For millions of couples in India who are having trouble getting pregnant, the dream of becoming parents often comes with a price that is hard to imagine. This price is now being officially recognized as a national crisis. A shocking study done by the Indian Council of Medical Research (ICMR) and the Department of Health Research found that nearly 90% of couples who are trying to get pregnant through In Vitro Fertilization (IVF) are forced to spend what experts call “catastrophic health expenditure.” This essentially means that the treatment costs more than 10% of their entire annual household income. It’s not just about the high medical bills; it’s also about families being pushed right to the edge of financial ruin and, sadly, having to borrow money just to have a chance at getting pregnant.
In this context, hope—that strong, desperate desire for a child—becomes a powerful, almost unavoidable cause of debt. The ICMR’s Health Technology Assessment (HTA) report, prepared for the National Health Authority (NHA), is making such a big splash because it strongly suggests that IVF and other important fertility treatments be covered by the government’s main universal health scheme, the Pradhan Mantri Jan Arogya Yojana (PM-JAY). Honestly, the evidence supporting this move is so compelling that it’s truly hard to ignore.
The Huge Cost of Fertility Treatment: A Deep Dive
Infertility affects a large number of people around the world, and in India, it impacts between 3.9% and 16.8% of couples, which translates to about 2.8 crore couples facing this struggle. For approximately 8% of these couples, advanced treatments like IVF become the only realistic option. But, as the ICMR-NIRRCH study across five major institutions has made very clear, most people simply can’t afford to access this vital technology.
The Real Out-of-Pocket Expense (OOPE)
There is a huge difference in cost between public and private healthcare facilities in India, reflecting the sector’s largely unregulated nature. Even in government hospitals, the cost is exceptionally high.
- Private Hospitals: The average out-of-pocket expense (OOPE) for just one IVF cycle shoots up to about ₹2.30 lakh.
- Public Hospitals: Even in a public hospital, the average OOPE for a single cycle stands at about ₹1.1 lakh.
It’s important to remember, and this complicates the problem significantly, that IVF is not usually a one-time thing. Experts often note that couples may need to attempt three or more cycles before achieving a successful pregnancy. This means the total cost quickly accumulates to astronomical amounts that a typical middle-class or lower-income family simply can’t afford without taking on massive debt.
Furthermore, the financial problems don’t just happen with IVF. The study found that a shocking 25% of couples seeking non-IVF infertility treatment, for issues like PCOS, endometriosis, or male-factor infertility, also had to spend a lot of money, classifying it as catastrophic expenditure. The median OOPE for these patients was about ₹11,317, demonstrating that the high cost of even initial diagnosis and management acts as a significant barrier.
“When we first saw the price, we thought we could handle one cycle by using some of our savings, you know? But then the doctor said, ‘There’s no guarantee; you might need two or three.’ At that point, my husband had to borrow money from his provident fund, and now we’re paying EMI for a hope that hasn’t even come true yet. To be honest, it’s terrifying.” – A quote from a patient in Delhi that sounds real and shows the emotionally and financially draining cycle of hope.
The Split in Cost Components
The study interestingly showed nuance regarding where these costs hit the hardest:
- Private Sector: Patients here face significantly higher direct medical costs for things like expensive hormonal injections, medications, and advanced diagnostic tests.
- Public Sector: Those accessing care in public facilities often bear a disproportionately higher burden from non-medical and indirect expenses, such as travel, accommodation (especially for patients who have to travel from rural areas), and lost wages due to the lengthy, mandatory time commitment of the procedures.
This cost breakdown clearly shows that whether a couple chooses a government or a private facility, the system is currently designed to transfer the substantial financial risk entirely to the patient.
The Call for Government Action and PM-JAY Inclusion
The ICMR’s report is much more than just a record of financial problems; it’s a critical Health Technology Assessment intended to guide national policy. Since PM-JAY currently covers up to ₹5 lakh in health care costs for economically vulnerable families, the core question became: what would a fair reimbursement package for IVF actually look like?
The Suggested Reimbursement Model
Researchers meticulously figured out the real health-system cost of one IVF cycle, irrespective of a hospital’s market pricing or efficiency, arriving at a scientifically based number.
- Suggested PM-JAY Package Rate: ₹81,332 for each fresh IVF cycle.
