Karole Di Tommaso and Alessia Arcolaci, a same-sex couple from Italy, chose to have children in 2015. But there was a significant obstacle to overcome: legal restrictions prevented them from having children in their home country. After studying a patchwork of options in other European countries, the couple chose a clinic in Barcelona, Spain. The decision was motivated by geographical and cultural proximity, as well as cost. After four cycles of treatment, Arcolaci finally gave birth to a healthy baby in 2016.

Hundreds of Europeans travel abroad each year to avail of Assisted Reproductive Technologies (ART). Experts call it “cross-border reproductive care”, or CBRC, i.e. the migration of individuals or couples to access ART treatment in a country other than their country of nationality.

Over the course of a 2-month investigation, we conducted an analysis of what is known and what remains to be learned about this largely hidden phenomenon.

According to the European Society of Human Reproduction and Embryology (ESHRE), which has been investigating ART for two decades, 776,556 cycles were registered in Europe in 2014, the year in which the data available is most complete. That figure represents an increase of 13,1 percent over the previous year.

These days, it is said that ART is particularly popular in the Old Continent, and this is supported by the facts. Europeans lead in numbers, initiating approximately 50 percent of all treatments reported worldwide. Another important figure is the number of clinics. In comparison to the 1997 data, the number of European centres specialising in these procedures grew from 482 to 1,279 clinics by 2014 – an increase of 165 per cent.  

Experts believe that this popularity is driven by technological progress, such as the possibility to store gametes for future use, and the increasing number of homosexual couples seeking to have children. Low fertility rates and lifestyle factors also play a part in the growth of the ART sector.

However, access to ART treatment in Europe varies significantly from country to country. Data shows that small countries like Belgium, Czech Republic, and Denmark have the highest rates of ART treatments as a percentage of the total population. In absolute terms, the three most active countries are Spain, Russia, and France: a record 109,275 treatment cycles were performed in Spain, followed by Russia (94.985 cycles) and France (90,434).

A difficult access to data

This is far from the whole story, however. At present, researchers have been unable to generate a complete database of the nationalities of Europeans seeking treatments abroad. This is confirmed by Eurostat, the World Health Organization (WHO), the ESHRE, and several experts and officials of European Union states.

Moreover, health authorities in the 28 EU member states have failed to share this data. Several did not reply to our – multiple – requests for information. Only two countries shared their data relating to the citizenship of patients in their countries: Slovenia and Bulgaria.

According to Ljubljana’s authorities, in the year 2014, the majority of IVF/ICSI cycles were performed on Slovenian patients. However, there was also a smaller group of non-Slovenian patients from Croatia (67 patients), Bosnia and Herzegovina (51), Serbia (29), Italy (14), Montenegro (5) and others (16). The Bulgarian data was even less illuminating.

Since individuals and couples that undergo ART treatments are asked to share their biographical