Editing Assisted reproductive technology (section)

==By country==

=== United States ===
Many Americans do not have [[health insurance|insurance]] coverage for fertility investigations and treatments. Many states are starting to mandate coverage, and the rate of use is 278% higher in states with complete coverage.<ref>{{cite journal |vauthors=Jain T, Harlow BL, Hornstein MD |title=Insurance coverage and outcomes of ''in vitro'' fertilization |journal=N. Engl. J. Med. |volume=347 |issue=9 |pages=661–6 |date=August 2002 |pmid=12200554 |doi=10.1056/NEJMsa013491|doi-access=free }}</ref>

There are some health insurance companies that cover diagnosis of infertility, but frequently once diagnosed will not cover any treatment costs.{{citation needed|date=February 2022}}

Approximate treatment/diagnosis costs in the United States, with inflation, as of {{Inflation/year|index=US}} (US$):
* Initial workup: [[hysteroscopy]], [[hysterosalpingogram]], [[blood test]]s ~${{Inflation|index=US|value=2000|start_year=2005|r=-2|fmt=c}}{{Citation needed|date=September 2024}}
* Sonohysterogram (SHG) ~ ${{Inflation|index=US|value=600|start_year=2005|r=-1|fmt=c}}–${{Inflation|index=US|value=1000|start_year=2005|r=-2|fmt=c}}{{Citation needed|date=September 2024}}
* Clomiphene citrate cycle ~ ${{Inflation|index=US|value=200|start_year=2005|r=-1|fmt=c}}–${{Inflation|index=US|value=500|start_year=2005|r=-1|fmt=c}}{{Citation needed|date=September 2024}}
* IVF cycle ~ ${{Inflation|index=US|value=10000|start_year=2005|r=-2|fmt=c}}–${{Inflation|index=US|value=30000|start_year=2005|r=-2|fmt=c}}{{Citation needed|date=September 2024}}
* Use of a [[surrogate mother]] to carry the child – dependent on arrangements

Another way to look at costs is to determine the expected cost of establishing a pregnancy. Thus, if a clomiphene treatment has a chance to establish a pregnancy in 8% of cycles and costs ${{Inflation|index=US|value=500|start_year=2005|r=-1|fmt=c}}, the expected cost is ${{Inflation|index=US|value=6000|start_year=2005|r=-2|fmt=c}} to establish a pregnancy, compared to an IVF cycle (cycle fecundity 40%) with a corresponding expected cost of ${{Inflation|index=US|value=30000|start_year=2005|r=-2|fmt=c}} (${{Inflation|index=US|value=12000|start_year=2005|r=-2|fmt=c}} × 40%).{{Citation needed|date=September 2024}}

For the community as a whole, the cost of IVF on average pays back by 700% by tax from future employment by the conceived human being.<ref>{{cite journal |vauthors=Connolly MP, Pollard MS, Hoorens S, Kaplan BR, Oskowitz SP, Silber SJ |title=Long-term economic benefits attributed to IVF-conceived children: a lifetime tax calculation |journal=Am J Manag Care |volume=14 |issue=9 |pages=598–604 |date=September 2008 |pmid=18778175 |url=http://www.ajmc.com/pubMed.php?pii=10709}}</ref>

