This document summarizes a policy audit analyzing fertility policies in 9 EU countries. It finds that across the countries studied, there is limited public education and information about infertility, which is often seen as a social rather than medical issue. As a result, infertility remains stigmatized with few avenues for public discussion. Treatment availability and reimbursement also varies significantly between countries, with options ranging from full coverage of multiple IVF cycles to no state support at all. Psychological counseling is inconsistently provided as well. Overall the report identifies a need for improved health literacy, consistent access to care, and reducing the social stigma surrounding infertility across Europe.

1. Helen Kendrew
Chair
ESHRE Paramedical
Board

2. A Policy Audit on
Fertility - Analysis of
9 EU Countries
28 March 2017
European Parliament

3. Infertility
WHO
definition
no pregnancy
after 12
months
One in six
couples
seek medical
advice and
help to create
a family
Prevalence
25 million EU
Citizens
Education Stigma

4. Methodology
Country
selection -
balanced
geography
Questionnaire
Interviews -
one to one,
patient groups,
fertility
specialists
Written input

5. Czech
Republic
France Germany Italy Poland
Romania Spain Sweden United
Kingdom
Countries

6. Overview
Key facts and figures
Infertility policies
Screening and diagnosis
Treatment
Reimbursement/state funding
Awareness raising activities
Future outlook
Country chapter structure

7. United Kingdom
• Infertility rate - 2.1% Primary; 8.6% Secondary
• Mean age of first delivery - 30.2 years
• Treatments offered
• Investigations
• Fertility drugs
• Intrauterine Insemination
• IVF
• ICSI
• Embryo freezing
• Oocyte freezing
• Sperm freezing
• PGD
• PGS
• Surrogacy

8. United Kingdom
Fertility Treatment
success rates
27% IVF,
27.8% ICSI
Reimbursement/state
funding
England:
• Varies by region
Scotland and Wales:
• 2 cycles of IVF
• State funded up to the
age of 40
Northern Ireland:
• 1 fresh and 1 frozen
• State funded up to the
age of 40
Awareness raising
campaigns
National Fertility
Awareness
Week
Fertility Fairness
Campaign

9. United Kingdom
• Private and NHS Clinics
• Fertility Clinics regulated by the Human Fertilisation and
Embryology Authority (HFEA)
• 2013
• 41.3% NHS
• 58.7% Private
• Psychological counselling

10. Education
HFEA Website
Professional
societies
Clinics
Newspapers,
Magazines
television and
radio
Websites
Patient forums
Novel and
miraculous
interventions

11. Education……age?

12. Future outlook
Reduction in state funded treatment
Tariff payment
Underestimation of the psychological burden on
the NHS
Brexit

13. Key findings
•Health literacy, stigma and taboos

14. Key findings:
Health literacy, education and information
Common to all
countries in the
study
Limited
information
and
education
Underestimated
and
misunderstood
Infertility
and fertility
protection
Patient groups
HCP organisations
Some government
involvement
Awareness
raising
campaigns
driven by:
Prevailing
perception that it
is a social, not a
medical condition
Considerable
issue to be
addressed
Difficulty
discussing with
partner/HCP
Male infertility
stigma
Infertility
stigma and
taboos

15. Key findings
CZ, UK largest no
of options
followed by ES
Available
treatment
options vary Making treatment
availability more
restrictive
Rules,
conditions
and structures
in place
Patients identify a
common need not
only before but
also during and
after treatment
Psychological
counselling

16. Key findings
Variety of biological
factors (age most
common)
Italy and Spain –
medical certificate
Poland ceased
state funding in
June 2016
Eligibility for
treatment
reimbursem
ent
1st line of treatment
available
IVF
Surrogacy, gamete
and embryo
donnation
Public
debate

17. Key findings
UK
Italy
Spain
Germany
Intra-regional
variation state
funded MAR
Sweden
UK
Wait times,
psychological
counselling
variability
High variability
Reimburse-
ment

18. Key findings

20. Thank you!