FERTILITY care-seeking remains shaped by intersecting social, financial, cultural and health system barriers, according to a global qualitative synthesis of 27 studies. The review examined how people experiencing infertility navigate care, highlighting non-linear pathways that can involve delayed recognition, treatment interruptions and substantial emotional and financial costs.
Infertility affects an estimated one in six people worldwide, yet a substantial gap remains between those who need fertility services and those who access them. To better understand the factors influencing care-seeking, researchers searched seven databases up to May 2026, identifying qualitative and mixed-methods studies from low-, middle- and high-income countries.
The 27 included studies covered people using biomedical, traditional, complementary and cross-border fertility care. Researchers coded and thematically synthesised the findings, organising determinants across socio-ecological levels and interpreting them through a framework focused on how people become recognised and supported as candidates for healthcare.
The analysis identified six interconnected domains influencing fertility care-seeking: individual, relational, socio-cultural, socio-economic, health system and therapeutic, and policy and political factors.
Individual influences included fertility knowledge, age, psychological factors and personal aspirations. Relationships and gender norms affected decision-making within couples, while stigma, family expectations and peer influences shaped responses to infertility.
Financial hardship and insurance coverage also influenced access. Within health systems, treatment costs, service quality, waiting times, geographical accessibility and the availability of medically assisted reproduction affected whether people could obtain care. Policy and regulatory environments, including national recognition of infertility and rules governing cross-border treatment, further shaped available options.
Care pathways were frequently non-linear and gendered. People could move between different treatment approaches, interrupt care and return later, reflecting both personal circumstances and wider structural constraints.
The researchers argued that improving access requires interventions across multiple levels rather than isolated changes to individual services. They highlighted the need to address stigma, gendered expectations, financial barriers and regulatory constraints while improving the organisation and accessibility of fertility care.
Suggested priorities included integrating infertility into universal health coverage, strengthening regulation of cross-border care, and embedding culturally competent, patient-centred fertility services within sexual and reproductive health programmes.
The synthesis provides a framework for developing context-sensitive interventions across different populations and health systems. Its findings underline the importance of considering the full range of determinants shaping care-seeking when designing policies and services intended to make fertility care more equitable.
Reference
Afferri A et al. Delayed, fragmented, inequitable: a global qualitative systematic synthesis of fertility care pathways and determinants. Hum Reprod Update. 2026;DOI: 10.1093/humupd/dmag031.
Featured image: Ratirat on Adobe Stock
Featured image: Ratirat on Adobe Stock
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