Barriers beyond biology: The socioeconomic and cultural determinants of infertility treatment-seeking behaviour – A systematic review

Infertility affects both men and women and is recognized as a significant global health concern. It remains highly stigmatized and often disproportionately attributed to women in low- and middle-income countries such as India. To systematically review and synthesize evidence on the influence of cultural and socioeconomic factors on infertility treatment-seeking behavior across diverse populations. This review followed PRISMA guidelines. Conducted Comprehensive database searches and included studies published between January 2018 and April 2025. 21 studies met the inclusion criteria. Financial constraints, absence of health insurance, low fertility literacy, and social stigma emerged as consistent barriers, particularly for women in rural and socioeconomically disadvantaged settings. Cultural beliefs often led couples to seek traditional or religious healing prior to biomedical interventions. Geographic location, educational attainment, occupation, and income significantly influenced treatment initiation and continuation. Disparities were also evident among ethnic minorities in high-income countries. Addressing these disparities requires integrated public health approaches, including equitable reproductive health policies, targeted financial support, and culturally sensitive care models.