Expanding Access and Driving Down the Cost of Fertility Care
July 22, 2025
The Fertility Care Gap: A Crisis of Access and Affordability
Fertility challenges affect a huge segment of the population, yet access to care remains far from adequate. According to the World Health Organization (World Health Organization, 2023), 1 in 6 people globally experiences infertility, underscoring an urgent need to improve access to fertility services.
Despite this widespread need, fertility treatments are often inaccessible due to high costs and limited availability, with most care paid for out-of-pocket and causing financial hardship for patients.
The U.S. exemplifies this gap: an estimated 12.2 million Americans (American Society for Reproductive Medicine, 2022) face infertility, but there are only about 1,351 reproductive endocrinologists (fertility specialists) to serve them, mostly clustered in urban centers.
This severe mismatch means millions go untreated or face long waits and travel burdens. Improving access isn’t just ideal, it’s imperative. We’re solving for access first, and price second, because without accessible care, affordability alone means little.
Why "Point Solutions" Aren’t Enough: A Need for Systemic Change
Countless startups and digital tools have sprouted to address individual pain points in fertility care: appointment booking, ovulation tracking, telehealth, financial planning, AI embryo scoring, etc. While these point solutions solve real issues, they don’t tackle the fundamental systemic problems:
No earlier interventions: Tools today rarely reach the root: fertility decline starting years before a patient ultimately seeks advanced treatment like IVF. Patients miss early-stage care (stage 0), and treatments only begin at stage 3 or 4, when options become costly and complex and emotional stakes are high.
Clinician education gaps: Fertility education is largely absent from medical school and residency, even for OB-GYNs. One survey found that 75 % of graduating medical students received fewer than five hours of fertility-related training, with OB-GYN residents demonstrating significant knowledge gaps in foundational fertility topics (FACTS about Fertility, 2021). This means many providers aren’t equipped to offer preventive fertility care or guide patients early in their journeys.
Fragmented fire-fighting: Adding yet another app or portal without strengthening clinical expertise is like throwing more wood at a fire in a room with no ventilation. Without shifting the core of the system, these tools can’t create lasting, industry-wide change.
Onto recognizes that true progress requires a systemic shift: informing patients via enabling and educating clinicians, integrating fertility into standard practice, and building comprehensive supportive systems versus just parts or patches.
Empowering Clinicians as First-Line Defenders of Fertility
One of the most powerful ways to expand access is to empower generalist healthcare providers – the OB/GYNs, family doctors, nurse practitioners, and others to whom patients already turn. In fact, 84% of women seeking fertility care go first to a generalist clinician, not a specialist (Senapati et al., 2022).
These frontline providers should be the first line of defense for fertility issues. However, too often they are ill-equipped to diagnose or manage infertility, leading to missed opportunities for early intervention. Studies emphasize that primary care professionals must be familiar and comfortable treating infertility issues, and patients deeply value generalist physicians who are knowledgeable about fertility and the treatment process.
Onto is closing this knowledge gap. We have developed a digital suite of microlearning products and curricula designed to train and support generalist clinicians in fertility care. Our education programs, including bite-sized continuing education (CE) modules and a comprehensive 10-module Fertility Curriculum for healthcare organizations, give providers the latest evidence-based know-how to counsel patients, order appropriate evaluations, and even initiate basic treatments in-house.
By arming generalists with these tools, we enable them to act sooner, catching fertility issues at “stage 0” rather than “stage 4,” and managing care that previously might have been deferred or referred out. Earlier intervention means simpler, less costly solutions, for example, treating an ovulatory disorder or addressing lifestyle factors now, instead of resorting to IVF later. This approach isn’t just theoretical; research backs it up. A recent study found that women who started their infertility journey with a generalist had the same chances of achieving a live birth as those who went directly to a specialist (Senapati et al., 2022).
Notably, those who began with generalist care were significantly less likely to end up needing IVF, yet had similar time-to-pregnancy outcomes. In other words, empowered primary care providers can often help patients conceive without immediately resorting to invasive and costly treatments, sparing patients the high expense and risks of procedures like IVF. Starting fertility care in the primary care setting can also be more cost-effective and prevent unnecessary medical complications.
Experts agree that leveraging general OB/GYNs and primary care in fertility care, through additional training and collaboration, is a key strategy to expand access in the face of specialist shortages. At Onto, we are proud to be thought leaders in this space, equipping the “troops on the ground” - the generalist clinicians - with the education, tools, and support to be true first-line defenders in fertility. By doing so, we create access and value for patients at scale, ensuring more people get guidance before problems escalate.
