The impact of recent regulatory changes on access and utilization of assisted reproductive technologies in Hungary

Introduction: Fertility trends are decreasing worldwide. A total fertility rate (TFR) of 2.1 is required to maintain population size, but it has been below replacement level in the industrialized nations for decades. Governmental policies have introduced various measures to boost pregnancy rates. Increasing access to assisted reproduction (ART) is one such measure. In Hungary, the TFR has been below 2.1 since 1978, despite a generous ART reimbursement scheme with recent further changes that have been introduced. This article discusses the impact of these changes on access to fertility care and ART utilization. Materials and methods: Narrative review of the recent legislative and financial changes related to ART in Hungary and an evaluation of their impact on access and use of fertility treatments based on official statistical records, reports submitted to ESHRE, and our own clinic data. Results: The changes affecting the type and number of reimbursed ART treatments are favorable for patients. The overall legal framework, however, has not been modified. Most of the additional financial resources are spent on treatments of an unfavorable population whose contribution to the TFR is negligible. While access to care has improved, the number of clinics or their personnel has not increased, adding work for the existing clinics. Importantly, due to reporting anomalies, accurate data on ART outcomes and, therefore, a proper assessment of the impact of the introduced measures are not yet possible. Discussion: ART has been reported to be responsible for 1%–10% of births in different countries. In Hungary, based on nonofficial data, about 4%–5% of live births can be attributed to ART treatments. Further adjustments of the financial policies and broadening of the available services could further increase the role of ART. Before introducing substantial changes, proper data collection is needed to better assess the impact.