===European Union===
[[File:Europe and assisted reproductive technology.svg|thumb|Number of assisted reproductive technology cycles in Europe between 1997 and 2014<ref name=edjnet>{{cite news |last1=Jézéquélou |first1=Orlane |title=How does assisted reproductive technology work in Europe? |url=https://www.europeandatajournalism.eu/News/Data-news/How-does-assisted-reproductive-technology-work-in-Europe |access-date=29 November 2019 |work=Alternatives Economiques/EDJNet |date=23 October 2019}}</ref><ref>{{cite journal |last1=De Geyter |first1=Ch. |last2=Calhaz-Jorge |first2=C. |last3=Kupka |first3=M.S. |last4=Wyns |first4=C. |last5=Mocanu |first5=E. |last6=Motrenko |first6=T. |last7=Scaravelli |first7=G. |last8=Smeenk |first8=J. |last9=Vidakovic1 |first9=S. |last10=Goossens |first10=V. |title=ART in Europe, 2014: results generated from European registries by ESHRE: The European IVF-monitoring Consortium (EIM) for the European Society of Human Reproduction and Embryology (ESHRE) |journal=Human Reproduction |date=September 2018 |volume=33 |issue=9 |pages=1586–1601 |doi=10.1093/humrep/dey242 |pmid=30032255 |doi-access=free |hdl=10451/49519 |hdl-access=free }}</ref>]]
In [[Europe]], 157,500 children were born using assisted reproductive technology in 2015, according to the [[European Society of Human Reproduction and Embryology]] (ESHRE).<ref name=edjnet /> But there are major differences in legislation across the Old Continent.
A [[Directive (European Union)|European directive]] fixes standards concerning the use of human tissue and cells,<ref>{{cite web |title=Directive 2004/23/EC of the European Parliament and of the Council of 31 March 2004 on setting standards of quality and safety for the donation, procurement, testing, processing, preservation, storage and distribution of human tissues and cells |url=https://eur-lex.europa.eu/legal-content/en/TXT/HTML/?uri=CELEX:32004L0023 |access-date=3 December 2019}}</ref> but all ethical and legal questions on ART remain the prerogative of [[Member state of the European Union|EU member states]].

[[File:Assisted reproductive technology across Europe.svg|left|thumb|Conditions of assisted reproductive technology in different European countries:<ref name=edjnet /><ref>{{Cite web|url=https://www.rainbow-europe.org/#0/8682/0|title=Rainbow Map|access-date=2019-11-12|language=en|publisher=ILGA-Europe}}</ref>
{{legend|#a6ce39|ART authorized for lesbian couples}}
{{legend|#b2df8a|ART authorized for single women}}
{{legend|#33a02c|ART authorized for single women and lesbian couples}}
{{legend|#6F2C91|ART prohibited for single women and lesbian couples}}]]
Across Europe, the legal criteria per availability vary somewhat.<ref>{{Cite web|url=https://www.ieb-eib.org/docs/pdf/2019-04/doc-1554801302-21.pdf|title=Encadrement juridique international dans les différents domaines de la bioéthique|access-date=2019-11-04|language=fr|publisher=Agence de la biomédecine}}</ref> In 11 countries all women may benefit; in 8 others only heterosexual couples are concerned; in 7 only single women; and in 2 ([[Austria]] and [[Germany]]) only lesbian couples.
[[Spain]] was the first European country to open ART to all women, in 1977, the year the first sperm bank was opened there. In [[France]], the right to ART is accorded to all women since 2019. In the last 15 years, legislation has evolved quickly. For example, [[Portugal]] made ART available in 2006 with conditions very similar to those in France, before amending the law in 2016 to allow lesbian couples and single women to benefit. [[Italy]] clarified its uncertain legal situation in 2004 by adopting Europe's strictest laws: ART is only available to heterosexual couples, married or otherwise, and sperm donation is prohibited.

Today, 21 countries provide partial public funding for ART treatment. The seven others, which do not, are [[Ireland]], [[Cyprus]], [[Estonia]], [[Latvia]], [[Luxembourg]], [[Malta]], and [[Romania]].
Such subsidies are subject to conditions, however. In [[Belgium]], a fixed payment of €1,073 is made for each full cycle of the IVF process. The woman must be aged under 43 and may not carry out more than six cycles of ART. There is also a limit on the number of transferable embryos, which varies according to age and the number of cycles completed.
In France, ART is subsidized in full by national health insurance for women up to age 43, with limits of 4 attempts at IVF and 6 at artificial insemination.
[[Germany]] tightened its conditions for public funding in 2004, which caused a sharp drop in the number of ART cycles carried out, from more than 102,000 in 2003 to fewer than 57,000 the following year. Since then the figure has remained stable.

