JBRA Assisted Reproduction 2025;29(Suppl.2 SBRA 2025):44
Poster Presentation
29^th Annual Congress of the SBRA. São Paulo/SP - Brazil, 2025
doi: 10.5935/1518-0557.20263582

P-32. Barriers to Infertility Treatment Access in Brazil: A Cross-Sectional Study on Socioeconomic and Ethical Aspects

Drauzio Oppenheimer¹, Francisca Rego², Rui Nunes²

¹Instituto de Ensino e Pesquisa GERA - São Paulo - SP - Brasil
²Universidade do Porto, Portugal

Objective: Infertility is a globally recognized public health issue, particularly prevalent in low- and middle-income countries. Despite the inclusion of reproductive health in the 1994 International Conference on Population and Development agenda, barriers to infertility care remain significant in developing nations. This study aimed to investigate the socioeconomic characteristics of infertile couples in Brazil and evaluate how access barriers affect treatment-seeking behavior, under the bioethical perspective of justice.
Methods: A cross-sectional observational study was conducted between September 2021 and January 2022. An online questionnaire was developed and validated in a pilot phase, assessing sociodemographic, economic, and psychosocial variables. The questionnaire included 30 items (24 closed-ended and 6 open-ended), exploring participants' profiles, infertility history, access to specialized care, financial barriers, emotional impact, and quality of life perceptions. The study population included heterosexual couples diagnosed with infertility, who sought medical assistance at two fertility clinics in Brazil. Exclusion criteria were single women and same-sex couples, considering the distinct ethical contexts involved in their access to assisted reproductive technologies. Data were analyzed using descriptive statistics and correlation tests (Pearson and Spearman), with a significance level set at p<0.05.
Results: A total of 201 eligible couples participated. The mean age was 36.7 years for female partners and 38.6 years for male partners, with an average infertility duration of 6 years. Most participants self-identified as white (69.2% of women and 72.6% of men), with a high educational level, especially among women (38% held postgraduate degrees). However, despite the higher education profile, financial barriers were consistently reported. Approximately 65% of couples had to travel to another city for infertility treatment, and only 34.3% reported easy access to specialized care after receiving referrals. Moreover, 51.7% of couples had considered abandoning treatment due to access difficulties. Financial burden emerged as the primary obstacle: 67.2% of couples identified treatment cost as the most significant barrier, and 48.3% reported resorting to loans or selling assets to afford treatment. Furthermore, 65.2% had to postpone treatment while saving financial resources, and 45.3% sought assistance through public health programs or private insurance, with limited success. Psychosocial impacts were also significant: 54.2% of couples experienced anxiety and stress since the onset of infertility, with an additional 33% developing these feelings after unsuccessful treatment attempts. Despite this, 72.6% rated their overall quality of life as good, and 24.4% as excellent. Importantly, lower family income was statistically associated with poorer self-reported quality of life (p=0.010) and greater difficulty accessing fertility services (p<0.0001). Qualitative responses highlighted emotional suffering, social isolation, and the distress of repeated treatment failures. Participants often expressed feelings of frustration, hopelessness, and financial exhaustion. Furthermore, the study revealed a racial and economic disparity in treatment access, consistent with global literature.
Conclusion: This study reveals significant social, economic, and geographic barriers to infertility treatment in Brazil. Financial constraints, limited geographic availability of specialized services, and inadequate public policy support remain key challenges. The data emphasize the ethical imperative for health policymakers to address reproductive health inequities, fostering access aligned with the principle of justice. Strategies should include public education, financial support mechanisms, simplification of treatment protocols, and expansion of assisted reproduction services within public health systems. Considering infertility’s psychological burden and its classification as a disease by the World Health Organization, these findings reinforce the need for comprehensive and equitable healthcare policies in reproductive medicine.