The study captured costs that rarely appear in official records. Non-medical expenses — such as travel, food, and lodging — added another layer of burden.
Published Dec 12, 2025 | 7:00 AM ⚊ Updated Dec 12, 2025 | 7:00 AM
IVF clinic bills. Representative image. (AI-generated)
Synopsis: A study found that nearly nine out of 10 couples in India spend more than a tenth of what their household earns in a year for IVF treatment. It recommended that the government introduce a standardised package under Ayushman Bharat–Pradhan Mantri Jan Arogya Yojana, India’s flagship health insurance scheme.
Nearly nine out of 10 couples who walk into an IVF clinic in India walk out with a bill that consumes more than a tenth of what their household earns in a year.
A new government-backed cost analysis has revealed that couples undergoing in vitro fertilisation (IVF) spend an average of ₹1.6 lakh per cycle, with expenditure nearly doubling in private hospitals. The study, conducted by the Health Technology Assessment Resource Hub at ICMR–NIRRCH, Mumbai, tracked 148 couples across five tertiary centres in Chandigarh, Delhi, Chennai, Trivandrum and Wardha between April 2022 and March 2023.
The numbers tell a story of financial desperation. More than half the couples — 58 percent — borrowed money to pay for treatment. Among those who took loans, 60 percent turned to friends and family, while others pledged gold or approached banks. Only five percent had insurance that covered IVF, and even then, the average coverage stood at ₹1,00,625.
“Couples reported that on average they were spending 29 percent of their total household consumption expenditure on infertility treatment, including IVF,” the study noted.
The research arrives at a moment when India grapples with rising infertility rates. The World Health Organisation (WHO) estimates that between 3.9 percent and 16.8 percent of Indian couples face infertility, yet treatment remains largely absent from public health financing.
The study recommended that the government introduce a standardised ₹81,332 IVF package under Ayushman Bharat–Pradhan Mantri Jan Arogya Yojana, India’s flagship health insurance scheme.
Researchers at ICMR–NIRRCH partnered with three public and two private hospitals to map every rupee spent. They tracked out-of-pocket expenditure, health-related quality of life, and what it actually costs the health system to deliver IVF services.
The findings showed that public hospitals spend ₹54,232 to deliver one IVF cycle. When medicines are included — calculated using the lowest prices available on India Mart — the cost rises to ₹81,332. The private hospitals in the study charged patients far more. At SRIHER, Chennai, couples paid an average of ₹3,29,000 for a single cycle. At MAMC, Delhi, the figure stood at ₹54,876.
“The health system cost of providing one IVF cycle, including costs of medicines irrespective of the facility’s operational efficiency, is ₹81,332,” the study stated.
Human resources consumed the largest share of system costs, followed by consumables. Laboratory services accounted for the highest proportion among cost centres, followed by operation theatre and inpatient departments.
For couples, the direct health costs — investigations, procedures, and medicines — formed the bulk of expenditure. At MAMC, Delhi, participants spent around 81 percent of their total direct health costs on medicines. The public hospital provided free investigations but stocked no hormonal injections or IVF-specific drugs, forcing patients to purchase them out of pocket.
In Thiruvananthapuram, more than 50 percent of direct health costs went towards medicines despite subsidised rates. In Chennai, procedures such as hysterolaparoscopy, sonosalpingography, and cryopreservation carried higher charges than other sites, driving up overall procedure costs.
The study captured costs that rarely appear in official records. Non-medical expenses — such as travel, food, and lodging — added another layer of burden. Participants from Wardha, Delhi, and Chandigarh reported the highest travel costs. The median distance travelled from residence to hospital in Wardha stretched to 119.7 kilometres. In Chandigarh, it reached 75.6 kilometres.
More than 40 percent of non-medical costs at Thiruvananthapuram and Chennai went towards food. In Chandigarh, lodging costs climbed as patients from neighbouring states stayed through the IVF process.
Indirect costs — the wages lost when couples missed work — hit hardest. Loss of the male partner’s wage accounted for more than 80 percent of indirect expenditure across all sites. Female partners who worked lost wages as well, with the highest losses reported at PGIMER Chandigarh, SRIHER Chennai, and MAMC Delhi.
“The share of OOPE on one IVF cycle in the total annual household consumption was 31 percent among the participants. The majority, ie 88.5 percent couples, were spending more than 10 percent of their total annual household consumption expenditure as OOPE for one IVF cycle, which amounts to catastrophic expenditure,” the study documented.
The researchers assessed health-related quality of life using standardised tools. Among male participants undergoing IVF, 35 percent reported slight anxiety and depression, while 15 percent experienced moderate levels. More than 90 perent reported no problems with self-care and usual activities, though 11 percent noted slight pain and discomfort from other health conditions like back pain.
Female-factor infertility accounted for 72 percent of IVF cases in the study. Tubal issues emerged as the most common cause. Among male-factor cases, oligospermia led the list.
The couples enrolled in the study had searched for solutions for years. On average, they had undergone infertility treatment for six years and visited four different clinics before arriving at an IVF centre. Nearly half — 49 percent — had attempted intrauterine insemination, undergoing an average of three cycles before moving to IVF.
The median annual household income stood at ₹3,60,000. Most male participants held jobs. Only 21 percent of female participants worked.
The study laid out clear recommendations. First, introduce a standardised ₹81,332 IVF package under PM-JAY. Second, consider covering outpatient infertility expenses, which form the bulk of treatment costs. Third, provide financial protection to patients who incur catastrophic spending even without IVF.
The research also examined infertility treatment for five specific conditions — PCOS, endometriosis, tubal factors, uterine factors, and male infertility. Among 500 participants enrolled for this component, the median annual spending reached ₹11,317. One in four patients faced catastrophic expenses.
PCOS emerged as the most common cause of infertility in this group, accounting for 38 percent of cases. Less than half — 44 percent — of participant couples had obtained financial support through borrowing or loans to pay for treatment.
“Since nearly 44 percent of couples undergoing infertility treatment face catastrophic expenditure, this cost could also be considered for reimbursement under PM-JAY,” the study recommended.
The budget impact analysis projects that providing IVF services to the entire eligible cohort would require ₹2,703 crores. The analysis calculated that 3,32,381 women married for five years or more between ages 15 and 49 would opt for IVF treatment, based on infertility prevalence data from the National Family Health Survey-5.
Currently, OPD expenses remain excluded from PM-JAY coverage. The study noted this creates a significant gap, as the majority of expenditure for infertility treatment, including IVF, occurs on an outpatient basis.
In 2011, CGHS issued an order to reimburse up to three cycles of IVF. NICE guidelines recommend three cycles for women under 40 who have not conceived after six or more cycles of intrauterine insemination. The study suggests PM-JAY could consider including three cycles of IVF for reimbursement.
(Edited by Muhammed Fazil.)
