Published Jun 08, 2026 | 7:00 AM ⚊ Updated Jun 08, 2026 | 7:00 AM
Male infertility. Representative image. (iStock)
Synopsis: A new multicentre Indian study has found that infertility treatment is pushing many couples into financial distress, with male infertility emerging as the second-costliest condition after endometriosis. Couples spent a median ₹16,566 annually on male infertility treatment, while nearly 60 percent faced catastrophic health expenditure, highlighting major gaps in insurance coverage and public support.
Male infertility, often overlooked in discussions around reproductive health, is emerging as one of the costliest infertility conditions in India, with treatment expenses nearly matching those incurred by women with endometriosis, according to a new multicentre study that highlights the growing financial burden of fertility care on Indian families.
The study, published in the Indian Journal of Medical Research (IJMR), found that couples seeking treatment for male infertility spent a median of ₹16,566 annually out of pocket, only marginally lower than the ₹16,943 spent by couples dealing with endometriosis, the most expensive condition among the five major infertility causes examined by researchers.
The findings come amid growing concern over the economic impact of infertility treatment in India, where most services remain outside mainstream public health programmes and are largely financed directly by patients.
Researchers found that the overall median annual out-of-pocket expenditure on infertility treatment was ₹11,317. However, costs varied considerably depending on the underlying cause. While endometriosis emerged as the most expensive condition, male infertility ranked second, followed by uterine factor infertility at ₹14,605, polycystic ovary syndrome (PCOS) at ₹13,020 and tubal factor infertility at ₹8,688.
“This study highlights the economic burden associated with infertility care in India, where treatment is mostly financed through out-of-pocket expenditure,” the authors wrote.
The multicentric study was conducted across five tertiary healthcare facilities in India and included couples seeking treatment for endometriosis, male infertility, PCOS (PMOS), tubal factor infertility and uterine factor infertility. Researchers assessed the costs incurred over a one-year period, including direct medical expenses, non-medical costs and indirect losses such as missed work.
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The study found that male infertility imposes a substantial financial burden because diagnosis and treatment often involve extensive investigations and hormonal therapies.
For male infertility alone, couples spent a median of ₹7,034 on direct medical costs, ₹2,040 on non-medical expenses such as travel and food, and ₹1,903 on indirect costs including loss of wages. Investigation costs accounted for the largest share of expenditure at ₹5,220, while medicines added another ₹1,166.
“Male infertility contributes substantially to the infertility burden in India and often requires hormonal treatment and diagnostic evaluation, which increases the costs,” the researchers noted.
The authors said infertility treatment expenses are driven not only by medicines but also by diagnostic procedures and repeated evaluations. Investigations such as ultrasonography, hysterosalpingography and laparoscopy form an essential part of infertility management and contribute significantly to out-of-pocket spending.
Researchers also observed that infertility diagnosis and management in India remain highly heterogeneous due to the absence of standardised technical and operational guidelines.
The findings challenge the persistent perception that infertility is primarily a women’s health concern.
According to the World Health Organisation, infertility affects nearly one in six adults globally. The study notes that male factors are solely responsible for about 20 percent of infertility cases and contribute to another 30–40 percent of cases.
An accompanying report by the Indian Council of Medical Research’s National Institute for Research in Reproductive and Child Health (ICMR-NIRRCH), which examined costs and quality of life among couples undergoing infertility treatment and IVF (In Vitro Fertilisation), found that male-factor infertility accounted for 14 percent of IVF cases. Another 14 percent involved both male and female factors.
Among men undergoing IVF treatment, oligospermia, or low sperm count, emerged as the most common diagnosis, accounting for 36 percent of male infertility cases. It was followed by asthenospermia (22%), azoospermia (17%), varicocele (7%) and teratozoospermia (2%).
The report highlights that infertility treatment often requires repeated consultations, specialised investigations and prolonged follow-up, all of which contribute to escalating costs for families.
The financial impact extends beyond hospital bills.
The ICMR-NIRRCH report found that men bore the majority of productivity losses associated with fertility treatment. Across all IVF centres included in the study, husbands accounted for more than 80 percent of indirect costs due to lost wages during treatment visits and procedures.
Researchers said such losses are frequently overlooked when estimating the economic burden of infertility.
The report also showed wide variations in travel-related expenses, with many patients travelling long distances to access specialised fertility services. Public hospitals often generated lower direct treatment costs but higher travel and accommodation expenses because couples frequently had to travel from neighbouring districts or states.
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One of the most alarming findings was the extent of catastrophic health expenditure among infertile couples.
Researchers found that 59.4 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 among households with lower incomes, patients with co-morbidities such as diabetes, hypertension and thyroid disorders, and couples undergoing intrauterine insemination (IUI).
“A major finding of this study is the high proportion of couples experiencing catastrophic expenditure. This aligns with evidence on inadequate financial protection in healthcare, which highlights that high out-of-pocket expenditure can lead to distress financing and impoverishment,” the authors wrote.
The study also found that only one percent of the infertility patients had insurance coverage for treatment, forcing many families to depend on loans, borrowing or financial support from relatives.
Researchers attributed part of the financial burden to limited public financing of infertility services.
Although infertility is increasingly recognised as a significant reproductive health concern, diagnosis and treatment remain largely excluded from major public health programmes. Several fertility medicines and investigations are either unavailable in public hospitals or not covered under existing insurance schemes.
The authors noted that medicines such as letrozole, metformin and human chorionic gonadotropin (HCG) were often unavailable at public facilities, compelling patients to purchase them privately. Other commonly used fertility drugs, including clomifene citrate and follicle-stimulating hormone injections, are not part of essential drug lists in many settings.
In addition, several infertility-related investigations are conducted on an outpatient basis and therefore remain outside the reimbursement framework of schemes such as Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (PM-JAY).
The researchers said their findings mirror evidence from other low- and middle-income countries, where infertility treatment is heavily dependent on out-of-pocket spending and often remains unaffordable for many households.
They 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.
“In conclusion, 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,” the authors concluded.
The findings suggest that while infertility is frequently discussed through the lens of women’s health, male infertility carries a substantial and often under-recognised financial burden, one that rivals the costs associated with endometriosis and contributes significantly to the economic hardship faced by Indian couples seeking to start a family.
(Edited by Muhammed Fazil.)
