ART and IUI in Europe – ESHRE EIM survey

Overview of legislation, regulation, funding and registries of ART and IUI in Europe

The European IVF-monitoring Consortium (EIM) produced an overview on ART (assisted reproduction techniques) and IUI (intra uterine insemination). They collected the information about regulation, funding and registries in European countries for the European Society of Human Reproduction and Embryology (ESHRE).

The study question was: How are ART and IUI regulated, funded and registered in European countries?

Main findings

Information was received from 43 out of the 45 European countries where ART and IUI are performed and the data provided was valid for 31st December 2022. There were 39 countries with specific legislation on ART, and artificial insemination was considered an ART technique in 33 of them. Accessibility is limited to infertile couples only in 8 of the 43 countries. In 5 countries, ART and IUI are permitted also for treatments of single women and all same sex couples, while a total of 33 offer treatment to single women and 19 offer treatment to female couples. Use of donated sperm is allowed in all except 2 countries, oocyte donation is allowed in 38, simultaneous donation of sperm and oocyte is allowed in 32, and embryo donation is allowed in 29 countries.

Preimplantation genetic testing (PGT)-M/SR (for monogenetic disorders, structural rearrangements) is not allowed in 3 countries and PGT-A (for aneuploidy) is not allowed in 10; surrogacy is accepted in 15 countries.

Except for marital/sexual situation, female age is the most frequently reported limiting criterion for legal access to ART: minimal age is usually set at 18 years and the maximum ranges from 42 to 54 with some countries not using numeric definition. Male maximum age is set in very few countries. Where third-party donors are permitted, age is frequently a limiting criterion (male maximum age ranging from 35 to 50; female maximum age from 30 to 37).

Other legal restrictions in third-party donation are the number of children born from the same donor (or, in some countries, the number of families with children from the same donor) and, in 12 countries, there is a maximum number of oocyte donations.

How countries deal with the anonymity is diverse: strict anonymity, anonymity just for the recipients (not for children when reaching legal adulthood age), a mixed system (anonymous and non-anonymous donations), and strict non-anonymity. Inquiring about donors’ genetic screening showed that most countries have enforced either mandatory or scientific recommendations that exclude the most prevalent genetic diseases, although, again, diversity is evident.

Reimbursement/compensation systems exist in more than 30 European countries, with around 10 describing clearly defined maximum amounts considered acceptable. Public funding systems are extremely variable. One country provides no financial assistance to ART/IUI patients and three offer only minimal support. Limits to the provision of funding are defined in the others i.e. age (female maximum age is the most used), existence of previous children, BMI, maximum number of treatments publicly supported, and techniques not entitled for funding. In a few countries reimbursement is linked to a clinical policy. The definitions of the type of expenses covered within an IVF/ICSI cycle, up to which limit, and the proportion of out-of-pocket costs for patients are also extremely dissimilar.

National registries of ART are in place in 33 out of the 43 countries contributing to the survey and a registry of donors exists in 19 of them.

When comparing with the results of the previous survey (situation for 31st December 2018), the main changes are: an extension of the beneficiaries of ART techniques (and IUI), evident in nine countries; public financial support exists now in Albania and Armenia; in Luxembourg, the only ART centre expanded its on-site activities; donor-conceived children are entitled to know the donor identity in six countries more than in 2018; and four more countries have set a maximum number of oocyte donations. Find out more from the ESHRE EIM publication: Survey on ART and IUI: legislation, regulation, funding, and registries in European countries—an update

European Atlas of Fertility Treatment Policies 2024 illustrates the access to treatments in the European countries based on the selected criteria from ESHRE EIM survey.

Main findings from the EIM ESHRE survey 2018

Of the 43 countries performing ART and IUI in Europe, and participating in the survey, specific legislation exists in only 39 countries, public funding (also available in the 39 countries) varies across and sometimes within countries and national registries are in place in 31 countries.
The report reflects the situation in 43 countries on 31 December 2018. The changes in legislation that occurred since then are not included in the data presented.

Go to the 2018 study results or download the pdf of the study results.

European Atlas of Fertility Treatment Policies 2021 illustrates the access to treatments in the European countries based on the selected criteria from ESHRE EIM survey.