The World Health Organization recognizes infertility as a public health issue worldwide
and a major medical and social burden. Fertility is a major component of population dynamics
and declining family size make the problem of infertility more urgent. Assisted reproductive
technology (ART) cycles are performed worldwide, but only a small percentage of those needing
ART actually access it. In order to pay for high-cost in vitro fertilization (IVF) treatments, many
infertile couples, especially those living in resource-poor settings, engage in a form of financial
sacrifice. While at an individual level the treatment is expensive, it is not from a national
healthcare perspective. Several studies have demonstrated the lifetime economic value of an
“IVF-conceived individual” in terms of revenues and expenses: the fiscal contribution generated
by these citizens may compensate and justify government’s investment in future generations.
The birth rate in Armenia has dropped significantly and along with the intensification of
migration, difficult social economic conditions, as well as increasing rates of abortions and
infertility, became a serious threat to national security. To address this problem of fertility, a
charity fund called “Aragil” was founded in 2011 to assist the solution of demographic problems
in the Republic of Armenia. The fund pays for infertility treatments using ART for socially
vulnerable families. Moreover, on 27 May 2015. The government enacted a policy to help fund
reproductive services. The proposed study seeks to a) examine the resource use/out-of-pocket
expenditure by couples (females aged 20-49) seeking infertility treatment over 18 months and
translate those findings into cost estimates regardless of the treatment pursued, b) determine the
frequency of catastrophic expenditure and financial coping strategies used by households c)
compare the out-of-pocket (OOP) expenditures by couples who received/did not receive
financial and medical support from the RA government.
The cost study will be conducted as a prospective quantitative descriptive study in all
Armenian healthcare facilities that provide ART services. The patients will be recruited between
2017 and 2018 and will be followed for 18 months. This study will adapt a survey instrument, a
six part questionnaire developed for a study conducted at the Reproductive Medicine Unit of
Groote Schuur Hospital in Cape Town, South Africa. Both direct costs, defined as total OPPs for
one ART cycle and indirect costs related to lost time and productivity during treatment, will be
captured. To determine the cost burden level for each household and to determine to what extent
it may be catastrophic the following dependent variables will be identified: catastrophic cost,
coping strategies, emotional and financial stress. A multiple regression model will be developed
for the determinants of OOP payments using methods of Ordinary Least Square (OLS) in order
to evaluate the effect of support from the RA government on OOP spending.