Assisted Reproduction and Family Policy in the Czech Republic

Assisted Reproduction and Family Policy in the Czech Republic Presented by: Prof. Dr. Králíčková Date: April 14, 2025 About The First „Test-Tube Baby In Czechoslovakia - Brno 1982 - firs’, test-tube" baby in former Eastern Europe - medical science was quicker" than law-maker - decree by Ministry of Health: Lege artis rules - 1989-1990: a total of 1 456 IVF, 66 pregnancies, 36 children were born - 2006 amendment to the Health Act from 1966 - 2011 Act on Specific Health Services Statistical Data And Family Policy - The Czech Statistical Office stated that the Czech Republic had a very low fertility rate (below 1.3 children per woman) in 1995-2005 and was in the low fertility zone of below 1.5 children per woman until 2013. - Only since 2014 there have been increase. In 2015 the total fertility rate reached 1.57 children per woman, between 2018-2020 it was 1,71 children, in 2021 it was 1,83 children, in 2022 it was 1,66 children, in 2023 it was 1,45 children. Now have been less and less children. - The Ministry of Labor and Social Affairs paid attention to the phenomenon of starting families later in life and created a New Family Policy: • CCA 20% of couples are struggling infertility; • the increase in the proportion of children born after assisted reproduction is close to 4% and is also related to the shift of parenthood to a higher age; • the most frequent use of assisted reproduction is by couples between 30-39 years of age, when the assisted reproduction is still relatively successful and the procedure was covered by public health insurance. Fertility Forecast For Czechia Years 2019 2022 2023 2026 2027 2028 2030 Number 112 944 Of Children 107 293 105 341 99 637 97 993 96 589 94 685 In The -1269 Number Of Births -1929 -1952 -1828 -1644 -1 404 -794 In The -1.1 Number Of Births -1.8 -1.8 -1.8 -1.6 -1.4 -0.8 Constitutional LEVEL - CONVENTION RIGHTS AND FOR THE PROTECTION OF HUMAN FUNDAMENTAL FREEDOMS (1991) - CONVENTION ON THE RIGHTS OF THE CHILD (1991) - CONVENTION FOR THE PROTECTION OF HUMAN RIGHTS AND DIGNITY OF THE HUMAN BEING WITH REGARD TO THE APPLICATION OF BIOLOGY AND MEDICINE: CONVENTION ON HUMAN RIGHTS AND BIOMEDICINE (2001) - CHARTER OF FUNDMENTAL RIGHTS AND FREEDOMS (1991) Special Acts - Act on Public Health Insurance (Act No 48/1997 Sb., as amended), • Decree on the Transmission of Data to the National Health Information System (Decree No 373/2016 Sb.) - Act on Health Services (Act No 372/2011 Sb., as amended) - Act on Specific Health Services (Act No 373/2011 Sb., as amended) the basic source regulating assisted reproduction, but not surrogacy, it is not regulated as "a healing method of infertility" in Czechia - Act on Quality Assurance and Safety of Human Tissues and Cells for Human Use and on Amendments to Related Acts - Human Tissues and Cells Act (Act No 296/2008 Sb., as amended) - Act on Research on Human Embryonic Cells and related activities and on amending certain related acts - Human Embryonic Stem Cells Research Act (Act No 227/2006 Sb., as amended) - Act on Artificial interruption of pregnancy -Abortion Act (Act No 66/1986 Sb., as amended) and its implementing degree (Degree No 75/1986 Sb.) - Civil Code (Act No 89/2012 Sb., as amended) Concept of ART according to the Act on Specific Health Services - The Act defines the basic concepts such as assisted reproduction, infertile couple (married or de facto) and its informed consent, anonymous donor, mutual anonymity of the donor and the infertile couple, and especially the conditions and limits for its implementation, providers and sanctions. - According to law, the assisted reproduction means methods and procedures involving the collection and manipulation of germ cells (eggs and sperm), the creation of a human embryo by fertilization of an egg with sperm outside the woman's body, the manipulation and storage of human embryos for assisted reproduction of the woman, namely • (a) for medical reasons in the treatment of her infertility or the infertility of a man, if it is unlikely or impossible for the woman to become pregnant naturally or to bear a viable fetus and other treatments for her infertility or male infertility have not led or are highly unlikely to lead to her becoming pregnant or • (b) as regards the need for early genetic testing of the human embryo, if the health of the future child is endangered because of a demonstrable risk of transmission of genetic diseases or defects carried by the woman or man. - It is significant that assisted reproduction may be performed on a woman of child bearing age, provided that she is under 49 years of age. ART In Details - The assisted reproduction of a woman as a treatment of infertility is • (a) the introduction of sperm into the reproductive organs of a woman; • (b) the transfer of a human embryo resulting from the fertilization of an egg by sperm outside the woman's body into the woman's reproductive organs (i.e. "in vitro fertilization" and "embryo transfer", i.e. "IVF" and "ET"). - Assisted reproduction may not be performed on a woman who has a relationship to the man with whom she has submitted