Helen KendrewChair

ESHRE Paramedical Board

A Policy Audit onFertility - Analysis of

9 EU Countries

28 March 2017

European Parliament

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

Methodology

Country selection -balanced geography

Questionnaire

Interviews -one to one, patient groups, fertility specialists

Written input

Czech Republic

France Germany Italy Poland

Romania Spain Sweden United Kingdom

Countries

Overview

Key facts and figures

Infertility policies

Screening and diagnosis

Treatment

Reimbursement/state funding

Awareness raising activities

Future outlook

Country chapter structure

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

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

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

Education

HFEA Website

Professional societies

Clinics

Newspapers, Magazines

television and radio

Websites

Patient forums

Novel and miraculous

interventions

Education……age?

Future outlook

Reduction in state funded treatment

Tariff payment

Underestimation of the psychological burden on the NHS

Brexit

Key findings

•Health literacy, stigma and taboos

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

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

Key findings

Variety of biological factors (age most common)

Italy and Spain –medical certificate

Poland ceased state funding in June 2016

Eligibility for treatment

reimbursement

1st line of treatment available

IVF

Surrogacy, gamete and embryo donnation

Public debate

Key findings

UK

Italy

Spain

Germany

Intra-regional variation state funded MAR

Sweden

UK

Wait times, psychological counselling variability

High variability

Reimburse-ment

Key findings

Thank you!