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What fertility care costs women before IVF begins
This article is authored by Dr Renu Malik, gynaecologist & obstetrician, director, Malik Radix Healthcare.
Conversations on fertility tend to settle on the IVF cycle. It is the visible part: a few weeks of hormone injections to raise a batch of eggs, a short procedure to collect them, fertilisation in the laboratory, and the placing of an embryo in the womb. It is also the last step in a long process, and by the time a woman reaches it, much of what will decide the result has already happened, or already failed to happen.
Infertility is common. The World Health Organization puts its lifetime prevalence at roughly one in six adults, with little variation between richer and poorer countries. In India, many of those it affects never reach the treatment that might help, falling away long before any cycle begins.
What separates the women who do well from those who do not is rarely how quickly they reached a clinic. It is what was found and treated before they arrived. A fallopian tube blocked with fluid, left as it is, can quietly halve the chance of an embryo settling in the womb, and the repair for it belongs to the weeks before treatment rather than to the cycle itself. The number of eggs a woman has left, her ovarian reserve, can be estimated well ahead from a simple, inexpensive blood test, one rarely ordered until she is already short of time. The laboratory has grown remarkably capable, yet it cannot recover ground lost before a woman walks in.
The early phase of investigation is what few people budget for: Blood tests to check hormone levels, scans to follow the ovaries, a test of the partner's sperm, medicines to steady an irregular monthly cycle, and visits that repeat month after month. Added across several rounds, the cost of simply establishing what is wrong can reach tens of thousands of rupees before any treatment is decided on, and each visit costs a working woman a day she may not be able to explain at her job. Many step away here, during the investigation, the one stage where stepping away does the most lasting harm.
Geography compounds it. The clinics able to do this work well gather in a few large cities. A woman in Delhi or Mumbai has real choice. A woman a few hours away may have one distant option or none, which turns every appointment into a full day of travel and lost earnings. The equipment and specialists it requires pay their way only where demand is concentrated, leaving smaller towns dependent on distant referrals.
India regulates this field far more closely than it did a decade ago. The Assisted Reproductive Technology (Regulation) Act, in force since 2022, brought clinic registration and minimum standards for practitioners to a sector that had grown quickly and unevenly, under a new layer of national and state oversight. That was the right first priority but the natural next stage is access, so that the standards now expected of clinics are matched by a realistic path for women to reach them.
Financing has not kept pace either. Insurers are not required to cover fertility treatment, and most standard policies treat it as elective. Where cover exists, it sits inside corporate group plans or add-ons with long waiting periods and low pay-out caps, beyond the women who carry the heaviest costs. A few insurers now offer partial cover and some public hospitals treat at reduced rates, though both remain exceptions. For most families, the bill is paid directly, from the first test.
Much of the public conversation reaches for the final step: Cheaper cycles and wider availability. That helps the women who reach a clinic, not the majority who never get that far or who arrive after the years that mattered most have passed. The higher-value work sits earlier. A basic fertility assessment could be built into the women's health services public hospitals already run, so a first workup need not mean a private clinic in a distant city. Financing could recognise the months of investigation, not only the procedure that follows. Other health systems show this is workable: Morocco offers fertility care through its public sector, and Indonesia has folded it into primary care.
Infertility does not wait for a woman to reach the right city or save the right amount. Treating the cycle as the whole of fertility care fixes attention on its most expensive and visible part, often not the part that decides the outcome. A single round can cost ₹1.5 to ₹3 lakh, often across more than one attempt, yet the effort that most improves the odds is spent well before it. The women India loses are lost earlier, in the quiet months of tests and referrals, and that is where a fairer system would meet them.
(The views expressed are personal)
This article is authored by Dr Renu Malik, gynaecologist & obstetrician, director, Malik Radix Healthcare.
