Abstract

Background: Assisted reproductive technologies (ART) have revolutionised infertility management worldwide, yet persistent socio-cultural barriers and ethical challenges limit equitable access and responsible implementation, particularly in diverse global contexts. Methods: This comprehensive review synthesised evidence from peer-reviewed literature, guidelines, and reports accessed through PubMed/MEDLINE, Scopus, Web of Science, Embase, and Google Scholar (searched January–October 2025). Key terms combined concepts of ART, infertility, socio-cultural factors, stigma, religion, ethics, equity, and global disparities. Inclusion focused on studies addressing barriers (religious/cultural beliefs, stigma, gender bias, economic factors) and ethical issues (embryo selection, gene editing, surrogacy, gamete donation, child rights) across high, middle, and low-income settings, with supplementary hand searching and citation tracking for breadth. Results: ART adoption has expanded, with millions of cycles annually and over 13–17 million births globally, yet utilisation remains low in resource-limited regions due to high costs, absent insurance coverage, and infrastructural gaps. Socio-cultural barriers include infertility stigma disproportionately affecting women, religious restrictions (e.g., prohibitions on third-party donation in Islam, embryo concerns in Christianity), and regional resistance rooted in traditional attributions of infertility. Gender bias exacerbates unequal burden, while ethical dilemmas encompass commodification in commercial surrogacy, exploitation of vulnerable women, donor anonymity versus offspring rights to origins, and moral hazards of preimplantation genetic testing and emerging gene editing. Regulatory fragmentation erpetuates inequities and reproductive tourism.

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