In the last few decades, a growing proportion of prospective parents have resorted to medically assisted reproduction (MAR) – broadly conceptualized as interventions, procedures, surgeries, and technologies that treat fertility impairment and infertility (1) – to realize their fertility intentions. Because fertility rates decline, due to a preference for a small(er) offspring, childbearing postponement, or for other reasons, the recourse to medical assistance to conceive has increased markedly and it has intensified most notably in Europe, Australia, Asia, and North America (2).The economic costs of accessing MAR – which depend on public coverage and vary substantially across countries (3) – as well as other barriers to access such as geographic distance and normative and cultural factors (4), suggest the existence of a socioeconomic gradient in usage and births. A handful of studies from single countries have consistently shown that parents of children conceived through medical assistance are more likely to have higher socioeconomic status (SES) relative to parents of naturally conceived (NC) children. Evidence thus far has been mostly focused on Finland (5, 6), the United States (7, 8, 9), and Norway (10).Cross-country research drawing on comparable measurements is still scarce. Heterogeneity across studies regarding the methodologies, socioeconomic indicators, and outcome variables used makes it difficult to compare the results of existing studies on the basis of individual countries. As a result, evidence on whether context moderates the social gradient in MAR births is still limited; that is whether the gradient is more marked in settings with lower subsidization of MAR treatments.In this study, we investigated whether educational gradients in births differ across countries with diverse institutional settings around MAR access and use. Using harmonized data from 5 high-income countries – Denmark, France, Spain, the United Kingdom, and the United States – with diverse institutional frameworks facilitating or hindering access to MAR, we provide a comprehensive assessment of educational disparities in MAR births from a comparative perspective.