{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T12:07:43Z","timestamp":1779797263066,"version":"3.53.1"},"reference-count":17,"publisher":"Scientific Scholar","content-domain":{"domain":["ijmr.org.in"],"crossmark-restriction":true},"short-container-title":["Indian J Med Res"],"abstract":"<jats:sec>\n                    <jats:title>Background and objectives<\/jats:title>\n                    <jats:p>Diagnosis and treatment of infertility, mostly sought at tertiary facilities, contribute to substantial out-of-pocket expenditure (OOPE). This study estimated OOPE among couples seeking care for endometriosis, male infertility, polycystic ovary syndrome (PCOS), tubal factor, and uterine factor, including costs of diagnosis, management, and intrauterine insemination (IUI).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A cross-sectional study was conducted across five tertiary healthcare facilities (three public, two private) selected through convenience sampling to represent different regions. Based on mean (SD) OOPE INR (\u20b9)144,393 (\u20b9130,943), effect size 0.16, \u03b1=0.05, and 80% power, the sample was equally distributed across sites and IVF\/non-IVF groups, with \u223c100 participants per site. Couples were interviewed between April 2022\u2013March 2023. Catastrophic health expenditure was defined as infertility spending exceeding 40% of annual household non-food expenditure. OOPE over the preceding year covered direct medical, non-medical, and indirect costs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Annual median OOPE was \u20b911,317 (US $136.5) (IQR: \u20b94,801\u2013\u20b919,513) US $, higher in private facilities \u20b914,217 ($171.4) (IQR: \u20b98,030\u2013\u20b921,848) than public facilities \u20b98,355 ($100.7) (IQR: \u20b93,785\u2013\u20b917,386). Direct medical costs were the major contributor: median \u20b95,802 ($69.9) (IQR: \u20b92,186\u2013\u20b911,847) Highest OOPE was for endometriosis \u20b915,084 ($181.9) (IQR: \u20b98,114\u2013\u20b920,758), followed by uterine factor and male infertility \u20b913,211 ($159.3) (IQR: \u20b96,654\u2013\u20b921,521). OOPE increased with absence of insurance (\u20b96,919; $83.4), comorbidities (\u20b92,593; $31.3), IUI (\u20b92,668; $32.1), and PCOS (\u20b92,004; $24.1). Catastrophic Health Expenditure was associated with comorbidities (OR=1.61), IUI (OR=1.88), and lower per capita income &lt;\u20b959,400 ($715.7) (OR=3.44). Overall, 59.4% experienced CHE.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interpretation and conclusions<\/jats:title>\n                    <jats:p>Infertility care imposes substantial out of pocket expenditure in India. Strengthened insurance coverage and public sector investment are critical for equitable access.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.25259\/ijmr_2286_2025","type":"journal-article","created":{"date-parts":[[2026,5,17]],"date-time":"2026-05-17T12:14:32Z","timestamp":1779020072000},"page":"618-624","update-policy":"https:\/\/doi.org\/10.25259\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Out of pocket expenditure incurred by couples seeking infertility services at tertiary level facilities in India"],"prefix":"10.25259","volume":"163","author":[{"given":"Asim Kumar","family":"Padhan","sequence":"first","affiliation":[{"name":"Department of Operational Research, ICMR-National Institute For Research in Reproductive and Child Health, Mumbai, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prerana","family":"Patil","sequence":"additional","affiliation":[{"name":"National Cancer Grid, Tata Memorial Hospital, Mumbai, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akshita","family":"Vikani","sequence":"additional","affiliation":[{"name":"Department of Community Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deepshikha","family":"Sharma","sequence":"additional","affiliation":[{"name":"Department of Health Research, Government of India, Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oshima","family":"Sachin","sequence":"additional","affiliation":[{"name":"Department of Community Medicine, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Biju","family":"Somen","sequence":"additional","affiliation":[{"name":"ICMR-National Centre for Disease Informatics and Research, Bengaluru, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bhavani","family":"Shankara