Despite significant global strides in advancing sexual and reproductive rights, infertility remains a neglected issue. Changing gender roles and economic instability have led to postponed childbearing, contributing to increased infertility rates among both men and women. Currently, one in six individuals faces infertility challenges. However, there is a notable lack of awareness regarding the decline in fertility, its risk factors, and available treatments.
Assisted reproductive technologies (ARTs), notably in-vitro fertilization (IVF), have been transformative, helping countless people become parents. Nearly 50 years after the first IVF baby was born, this technology is now used in approximately 9% of births in some affluent nations. While these advancements have benefited many, the fertility industry has evolved into a profit-driven sector that often exacerbates the psychological strain of infertility and perpetuates inequities in accessing quality care.
Medical innovations have improved the effectiveness of IVF. For example, in the UK, the live birth rate per embryo transferred in women aged 35–37 increased from 6% in 1991 to 25% in 2019. However, some IVF-related procedures remain controversial. Recent trials reveal that various endometrial preparation protocols for frozen embryo transfers show no difference in effectiveness, although safety assessments are still pending. Additionally, many patients are offered non-essential procedures—known as “add-ons”—such as time-lapse imaging for embryo selection, pre-implantation genetic testing for aneuploidy screening (PGT-A), and endometrial scratching. Despite widespread promotion by private clinics, robust evidence supporting these add-ons is often lacking. For instance, time-lapse imaging has not been shown to improve birth outcomes compared to routine care, and intracytoplasmic sperm injection, despite its invasiveness, does not enhance live birth rates but raises costs and potential risks to offspring health. Regulatory bodies, including the Human Fertilisation and Embryology Authority, have reviewed these add-ons and generally do not endorse their routine use. Yet, they remain available to patients.
In countries like the Netherlands, where infertility treatments are predominantly publicly funded, such add-ons are relatively rare. In contrast, many countries rely on a profit-driven private sector for infertility treatments. In the UK, over 60% of IVF treatments are privately funded, with a single cycle costing £5,000 or more. The lack of public funding and regulation, combined with high demand for fertility treatments, has led to the commercialization and financialization of ARTs. In the US, about one-third of IVF cycles are performed in clinics associated with private-equity firms, where PGT-A is more commonly included in treatment protocols. The financial stakes are enormous, with the global fertility market valued at $34.7 billion in 2023 and expected to reach $62.8 billion within a decade.
The emotional and physical toll on individuals and families undergoing these treatments can be severe. The intense desire for a child coupled with infertility often leads to significant mental health challenges, including anxiety, depression, and relationship issues. Many women experience repeated unsuccessful IVF cycles, leading to feelings of loss and grief. The stigma surrounding infertility and IVF further contributes to feelings of shame and isolation. The evolving fertility industry risks shifting its focus from evidence-based, patient-centered care to prioritizing shareholder profits and business expansion.
Moreover, the exorbitant costs of ART treatments exacerbate global inequalities in access, despite similar levels of infertility worldwide. In over half of low- and middle-income countries studied, the cost of a single ART cycle exceeds the average annual gross domestic product per capita. Disparities also exist within countries, influenced by geography, socioeconomic status, and ethnicity, intersecting with higher infertility risk factors.
This situation is untenable. There is an urgent need to enhance public awareness about infertility risk factors and available treatments. Improving access to effective, patient-centered, and evidence-based care is crucial. The fertility industry must shift away from exploiting individuals’ vulnerabilities and towards a model that prioritizes compassionate, equitable care.
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