requiring structural change, rather than an individualized health burden borne disproportionately by women.
Akshata Nete
