How fertility care went from an evolutionary need to a multibillion dollar industry

💡The Big Idea

Fertility care provides hopeful parents with a chance of conceiving a child. But for now it’s mostly limited to the wealthiest people in the world. Here’s the TLDR on our latest member-exclusive field guide on the business of fertility.

🤔Here’s Why

1️⃣ Infertility is a disease that is overlooked by the medical system.

2️⃣ The development of outpatient procedures has allowed the private sector to dominate fertility care.

3️⃣ Technological advancements have improved the success of fertility care, but have done little to lower costs.

4️⃣ Third-party insurance, private loans, and better information could make this treatment more accessible.

5️⃣ But most people who need fertility care still can’t afford it, raising the risk of conception becoming a luxury good.

📝 The Details

1️⃣ Infertility is a disease that is overlooked by the medical system.

About 50 million couples worldwide experience some kind of infertility—defined as having unprotected vaginal sex for a year without conceiving. This figure likely underestimates the demand for fertility care. It excludes people who choose to be parents without a partner and members of the LGBTQ+ community. Most reproductive health care has historically been concerned with contraception and abortion. And because not having a child is not life-threatening and considered elective, private insurance doesn’t cover treatments and neither do most public health systems.

2️⃣ The development of outpatient surgical procedures has allowed the private sector to take over the majority of the industry.

Compared to other medical procedures, most fertility care is minimally invasive. It requires a sterile environment, not a full surgical ward. This has allowed private fertility clinics without a hospital affiliation to proliferate. These clinics have start-up costs in the hundreds of thousands of dollars to cover laboratory build-out. But even with routine operating costs of hiring technically-trained staff, these costs are recouped quickly: The average amount a person spends on fertility treatment in the US is around $50,000.

3️⃣ Technological advancements have improved the success of fertility care, but done little to lower costs.

The success rates of fertility care have gone up dramatically since its advent 40 years ago—as have the associated costs. People under the age of 35 have about a 50% success rate of conceiving, if using their own eggs, according to the Society for Assisted Reproductive Technology. There are also new ways to test for the causes of infertility or screen for heritable genetic conditions, but these tests are expensive and prone to errors, and haven’t actually improved overall success rates. Some technological advances promise to make basic fertility care cheaper, but they haven’t received backing from major fertility organizations or regulatory agencies.

🎧 For more intel on fertility care, listen to the Quartz Obsession podcast episode on egg freezing. Or subscribe via: Apple Podcasts | Spotify | Google | Stitcher.

4️⃣ Third-party insurance, private loans, and better information could make this treatment more accessible.

Some groups are trying to make fertility care more affordable by simply by providing information, to help prospective parents pick the procedure with the highest odds of success for them—potentially sparing them the cost of failed attempts. Increasingly, some employers are providing their staff with fertility coverage and guiding them through the process. And for those going it alone, there are private companies that provide fertility loans or bundle packages with a money-back guarantee.

5️⃣ But most people who need fertility care still can’t afford it.

Most people who get fertility care are wealthy, or have the means of attaining wealth to make sure they get the care they need. Although fertility care has made it possible for some in the LGBTQ+ population to have children, the trans community in particular has been left out of the conversation. Even the most well-intentioned clinics are not up to date on the most recent research regarding trans fertility care, nor on best practices for serving this population.