For thousands of Indian couples struggling to conceive, the emotional toll of infertility is often accompanied by a significant financial burden. A new multicentric study published in the Indian Journal of Medical Research (IJMR) has revealed that out-of-pocket expenditure (OOPE) for infertility treatment remains substantial, with male infertility treatment costs nearly matching those associated with endometriosis—traditionally considered one of the most expensive infertility-related conditions.
The findings highlight a largely overlooked aspect of reproductive healthcare in India: the high cost of diagnosing and treating male infertility. Researchers found that more than half of the participating couples experienced catastrophic health expenditure while seeking infertility services, underscoring the urgent need for stronger insurance coverage and greater public investment in fertility care.
The study was conducted by researchers from the ICMR-National Institute for Research in Reproductive and Child Health and several collaborating institutions. Investigators surveyed 500 couples seeking infertility treatment at five tertiary healthcare facilities across India, including three public hospitals and two private institutions. Data were collected between April 2022 and March 2023.
Researchers focused on couples diagnosed with a single infertility factor, including:
Male infertility
Endometriosis
Polycystic Ovary Syndrome (PCOS)
Tubal factor infertility
Uterine factor infertility
The analysis covered expenses related to diagnosis, treatment, consultations, medications, investigations, travel, accommodation, food, and income lost due to missed work.
Among all infertility conditions examined, endometriosis generated the highest median annual out-of-pocket expenditure. Couples affected by endometriosis spent approximately ₹15,084 annually on infertility-related care. Surprisingly, male infertility followed closely, with median annual expenses reaching ₹13,211. Uterine factor infertility also imposed a similar financial burden.
The findings challenge a common perception that infertility treatment costs are largely driven by female reproductive conditions. Researchers noted that male infertility contributes significantly to healthcare expenses and deserves greater attention in both clinical practice and public health policy.
The study found a clear difference in spending between public and private healthcare facilities.
Couples seeking treatment in private centers reported a median annual expenditure of ₹14,217, compared with ₹8,355 among those receiving care at public facilities. Direct medical expenses including consultations, laboratory investigations, medications, and treatment procedures accounted for the largest share of total spending.
Researchers observed that fertility treatment often requires repeated visits, multiple investigations, and long-term follow-up, all of which increase costs over time. Many couples had already visited at least three healthcare facilities before enrolling in the study.
One of the study’s most concerning findings was the prevalence of catastrophic health expenditure (CHE), defined as infertility-related spending exceeding 40% of a household’s annual non-food expenditure.
Overall, 59.4% of participating couples experienced catastrophic health expenditure while pursuing infertility treatment.
The risk of financial hardship increased among couples who:
Had lower household incomes
Had additional medical conditions
Underwent intrauterine insemination (IUI)
Lacked health insurance coverage
Couples with lower per-capita incomes faced the greatest risk of catastrophic spending, demonstrating how infertility can deepen existing economic inequalities.
According to the study, infertility affects nearly one in six adults globally. While infertility is often viewed as a women's health issue, male factors are solely responsible for approximately 20% of infertility cases and contribute to another 30–40% of cases worldwide.
Despite this, infertility in India continues to be largely perceived as a woman's inability to conceive. This misconception can delay evaluation and treatment for male partners, potentially increasing both emotional stress and healthcare costs.
The new findings suggest that male infertility should receive equal attention in clinical discussions, public awareness campaigns, and healthcare planning.
Researchers identified several contributors to infertility-related expenses:
These include:
Specialist consultations
Diagnostic tests
Hormonal investigations
Medications
Treatment procedures such as IUI
Direct medical expenses represented the largest component of overall spending.
Couples also incurred costs for:
Transportation
Accommodation
Food during treatment visits
These expenses accumulated over repeated hospital visits.
Many couples lost wages due to time spent attending appointments and undergoing treatment. Researchers calculated these indirect costs using the human capital approach, which estimates income lost because of missed workdays.
The study highlighted the limited availability of financial protection for infertility care in India. Unlike many other health conditions, infertility diagnosis and treatment are largely excluded from major public health programmes and insurance schemes.
As a result, most couples pay directly from their own pockets, making fertility treatment inaccessible for many families. Researchers concluded that expanding insurance coverage and strengthening public fertility services could reduce financial hardship and improve access to reproductive healthcare.
Infertility treatment in India continues to impose considerable financial pressure on couples, with nearly six in ten households experiencing catastrophic health expenditure. While endometriosis remains the costliest infertility-related condition, the new research reveals that male infertility treatment carries nearly the same economic burden.
Reference:
1. Patil, Prerana, Akshita Vikani, Deepshikha Sharma, Mihir Bhatta, Bhumika Tumkur Venkatesh, Utsha Ghosh, Rajatasubhra Adhikary, et al. “Out of Pocket Expenditure Incurred by Couples Seeking Infertility Services at Tertiary Level Facilities in India.” Indian Journal of Medical Research (May 16, 2026). Accessed June 8, 2026.
(Rh/ARC)