The economics of hope: valuing the long-term fiscal returns from assisted reproduction.

In society, parents bear most costs of raising children, while the majority of economic benefits accrue to society and governments. From this perspective, parenting can be viewed as a public service from which society obtains financial benefits from the future productive output of children. Understanding where benefits accrue from future output attributed to children born today and in the future is important for establishing how to value live births attributable to assisted reproduction. Low fertility, driven by delayed childbearing, rising opportunity costs and reproductive ageing, currently contributes to population ageing, higher dependency ratios and fiscal pressure on pensions, healthcare and social transfers. Consequently, ageing populations currently being experienced in many developed economies have increased relevance to the children born every year and their lifetime contributions to the economy. Assisted reproduction and related fertility services partially offset these dynamics by converting unmet fertility intentions into additional births. From a fiscal perspective, live births achieved through assisted reproduction can yield substantial net lifetime returns to the public sector, supporting the view that fertility treatment is an investment in human capital and intergenerational equity rather than a purely consumptive healthcare expense. Reproductive medicine policy should therefore integrate demographic and fiscal impacts when setting coverage and subsidy levels for infertility care.