In Across Asia Pacific, fertility care remains financially out of reach for many, despite falling birth rates and growing demand. Experts now say it’s time for policies to catch up.
If you are a woman in Asia thinking about having kids “later,” chances are, you’ve thought about fertility. You’ve probably heard of egg freezing, IVF, and stories of friends or colleagues flying overseas to seek treatment. But while the science has advanced, policies and access remain stuck in the past.
Despite shrinking populations in countries like Japan, South Korea, and China, fertility treatment remains a luxury few can afford, and a taboo many still avoid discussing.
A new policy paper, Improving Access to Fertility Treatment in Asia Pacific, highlights the region’s failure to recognise infertility as a disease and calls for policy reform to close treatment gaps.
The paper was released to highlight urgent gaps in fertility care policy and to propose region-specific solutions for improving access to fertility treatment across Asia Pacific (APAC).
Birth Rates Are Falling, but Policy Isn’t Keeping Up
APAC governments are at odds with a quiet but accelerating demographic shift. Most countries in the region now report birth rates well below the replacement threshold of 2.1 children per woman. Nations including Japan, South Korea, China, and Thailand are experiencing sustained population decline.
In Japan, the consequences are already grave. The country’s working-age population is projected to fall from 81 million in 2010 to just 44 million by 2060. In response, several governments have turned to pronatalist incentives such as tax credits, childcare subsidies and expanded parental leave.
But these policies largely benefit those who can already conceive. For the 1 in 6 people facing infertility, a figure highlighted in the same paper, access to treatment remains limited and in many cases unaffordable.
Commissioned by Organon and developed by Charles River Associates, the report argues that national strategies have yet to recognise infertility as a disease. Without this recognition, health systems often fail to provide timely diagnosis or coverage for assisted reproductive services.
As the paper notes, “Pronatalist policies often focus solely on financial incentives and overlook the medical aspect of this challenge.”
Access to Fertility Treatment Is Deeply Unequal
The report finds that access to fertility treatment across APAC remains highly uneven, with stark differences in availability, affordability, and eligibility.
In Australia and Japan, over 3,600 assisted reproductive technology (ART) cycles are performed per million people. In Indonesia? Just 25 – a hundred-fold difference.
Much of this disparity comes down to infrastructure, money, and outdated policies. Fertility clinics are often concentrated in major cities, leaving rural populations without viable options. If you live in rural China, your nearest clinic might be hours away. For many, the travel time and associated costs discourage treatment altogether.
Financial access is another major barrier. According to the paper, five of the 13 countries studied offer no public reimbursement for ART. In Vietnam, one IVF cycle can cost more than your yearly salary.
Even where funding exists, eligibility rules restrict access. In Thailand, government subsidies are only available to married women aged 30 to 40.
Infertility Is a Disease, But Policies Haven’t Caught Up
Infertility is recognised by the World Health Organization as a disease.
Yet in much of APAC, health systems still fail to treat it as one. The new policy paper identifies this lack of recognition as a core barrier to progress.
Without formal classification as a medical condition, infertility is rarely prioritised in national health strategies. Public education remains minimal. Many individuals are unaware of when to seek help, and delay treatment for years. In countries like Korea and Taiwan, women often wait over two years before consulting a doctor. In rural areas, the delay can be even longer.
And when they finally do seek help, the window for successful treatment might already be closing.
This policy neglect limits access to treatments like ART, which includes in-vitro fertilisation (IVF) and related procedures. ART has helped millions globally conceive but remains inaccessible to many across the region due to cost, regulation and infrastructure.
ART is not simply a lifestyle option. It is a clinically validated treatment that can improve reproductive outcomes and help address low birth rates. Yet few governments integrate ART into public health systems or cover its costs. As a result, even those who could benefit most from ART often cannot afford it.
Professor Human Fatemi, a fertility specialist and Group Medical Director at ART Fertility Clinics in the UAE, contributed to the policy paper. With decades of clinical experience in reproductive medicine, he emphasised why timely access to care matters.
“Fertility preservation is a personal choice that women should be able to make when they are ready.” he said.
“Elective egg freezing can provide women with more time and flexibility in planning their families. When done at a younger age, it may preserve higher-quality eggs, improving future fertility outcomes. This supports women and families to have the children and the family sizes they desire.”
Egg Freezing and Other Gaps in Care
Even where fertility treatment is available, many patients face outdated policies and limited options. Egg freezing, a procedure that can preserve a woman’s fertility potential, is one such area where access remains restricted across Asia Pacific.
The policy paper draws a distinction between medical egg freezing, such as before cancer treatment, and social egg freezing, where women delay childbearing for personal or financial reasons.
In many countries, the latter remains either prohibited or unfunded.
Single women in China and India are often barred from the procedure due to cultural and legal restrictions. Meanwhile, Singapore only recently legalised elective egg freezing – but the cost remains high and it is not covered by insurance. The same goes for Australia.
There is also a widespread lack of awareness. Women are sometimes unaware of the optimal age window for freezing eggs, leading many to pursue the procedure later than is medically advisable.
A study from Malaysia, cited in the report, found that referrals for oncofertility care before cancer treatment were rare, suggesting that even doctors may not fully understand the value of fertility preservation.
A Policy Shift Is Needed and What It Means for Women
The policy paper lays out a clear path forward. Countries across Asia Pacific must formally recognise infertility as a disease and expand access to fertility treatment. This includes subsidising ART, easing eligibility rules, increasing clinic availability and providing timely public education on fertility.
Some countries are already taking action. Taiwan covers up to half the cost of ART through public funding. Australia and Japan have national strategies that include both treatment and emotional support. These examples offer practical models for others in the region.
For women, policy decisions carry real consequences. Access to fertility treatment shapes not only when they can seek care, but also how they balance work, age and family plans.
Ana Alsina’s reflections, shared with Medical Channel Asia in Career vs Children: Can Women Really Have It All?, show the reality many face when navigating these choices in Singapore’s evolving fertility landscape.
“I don’t want to become part of these statistics; I want to challenge them,” she wrote, describing her decision to undergo fertility preservation. For her, early fertility checks were not about pressure but clarity. “Looking back, I see the value in having fertility checks earlier—not as a source of pressure, but as a way to make informed decisions.”
Whether it is IVF, egg freezing, or fertility screening, the conversation needs to shift. Fertility care isn’t just about choice – it’s about access. And right now, that access is far from equal.
