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Assisted reproduction is now more available and more frequent. It is fostered by the increasing age of primiparas

According to recent statistics, 20 - 25 % of couples in the Czech Republic face infertility. Nevertheless, they should approach a specialist, even if, after one year of trying, they are not able to conceive a child. Thanks to suitable and timely treatment, specialists can nowadays help in 95% of cases. From 2007 the number of artificial inseminations doubled, resulting in a quick increase of IVF centres in the Czech Republic. Detailed statistics dealing with the cases in which women (but also men) approach the specialists and the corresponding success rates are shown by unique outputs of the National Register of Assisted Reproduction from 2007 - 2013 from which also the statistics of the project "Czechia in data" draw information.

More cycles, more clinics 

How does the speech by numbers sound in the case of resolving the infertility problem? While in 2007 approximately 17,000 cycles of assisted reproduction (AR) took place, aiming for a pregnancy (in addition to them, IVF cycles aiming at the storage of ova and their usage in future also exist), in 2013 their number exceeded 27,000. In the Czech Republic the number of centres dealing with assisted reproduction also increased: While fifteen years ago there were 26 of them, in 2013 the AR methods were applied by 41 clinics. This increase was induced both by higher demand and also by the fact that their foundations or acquisitions represent an interesting investment opportunity. The Czech Republic can, given the high quality of care provided, pride itself on having an excellent reputation within Europe-wide context. 

"In past years we witnessed an extensive acquisition wave in the field of assisted reproduction. We can attribute this extraordinary interest in the branch especially to the considerable profitability of this type of health facilities and a further growing potential driven, in particular, by the continuing influx of foreign clients. As regards the attractiveness for the so-called "medical clients", the Czech Republic is among the absolute top. It is not only due to a high and, basically, "western" standard of services which are, nevertheless, provided for "eastern" prices but, in the area of IVF, also due to favourable and liberal legislation" comments Miroslav Svoboda, partner in charge of of the financial advisory function of Deloitte. 

The increased interest in the methods of assisted reproduction can be, according to Miloš Čekal, doctor of the Prague Centre of Reproductive Medicine GEST, explained as a result of several circumstances: "The methods of assisted reproduction gained wider awareness from the public and, today, they are much more available as can be seen by the quantity of the health facilities dealing with them. In the Czech Republic it is positively supported by the mood in society: The topic is not stigmatised among the public so people are not ashamed to speak about their troubles or seek a doctor. Nevertheless, it is also worth mentioning the increasing age of primiparas, ie, the women who postpone conception for various reasons and then can run into troubles when trying to become pregnant," explainsČekal. 

Note: The Cycle is a unit observed in the National Register of Assisted Reproduction. It is a process of monitoring and/or treatment directed at the pregnancy of a woman, mostly in the period between one menses and the next one. In the case of application of the assisted reproduction for storing ova and their usage in the future or the donation of the ova, the cycle is defined analogically, however, it ends by their freezing or donation. Its effectiveness regarding pregnancy cannot be evaluated. (ÚZIS (institute for Health Information and Statistics of the Czech Republic, 2015) 

Age of primiparas increases 

"Based on the analysis of data from the National Register of Assisted Reproduction we discovered that the average age at which women have their first child increased since 1989 by more than 5 years. At the moment it is the age limit of 28 years. The most massive "growing old" took place between 1993-2008 when the average age of the primiparas increased by more than 4 months per each year," explainsZuzana Lhotáková, SAS Institute Marketing Manager. 

This trend is not so dynamic but the assumption that women rather postpose the foundation of a family is more or less valid. "This increase will not be as dramatic in the future but some studies show even today that the first children are more and more frequently born to women above 30. Other sources are a bit more optimistic and speak about the age around 29, nevertheless, from a medical point of view it is not optimal," Miloš Čekal comments on the situation. 

Age is an important factor 

The biggest interest in assisted reproduction is shown today by women between the 30th and the 39th year of life, who also undergo the highest number of cycles. A sharp drop in interest in the IVF cycles is in the case of women between the 39th and the 40th year – this is partially caused by the limit for coverage by health insurance companies. After the lapse of the 39th year of life, women must pay for the treatment themselves to a full extent. 

Age is a very important factor in assisted reproduction. In addition to the fact that older women must seek out AR more frequently, the effectiveness of its methods decreases according to age. The success rate of cycles increases on a year-on-year basis, anyway, it is more and more noticeable in the case of younger patients. The probability of a successful conception per one IVF/PDG cycle is the following: 

Woman by 34 years of age – 23.5 %
Woman - 35-39 years of age – 16.8 %
Woman over 40 let – 5.6 % 

Let us provide also specific numbers of new born children: In 2013 in the Czech Republic 2,939 children were born in total, of which 1,857 were born to mothers by 34 years of age, 976 to mothers between 35 and 39 and 106 children to older mothers. 

Infertility as a lifestyle disease? 

"In recent years we can observe that the expert and non-expert public begin to perceive infertility as a lifestyle disease which is directly connected to a modern life style and the postponement of maternity to a later age. At the same time, treatment of this disease, including the execution of assisted reproduction is an example of the fact that Czech patients are willing to spend considerable financial means as insurance companies certainly do not pay all what is linked with these procedures," says Filip Vrubel, lawyer in Ambruz & Dark Deloitte Legal, who has been dealing with health service and adds that "couples having troubles conceiving a child are ready in advance to spend tens of thousands of crowns in extra charges for the required medicines and laboratory examinations. This fact, together with the increasing number of executed performances, make artificial fertilisation a perfect business, given the fact that often, it concerns economically higher-than-average (or well-off) couples." 

Investment for the future

While motivation for the postponement of motherhood can partly be of an economic nature, its results can also have an economic extent. What investment can thus be required by one AR cycle? "Each case is specific but it can be said that an average extra charge above the scope of health insurance is around 30 thousand. The amount of costs is influenced by the selection of applied medicines and specific laboratory methods. Here it is possible to save money but, on the other hand, also to decrease the success rate of treatment. If a woman comes to a clinic, let us say by the age of 35, and she will uses all offered methods, her chances of becoming pregnant within one cycle can be equal up to 40%," says Miloš Čekal from the Prague Centre of Reproductive Medicine GEST. 

"The data provided by the study concern Czech clients only. Nevertheless, it is necessary to add to their number at least once as much foreign clients. In this regard the Czech Republic is an exceptionally attractive destination – we have a top professional background and services in the Czech Republic are a bit cheaper as compared to foreign countries," Čekal adds the reasons leading to the workload of clinics.

Source: National Register of Assisted Reproduction

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