Tuesday 12 December 2017

Free IVF linked to small European birth rate rise as families shrink

The milestone figure was announced at a meeting of the European Society of Human Reproduction and Embryology in Turkey
The milestone figure was announced at a meeting of the European Society of Human Reproduction and Embryology in Turkey

John von Radowitz

ACCESS to free fertility treatment has a small but positive effect on national birth rates, a European study has shown.

The finding could have important policy implications in the EU where there is increasing concern over shrinking families.

A lifetime average of 2.1 live births per woman is needed to replace the EU's population with adequate numbers of babies, according to experts.

But fertility rates in Europe have declined well below this figure in recent decades. The lowest "total fertility rate" (TFR) figure of 1.45 live births per woman was recorded in 2002, and in 2009 it stood at 1.59.

A low birth rate can have devastating effects on economies, leading to a large dependent elderly population and too few working age people creating wealth.

One factor that can help lift birth rates is state-funded fertility treatment, the new research suggests.

Scientists led by health economist Dr Mark Connolly, from the University of Groningen in the Netherlands, assessed the reimbursement policies of 23 European countries.

Each was given an index score ranging from zero to 18, with higher numbers indicating a greater willingness by the state to pay for fertility treatment.

Countries with the most generous funding policies were Belgium, France and Slovenia, with scores between 14 and 18.

The UK, together with Russia and Ireland, had the least generous policies and scored less than three.

A "significant relationship" was seen between reimbursement levels and the annual contribution of assisted reproduction technology (ART) to national birth numbers. Greater access to free IVF (in-vitro fertilisation) led to fertility treatment making a bigger impact on national birth statistics.

"This finding has important policy implications for national authorities concerned about ageing populations and interested in policies for influencing national birth rates," said Dr Connolly, who presented the results at the annual meeting of the European Society of Human Reproduction and Embryology in Istanbul, Turkey.

"Although the influence on birth rates is small, the relationship is positive and provides an opportunity to compare with other policies implemented by local and national governments to influence birth rates."

A striking example of the effect was seen in Denmark, where public funding cuts led to the introduction of a 50pc co-payment scheme for fertility treatment in 2011.

The number of treatments subsequently fell, resulting in a calculated loss of around 700 children compared with 2010 - 1.2pc of the national birth cohort. The annual birth rate in Denmark in 2011 was the lowest for 13 years.

The research also showed that higher levels of state funding correlated with more cycles of IVF treatment being performed.

"If one considers medical need is similar across countries, then the data here suggest a great unmet need in those countries with limited reimbursement," said Dr Connolly.

Britain has bucked the trend seen in many other European countries by experiencing a mini "baby boom" in recent years.

In 2001, the UK had a total fertility rate of 1.64 live births per woman. By 2008 it had risen to 1.97, and last year it dipped slightly to 1.91. However, it still remains below the "replacement" figure of 2.1.

Why rates have risen in the UK is unclear, but the reason is not immigration, say experts. Policies to reduce child poverty may be one factor, but part of the reason could also be related to IVF treatment and women over the age of 40 giving birth.

Clare Lewis-Jones, from the National Infertility Awareness Campaign (NIAC), said: "It is totally unacceptable that many other European countries have better service provision for infertility patients than the UK, where IVF was pioneered.

"Infertility treatment has for too long been seen as a low priority, failing the one in six couples who live with the devastating impact this illness has on their lives. NIAC will continue to fight for fair and equitable access to IVF and ICSI on the NHS, because those suffering from the disease of infertility have the right to expect the chance to try to have a healthy baby of their own."

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