Is Having Children Becoming a Luxury? The Equity Question in Assisted Reproduction

When Parenthood Becomes a Privilege

Egg-freezing parties, embryo genetic screening, carefully selected "perfect embryos" — these high-tech approaches to having children are painting an increasingly unsettling picture: the path to parenthood looks more and more like something that requires serious financial resources.

As one interview on this topic put it, "Not everyone can afford to attend a fancy cocktail party to freeze their eggs, or access certain networks to test all their embryos and select only the best one." When assisted reproductive technologies come bundled with steep price tags, what should be a universal life choice is being carved into a privilege reserved for the few.

This isn't alarmism. The inherent uncertainty of fertility, layered on top of financial barriers, means that "who gets access to fertility care" increasingly resembles a lottery — not an equitable distribution based on medical need.

Global Infertility Is Rising Sharply

The data reveals the scale of the problem. The World Health Organization estimated several years ago that one in six people worldwide has experienced infertility. Even more alarming is the trend: a projection published in The Lancet indicates that infertility cases among women aged 35 to 49 will rise by 50% over the next decade.

This means the population in need of fertility care will expand dramatically. This is not a niche issue affecting a small minority — it is a public health challenge that will soon affect hundreds of millions of people. As demand grows rapidly while resources remain unevenly distributed, the tension can only intensify.

Multiple structural factors are driving the rise in infertility rates. First, there is the widespread delay in childbearing — under pressure from economic stress, longer education, and career development, many women are not trying to conceive until their 30s or later, while female fertility declines sharply after age 35. Second, environmental and lifestyle factors play a role, including widespread exposure to endocrine disruptors (such as pesticides and plasticizers), rising obesity rates, and increasing incidence of polycystic ovary syndrome (PCOS). Male infertility is equally significant — over the past fifty years, sperm counts among men in Western countries have dropped by more than 50%, a trend researchers have called the "sperm crisis." The 50% increase projected by The Lancet reflects the compounding effect of these long-term trends, not a short-term fluctuation.

Should Fertility Care Be Part of the Healthcare System?

A key point of contention is whether assisted reproduction should be viewed as a consumer choice or as basic medical care.

The WHO has explicitly defined infertility as a disease — a disease of the reproductive system. This definition carries policy implications: if infertility is a disease, then treating it should fall within the realm of healthcare, not luxury consumption.

In fact, in some regions with universal healthcare coverage, fertility care is already part of the medical system. These precedents offer a reference point: integrating fertility treatment into public healthcare is institutionally feasible. The real question is whether societies are willing to make that resource allocation decision.

Regions that have incorporated fertility treatment into public healthcare provide useful policy models. Israel is one of the most generous countries in the world when it comes to fertility treatment coverage — national health insurance subsidizes unlimited IVF cycles for every woman until she has given birth to two children. The Nordic countries, including Denmark and Sweden, also cover multiple IVF cycles under public health insurance. In China, some provinces and cities have recently begun including certain assisted reproductive services in their medical insurance coverage. These examples demonstrate that making fertility care public is not fiscally impossible — it is a matter of policy priorities. By contrast, in the United States, only about 20 states have passed laws requiring insurers to cover infertility treatment, coverage varies widely, and there is no federal mandate, meaning access to fertility care depends heavily on where you live and who your employer is.

Technology Is Not a Silver Bullet: The Real Success Rates of Assisted Reproduction

When discussing reproductive equity, one easily overlooked reality must be addressed: assisted reproductive technologies are not a reliable "cure."

As one interview made clear, the success rates for these technologies are roughly one-in-three to one-in-two, depending on age group — and for women over 40, the odds are even lower. This is a reminder that we should not mythologize assisted reproduction as something money can reliably buy.

Even so, these technologies remain the best available treatment options we currently have. Precisely because they are both expensive and uncertain, allowing access to be determined by ability to pay rather than medical need — turning it into a lottery of wealth — makes the inequity all the more glaring.

The most common form of assisted reproductive technology (ART) is in vitro fertilization (IVF). The basic process involves stimulating a woman's ovaries with hormonal medications to produce multiple eggs, retrieving those eggs, fertilizing them with sperm outside the body to create embryos, and then transferring an embryo back into the uterus. Egg freezing (oocyte cryopreservation) involves retrieving eggs without fertilizing them immediately, freezing them for future use. Preimplantation Genetic Testing (PGT) involves testing embryo cells for genetic abnormalities before transfer, with the goal of selecting chromosomally normal embryos to theoretically improve implantation rates and reduce miscarriage risk — but this additional step significantly raises the overall cost. In the United States, a single complete IVF cycle typically costs between $12,000 and $15,000; with PGT and cryopreservation added, the total can easily exceed $20,000, and it is often not covered by health insurance.

Less Lottery, More Equity in Fertility Care

Connecting these points, a clear argument emerges: as structural infertility continues to rise, the case for making fertility care less dependent on financial means grows stronger.

When more and more people need this type of care, when the WHO has already classified infertility as a disease, and when certain regions have already proven that integrating it into healthcare systems is workable — allowing high costs to serve as a gatekeeping mechanism is tantamount to turning a fundamental life right into the exclusive domain of the privileged.

Whether parenthood becomes a luxury is ultimately not a technical question. It is a question about how society chooses to allocate medical resources and opportunity. The answer depends on whether we are willing to treat reproduction as a consumer product — or as care.