17 countries limit access to ART according to the age of the woman. 10 countries have established an upper age limit, varying from 40 ([[Finland]], [[Netherlands]]) to 50 (including Spain, [[Greece]] and Estonia).
Since 1994, France is one of a number of countries (including Germany, Spain, and the UK) which use the somewhat vague notion of "natural age of procreation". In 2017, the steering council of France's Agency of Biomedicine established an age limit of 43 for women using ART.
10 countries have no age limit for ART. These include Austria, [[Hungary]], Italy and [[Poland]].

Most European countries allow donations of gametes by third parties. But the situations vary depending on whether sperm or eggs are concerned. Sperm donations are authorized in 20 EU member states; in 11 of them anonymity is allowed. Egg donations are possible in 17 states, including 8 under anonymous conditions.
On 12 April, the [[Council of Europe]] adopted a recommendation which encourages an end to anonymity.<ref>{{Cite web|url=http://assembly.coe.int/nw/xml/XRef/Xref-DocDetails-EN.asp?FileID=27680&lang=EN|title=Recommendation 2156 (2019){{dash}}Anonymous donation of sperm and oocytes: balancing the rights of parents, donors and children|access-date=2019-11-12}}</ref> In the UK, anonymous sperm donations ended in 2005 and children have access to the identity of the donor when they reach adulthood.
In France, the principle of anonymous donations of sperm or embryos is maintained in the law of bioethics of 2011, but a new bill under discussion may change the situation.<ref>{{Cite web|url=https://www.alternatives-economiques.fr/pma-panique-filiation/00090402|title=PMA: panique dans la filiation|author=Céline Mouzon|access-date=2019-11-12|language=fr|date=2019-09-23}}</ref>

=== United Kingdom ===
In the United Kingdom, all patients have the right to preliminary testing, provided free of charge by the [[National Health Service]] (NHS). However, treatment is not widely available on the NHS and there can be long waiting lists. Many patients therefore pay for immediate treatment within the NHS or seek help from private clinics.

In 2013, the [[National Institute for Health and Care Excellence]] (NICE) published new guidelines about who should have access to IVF treatment on the NHS in England and Wales.<ref>{{cite web|title=IVF|url=http://www.nhs.uk/conditions/IVF/Pages/Introduction.aspx|publisher=NHS Choices|access-date=19 April 2014|url-status=live|archive-url=https://web.archive.org/web/20140420030919/http://www.nhs.uk/conditions/IVF/Pages/Introduction.aspx|archive-date=20 April 2014}}</ref>

The guidelines say women aged between 40 and 42 should be offered one cycle of IVF on the NHS if they have never had IVF treatment before, have no evidence of low ovarian reserve (this is when eggs in the ovary are low in number, or low in quality), and have been informed of the additional implications of IVF and pregnancy at this age. However, if tests show IVF is the only treatment likely to help them get pregnant, women should be referred for IVF straight away.

This policy is often modified by local [[Clinical commissioning group|Clinical Commissioning Groups]], in a fairly blatant breach of the [[NHS Constitution for England]] which provides that patients have the right to drugs and treatments that have been recommended by NICE for use in the NHS. For example, the Cheshire, Merseyside and West Lancashire Clinical Commissioning Group insists on additional conditions:<ref>{{cite web|title=Services & how we can help|url=http://www.thehewittfertilitycentre.org.uk/funding-options/|publisher=Liverpool Women's NHS Foundation Trust|access-date=19 April 2014|url-status=dead|archive-url=https://web.archive.org/web/20140624054259/http://thehewittfertilitycentre.org.uk/funding-options/|archive-date=2014-06-24}}</ref>
* The person undergoing treatment must have commenced treatment before her 40th birthday;
* The person undergoing treatment must have a BMI of between 19 and 29;
* Neither partner must have any living children, from either the current or previous relationships. This includes adopted as well as biological children; and,
* Sub-fertility must not be the direct result of a sterilisation procedure in either partner (this does not include conditions where sterilisation occurs as a result of another medical problem). Couples who have undertaken a reversal of their sterilisation procedure are not eligible for treatment.

