Household cost of seeking fertility treatment in Sri Lanka: a cross-sectional study

Subfertility is not merely a medical problem; it has substantial psychological, economic, and social consequences. Although subfertility treatment can impose a considerable financial burden on households, evidence on the household cost of seeking fertility treatment in Sri Lanka is limited. To assess the household cost of accessing healthcare services among couples with subfertility attending clinics in teaching hospitals in the Colombo district, Sri Lanka. An analytical cross-sectional study was conducted in three teaching hospitals in the Colombo District among 402 female partners of couples with subfertility attending subfertility clinics. Participants were selected using proportionate allocation across hospitals and simple random sampling from clinic attendance registers. Data were collected by trained pre-intern medical officers using an interviewer-administered questionnaire. The median household cost per clinic visit was USD 14.58 (IQR 7.56–24.30). Sixty-five participants (16.2%) were hospitalized in the past six months for subfertility treatment, with a median cost of USD 6.75 (2.89–15.63) for government and USD 255.47 (IQR 134.87–282.48) for private hospitals. Intrauterine Insemination (IUI) was performed in 144 cases (35.8%) at a median cost of USD 11.07 (IQR 5.56–19.44). Monthly median direct costs for households were USD 25.62 (IQR 13.47–37.51), with indirect costs at USD 10.80 (IQR 8.10–20.52), totalling USD 36.42 (IQR 18.01–54.97). Despite government health facilities providing free services for subfertility, households still incurred costs for medications and diagnostic investigations. With limited insurance coverage for subfertility in Sri Lanka, nearly all household costs were out-of-pocket expenses. These findings highlight the need to assess opportunities to reduce household expenditure and improve the affordability of subfertility care in Sri Lanka.