Male Infertility Costs Nearly As Much As Endometriosis Treatment In India: Study

Infertility is often viewed as a women's health issue in India, despite medical evidence showing that male factors contribute to nearly half of all infertility cases. Now, a new multicentric study published in the Indian Journal of Medical Research (IJMR) has highlighted another overlooked aspect of the problem: the significant financial burden of male infertility treatment. Researchers found that couples seeking treatment for male infertility spent almost as much out of pocket as those dealing with endometriosis, a chronic and often painful gynaecological condition (also associated with female infertility) widely recognised for its treatment costs.

The findings challenge longstanding perceptions that infertility-related expenses are driven primarily by female reproductive disorders and underscore the need for broader insurance coverage and public health support. The study, conducted across public and private tertiary healthcare facilities in India, also revealed that nearly six in ten couples experienced catastrophic health expenditure due to infertility care.

With infertility affecting approximately one in six adults globally and treatment largely financed through personal savings in India, experts say the findings expose a major but under-recognised public health challenge. 

Infertility's Hidden Economic Burden

Infertility is defined by the World Health Organization (WHO) as the inability to achieve pregnancy after 12 months or more of regular unprotected intercourse. According to WHO estimates, around 17.5% of adults worldwide experience infertility during their lifetime, making it a significant global health issue.

In India, however, infertility services remain largely outside major public health programmes. Diagnosis and treatment often require repeated consultations, laboratory investigations, imaging procedures, medications and assisted reproductive technologies, all of which are typically paid for out of pocket. 

The new IJMR study sought to quantify these costs by examining expenditure among 500 couples receiving treatment for five common causes of infertility: polycystic ovary syndrome (PCOS), endometriosis, tubal-factor infertility, uterine-factor infertility and male infertility.

Also Read: Falling Fertility Rate, Rising Hospital Deliveries: NFHS-6 Shows A Changing Motherhood Story

Male Infertility Costs Rival Endometriosis

One of the study's most striking findings was that the financial burden associated with male infertility was nearly identical to that of endometriosis, traditionally considered one of the costliest infertility-related conditions.

Researchers found:

• Median annual out-of-pocket expenditure for endometriosis: Rs 16,943
• Median annual out-of-pocket expenditure for male infertility: Rs 16,566
• Median annual expenditure across all infertility causes: Rs 11,317

The difference between male infertility and endometriosis treatment costs was minimal, suggesting that male reproductive health issues place a much larger financial burden on families than is commonly recognised. The study also reported that male infertility accounted for nearly one-fifth of all infertility diagnoses among participating couples.

Why Male Infertility Can Be Expensive

Male infertility investigations frequently involve specialised diagnostic procedures, hormonal testing, semen analysis, genetic evaluations and, in some cases, surgical interventions. Treatment may include medications, hormone therapy, sperm retrieval procedures or assisted reproductive techniques such as intrauterine insemination (IUI) and intracytoplasmic sperm injection (ICSI).

The researchers noted that direct medical costs represented the largest component of infertility-related spending. These included consultations, diagnostic tests, medications and procedures. Many couples also incurred indirect expenses such as travel, accommodation and loss of income due to repeated hospital visits.

Private Care Comes At A Higher Price

The study found significant differences in expenditure between public and private healthcare facilities.

Median annual out-of-pocket expenditure was:

• Rs 14,217 in private facilities
• Rs 8,355 in public facilities

Direct medical expenses in private facilities were nearly four times higher than in government hospitals. However, public-sector patients often faced higher travel-related and indirect costs because many specialised fertility services are concentrated in urban tertiary-care centres. On average, couples travelled 57 kilometres for treatment, although some reported journeys exceeding 1,000 kilometres.

Nearly 60% Faced Catastrophic Health Expenditure

Perhaps the most concerning finding was the extent of financial distress experienced by families. Researchers defined catastrophic health expenditure as infertility-related spending exceeding 40% of a household's annual non-food expenditure. Overall, 59.4% of couples experienced catastrophic health expenditure while seeking infertility care.

The risk was especially high among:

• Lower-income households
• Couples undergoing IUI treatment
• Patients with additional medical conditions
• Families dealing with endometriosis or uterine-factor infertility

Only 1% of participants reported having insurance coverage for infertility-related expenses, while many relied on loans, savings or borrowed money to finance treatment.

Also Read: Infertility Found to Be A Potential Risk Factor For Early Menopause, Says New Study

Why The Findings Matter

The study arrives at a time when infertility is increasingly being recognised as a public health issue rather than solely a private concern. The WHO has repeatedly stressed that infertility affects millions globally and can have profound emotional, psychological and social consequences. Beyond the medical challenges, treatment costs can push families into debt, delay care or force couples to abandon treatment altogether.

Researchers argue that infertility care should be integrated into broader health financing systems and insurance schemes to reduce financial hardship and improve equitable access to treatment.

The findings are particularly significant because they challenge gendered assumptions surrounding infertility. By demonstrating that male infertility can be just as financially burdensome as some of the most expensive female reproductive conditions, the study highlights the need for a more balanced and inclusive approach to reproductive healthcare.

The new IJMR study sheds light on an often-overlooked reality of infertility care in India: male infertility can impose treatment costs nearly equal to those associated with endometriosis. At the same time, the research reveals that infertility care remains largely financed through out-of-pocket spending, leaving many couples vulnerable to financial hardship.

With nearly six in ten families experiencing catastrophic health expenditure and insurance coverage remaining virtually absent, experts say the findings should prompt policymakers to consider stronger public investment, expanded insurance benefits and greater recognition of infertility as a critical component of reproductive health.

Disclaimer: This content including advice provides generic information only. It is in no way a substitute for a qualified medical opinion. Always consult a specialist or your own doctor for more information. NDTV does not claim responsibility for this information.