OBJECTIVES: To understand IVF policy landscape, reimbursement and access to treatment in the global health markets, and trends and drivers of change, for the purpose of identifying markets likely to support reproductive health franchises. METHODS: IVF ecosystems were assessed in 19 countries. We conducted a thorough review of published literature pertaining to Assisted Reproductive Technology (ART) policy, reviewed infertility organization and clinic websites and associated publications. Key market differences impacting the IVF environment were identified and analyzed for comparison. RESULTS: Opportunities in IVF must consider reimbursement policy, cultural influences, and med-tourism. While the US is one of the most advanced markets with respect to number of IVF cycles, technologies utilized, and cultural trends, healthplans provide no reimbursement and most patients pay 100% out-of-pocket (OOP). Elsewhere, reimbursement varies greatly: Israel and European countries tend to provide more generous reimbursement than Latin America and Africa, however restrictions and requirements can greatly limit the coverage. Recent legislation changes in European markets have expanded reimbursement, and changes in South America are likely to evolve as reproductive health awareness and access to infertility treatment becomes more widespread. Finally, many patients do seek treatment abroad due to lower costs, shorter waitlists, and fewer restrictions: South America, South Africa, and Israel tend to be sought after destinations for patients willing to pay OOP. CONCLUSIONS: Reproductive health is unlike other therapeutic areas because reimbursement, alone, is insufficient to assess opportunity.  Given the breadth of this poorly reimbursed therapeutic area, stakeholders must seek to appreciate the impact of cultural trends and med-tourism, including: declining birth rates, increasing access to IVF and reproductive health awareness, improvements in local economies and reforms to public policy.  Manufacturers and policy makers should prepare to understand evolving market access and patient environments to effectively prioritize traditionally overlooked countries as key factors shift in the coming years.