International Journal of Health Policy and Management

International Journal of Health Policy and Management

Exploring Socio-Economic Characteristics Associated With Having a Live Birth Using Assisted Reproductive Technology Compared to Conceiving Naturally: Evidence From the UK Household Longitudinal Survey 2009-2022

Document Type : Original Article

Authors
Heather Brown 1
Sophie Guthmuller 2
1 Division of Health Research, Lancaster University, Lancaster, UK
2 Health Economics and Policy Group, Vienna University of Economics and Business, Wien, Austria
10.34172/ijhpm.9268
Abstract
Background
In England, the National Institute for Health and Care Excellence (NICE) guidance recommends that women under 43 years old are offered 3 cycles of in vitro fertilisation (IVF) on the publicly funded healthcare system if they have not conceived after two years. However, regional commissioners decide the funding allocated for IVF. Our study aims to assess socioeconomic and regional factors associated with having a live birth after using IVF over time to determine if decreases in funding for IVF increase regional inequalities in live birth success rates.

Methods
We use Understanding Society Survey data from 2009-2022 employing a random effects probit model to estimate the determinants associated with a live birth via IVF among women having given birth in the previous year. Next, we estimate a random effects probit model to compare the determinants of live birth from IVF between 2009-2018 and 2019-2022 to assess the impact of unequal decreases in funding across different regions of England.

Results
Between 2009-2022, living in London, being older, in employment, degree level or higher education, and owning/mortgage home are positively and statistically significantly associated with a live birth using IVF. Comparing 2009-2018, to 2019-2022 with less generous funding we find that in Yorkshire and Humber, there is a decrease in women successfully conceiving using IVF. Married/cohabiting women are three percentage points more likely to have a live birth with IVF compared to single women in 2019-2022 compared to 2009-2018. Women living in a middle deprivation quintile area (3) are three percentage points more likely to have a live birth from IVF in 2019-2022 compared to 2009-2018.

Conclusion
Lack of individual resources in conjunction with regional difference in in IVF funding contribute to inequalities in reproductive autonomy by reducing opportunities to access IVF.

