The Real Cost of Fertility Care Isn't Per Cycle. It's Per Outcome.
New research co-authored by Pendant Medical Advisor Dr. David Adamson reveals a powerful connection between fertility treatment affordability and access, reinforcing the need for a more accountable approach to reproductive healthcare.
For millions of people hoping to build a family, the question isn't simply whether fertility treatment is available. It's whether they can afford to pursue it and continue treatment long enough to reach their goal.
A new study published in Human Reproduction Open, “Cost-to-baby as a percentage of median household income predicts population-level access to ART: a global health economics analysis”, examines how the cost of achieving a live birth through assisted reproductive technology (ART) influences access to fertility care around the world.
Co-authored by Dr. G. David Adamson, Medical Advisor to Pendant Health, the research makes a compelling case for rethinking how we measure the affordability and value of fertility treatment.
At Pendant, we believe these findings reinforce an important principle: the value of fertility care should be measured not simply by access to treatment, but by the ability to help people reach better outcomes at a sustainable cost.
What the Research Reveals
Analyzing data from 22 countries and regions representing more than 95% of estimated global ART treatment cycles, researchers examined the relationship between fertility treatment affordability and utilization.
Rather than focusing on the cost of a single IVF cycle, the study introduced a more meaningful measure: cost-to-baby, or the cumulative cost of achieving a live birth, including the multiple treatment cycles that may be required.
Three key findings stand out:
1. Affordability is strongly linked to access.
The study found a strong relationship between the cost of achieving a live birth, measured relative to median household income, and the rate at which populations access ART.
The researchers' model found that halving patients' out-of-pocket cost-to-baby was associated with approximately 2.7 times higher ART utilization. While this population-level relationship does not establish causation, it underscores the importance of affordability in expanding access.
2. The most accessible fertility systems address both treatment costs and patient expenses.
Countries with the highest ART utilization consistently had two characteristics:
- Gross cost-to-baby below 100% of median household income.
- Net out-of-pocket cost-to-baby below 50% of median household income.
Countries including Israel, Japan, Spain, and South Korea demonstrated how more affordable treatment delivery, combined with meaningful financial coverage, is associated with greater access.
3. Measuring the cost of a cycle doesn't tell the whole story.
A single treatment cycle is only one part of a patient's fertility journey. Many patients require multiple cycles, additional services, and ongoing clinical support before achieving a live birth.
The study highlights why measuring the cumulative cost of reaching an outcome provides a more meaningful picture of affordability than looking at individual treatment expenses alone.
What This Means for Employers
As employers expand fertility and family-building benefits, this research raises an important question:
Are we designing benefits that simply pay for treatment, or benefits that help employees successfully navigate the full journey?
Traditional fertility benefits often emphasize coverage amounts, cycle limits, and provider discounts. While these features matter, they don't necessarily capture the full experience or cost of achieving a successful outcome.
The findings suggest that employers have an opportunity to think differently about how they structure and evaluate their fertility benefits.
That means looking beyond the cost of individual services to consider the entire care journey, including how quickly employees access appropriate treatment, whether they receive evidence-based guidance, how effectively care is coordinated, and what it ultimately costs to achieve their goals.
For employers, the opportunity isn't simply to spend more on fertility benefits. It's to make every dollar work harder toward better care, greater affordability, and meaningful outcomes.
Bringing the Research to Life: Pendant's Approach to Value-Based Care
At Pendant, we're redefining value-based care in women's health by aligning employers, members, and providers around measurable outcomes, lower total costs, and faster time to success.
The research reinforces the principles behind our operating model and our belief that better fertility benefits require more than financial coverage alone.
Evidence-Based Care: Getting to the Right Care Sooner
Not every patient needs the same treatment or follows the same path. Through evidence-based guidance and personalized Care Navigation, Pendant helps members understand their options, connect with appropriate providers, and make informed decisions.
By helping patients pursue the right care at the right time, we aim to reduce unnecessary interventions, avoidable costs, and delays.
Treatment-Ready Patients: Making Every Step Count
A more efficient fertility journey starts before treatment begins. Pendant works to ensure members have the education, preparation, and support they need before entering care.
Our approach helps providers focus on delivering individualized clinical treatment while reducing unnecessary friction and delays that can increase the cost and complexity of the journey.
Care Beyond the Benefit: Supporting Members Through Completion
The fertility journey often extends beyond what the employer benefit covers. We help members fill those financial and support gaps so they can stay in treatment long enough to get the desired outcome.
Pendant provides ongoing navigation, education, and coordination to support members as their needs evolve. Our model is designed to help people remain engaged in appropriate care rather than leaving them to navigate complex decisions and transitions on their own.
Accountability for Outcomes: Measuring What Matters
The study's focus on cost-to-baby reflects a broader shift toward measuring the value of fertility care through outcomes rather than individual services.
Pendant brings that philosophy to employer benefits by focusing on measurable clinical outcomes, total cost of care, and a more coordinated member experience.
By aligning employers, members, and providers around shared goals, we work to create a system where better outcomes and responsible spending go hand in hand.
Moving Toward What's Next in Fertility Benefits
The research offers an important perspective on the future of fertility care: improving affordability requires attention to both the underlying cost of treatment and the financial burden experienced by patients.
For employers, this creates an opportunity to move beyond traditional benefit administration toward a more comprehensive, outcomes-focused approach.
At Pendant, our mission is to deliver what's next in family-building benefits, creating a world where reproductive care is seamless, supportive, and within reach.
We believe that the future is built by connecting evidence-based care, provider partnerships, financial clarity, and ongoing member support into one accountable model.
Because ultimately, the goal isn't simply to help more people start fertility treatment. It's to help more people reach their family-building goals.
Read the Full Research
We're proud to recognize Pendant Medical Advisor Dr. G. David Adamson for his contribution to this important research and to the broader conversation about improving fertility care worldwide.
We encourage employers, benefits consultants, healthcare providers, and industry leaders to explore the full findings and consider what they mean for the future of reproductive health benefits.
📖 Read the full study in Human Reproduction Open
Interested in building a fertility benefit focused on better outcomes and greater value? Connect with Pendant at info@pendanthealth.com to learn how our accountable care model can support your workforce.