Fertility care is a deeply personal journey, but it is also shaped by geography, culture, and law. Around the world, the availability of fertility treatments, and the rules governing them, differ dramatically. For some, these differences open new opportunities; for others, they create barriers and challenges. By exploring how fertility is approached across the globe, we can better understand both the progress and the inequities that shape family-building today.
Fertility as a Global Health Issue
The World Health Organization (WHO) recognizes infertility as a disease of the reproductive system, affecting approximately 1 in 6 people worldwide. Yet, access to fertility care is far from equal. In some countries, fertility services are considered part of essential healthcare, while in others they are seen as elective or even restricted for cultural or religious reasons. This uneven landscape means that one’s geographical location can determine whether they can access the treatments they need.
Access and Funding
One of the starkest global differences lies in how fertility treatments are funded.
- Europe: Countries such as Denmark, France, and the U.K. provide significant public funding for in vitro fertilization (IVF) and related services. In Denmark, for example, IVF is fully covered for women under 40.
- North America: In Canada, funding depends on the province. Ontario covers one cycle of IVF for eligible patients, while other provinces provide little or no coverage. In the United States, fertility treatment is largely self-funded, with only some states mandating insurance coverage.
- Asia: Japan has recently expanded public subsidies for fertility treatments in response to declining birth rates, while other countries in the region offer minimal support.
- Low- and Middle-Income Countries (LMICs): In many parts of Africa, South America, and Southeast Asia, fertility treatment is available only in private clinics and at high cost.
These differences raise important ethical questions about equity. Should the ability to have a family depend on personal wealth or geographic location?
Legal and Ethical Landscapes
The laws surrounding fertility vary widely.
- Gamete and embryo donation: In Canada and the U.K., donors cannot be paid beyond expenses. In contrast, countries like the U.S. allow compensation, which has created a larger donor pool but also sparked debates about commercialization.
- Surrogacy: Surrogacy is legal and regulated in Canada, the U.S., and parts of Eastern Europe. In countries such as France, Germany, and Italy, it is prohibited. Some nations, such as India, once served as hubs for international surrogacy, but have since restricted the practice to protect women from possible exploitation.
- Genetic testing and embryo selection: In many Western countries, preimplantation genetic testing is permitted, though regulations differ on what can be tested for. In Germany, for instance, embryo selection is heavily restricted, while in the U.S. clinics offer broad testing options, including non-medical traits like sex selection.
Cultural and Religious Influences
Fertility is also deeply shaped by culture and faith.
- In some cultures, infertility carries a stigma, particularly for women, making access to treatment not just a medical issue but also a social one.
- In countries where kinship and genetic lineage are highly valued, third-party reproduction (such as egg or sperm donation) may be less socially accepted. Conversely, cultures that emphasize community may view shared reproductive roles more positively.
- These cultural factors influence not only how fertility care is delivered, but also how families are formed and supported.
Technology and Innovation
Globally, fertility science is advancing at an incredible pace, though access to these innovations are uneven.
- Egg and sperm freezing are increasingly available, giving individuals more flexibility in family planning.
- Artificial intelligence is being tested to help select embryos.
- Artificial wombs and gene editing remain experimental but have the potential to one day reshape reproductive care entirely.
- Wealthier nations tend to adopt these technologies first, while LMICs often struggle to provide even the most basic fertility treatments.
The Human Impact
Global differences in fertility care remind us that parenthood is not only a personal dream but also a matter of justice. Ensuring safe, affordable, and ethical fertility treatment worldwide will require collaboration among governments, medical professionals, and advocacy organizations.
Looking Ahead
The global landscape of fertility is constantly changing. More countries are beginning to recognize infertility as a public health issue and are expanding access to care. At the same time, advances in science will continue to raise new legal and ethical questions.
For patients, awareness of these differences are empowering – it helps families make informed decisions about their options, whether close to home or abroad. For policymakers and advocates, the goal is clear – to ensure that the chance to build a family is not limited by geography, culture, or income.
At Fertility Friends Foundation, we believe knowledge is a powerful tool. By understanding fertility in a global context, we can better support patients, challenge inequities, and celebrate the diverse ways families are created around the world.
References
- World Health Organization (WHO), Infertility prevalence estimates, 1990–2021 (2023).
- European Society of Human Reproduction and Embryology (ESHRE), ART in Europe Report (2022).
- Government of Ontario, Ontario Fertility Program.
- Inhorn, M.C. & Patrizio, P., “Infertility around the globe: new thinking on childlessness, gender, and reproductive technologies,” Human Reproduction Update (2015).
- Shenfield, F. et al., “Cross-border reproductive care in six European countries,” Human Reproduction (2010).
- Pennings, G., “Ethics of fertility tourism,” Reproductive BioMedicine Online (2012).
- Duke University School of Medicine, “EXTENDing Hope: Artificial Wombs for Safer Neonatal Development” (2025).