=== Canada ===
{{See also|Assisted Human Reproduction Act}}
Some treatments are covered by [[OHIP]] (public health insurance) in Ontario and others are not. Women with bilaterally blocked fallopian tubes and are under the age of 40 have treatment covered but are still required to pay test fees (around CA$3,000–4,000). Coverage varies in other provinces. Most other patients are required to pay for treatments themselves.<ref>{{Cite web|url=http://www.ivfcanada.com/services/fees/general_fee_schedule.cfm|archive-url=https://web.archive.org/web/20090808064341/http://www.ivfcanada.com/services/fees/general_fee_schedule.cfm|url-status=dead|title=IVF Canada|archive-date=August 8, 2009}}</ref>

=== Germany ===
On 27 January 2009, the [[Federal Constitutional Court]] ruled that it is unconstitutional, that the health insurance companies have to bear only 50% of the cost for IVF.<ref>[http://www.samenspender-info.de/zuschuesse-kuenstliche-befruchtung.html Zuschüsse der Krankenversicherung für eine künstliche Befruchtung] {{webarchive|url=https://web.archive.org/web/20130208072207/http://www.samenspender-info.de/zuschuesse-kuenstliche-befruchtung.html |date=2013-02-08 }} Retrieved 2. January 2013.</ref> On 2 March 2012, the [[Federal Council (Germany)|Federal Council]] has approved a draft law of some federal states, which provides that the federal government provides a subsidy of 25% to the cost. Thus, the share of costs borne for the pair would drop to just 25%.<ref>[http://www.insemination-erfolg.de/finanzierung-befruchtung.html Finanzierung künstlicher Befruchtung] {{webarchive|url=https://web.archive.org/web/20130219152136/http://www.insemination-erfolg.de/finanzierung-befruchtung.html |date=2013-02-19 }} Retrieved 2. January 2013.</ref> Since July 2017, assisted reproductive technology is also allowed for married lesbian couples, as German parliament allowed [[Same-sex marriage in Germany|same-sex marriages in Germany]].

=== France ===
In July 2020, the [[French Parliament]] allowed assisted reproductive technology also for lesbian couples and single women.<ref>[https://www.queer.de/detail.php?article_id=36724 Queer.de: Frankreich: Künstliche Befruchtung auch für lesbische Paare (german)], July 21, 2020</ref><ref>[https://www.noz.de/deutschland-welt/politik/artikel/2097957/frankreich-legalisiert-kuenstliche-befruchtung-fuer-alle-frauen NOZ.de: Beifall im Parlament: Frankreich legalisiert künstliche Befruchtung für alle Frauen (german)], July 31, 2020</ref>

=== Cuba ===
Cuban sources mention that assisted reproduction is completely legal and free in the country.<ref>http://www.ahora.cu/fr/sante/5715-reproduction-assistee-et-droit-du-travail-a-cuba (in French), on ''Ahora''</ref><ref>http://www.granma.cu/cuba/2020-01-15/reproduccion-asistida-en-cuba-nuevas-razones-para-la-felicidad (in Spanish), on ''Granma.cu''</ref>

=== India ===
The Government of India has notified the Surrogacy (Regulation) Act 2021 and the Assisted Reproductive Technology (Regulation) Act 2021<ref>{{Cite web|title=Govt notifies laws to regulate surrogacy, assisted reproductive technology|url=https://www.businesstoday.in/latest/policy/story/govt-notifies-laws-to-regulate-surrogacy-assisted-reproductive-technology-320438-2022-01-26|access-date=2022-02-03|website=Business Today|date=26 January 2022 |language=en}}</ref> to regulate the practice of ART. Prior to that, the National Guidelines for Accreditation, Supervision and Regulation of ART Clinics in India published by the Ministry for Health and Family Welfare, Government of India in the year 2005 was governing the field.<ref>{{Cite web|title=IVF Clinics|url=https://pib.gov.in/newsite/PrintRelease.aspx?relid=118621|access-date=2022-02-03|website=pib.gov.in}}</ref> Indian law recognises the right of a single woman, who is a major, to have children through ART.<ref>{{Cite web|last=A|first=Aruna|date=2021-09-14|title=Need to understand the rights of a single mother by choice.|url=https://www.legalbay.co.in/post/need-to-understand-the-rights-of-a-single-mother-by-choice|access-date=2022-02-03|website=Legal Bay|language=en}}</ref>