As populations age, time to talk about fertility

DISCLAIMER: All opinions in this column reflect the views of the author(s), not of EURACTIV Media network.

In vitro fertilisation (IVF) has made it possible to treat infertility, a medical condition afflicting a growing proportion of European citizens. [Shutterstock]

EU countries should take concrete actions to ensure that fertility treatments are reimbursed and made available irrespective of the income or place of residence of patients, writes Norica Nicolai.

Norica Nicolai is a Romanian lawyer and Member of the European Parliament for the Alliance of Liberals and Democrats for Europe (ALDE).

This year we celebrate 40 years since the conception of Louise Brown, the first person to be born through in vitro. Sir Robert G. Edwards, the British physiologist who developed the treatment, was awarded the Nobel Prize in Physiology or Medicine in 2010. His discovery has made it possible to treat infertility, a medical condition afflicting a growing proportion of European citizens.

Since that moment, approximately 6.5 million individuals have been born worldwide thanks to in vitro fertilisation. Yet, despite the huge medical progress that has been made, there is still a tremendous amount to do to ensure access to fertility treatments across the region, while at the same time also improving treatment outcomes.

Today there is much talk of Europe’s demographic challenge, and on its implications for the sustainability of our economic and social systems. The European population is ageing, with many countries falling under the desired birth rate of 2.1 children per woman, the amount estimated to keep the population stable. In fact, the average number of children per woman in the European Union is as low as 1.58.

Furthermore, growing life expectancy combined with falling birth rates has resulted in a steady rise in the proportion of older people in EU countries. In the meantime, couples reporting infertility in centres across Europe is increasing by 8 to 9% annually.

Infertility is a medical condition, as recognised by the World Health Organisation, which prevents people of reproductive age from conceiving naturally. A woman’s fertility peaks in her mid-20’s and declines rapidly after the age of 35.

But this is not just an issue that affects women: as a man ages, their chances of conceiving and having a healthy child also decline. Medically assisted reproduction (MAR) is a set of medical treatments that support individuals who want to start a family when spontaneous conception cannot be achieved due to infertility problems.

In 2008, an own-initiative report from the European Parliament “on the demographic future of Europe” (2007/2156 (INI)) called upon “all member states to ensure the right of couples to universal access to infertility treatments.”

Yet today inequality of access to fertility treatment still exists right across Europe. This includes disparity in the types of treatment offered, variations in eligibility criteria to access treatment and reimbursement policies.

In many places across Europe, fertility treatments are being restricted, leading to access being described as a “postcode lottery”, with massive discrepancies in access to treatment between areas in a given country.

While some are able to ensure access through private care, what about those who cannot afford treatments? Unsurprisingly, countries with the highest public reimbursement for MAR have seen the highest rates of people who are able to start families thanks to the treatments.

In the report from 2008, The European Parliament recognised that infertility can cause severe side effects, leading to a sense of loss and diminished self-esteem in a great number of people.

Yet the stigma and taboos around infertility persist to this day, starting at familial level and ending at political leaders level. Indeed, many of those affected experience difficulty discussing infertility with their partner or healthcare provider, and those who struggle with infertility often report feeling forever changed by the experience.

While a number of countries have, over the last few years, launched National Plans for Fertility focused on education and awareness raising activities, limited information and education on infertility remain common across the EU.

Over the past 10 years, little has been done to address the concerns raised by the European Parliament. It is now time for member states to take concrete actions to ensure that fertility treatments are reimbursed, with treatments of scientifically proven benefit to patients made available, irrespective of their income or place of residence.

That is why as this week is Fertility Week, I write to you to join the conversation online to show the impact fertility is currently having on Europe. You might see a lot around #40reasons why fertility matters to Europe, but let me assure you that there are many more. I fundamentally believe that this is not only a personal matter but a matter for Europe that is strongly connected to our demographic, economic and societal challenges.


Between 6 and 12 November 2017, the second annual European Fertility Week takes place. This year, Fertility Europe (an umbrella association of European infertility patient organisations) aims to snap Europe to attention by providing #40reasons to drive forward the fertility conversation. Each of the #40reasons is a relevant nugget of truth pulled from all aspects of European life, from economics to mental health.

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