Bagepally","sequence":"additional","affiliation":[{"name":"Department of IVF and Reproductive Biology Centre, Maulana Azad Medical College, Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renu","family":"Tanwar","sequence":"additional","affiliation":[{"name":"Department of IVF Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vanita","family":"Suri","sequence":"additional","affiliation":[{"name":"Department of Reproductive Medicine and Surgery, Sri Rama Chandra Institute of Higher Education and Research Chennai, Chennai, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Radha","family":"V.","sequence":"additional","affiliation":[{"name":"Department of IVF Centre, Sree Avittham Thirunal Hospital, Trivandrum, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anitha","family":"M.","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, Chhattisgarh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ramesh","family":"P.","sequence":"additional","affiliation":[{"name":"Department of Operational Research, ICMR-National Institute For Research in Reproductive and Child Health, Mumbai, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deepti","family":"Shrivastava","sequence":"additional","affiliation":[{"name":"Department of Operational Research, ICMR-National Institute For Research in Reproductive and Child Health, Mumbai, Maharashtra, India"},{"name":"Department of DOIR, ICMR-National Institute For Research in Reproductive and Child Health, Mumbai, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sukhpreet","family":"Patel","sequence":"additional","affiliation":[{"name":"Department of DOIR, ICMR-National Institute For Research in Reproductive and Child Health, Mumbai, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shankar","family":"Prinja","sequence":"additional","affiliation":[{"name":"Department of Community Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beena","family":"Joshi","sequence":"additional","affiliation":[{"name":"Department of Operational Research, ICMR-National Institute For Research in Reproductive and Child Health, Mumbai, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10894","published-online":{"date-parts":[[2026,5,16]]},"reference":[{"key":"10.25259\/IJMR_2286_2025\/ref-1","doi-asserted-by":"publisher","DOI":"10.15640\/jssw.v7n2a14","article-title":"Population Control Policies and Implementations in India","volume":"7","author":"Wang","year":"2019","journal-title":"Journal of sociology and social work."},{"key":"10.25259\/IJMR_2286_2025\/ref-2","doi-asserted-by":"publisher","first-page":"337","DOI":"10.4103\/ijcm.ijcm_7_19","article-title":"Prevalence of primary infertility and its associated risk factors in urban population of central India: A community-based cross-sectional study","volume":"44","author":"Katole","year":"2019","journal-title":"Indian Journal of Community Med."},{"key":"10.25259\/IJMR_2286_2025\/ref-3","doi-asserted-by":"publisher","first-page":"e057132","DOI":"10.1136\/bmjopen-2021-057132","article-title":"Worldwide prevalence, risk factors and psychological impact of infertility among women: a systematic review and meta-analysis","volume":"12","author":"Nik Hazlina","year":"2022","journal-title":"BMJ Open."},{"key":"10.25259\/IJMR_2286_2025\/ref-4","doi-asserted-by":"publisher","first-page":"e116","DOI":"10.1097\/j.pbj.0000000000000116","article-title":"Infertility management in women with polycystic ovary syndrome: a review","volume":"6","author":"Cunha","year":"2021","journal-title":"Porto Biomed J."},{"key":"10.25259\/IJMR_2286_2025\/ref-6","doi-asserted-by":"publisher","first-page":"385","DOI":"10.1007\/s13224-017-1060-x","article-title":"Intrauterine Insemination: Fundamentals Revisited","volume":"67","author":"Allahbadia","year":"2017","journal-title":"The Journal of Obstetrics and Gynecology of India."},{"key":"10.25259\/IJMR_2286_2025\/ref-7","doi-asserted-by":"publisher","first-page":"1506","DOI":"10.1093\/humrep\/dem299","article-title":"International estimates of infertility prevalence and treatment-seeking: potential need and demand for infertility medical care","volume":"22","author":"Boivin","year":"2007","journal-title":"Human Reproduction."},{"key":"10.25259\/IJMR_2286_2025\/ref-8","doi-asserted-by":"publisher","first-page":"189","DOI":"10.22074\/IJFS.2021.139093.1039","article-title":"Infertility Stigma: A Qualitative Study on Feelings and Experiences of Infertile Women","volume":"15","author":"Taebi","year":"2021","journal-title":"Int J Fertil Steril."