Send message to Authors

Paper short abstract

Spanish assisted reproductive care reveals a paradox: although publicly covered, most cycles occur in private clinics. Based on 35 interviews, this paper shows how market-driven innovation and resource-constrained evidence-based public care produce stratified access to personalised medicine.

Paper long abstract

Assisted Reproduction Technologies (ART) in Spain present a paradox: although formally included in the National Health System (NHS), 75% of ART cycles take place in private clinics, requiring substantial out-of-pocket expenditure. Drawing on 35 interviews with patients and practitioners across public and private centres, this paper examines how this configuration reshapes access to reproductive care in a sector marked by tensions between commercialisation and knowledge standardisation (Perrotta & Geampana, 2021).

Private clinics routinely offer expanded diagnostics, PGT-A and other IVF add-ons—interventions introduced despite limited evidence that they improve live birth rates. Research shows that innovation in this sector is closely linked to market competition and the expansion of technological portfolios (Perrotta & Geampana, 2020; van de Wiel, 2019). Clinicians describe pressures to innovate and differentiate services, while patients facing age-related time constraints seek private providers for more extensive testing and the possibility to pursue every available option.

Public hospitals, by contrast, operate within stricter evidentiary and budgetary frameworks, where hierarchies of evidence and cost-effectiveness criteria shape which interventions can be funded. Some clinicians view these constraints as safeguards against unproven treatments, while others argue that rigid criteria may disadvantage certain patients.

These dynamics reveal a broader tension between market-driven personalisation and resource-constrained evidence-based care. This tension fuels an ongoing stratification of reproduction, as access to expanded technological options increasingly depends on patients’ ability to pay. How can personalised medicine be equitable when access to precision technologies is market-mediated? Does a “better” personalised medicine require reconciling individual tailoring with collective sustainability?