Weighing Parenthood Wishes: A Conjoint Analysis of Criteria to Prioritize Infertile Couples for Publicly Funded Fertility Treatment

Background Parenthood is a key life goal for many, but infertility affects about 1 in 6 globally. While fertility treatments offer solutions, their high costs limit access. Many health systems provide public funding, yet budget constraints prevent fully funded access, often leaving patients with significant out-of-pocket costs. Policy makers face the challenge of prioritizing individuals for publicly funded treatments, but how to do this remains unclear and underresearched. Worldwide, funding policies vary widely, often adopting controversial access criteria. Methods We investigated Belgian population preferences for prioritizing in vitro fertilization (IVF) funding through a discrete-choice experiment with a representative sample of 3,000 Belgians. Attributes included maternal and partner age, infertility cause, civil status, prior biological children, and treatment cost. Using a Bayesian D-optimal design and panel mixed logit model, we assessed criteria relevance. The resulting multiattribute utility function created a priority ranking of couples, which we compared to the ranking under the current Belgian policy, which focuses only on maternal age (