Editor's note: This article discusses historical and structural bias in medicine, including how non-Western medical systems have been marginalised within modern healthcare. It does not suggest that individual clinicians or clinics act with racial prejudice, but examines how inherited frameworks shape access, legitimacy and care.

Structural Bias in Fertility Care: Where IVF Falls Short

Modern fertility care is often presented as neutral, objective, and evidence-led. And in many ways, it is. IVF is one of the most studied and technologically advanced interventions in medicine.

But medicine does not exist outside history.

What we research, fund, legitimise, and integrate into care pathways is shaped by long-standing hierarchies of knowledge — and those hierarchies have consequences for patients.

To understand where fertility care succeeds and where it fails, we have to look beyond individual treatments and examine the systems that surround them.

Medicine is not culturally neutral

Western biomedicine has historically positioned itself as the default authority on health, while categorising other medical traditions as “alternative,” “unscientific,” or anecdotal — often without rigorous engagement or equivalent investment in research.

This pattern is well documented across multiple fields, from pain management to mental health to reproductive care. Medical anthropologists describe this as epistemic bias: the privileging of certain knowledge systems over others, not necessarily because they are more effective, but because they align with dominant cultural and institutional frameworks.
(Source: Kleinman, Patients and Healers in the Context of Culture; WHO Traditional Medicine Strategy)

This is not about individual prejudice. It is about whose knowledge is considered legitimate enough to study, fund, and integrate.

How this shows up in fertility care

IVF is a powerful intervention. It bypasses blocked tubes, severe male-factor infertility, and ovulatory disorders in ways no holistic therapy can.

But IVF is not designed to address everything that affects fertility outcomes.

It does not directly treat:

• chronic stress physiology
• autonomic nervous system dysregulation
• inflammatory or metabolic patterns outside narrow diagnostic thresholds
• the cumulative physiological impact of repeated loss or treatment failure

These factors are often acknowledged in conversation, but they rarely shape protocols or funding decisions.

When patients seek support for these areas — whether through acupuncture, counselling, nutrition, or other modalities — they are often told these approaches are “unproven” or “non-essential.”

Yet the absence of strong evidence is not the same as evidence of absence. In many cases, these areas are under-researched precisely because they sit outside the dominant biomedical frame.
(Source: HFEA guidance on treatment add-ons; Cochrane reviews on adjunct therapies)

Acupuncture and the limits of the evidence conversation

Acupuncture occupies an uncomfortable position in fertility care.

Research examining acupuncture alongside IVF shows mixed results. Some studies suggest improvements in treatment experience or certain pregnancy outcomes; others show no statistically significant effect, particularly when live birth is used as the primary endpoint.
(Sources: Cochrane Database of Systematic Reviews; Human Reproduction)

This ambiguity is often used to dismiss acupuncture entirely.

But here’s the uncomfortable truth: fertility medicine already uses many interventions with incomplete or evolving evidence — particularly in the add-on space — while continuing to offer them because patients want something that addresses the parts of their experience medicine doesn’t reach.

The question isn’t whether acupuncture “beats” IVF.
It’s whether the system is willing to seriously investigate how supportive therapies might influence outcomes, rather than relegating them to the margins.

Structural bias doesn’t require bad actors

Structural bias persists even when clinicians act in good faith.

It shows up when:

• funding is directed almost exclusively toward procedural interventions
• outcomes are measured narrowly, without regard to patient experience or cumulative burden
• adjunctive care is framed as optional or indulgent rather than potentially supportive

This mirrors broader patterns in healthcare, where socially patterned stress, access to care, and support systems profoundly shape outcomes — yet sit awkwardly within traditional evidence models.
(Source: Marmot Review on health inequalities; NHS Race & Health Observatory)

Who is most affected?

When fertility care is narrowly defined, the people most affected are often those already navigating disadvantage:

• patients with limited financial access to repeated IVF cycles
• those experiencing long-term stress, trauma, or loss
• people who feel unseen by protocol-driven care

This isn’t about blaming IVF clinics. It’s about recognising that fertility outcomes are shaped by biology and context— and systems that ignore context inevitably leave people behind.

A false choice helps no one

Framing fertility care as IVF versus acupuncture is a distraction.

IVF is indispensable for many people.
Supportive therapies are not replacements — but they may influence the conditions in which treatment takes place.

The real failure isn’t the existence of different approaches.
It’s the reluctance to integrate them thoughtfully, research them properly, and communicate honestly about what they can — and cannot — do.

What better fertility care looks like

Progress doesn’t come from choosing sides. It comes from:

• acknowledging historical and structural bias in medicine
• investing in research that reflects real patient experience
• integrating care that supports both physiology and nervous system regulation
• being transparent about uncertainty rather than pretending it doesn’t exist

Fertility care doesn’t need to be perfect.
But it does need to be honest, humane, and willing to examine its own assumptions.

That’s how patients truly benefit.