The impact of consumer affordability on access to assisted reproductive technologies and embryo transfer practices an international analysis

In this international econometric study of assisted reproduction technology treatment, we show that the cost that consumers pay for treatment relative to income predicts the level of access and number of embryos transferred.

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Georgina M. Chambers, Ph.D., M.B.A., Van Phuong Hoang, Ph.D., M.P.P.,, Elizabeth A. Sullivan, M.D., M.P.H., M.Med., M.B.B.S., Michael G. Chapman, M.B.B.S., C.R.E.I., Osamu Ishihara, M.D., Ph.D., Fernando Zegers Hochschild, M.D., Karl G. Nygren, M.D., Ph.D., G. David Adamson, M.D.

Volume 101, Issue 1, Pages 191-198.e4, January 2014



To systematically quantify the impact of consumer cost on assisted reproduction technology (ART) utilization and numbers of embryos transferred.


Ordinary least squared (OLS) regression models were constructed to measure the independent impact of ART affordability—measured as consumer cost relative to average disposable income—on ART utilization and embryo transfer practices.


Not applicable.


Women undergoing ART treatment.



Main Outcome Measure(s):

OLS regression coefficient for ART affordability, which estimates the independent effect of consumer cost relative to income on utilization and number of embryos transferred.


ART affordability was independently and positively associated with ART utilization with a mean OLS coefficient of 0.032. This indicates that, on average, a decrease in the cost of a cycle of 1 percentage point of disposable income predicts a 3.2% increase in utilization. ART affordability was independently and negatively associated with the number of embryos transferred, indicating that a decrease in the cost of a cycle of 10 percentage points of disposable income predicts a 5.1% increase in single-embryo transfer cycles.


The relative cost that consumers pay for ART treatment predicts the level of access and number of embryos transferred. Policies that affect ART funding should be informed by these findings to ensure equitable access to treatment and clinically responsible embryo transfer practices.

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Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders. The journal publishes juried original scientific articles in clinical and laboratory research relevant to reproductive endocrinology, urology, andrology, physiology, immunology, genetics, contraception, and menopause. Fertility and Sterility® encourages and supports meaningful basic and clinical research, and facilitates and promotes excellence in professional education, in the field of reproductive medicine.