A new Atlas of fertility treatment policies in Europe exposes inconsistencies in regulation and funding

Published 17 December 2021

A country-by-country review of policies and funding in ART finds that only four of 43 countries surveyed are rated as ‘excellent’ according to a nine-point list of treatment criteria; Fertility Europe and the European Parliamentary Forum for Sexual and Reproductive Rights call for a ‘game-changing’ shift in policies.

What makes the ‘perfect’ ART country? There are nine criteria, according to a new review of policies in Europe produced by ESHRE’s partner consumer group Fertility Europe and the European Parliamentary Forum for Sexual and Reproductive Rights.(1) Not surprisingly, few countries meet every criterion:

* Dedicated ART legislation providing stability of access
* National registers of treatments and donors
* Access to treatments for all who need them
* Access to genetic testing for serious diseases
* Non-anonymous donation
* Full funding of treatment, to include six IUIs and six IVF/ICSIs
* Psychological support
* Patients consulted before any regulatory changes
* Fertility education in schools

As ever, the review, launched as an Atlas of Fertility Treatment Policies in mid-December, found a patchy picture of regulation and funding, with just four countries rated as ‘excellent’ (Belgium, Israel, Netherlands and France) and scoring 84% or more according to the criteria. At the other end of the scale, 11 countries were rated as ‘poor’ or ‘exceptionally poor’, scoring just 50% or less. These included Belarus, Czech Republic, Switzerland, Turkey, Ireland and Poland.

As a result, the authors called for a European ‘game-changing movement’ in infertility by which policymakers would recognise the universal rights of people to have children, ensure fair access to treatment and provide public funding.

Among the 43 countries surveyed, 38 were found to have dedicated laws on reproductive technologies and 33 a national register of activity. However, among treatments the ‘most notable trend appears to be a clear bias towards heterosexual couples at the expense of single people and LGBT couples’. For example, 41 countries provide donor insemination to heterosexual couples – yet only 19 to female couples and 30 to single women.

Funding was also found to be wanting across the entire continent. Only 12 countries offer up to six funded cycles of IUI and only three offer up to six fully funded cycles of IVF/ICSI - with 35 offering no more than partial funding.

In introducing the Atlas, Anita Fincham, manager of Fertility Europe, said: ‘Every country deserves to be a perfect country with good regulations granting equal, safe and efficient access to fertility treatment to all who need it; good regulations that consider rights and wellbeing of all parties involved including children and donors. Fertility treatment should be offered as part of health system without discrimination against sexual orientation and civil status. This Atlas is to support the European and national policymakers in understanding how to make their country perfect.’(2)

Opening the launch of the Atlas, Dublin MEP Frances Fitzgerald spoke of the ‘heart-wrenching’ appeals of infertile people across Europe and the denial of their rights to have children of their own. The Atlas, she said, highlights just where in Europe fertility treatments are easily accessible and where more needs to be done for those facing the prospect of infertility. She reaffirmed the European Parliament’s 2008 call for universal access to treatment, noting that since then there had been notable advances but that it’s now time for governments to ‘roll up their sleeves’ and recognise what more can be done to meet the reproductive rights of individuals and families. Such sentiments were echoed by ESHRE’s Past Chair Cristina Magli in her comments on the survey’s results, hoping that those countries not rated ‘excellent’ or ‘good’ in the rankings would look at the data to improve their policies.

The input of ESHRE, based largely on data from the EIM Consortium’s Survey on ART and IUI: legislation, regulation, funding and registries in European countries, was represented by ESHRE Chair Carlos Calhaz Jorge.(3) An additional psychological perspective was provided by former co-ordinator of the SIG Psychology & Counselling Mariana Martins, who emphasised the societal trends now implicated in infertility, and particularly those associated with donor conception. On the latter, the review found that 18 countries continue to make donation strictly anonymous (‘This is bad,’ said Fertility Europe’s Anita Fincham, reiterating the group’s advocacy of non-anonymous donation), 11 countries offer mixed anonymous and non-anonymous donation, and 11 countries offer identity released schemes.

The Atlas’s appeal for state funding of ART and recognition of reproductive rights as defined by the WHO and European Parliament will be familiar to ESHRE members, but they too will know that expediency and politics usually define the place of ART in national landscapes. But now, for the first time, we have a case for reproductive rights made with the support of evidence and not just of rhetoric, and the regulatory anomalies exposed by the data cannot be merely brushed aside.

1. See
2. See
3. Calhaz-Jorge C, De Geyter CH, Kupka MS, et al. Survey on ART and IUI: legislation, regulation, funding and registries in European countries: The European IVF-monitoring Consortium (EIM) for the European Society of Human Reproduction and Embryology (ESHRE). Hum Reprod Open 2020(1): hoz044. doi: 10.1093/hropen/hoz044

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