We have analyzed in previous articles the ethical, social and demographic implications of the increase in infertility (both female and male) in developed countries and the tendency to be a mother after the age of 30. This is generating an increase in the demand for assisted reproduction treatments (ART). Now, we will give a quick overview focusing on the evolution of ART in Europe.

An article published on the website “Reproductive BioMedicine Online” (September 2021) of the Science group, offers an updated vision of ART in Europe.

The article says that, in different countries of the European Union, laws that differ from one country to another were implemented. As stated in the aforementioned article: “While sex selection techniques for disease prevention in Europe are generally allowed in many countries, sex selection for social reasons has sparked a great ethical debate (Shenfield et al., 2003)”.

Although ART is now controlled by legislation, in almost all European countries there are substantial variations in the details. In this sense, a survey carried out by the European Society for Human Reproduction and Embryology (ESHRE) in 43 European countries, has shown that almost all of them (with the exception of Albania, Bosnia and Herzegovina, Ireland, Romania and Ukraine) have specific legislation in force (Calhaz-Jorge et al., 2020). The major legal variants were found in access to treatment (according to age, marital status), donation of gametes, preservation of fertility (cryopreservation of gametes or embryos) and public funding. The exception is given prior to cancer treatment.

11 countries access to ART is limited to heterosexual couples with a diagnosis of infertility

In 11 of the 43 countries that participated in the ESHRE study, access is limited to heterosexual couples with a diagnosis of infertility, excluding treatment of single women and lesbians.

Thirty-four of the 43 countries that participated have legal age limits for receiving treatment, for example, men and women must be over 18 years of age in 21 countries.

Female maximum age has also a legal limit in 18 countries (see HERE), ranging from 45 in Denmark and Belgium to 51 in Bulgaria (Calhaz-Jorge et al., 2020).

The use of donated sperm is allowed in almost all European countries. Egg donation is prohibited in Germany, Norway, Switzerland, and Turkey.

Genetic screening prior to implantation is not allowed in 9 countries

Genetic screening prior to implantation is not allowed in Denmark, France, Germany, Hungary, Lithuania, Norway, Slovenia, Sweden and the Netherlands.

Social freezing is not allowed in 8 countries

Freezing oocytes for non-medical purposes (social freezing) is not allowed in Austria, France, Hungary, Lithuania, Malta, Norway, Serbia and Slovenia, but it is allowed in Germany, Switzerland and Spain. Social, cultural, religious and legal factors in different countries explain some of these variations in regulations and in the application of ART, according to the authors of the aforementioned article (read HERE).

Assisted reproductive treatments in Europe including reproductive tourism

Some people travel to receive treatment in other countries so they can overcome these restrictions. This explains what has come to be called “reproductive tourism”, which is used to obtain ART modalities not available in the countries of origin. This cross-border movement can expose patients to exploitation and less controlled clinical settings.

The case of England and Wales is an example of the support of European governments for assisted reproductive techniques carried out abroad (reproductive tourism) and legalized in the country of origin of the intended couples/individuals (read HERE about the increase in legal paternity to intended parents in those countries).

While there is a change towards homogeneity in a growing number of countries, such as removing the anonymity of gamete donors or treating single women and lesbians, Europe continues to reflect a patchwork of ART laws and regulations (ESHRE, 2020).

Assisted reproductive treatments in Europe from a bioethical perspective

In the opinion of our Observatory, the trend towards homogeneity of legislation in Europe does not always mean a change for the better from a bioethical point of view. If the elimination of the anonymity of gamete donors and the establishment of age limits to access assisted reproduction are changes for the better (see HERE), the access to ART for same-sex couples and single women is not.


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