Greece is making a significant investment to improve its fertility rate. What’s happening and how did it come about? We talked to Dr. Basil Tarlatzis, Professor of Obstetrics and Chairman of the Scientific Board FIVI Fertility & IVF Center, European Interbalkan Medical Center, and Past President of the European Board and College of Obstetrics and Gynecology (EBCOG).
Q. What is the current infertility situation in Greece?
Basil Tarlatzis (BT): Greece, Italy, and Spain have among the lowest fertility rates in Europe, which is 1.4 children per family, while the replacement number to replace the population from deaths is 2.1. This means Greece is facing a population decline. Declining fertility can be a deliberate choice of couples to not have children, whereas infertility, the couples want children and can’t have them.
The first IVF Center in Greece was in Thessaloniki in 1985 and now we have 56 IVF centers and cryopreservation banks all over Greece. At the beginning, couples had to pay for everything out of their own pocket. Some years back, the government decided to subsidize medication to allow each couple access to hormonal medication free of charge for 4 IVF attempts (with some prerequisites).
Q. Greece has made a major investment in fertility care despite being one of the poorer nations in the EU. What has Greece done?
BT: Between 2020 – 2022 our births were 56,000 less than the deaths, so our population is shrinking. Politicians realized these figures are alarming, so our government started to invest quite a substantial amount of money in providing help for couples to have a child. One of the things they did was to create nurseries and daycare units so working parents have a place to leave their child. The government also provides financial support to couples who have more children.
It takes time for population numbers to change. Choosing to have less children is multi-factorial. We can’t solve this problem immediately, but our government is investing a lot of money to change the situation.
Q. What has Greece done on infertility treatment?
BT: We had to convince the government that treatment of infertility can help, but it will not solve the problem alone. In Denmark, where IVF is fully reimbursed by the state, the percentage of children born every year through IVF is 9.2%, whereas in Belgium it’s 6.5. In 2018, in Greece it was 5.8 and in 2020 7.5%.
We need to increase the number of children born and the government is now working on that. For example, Greece offers free AMH tests to check ovarian reserve, so women can plan to have their children earlier in life or freeze their eggs. Our government passed a law that egg freezing for social reasons is acceptable. That was a big step forward.
Greece is also looking into covering the cost of IVF. Couples now receive free medication, but still must pay the rest. There is an effort to provide coverage for that, but it’s not yet decided.
Q. How were you able to make these changes happen?
BT: I was personally involved for a few years as President of the Hellenic Society of Fertility and Sterility, and Past President of IFFS and ESHRE. We collaborated with patient organizations to distribute leaflets about what is happening and how the government can help.
They also started to educate students in school about fertility and the effects of aging on fertility. IFFS prepared a big review on this topic, published in January 2024 by lead author Bart Fauser, that I was also a part of, about global fertility rates. We are promoting that work and have had meetings in Athens where I presented data on how government subsidies for IVF would pay for itself. The Prime Minister announced last September that infertility will be supported and they are looking into subsidizing IVF.
Q. How did Greece find political will?
The government realized the very frightening ramifications of population decline. First, you don’t have working people to support the pensions and social security of older people. Or workers for industry, hotels, even the Army. All these things need people.
Second, during covid, the European Union (EU) decided to offer funds for action on this, which Greece has used to increase access to care.
Q. IFFS launched the More Joy campaign to help make fertility care more affordable, accessible, and equitable around the world. What does the campaign need to do to be successful?
BT: We need to spread the word about how serious population decline is. It is important to have lectures; I have done 3 or 4 in the last year and several other IFFS colleagues have done the same in different parts of the world. We need to present data; politicians want data; they want to be convinced that this is an issue worth spending money on and that there will be a return on investment.
The More Joy campaign has to become more visible with activities in different countries and working with patient organizations is an important part of this because patients have lived it. Declining fertility won’t fix itself. More Joy is a great initiative and a big accomplishment for IFFS, but we need to get it out there to change people’s thinking.