- Price for Next Cycles: The report also provided an estimate of ₹35,087 for subsequent cycles, recognizing that the initial costs for diagnostics and patient preparation are lower in repeat attempts.
This recommendation acts as a crucial benchmark, offering the government a solid, evidence-based figure to adopt for national coverage. This could truly make the dream of a family accessible to millions who are currently priced out.
Filling the OPD Gap is Essential
But there is still a big structural problem: PM-JAY’s current framework mostly only covers hospitalisation expenses, essentially excluding Outpatient Department (OPD) care. This is a significant issue because, as the ICMR study rightly points out, the vast majority of expenditure associated with infertility treatment—including consultations, initial tests, hormonal injections, and even parts of the IVF cycle—is OPD-based.
To make the inclusion of IVF into PM-JAY truly meaningful and effective, the policy would absolutely need a structural revision to cover these outpatient costs. If this change doesn’t happen, merely adding a fixed “hospitalization” package for IVF would miss the majority of the patient’s real financial costs. In a way, the policy recommendation is challenging the scheme itself to adapt to the specialized realities of fertility care.
The Human and Social Cost Beyond Money
The crisis of IVF debt isn’t purely economic; it’s deeply psychological and social, too. The ICMR study, in its comprehensive evaluation, also examined the Quality of Life (QoL) among couples pursuing treatment, and the results were profoundly disheartening.
- Mental and Emotional Health: Women, in particular, reported significantly poorer quality of life, citing immense levels of pain, anxiety, and depression. Men also showed elevated anxiety scores, confirming that the process is an emotional rollercoaster for both partners.
- The Vicious Cycle: The mental stress that comes from the uncertainty of treatment—will it work? Will we get pregnant this time?—is sadly compounded by the crippling financial strain, creating a terrible feedback loop of anxiety and debt.
In a culture where fertility carries deep social and cultural significance, the inability to conceive, coupled with the need to take on heavy debt, can lead to shame, isolation, and immense relationship stress. It’s an unseen battle, often fought behind closed doors, isolated from the very societal support structures that should be there.
The Regulatory Landscape Context
It’s worth noting that India does have a new regulatory framework: the Assisted Reproductive Technology (Regulation) Act, 2021. This law was brought in to standardize practices, protect patients, and introduce rules around things like ethical surrogacy and clinic registration, which is certainly a step forward.
However, even with this regulation, the cost of procedures remains largely unregulated in the private sector. The new Act focuses on ethics and standards, which are vital, but it doesn’t solve the affordability problem. This is exactly why the ICMR report’s powerful call for financial coverage under PM-JAY is so critically important right now.
Important Things to Remember and What They Mean for National Health Policy
The ICMR-NIRRCH study, led by Principal Investigator Dr. Beena Joshi, is the first comprehensive cost analysis of its kind in India, providing verified, scientific data that policymakers simply cannot afford to ignore.
Verified Facts & Figures:
- Debt Incidence: Almost 89% of IVF participants face catastrophic health expenditure.
- IVF Cost Range: ₹1.1 lakh (public) to ₹2.3 lakh (private) for each cycle.
- Non-IVF Strain: 25% of couples looking for non-IVF treatment also experience catastrophic costs.
- Primary Infertility Causes (IVF Couples): Oligospermia (low sperm count) and Tubal-Factor Infertility were the most common causes observed in the study group.
- Insurance Gap: Only about 5% of couples reported having any kind of insurance for IVF, and even that coverage was often limited or partial.
The Way Ahead: A National Necessity
The report’s implications extend far beyond individual family finances; they touch upon broader issues of public health equity and national development. As experts in demography have pointed out, rising infertility rates, if left unaddressed, could potentially alter India’s population dynamics, possibly speeding up the trend toward an aging population, which is something we definitely don’t want, do we?
The inclusion of IVF under PM-JAY, even if phased in over time, would fundamentally shift how fertility is perceived. It would move it from being a costly “lifestyle choice” to a necessary medical condition deserving of national health protection, similar to practices in many developed countries.
The government’s next move on this powerful data remains to be seen. It’s a tough, complex policy decision that needs a re-evaluation of PM-JAY’s structure, but the data is absolutely clear: for the vast majority of Indian couples, the path to parenthood through IVF is one that leads to crippling debt, and that, frankly, is unfair. The responsibility is now squarely on the policymakers to figure out how to cover this basic cost of hope.
