Fertility funding can boost birth rates

by Gary Finnegan – World Health Matters (Holland) –

Higher levels of public reimbursement for fertility treatment can positively influence national birth rates, according to a study by a Dutch research group.  

The findings come from a study reported at the annual meeting the European Society of Human Reproduction and Embryology. The results, says health economist Dr Mark Connolly from the University of Groningen in the Netherlands, reflect the wide variety of reimbursement policies throughout Europe and come at a time when many national and local authorities have made plans to cut back their IVF funding as a cost-cutting initiative.

Dr Connolly and colleagues examined reimbursement policies of 23 European countries, using an index score ranging from 0 to 18; the higher index scores indicated fuller state funding/reimbursement for treatment. The countries with the most generous funding policies were Belgium, France and Slovenia (with scores between 14 and 18); those with the least generous were the UK, Russia and Ireland (all with scores under 3).

The findings have important policy implications for national authorities concerned about ageing populations and interested in policies for influencing national birth rates, according to Dr Connolly. “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.”

Results also showed that in countries with higher levels of reimbursement a higher volume of ART cycles is performed. For example, data for 2008 showed that more ART cycles per million population were performed in Belgium and Denmark (2,479 and 2,450 ART cycles per million population in 2008) than in Germany, Italy and UK (801, 807 and 825 cycles).

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

While the study did not find correlations between reimbursement and patient age (or deliveries per cycle, or multiple embryo transfers), there was a trend towards more singleton deliveries in countries with higher levels of reimbursement, suggesting that results in poorly reimbursed countries are more dependent on a single cycle of treatment than on single embryo transfers in cumulative cycles.

Interestingly, when Denmark introduced a 50% co-payment scheme in 2011, there was a dramatic reduction in the number of ART cycles performed. This, according to Professor Anders Nyboe Andersen, from Rigshospitalet in Copenhagen and a co-author of the study, represents the loss of approximately 700 children from 2010, 1.2% of the national birth cohort.