Innovating to Reduce Costs and Improve Outcomes
While empowering providers is one pillar of our strategy, driving down the cost of care and improving outcomes is the other. Fertility treatments today can be prohibitively expensive. For example, a single IVF cycle in the U.S. costs around $20,000 on average (FertilityIQ, 2022). Often, multiple cycles are required to achieve pregnancy. It’s no surprise that financial burden is a top reason many patients discontinue treatment.
Moreover, the fertility journey is often fragmented and frustratingly “patient-driven,” meaning patients themselves must coordinate a maze of appointments, tests, and decisions. This fragmentation has consequences: the industry faces a shocking attrition rate, with over half of IVF patients dropping out before completing treatment. Cumulative dropout rates of 54–65% have been reported (Fertility Bridge, 2023), reflecting huge numbers of patients who start the process but never reach the end. Many prospective parents stop after the initial consultation or before their first treatment cycle. Why? Surveys reveal that emotional stress and lack of support are major factors (reported by ~36% of couples), alongside financial strain (Domar et al., 2018).
When the patient experience in an area that can be as complex as fertility care lacks guidance and integration, people understandably fall through the cracks. Onto refuses to accept this status quo. That’s why we operate our flagship fertility clinic in Denver, CO not just as another clinic, but as an innovation hub and incubator to tackle fragmentation and cost. Here, we are reimagining the fertility care model from the ground up, blending compassionate human care with cutting-edge technology to create a seamless, supportive journey for patients. For example, we’ve created a modern, digitally-enabled patient experience: patients can book appointments online and meet via telehealth, and our intuitive patient portal guides them step by step through their personalized fertility journey, showing where they are, what’s next, and when to expect it.
This kind of navigation and transparency removes uncertainty and burden from patients’ shoulders. Instead of a disjointed process, care becomes coordinated and proactive. We anticipate needs and reach out with support so that patients never feel alone or lost. By making the process easier to follow, we aim to dramatically reduce the high dropout rates seen industry-wide.
More broadly, our Denver innovation hub is where we develop and test new technologies that can improve outcomes and lower costs – not just for Onto’s patients, but eventually for the entire fertility field. We’re exploring advances in areas like AI-driven decision support, predictive analytics, lab automation, and novel treatment protocols. The fertility industry has made great strides over the past decades, but many signs suggest we’ve plateaued in success rates and approaches. IVF success rates, for instance, have improved only incrementally in recent years and appear to be stabilizing (Murray et al., 2021).
Breaking through this plateau will require innovation and we’re committed to spearheading it. Whether it’s employing data science to better select embryos, using automation and robotics in the embryology lab to increase efficiency, or leveraging new “omics” (genomic, proteomic, etc.) technologies to personalize treatments, Onto is on the forefront. These technologies promise to boost efficacy and potentially curb costs. For example, emerging tools like AI analytics could reduce trial-and-error and shorten time to pregnancy, and automated processes might scale lab operations at lower expense. As one industry report noted, advances in automation, data science, and microfluidics can help improve both the success rates and accessibility of fertility treatment (Murray et al., 2021), exactly our philosophy in action.
In our clinic, we are already piloting data-driven strategies to improve patient retention, conversion, and outcomes. One promising avenue is using predictive analytics to identify patients at risk of dropping out and intervening early. In fact, studies have shown that employing predictive patient support tools can cut dropouts after initial consults by up to 20%.
Imagine a system that alerts our care team when a patient might be losing hope or encountering obstacles so we can step in with counseling, financial guidance, or whatever support is needed to keep them moving forward. By experimenting with such innovations in a real clinical environment, we can fine-tune what works best to keep patients engaged, reduce costs per successful pregnancy, and improve success rates. And importantly, we aren’t keeping these breakthroughs to ourselves; our goal is to share successful innovations to benefit the entire industry. If we develop a protocol that improves egg freezing outcomes or a software that streamlines coordination, we want other clinics and providers to be able to use it. In a field as crucial as fertility, hoarding innovation helps no one, but sharing it can help everyone.
Decentralization and Scalability: Why the Current Model Can’t Scale
The fertility industry as it exists today is inherently unscalable. Clinics are resource-intensive, reliant on a handful of highly specialized staff, and built around fragmented workflows that limit throughput, increase costs, and restrict access. Despite growing demand, the current system simply can’t meet the needs of millions of patients. To unlock the next phase of growth and access, we need decentralization, not just of technology, but of process, training, and infrastructure.
Think about the dry cleaning industry: while consumers interact with neighborhood storefronts, the actual cleaning and processing often happens at centralized hubs. Items are dropped off locally, tagged, and transported to a lab-like center where economies of scale and process standardization drive efficiency and quality. Fertility labs, especially embryology, can operate similarly. Lab tickets can be centralized, while patient-facing care and early diagnostics can happen at the point of care, closer to home.
