Becoming a parent is a deeply personal and life-changing journey. But for many individuals and couples around the world, this journey doesn’t always begin naturally or easily. Infertility, reproductive health disparities, economic hardship, and legal restrictions are just a few of the barriers people face when trying to start or grow their families. Fortunately, a range of fertility treatments and delivery assistance options—such as in vitro fertilization (IVF), intrauterine insemination (IUI), egg/sperm donation, and surrogacy—are helping to break down these barriers and make parenthood possible for millions globally.
Understanding Infertility and the Need for Assistance
Infertility affects approximately 1 in 6 people globally during their lifetime. The World Health Organization defines it as the failure to achieve pregnancy after 12 months or more of regular, unprotected sexual intercourse. Causes of infertility vary and can affect individuals of all genders. They may be due to medical conditions such as polycystic ovary syndrome (PCOS), endometriosis, low sperm count or motility, or unexplained infertility. Lifestyle factors, age, stress, and environmental exposures also contribute.
For those facing infertility, fertility assistance can be an essential part of achieving parenthood. Treatments often involve medical technologies, emotional resilience, and financial investment.
Key Fertility Treatments Around the World
- In Vitro Fertilization (IVF)
IVF is the most well-known assisted reproductive technology (ART) and involves retrieving eggs and fertilizing them with sperm in a lab, then transferring the embryo(s) into the uterus. While success rates vary by age and clinic, IVF has enabled millions of births since its development in the late 1970s.
Access and affordability remain major concerns. In countries like Israel and Denmark, IVF is heavily subsidized or offered free under national health plans. Meanwhile, in places like the United States, treatment can cost upwards of $15,000 per cycle, with limited insurance coverage. In low- and middle-income countries (LMICS), IVF access is far more restricted due to cost, infrastructure, and availability of specialists. - Intrauterine Insemination (IUI)
IUI is a less invasive and more affordable fertility treatment in which sperm is inserted directly into the uterus during ovulation. It’s often used as a first step before more advanced methods like IVF. In many parts of the world, IUI is more accessible, but like IVF, coverage varies widely depending on health care systems and policies. - Fertility Medications and Hormone Therapies
For individuals with ovulation disorders or hormonal imbalances, medications such as Clomid or injectable gonadotropins can stimulate egg production. These are often used alone or in conjunction with IUI or IVF. However, they carry the risk of side effects and multiple births if not carefully monitored. - Egg, Sperm, and Embryo Donation
Donor-assisted reproduction helps individuals who may not have viable eggs or sperm conceive. Egg and sperm banks are available in many countries, though access and donor anonymity laws vary. In some countries, such as Spain and the Czech Republic, anonymous donation is permitted and widely practiced. In others, including the UK, donors must be identifiable. - Surrogacy
Surrogacy involves another person carrying a pregnancy on behalf of intended parents. There are two types: traditional (where the surrogate is genetically related to the baby) and gestational (using IVF to implant embryos not genetically related to the surrogate).
Surrogacy laws differ drastically worldwide. Countries like Ukraine, Georgia, and parts of the U.S. permit commercial surrogacy. Others, such as France, Germany, and Japan, ban or heavily restrict it. Ethical concerns, legal complexities, and exploitation risks are key challenges, particularly in international surrogacy arrangements.
Global Inequities and Barriers
While medical advances have made fertility treatments more effective, global disparities remain in who can access them.
Cost and Insurance Coverage: High costs place fertility assistance out of reach for many. IVF and IUI are rarely covered by insurance in low-income regions, and even in wealthier countries, coverage is inconsistent. Only a handful of nations—including Canada (select provinces), France, and Sweden—offer broad public funding.
Cultural and Social Barriers: In some societies, infertility is heavily stigmatized, especially for women. Single parents may face discrimination or exclusion from state-sponsored fertility programs.
Legal and Ethical Constraints: National laws heavily influence which procedures are legal, how donors are compensated, and who qualifies for treatments. In countries where reproductive rights are limited, individuals may travel abroad (a practice known as “fertility tourism”)—though this raises ethical concerns regarding consent, equity, and exploitation.
Resource Gaps in LMICS: Low- and middle-income countries often lack fertility clinics, trained personnel, or access to ART due to underfunded health systems. Innovative low-cost IVF models are being piloted in countries like India and Kenya, but scaling them remains a challenge.
Delivery Support and Assisted Birth Options
Fertility assistance does not end with conception. Safe pregnancy and delivery also require supportive systems, particularly for high-risk or ART-assisted pregnancies.
Obstetric Care: ART pregnancies are often considered higher risk, requiring frequent monitoring. In high-income countries, maternal-fetal medicine specialists help manage these pregnancies. In contrast, LMICS often face a shortage of skilled birth attendants and neonatal care facilities.
Cesarean Sections and Medical Interventions: Individuals who conceive via IVF or who are older at the time of delivery are more likely to have C-sections or medically assisted births. Some may also need hormone support or interventions to prevent preterm birth.
Postnatal Support and Mental Health Services: Fertility journeys are emotionally taxing. Access to postpartum mental health support is crucial but often overlooked. Programs that integrate counselling, parental leave, and support networks are more common in high-income nations.
Toward More Equitable Reproductive Access
Efforts to expand global access to fertility and delivery assistance are ongoing. Advocacy groups, public health agencies, and nonprofit organizations are pushing for:
Greater insurance and government funding for ART.
- Public awareness campaigns to destigmatize infertility.
- Training programs to expand provider capacity in LMICS.
- Ethical guidelines for surrogacy and donor arrangements.
- Inclusive fertility policies that serve single-parent families.
As fertility rates decline in many countries, governments may become more motivated to support individuals who wish to have children but cannot do so naturally. With the right investment, innovation, and regulation, reproductive care can become more inclusive and equitable.