Demographic relevancy of increased use of assisted reproduction in European countries

Abstract

Background: Delayed childbearing in European countries has resulted in an increase in the number of women having children later in life. Thus more women face the problem of age-related infertility and cannot achieve their desired number of children. Childbearing postponement is one of the main reasons for the increasing use of assisted reproductive technology (ART) and conversely, the latter may be one of the factors contributing to the rise in female childbearing age. The research goal of our article is to evaluate the demographic importance of ART increased use and to examine its impact on both the fertility rate and birth timing.

Methods: Comparative analysis based on demographic and ART data collected by the European IVF-monitoring (EIM) Consortium for the European Society of Human Reproduction and Embryology (ESHRE).

Results: Most countries with a higher total fertility rate (TFR) also registered a higher number of treatment cycles per 1 million women of reproductive age. Despite the positive relationship between the postponement rate and the demand for ART among women aged 35 and older, the highest share of children born after ART was not found in countries characterized by a "delayed" fertility schedule. Instead, the highest proportion of ART births was found in countries with fertility schedules concentrated on women aged between 25 and 34. Accordingly, the effective use of ART can be expected in populations with a less advanced postponement rate.

Conclusions: ART can have a demographic relevancy when women take advantage of it earlier rather than later in life. Furthermore it is suggested that the use of ART at a younger age increases women's chance of achieving their reproductive goals and reduces the risk of age-related infertility and failed ART. Based on a demographic approach, reproductive health policy may become an integral part of policies supporting early childbearing: it may keep women from delaying too long having children and increase the chance of diagnosing potential reproductive health problems requiring a timely ART application.

Figure 1

Trends in percentage of ART births between 1997 and 2009 in selected European countries. Data sources: ESHRE, The Czech National ART Register.

Figure 2

European countries by TFR and ART cycles per million women aged 15–49, 1997. Data sources: ESHRE, Eurostat.

Figure 3

European countries by TFR and ART cycles per million women aged 15–45, 2009. Data sources: ESHRE, Eurostat.

Figure 4

European countries by percentage of ART births and fertility postponement index, 2009. ^a Lesthaeghe & Niedert´s fertility postponement index (FPI) is the ratio of the sum of ASFR above age 29 to the sum of these rates between ages 20 and 29. Data sources: ESHRE, Eurostat, The Czech National ART Register.

Figure 5

Proportion of ASFRs on TFR in%, Denmark, Slovenia, Italy, 2009. Data source: Eurostat.

Figure 6

European countries by percentage of women 35+ treated with IVF/ICSI and fertility postponement index, 2009. ^a Lesthaeghe & Niedert´s fertility postponement index (FPI) is the ratio of the sum of ASFR above age 29 to the sum of these rates between ages 20 and 29. Data sources: ESHRE, Eurostat.