Objective: The paper attempts to analyze the implementation effect of including assisted reproductive technology in medical insurance in Zhejiang Province, compare the economic burden levels of patients undergoing different assisted reproductive technologies, and provide a reference basis for optimizing the medical insurance reimbursement structure and improving fertility support policies. Methods: Patients who underwent assisted reproductive technology treatment in F City from June 2023 to May 2025 were selected as the study subjects. Data on treatment volume, composition of patients with different medical insurance types, and medical expenses were collected. We further compared the changes in medical expenses before and after the inclusion of assisted reproductive technology in medical insurance and analyzed the differences in economic burden across different treatment items. Results: After the introduction of assisted reproduction into medical insurance, the total number of outpatient diagnosis and treatment of insured patients is on the slight rise. The total cost of the fresh embryo transfer project was lower than before, and the individual burden of employees' medical insurance and residents' medical insurance patients decreased by 7623.2 yuan and 6160.1 yuan respectively. The proportion of medical insurance reimbursement in the first routine embryo transfer stage of the whole process was 65.2 %. The proportion of patients with different assisted reproductive technologies at their own expense was maintained at 30% to 40%. Conclusion: The inclusion of assisted reproductive services in medical insurance has effectively reduced patients' financial burden and increased the willingness of infertile patients to undergo assisted reproductive technology treatment. However, several issues remain, including a higher out-of-pocket ratio, as well as disparities in reimbursement ratios across different types of medical insurance. It is recommended to implement a differentiated subsidy mechanism for diverse groups, establish a multi-dimensional fertility support system featuring basic medical insurance, commercial insurance, financial subsidies and medical loans, and improve the direct medical insurance settlement mechanism for cross-regional medical treatment, so as to further alleviate patients' financial pressure.