IVF pushes 9 in 10 Indian couples into debt, govt report warns

The average out-of-pocket expenditure for an in-vitro fertilisation (IVF) cycle in India is crushing for most families—about Rs 2.3 lakh in private hospitals and Rs 1.1 lakh in public hospitals.

Nearly 89 percent of participants undergoing IVF – a medical procedure to help people have a baby by combining eggs and sperm in a laboratory – were pushed into catastrophic medical spending, defined as treatment costs exceeding 10 percent of a household’s annual income.

These findings—India’s first empirical evidence on the financial burden of infertility treatment—come from a government-commissioned report led by the Indian Council of Medical Research–National Institute for Research in Reproductive and Child Health (ICMR–NIRRCH).

The report, commissioned by the Department of Health Research under the Union Health Ministry, lays bare the economic shock associated with IVF, a procedure most couples must attempt at least three times before achieving pregnancy.

The report, seen by India Today, cites WHO estimates indicating that primary infertility affects 4–17 percent of Indian couples, and around 8 percent of them require advanced assisted reproductive technologies like IVF.

The procedure involves multiple complex steps—from ovarian stimulation and egg retrieval to fertilisation, embryo transfer, and close monitoring—making it both expensive and technically demanding.

Prepared as a Health Technology Assessment for the National Health Authority (NHA), which oversees the Centre’s flagship Ayushman Bharat–Pradhan Mantri Jan Aarogya Yojana (AB-PMJAY), the report recommends the inclusion of IVF under the scheme.

AB-PMJAY currently provides hospitalisation coverage of up to Rs 5 lakh per family for economically vulnerable groups. Based on a calculated health-system cost of Rs 81,332 per IVF cycle, the report suggests adopting this figure as the reimbursable package rate should the treatment be brought under PMJAY.

India is estimated to have 2.8 crore couples facing infertility, many of whom encounter steep financial barriers to timely treatment. The report also notes that female factors account for 46 percent of infertility cases, while male factors contribute to 20 percent.

STRIKING FINDINGS

The analysis draws on data from 130 couples undergoing infertility treatment or IVF at three government centres—PGIMER Chandigarh, Maulana Azad Medical College in Delhi, and SAT Hospital at Government Medical College, Thiruvananthapuram—as well as two private facilities: Jawaharlal Nehru Medical College at Datta Meghe Institute of Medical Sciences in Wardha and Sri Ramachandra Institute of Higher Education and Research in Chennai.

Among those evaluated, polycystic ovarian syndrome (PCOS) emerged as the most



common cause of infertility.

The median out-of-pocket expenditure for infertility treatment across facilities stood at Rs 11,317.

While private-sector patients faced higher direct costs for medicines and investigations, public-sector patients bore disproportionately higher non-medical and indirect expenses such as travel, accommodation, and wage loss.

A quarter of all patients seeking infertility treatment experienced catastrophic health expenditure even before considering IVF costs.

Despite infertility’s significant prevalence, the report highlights its low visibility in India’s public health agenda, which offers minimal financial protection for diagnosis or treatment.

The report has said that currently, out-patient department services are not covered under PM-JAY but as the majority of expenditure for infertility treatment including IVF is OPD based, this consideration needs to be made for including IVF in the PMJAY package.

Also, since 25 percent of couples undergoing infertility treatment face catastrophic expenditure, this cost could also be considered for reimbursement under PMJAY.

WHY GOVERNMENT SUPPORT MATTERS

Experts widely agree that IVF remains prohibitively expensive in India, especially for couples who require multiple cycles.

Mumbai-based IVF specialist Dr Nandita Palshetkar noted that while the private sector offers extensive infertility services, the public health system’s reach is crucial given the rising burden of infertility.

Pointing to Madhya Pradesh—where IVF has already been included under PMJAY—she said the policy has been transformative for many patients and urged more states to adopt similar measures.

Abhishek Aggarwal, CEO of Birla Fertility & IVF, stressed that infertility care should be recognised as an essential medical service, not a discretionary one.

He said the Centre’s progress in expanding healthcare access through AB-PMJAY could be amplified by integrating infertility diagnostics and IVF into national insurance benefits through well-structured coverage.

Data from the Household Consumption Expenditure Survey 2022–23 shows that the average rural household spends around Rs 17,000 per month, with many lower- and middle-income families clustered between Rs 17,000 and Rs 20,000. Aggarwal noted that for these households, infertility interventions can quickly become financially devastating.

The report finalised last month also found that the annual health-system cost of infertility management in public hospitals ranges from Rs 6,822 to Rs 11,075—substantially lower than costs borne in the private sector, yet still unaffordable for a large segment of the population without insurance support.