},{"key":"10.25259\/IJMR_2286_2025\/ref-9","doi-asserted-by":"publisher","first-page":"990","DOI":"10.1186\/1471-2458-12-990","article-title":"Out-of-pocket healthcare payments on chronic conditions impoverish urban poor in Bangalore, India","volume":"12","author":"Bhojani","year":"2012","journal-title":"BMC Public Health."},{"key":"10.25259\/IJMR_2286_2025\/ref-10","doi-asserted-by":"publisher","DOI":"10.1093\/hropen\/hoad007","article-title":"Financial costs of assisted reproductive technology for patients in low- and middle-income countries: a systematic review","volume":"2023","author":"Njagi","year":"2023","journal-title":"Hum Reprod Open."},{"key":"10.25259\/IJMR_2286_2025\/ref-11","doi-asserted-by":"publisher","first-page":"427","DOI":"10.1016\/j.juro.2013.08.083","article-title":"Out-of-pocket fertility patient expense: data from a multicenter prospective infertility cohort","volume":"191","author":"Wu","year":"2014","journal-title":"J Urol."},{"key":"10.25259\/IJMR_2286_2025\/ref-14","doi-asserted-by":"publisher","first-page":"247","DOI":"10.1007\/s40142-013-0027-1","article-title":"The Genetics of Infertility: Current Status of the Field","volume":"1","author":"Zorrilla","year":"2013","journal-title":"Curr Genet Med Rep."},{"key":"10.25259\/IJMR_2286_2025\/ref-16","first-page":"671","article-title":"Incidence, symptoms, and signs of endometriosis in fertile and infertile women","volume":"74","author":"Verkauf","year":"1987","journal-title":"J Fla Med Assoc."},{"key":"10.25259\/IJMR_2286_2025\/ref-17","first-page":"333","article-title":"Epidemiology, pathogenesis, genetics & management of polycystic ovary syndrome in India","volume":"150","author":"Ganie","year":"2019","journal-title":"J Med Res."},{"key":"10.25259\/IJMR_2286_2025\/ref-19","doi-asserted-by":"publisher","first-page":"441","DOI":"10.1007\/s10815-010-9436-1","article-title":"Endometriosis and infertility","volume":"27","author":"Bulletti","year":"2010","journal-title":"J Assist Reprod Genet."},{"key":"10.25259\/IJMR_2286_2025\/ref-20","doi-asserted-by":"publisher","first-page":"180","DOI":"10.4103\/ijph.ijph_15_23","article-title":"Public health system\u2019s preparedness to address polycystic ovarian syndrome: a rapid assessment survey of health-care Providers in India","volume":"68","author":"Joshi","year":"2024","journal-title":"Indian J Public Health."},{"key":"10.25259\/IJMR_2286_2025\/ref-22","doi-asserted-by":"publisher","first-page":"145","DOI":"10.4103\/sajc.sajc_290_18","article-title":"Perspectives of primary healthcare providers on implementing cancer screening services in tribal block of Maharashtra, India","volume":"8","author":"Patil","year":"2019","journal-title":"South Asian J Cancer."},{"key":"10.25259\/IJMR_2286_2025\/ref-24","doi-asserted-by":"publisher","first-page":"1511","DOI":"10.12688\/f1000research.157203.2","article-title":"Out-of-pocket expenditure (OOPE) on selected surgeries in the obstetrics and gynaecology department incurred by Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), private health insurance and uninsured patients in a tertiary care teaching hospital in Karnataka state of India","volume":"13","author":"Kamath","year":"2025","journal-title":"F1000Res."}],"container-title":["The Indian Journal of Medical Research"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/ijmr.org.in\/out-of-pocket-expenditure-incurred-by-couples-seeking-infertility-services-at-tertiary-level-facilities-in-india\/","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/ijmr.org.in\/out-of-pocket-expenditure-incurred-by-couples-seeking-infertility-services-at-tertiary-level-facilities-in-india\/","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T11:54:21Z","timestamp":1779796461000},"score":1,"resource":{"primary":{"URL":"http:\/\/ijmr.org.in\/out-of-pocket-expenditure-incurred-by-couples-seeking-infertility-services-at-tertiary-level-facilities-in-india\/"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,16]]},"references-count":17,"alternative-id":["10.25259\/IJMR_2286_2025"],"URL":"https:\/\/doi.org\/10.25259\/ijmr_2286_2025","relation":{},"ISSN":["0971-5916"],"issn-type":[{"value":"0971-5916","type":"print"}],"subject":[],"published":{"date-parts":[[2026,5,16]]},"article-number":"618"}}