We need new thinking, not new waiting rooms. Simply replicating the existing clinic model in new markets does not address the root issues: it adds cost, complexity, and bottlenecks. A better system:
Distributes patient intake, education, and low-complexity care to generalist providers, already embedded in every community
Centralizes complex lab work and high-skill procedures, with standardization to ensure consistency and efficiency
Supports scalability via modular infrastructure, digital tooling, and workforce enablement, not more square footage
This is how nearly every other mature industry has scaled. Healthcare has been slow to follow, especially in high-touch specialties like fertility, but it’s time that we do. Onto is designing its model around these principles: distributed access, centralized excellence, and scalable systems. We can’t keep playing the same playbook and expecting new results; the structure must change if we want to change the outcome.
Driving Fertility Care Forward, Together
Onto’s vision is bigger than one company or clinic. We fundamentally believe that the fertility industry’s challenges from access, to cost, to patient experience can only be solved by collaboration and a bold, unified effort. Today’s standard approaches have taken us this far, but as we noted, progress has stagnated. It’s time to kickstart a new era.
We see ourselves as a catalyst for change: bringing together clinicians, health systems, researchers, and innovators to break through the plateau and solve the issues that have plagued the industry for too long. Whether it’s partnering with primary care networks to roll out our clinician training programs, collaborating with tech startups on better apps and AI for fertility, or working with employers and insurers to craft new pricing models, we plan to partner, build, and collaborate at every level.
A rising tide will lift all boats in the fertility space. If we can demonstrate better outcomes and lower costs, we want others to replicate it. If we can prove new ways to integrate care and reduce attrition, we will share that playbook. Onto is here to drive us all forward, together. This mission is nothing short of transformative. It means envisioning a world where fertility care is accessible in every community, not just big cities, where your trusted local doctor can help you early on, and where you only need a specialist for truly complex cases.
A world where patients get answers and interventions earlier, increasing their chances of success and reducing heartbreak and expense. A world where innovations are not siloed in select clinics but disseminated widely, so that success rates climb and costs fall across the board. Ultimately, it’s a world where far fewer people hear “there’s nothing we can do,” and far more people achieve the family of their dreams without bankrupting themselves or giving up in despair.
This is the future Onto is working toward: ACCESS to fertility knowledge and care at the earliest point of need, and VALUE in the form of better outcomes at lower cost. It’s a future where fertility issues are met proactively at “stage 0” with education, prevention, and early treatment rather than only addressed at “stage 4” when options are fewer and more expensive. We know this vision is ambitious. But with the support of forward-thinking clinicians, investors, and partners who share our passion, it is entirely achievable. The fertility industry has plateaued in some respects, but with collective effort, we can push through to new heights of innovation and service.
Want to learn more about what we’re doing?
We welcome conversations with anyone who wants to join this mission – from healthcare professionals looking to expand fertility services, to investors and partners who believe in making fertility care more equitable and effective. Contact us to learn how, together, we can bring Onto’s vision to life and usher in a new era of fertility care. Let’s drive the industry forward, so that everyone who wants to build a family has the Access, Support, and Hope they deserve.
✍️ Article written by Traci Keen, Co-Founder of Onto Health
https://www.linkedin.com/pulse/onto-expanding-access-driving-down-cost-fertility-care-3mgqc
References
World Health Organization. (2023). Infertility. https://www.who.int/news-room/fact-sheets/detail/infertility
American Society for Reproductive Medicine. (2022). 2021 ASRM Clinic Summary Report. https://www.asrm.org
FertilityIQ. (2022). Fertility treatment cost guide. https://www.fertilityiq.com
Fertility Bridge. (2023). IVF access, dropout, and barriers to care. https://www.fertilitybridge.com/news-articles/ivf-access-dropout-barriers
FACTS about Fertility. (2021). Fertility knowledge gaps in medical education: A research review. https://www.factsaboutfertility.org/fertility-knowledge-gaps-in-medical-education-a-research-review/
Centers for Disease Control and Prevention. (2022). 2020 Assisted Reproductive Technology Fertility Clinic Success Rates Report. https://www.cdc.gov/art/artdata/index.html
Domar, A. D., Rooney, K., Hacker, M. R., Sakkas, D., & Dodge, L. E. (2018). Burden of care is the primary reason why insured women terminate fertility treatment. Fertility and Sterility, 109(6), 1121–1126.
Senapati, S., Jain, T., & James, K. E. (2022). Empowering generalist physicians in fertility care: Outcomes and benefits. Journal of Women's Health, 31(3), 218–224.
Murray, K. S., et al. (2021). Trends in IVF success and clinical implications. Human Reproduction Update, 27(4), 563–579.
