Policy solutions to improve access to fertility treatment and optimise patient care: Consensus from an expert forum

G. David Adamson^1,2Hannah Armstrong³Ying Cheong⁴Elaine Damato³Human Fatemi⁵Rui Ferriani^6,7Georg Griesinger⁸William Leigh Ledger^10,9Michele Pistollato³Antonio Pellicer¹¹Angelina Petrova^3*Luk Rombauts^12,13Tim Wilsdon³Søren Ziebe¹⁴

• ¹International Committee for Monitoring Assisted Reproductive Technologies, Vancouver, Canada
• ²Equal3 Fertility, Cupertino, United States
• ³Charles River Associates International,Inc, London, United Kingdom
• ⁴University of Southampton, Southampton, Hampshire, United Kingdom
• ⁵ART Fertility Clinics LLC, Abu Dhabi, United Arab Emirates
• ⁶University of São Paulo, Ribeirão Preto, Ribeirão Preto, São Paulo, Brazil
• ⁷Member of Latin America Oncofertility Network, Oncofertility Consortium, São Paulo, Brazil
• ⁸Department of Gynaecological Endocrinology and Reproductive Medicine, University Hospital of Schleswig-Holstein, Lübeck, Germany
• ⁹University of New South Wales, Kensington, New South Wales, Australia
• ¹⁰Royal Hospital for Women, Randwick, New South Wales, Australia
• ¹¹IVIRMA Valencia, Valencia, Spain
• ¹²Monash IVF, Cremone, Australia
• ¹³Monash University, Melbourne, Victoria, Australia
• ¹⁴Rigshospitalet, University of Copenhagen, Copenhagen, Capital Region of Denmark, Denmark

Infertility is an underrecognized disease which affects over 17% of the reproductive age population worldwide. However, availability of, and access to, assisted reproductive technology (ART) is variable across countries. There are significant challenges relating to awareness, financial and other barriers to care, cultural considerations, and the level of support provided to people undergoing care. Previous studies have explored these challenges, but less attention has been given to the policy implications. As the need for fertility care rises, we investigate the evidence that policy changes can be implemented to improve access to ART treatment. A review of literature was conducted on fertility policy challenges and developments, covering fertility recognition and awareness; cultural and religious considerations; and access to ART treatment, psycho-social care, and supplementary care. Nine medical and academic experts were invited to validate secondary research findings and provide their perspectives on policy implications. The experts covered different specialties and geographic expertise. Experts participated in individual 60-minute interviews, then a half-day Policy Forum discussion was held virtually in May 2023.Lack of recognition of infertility as a disease, low financial coverage of fertility services, limited psychosocial support, and cultural considerations are substantial barriers to fertility services access. Some countries have limited reimbursement of services or offer only private care, significantly limiting treatment access. Others restrict reimbursement based on age, gender and family status, which creates access inequities. Policy action is needed to mitigate these challenges and to ensure timely and equitable access to fertility care. Decision-makers need to collectively recognize infertility as a disease, rather than just a social issue. Equity of access to infertility services should be ensured by expanding the availability of public funding, along with review and rationalisation of criteria for treatment reimbursement. To improve engagement in treatment and support through the fertility journey, access to psychosocial care should be expanded and included as a core service. Major obstacles to accessing ART treatment have been identified across regions globally, highlighting the urgent need for national policy action to enhance care quality by reviewing current legislation, improving patient and physician education, refining reimbursement procedures, and expanding psychosocial support services.