Keywords
In Vitro Fertilisation
Assisted Reproductive Technology
Socioeconomic Inequalities
Reproductive Autonomy
Health Care Access
England
1.     UN Office of the High Commissioner for Human Rights. Reproductive rights are human rights: a handbook for national human rights institutions.  2014. https://www.refworld.org/docid/534a01a44.html. Accessed Oct 24, 2024.
2.     UN Office of the High Commissioner for Human Rights. Convention on the Elimination of All Forms of Discrimination against Women. New York; 1979. https://www.ohchr.org/en/instruments-mechanisms/instruments/convention-elimination-all-forms-discrimination-against-women.  Accessed Oct 24, 2024.
3.     Glynn A, MacKenzie R, Fitzgerald T. Taming Healthcare Costs: Promise and Pitfalls for Women's Health. J Womens Health (Larchmt). 2016;25(2):110-116. doi:10.1089/jwh.2015.5295
4.     National Institute for Health and Care Excellence. NICE guidelines 2024. https://www.nice.org.uk/about/what-we-do/our-programmes/nice-guidance/nice-guidelines.  Accessed Oct 24, 2024.
5.     National Health Service. IVF. https://www.nhs.uk/conditions/ivf/.  Accessed October 27, 2024.
6.     National Health Service. What are integrated care systems? https://www.england.nhs.uk/integratedcare/what-is-integrated-care/.  Accessed October 27, 2024.
7.     Steventon L, Flynn H. ICBs fail to improve NHS fertility treatment access, despite Women’s Health Strategy. Bionews. Issue 1199.  https://www.progress.org.uk/icbs-fail-to-improve-nhs-fertility-treatment-access-despite-womens-health-strategy/.  Published July 24, 2023.
8.     Human Fertilisation & Embryology Authority. Fertility treatment 2019: trends and figures—UK statistics for IVF and DI treatment, storage, and donation. https://www.hfea.gov.uk/about-us/publications/research-and-data/fertility-treatment-2019-trends-and-figures/.  Accessed May 12, 2025. Published May 2021.
9.     Smith ADAC, Tilling K, Nelson SM, Lawlor DA. Live-Birth Rate Associated With Repeat In Vitro Fertilization Treatment Cycles. JAMA. 2015;314(24):2654-2662. doi:10.1001/jama.2015.17296
10. Hamper J, Perrotta M. Blurring the divide: Navigating the public/private landscape of fertility treatment in the UK. Health Place. 2023;80:102992. doi:10.1016/j.healthplace.2023.102992
11. Klemetti R, Gissler M, Sevón T, Hemminki E. Resource allocation of in vitro fertilization: a nationwide register-based cohort study. BMC Health Serv Res. 2007;7:210.  doi:10.1186/1472-6963-7-210
12. Brautsch LAS, Voss I, Schmidt L, Vassard D. Social disparities in the use of ART treatment: a national register-based cross-sectional study among women in Denmark. Hum Reprod. 2023;38(3):503-510. doi:10.1093/humrep/deac247
13. Jones B, Peri-Rotem N, Mountford-Zimdars A. Geographic opportunities for assisted reproduction: a study of regional variations in access to fertility treatment in England. Hum Fertil (Camb). 2023;26(3):494-503. doi:10.1080/14647273.2023.2190040
14. Goisis A, Fallesen P, Seiz M, Salazar L, Eremenko T, Cozzani M. Educational gradients in the prevalence of medically assisted reproduction births in a comparative perspective. Fertil Steril. 2024;122(4):648-657. doi:10.1016/j.fertnstert.2024.05.149
15. Chanfreau J, Goisis A, Kravdal Ø. Conceptualizing and Measuring the Contribution of Assisted Reproductive Technologies to Fertility Rates. Population and Development Review. 2025;51:828-857 doi:10.1111/padr.70009
16. Dhalwani NN, Fiaschi L, West J, Tata LJ. Occurrence of fertility problems presenting to primary care: population-level estimates of clinical burden and socioeconomic inequalities across the UK. Hum Reprod. 2013;28(4):960-968. doi:10.1093/humrep/des451
17. Datta J, Palmer MJ, Tanton C, et al. Prevalence of infertility and help seeking among 15 000 women and men. Hum Reprod. 2016;31(9):2108-2118. doi:10.1093/humrep/dew123
18. Chambers GM, Hoang VP, Zhu R, Illingworth PJ. A reduction in public funding for fertility treatment--an econometric analysis of access to treatment and savings to government. BMC Health Serv Res. 2012;12:142. doi:10.1186/1472-6963-12-142
19. Imrie R, Ghosh S, Narvekar N, Vigneswaran K, Wang Y, Savvas M. Socioeconomic status and fertility treatment outcomes in high-income countries: a review of the current literature. Hum Fertil (Camb). 2023;26(1):27-37. doi:10.1080/14647273.2021.1957503
20. Tain L. Health inequality and users' risk-taking: a longitudinal analysis in a French reproductive technology centre. Soc Sci Med. 2003;57(11):2115-2125. doi:10.1016/s0277-9536(03)00079-0
21. Källén B, Finnström O, Nygren KG, Otterblad Olausson P. In vitro fertilization in Sweden: maternal characteristics. Acta Obstet Gynecol Scand. 2005;84(12):1185-1191. doi:10.1111/j.0001-6349.2005.00858.x
22. Murray A. Biological risk versus socio-economic advantage: low birth-weight, multiple births and income variations among Irish infants born following fertility treatments. Ir J Med Sci. 2014;183(4):667-670. doi:10.1007/s11845-014-1134-z
23. Räisänen S, Randell K, Nielsen HS, et al. Socioeconomic status affects the prevalence, but not the perinatal outcomes, of in vitro fertilization pregnancies. Hum Reprod. 2013;28(11):3118-3125. doi:10.1093/humrep/det307
24. Tierney K, Cai Y. Assisted reproductive technology use in the United States: a population assessment. Fertil Steril. 2019;112(6):1136-1143.e4. doi:10.1016/j.fertnstert.2019.07.1323
25. Goisis A, Håberg SE, Hanevik HI, Magnus MC, Kravdal Ø. The demographics of assisted reproductive technology births in a Nordic country. Hum Reprod. 2020;35(6):1441-1450. doi:10.1093/humrep/deaa055
26. Lazzari E, Tierney K. Parental sociodemographics of medically assisted reproduction births in the United States: a dyadic population-level study. F S Rep. 2023;4(3):292-299. doi:10.1016/j.xfre.2023.05.008
27. Sochas L, Chanfreau J. Austerity as reproductive injustice: did local government spending cuts unequally impact births? Social Forces. 2025;soaf198. Doi:10.1093/sf/soaf198
28. University of Essex, Institute for Social and Economic Research. Understanding Society: Waves 1-13, 2009-2022 and Harmonised BHPS: Waves 1-18, 1991-2009. [data collection]. 18th ed. UK Data Service; 2010. doi:10.5255/UKDA-SN-6614-19
29. Ministry of Housing - Communities & Local Government. The English indices of deprivation 2019. https://assets.publishing.service.gov.uk/media/5dfb3d7ce5274a3432700cf3/IoD2019_FAQ_v4.pdf.
30. Ware J Jr, Kosinski M, Keller SD. A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care. 1996;34(3):220-233. doi:10.1097/00005650-199603000-00003
31. Pearson K. Mathematical contributions to the theory of evolution. VIII. On the correlation of characters not quantitatively measurable. Proceedings of the Royal Society of London. 1900;66:241-244.
32. Department of Health and Social Care. Women’s Health Strategy for England. Policy Paper. 2022.  https://www.gov.uk/government/publications/womens-health-strategy-for-england/womens-health-strategy-for-england.
33. Tippett A. Reproductive rights where conditions apply: an analysis of discriminatory practice in funding criteria against would-be parents seeking funded fertility treatment in England. Hum Fertil (Camb). 2023;26(3):483-493. doi:10.1080/14647273.2022.2164746
International Journal of Health Policy and Management
Volume 15, Issue 1
2026
Pages 1-9

  • Received Date 09 June 2025
  • Revised Date 22 May 2026
  • Accepted Date 16 July 2026
  • First Published Date 18 July 2026
  • Published Date 01 December 2026