an application that precludes marriage under the provisions settled by the Civil Code: they are relatives in a direct line and siblings. - Regarding the key prerequisite for assisted reproduction, it is a written request from a woman and a man who intend to undergo this medical service together: so-called informed infertile couple, married or de facto The request from the infertile couple asking artificial insemination must not be more than 6 months old it shall form part of the medical records kept on the woman. The request and then the written consent shall be repeated before each artificial insemination is performed. The record of the submission of the information shall be signed by the infertile couple, the attending physician and, where appropriate, the witness; it shall form part of the medical recorded kept on the recipient. Anonymous Donors - An anonymous donor may be • (a) only a woman who has reached the age of 18 and has not exceeded the age of 35 and • - (b) a man who has reached the age of 18 and has not exceeded the age of 40. Provider shall keep the information on the health status of the anonymous donor for 30 years after the assisted reproduction has been carried out and shall, on written request, provide the information on the health status of the anonymous donor to the infertile couple or the adult born from assisted reproduction. - It was published that while the donors are almost always women with current residence in the Czech Republic (99%), the recipients of the eggs are, on the contrary, foreign women in most cycles (85%). The trend corresponds to the well-known fact that the Czech Republic is sought by foreign women as a source of donated eggs, which is connected with the fact that this treatment is legally permitted in the Czech Republic, the availability of donors in the anonymous donation system, the quality of treatment in the Czech Republic and the intensive marketing of assisted reproduction centers. Providers of ART - Act on Specific Health Services states, that the treatment by assisted reproduction methods may only be carried out by a provider who has been granted an authorization to provide health services in the field of reproductive medicine or, in the case of assisted reproduction in the field of gynecology and obstetrics. - In the line with the freedom of enterprise, there are a lot of providers of the treatment of assisted reproduction, both natural or juristic persons according to the private or public law without any legal differences. Some of these entities are parts of university (teaching) hospitals as theirs' contributory organizations. - A total number of providers of assisted reproduction, or registered centers in 2020, it was 48. The increase in the number of centers covers the significant demands of foreign women coming to the Czech Republic for treatment. Financing of ART - Act on Public Health Insurance provides that health insurance covers health services provided on the basis of a recommendation from a registering provider in the field of gynecology and obstetrics in connection with artificial insemination in the form of in vitro fertilization • (a) women with bilateral fallopian tube incompetence aged 18 years and over until the date of their 40th birthday, • (b) other women aged from 22 years to the date of attainment of the age of 40 years, but not more than three times in a lifetime, or, if in the first two cases not more than one human embryo resulting from fertilization of an ovum by sperm outside the woman's body has been transferred into the woman's reproductive organs, four times in a lifetime. - It was stated that the cost of modern assisted reproductive techniques is a barrier to their use and that it is "basically inaccessible" for low-income families. The cost of an In Vitro Fertilization (IVF) CYCK including medication, costs CZK 30 000 - CZK 50 000 and the woman usually pays a third of the cost even if reimbursed by public health insurance. The Concept Of Motherhood - § 775 CC : „The child's mother is the woman who gives birth to the child." • Problems connected with motherhood and child's registration secret/hidden motherhood (since 2004) reality of baby-boxes (since 2005) de facto surrogate motherhood (since ???) - THE UN COMMITTEE ON THE RIGHTS OF THE CHILD • Report from 2011 „Presently out of every 10,000 newborn children, 62 children are placed in institutional care a number way over the EU average which is under 10." „Parents who can't cope are encouraged to give up their children rather than being helped to retain them." - „The country's 44 baby boxes contribute to this trend making it all too easy to give up a child on the spur of the moment." Ad c) de facto surrogate motherhood • § 804 CC Adoption is excluded among persons related in direct line and between siblings. This does not apply in the case of surrogate motherhood. • ECHR: Mennesson v. France, Labasse v. France Paradiso et Campanelli v. Italy Legislative Proposal On Surrogate Motherhood - The proposed legislation on surrogate motherhood by the Ministry of Justice is based on the following principles: • a) altruism, which means that surrogacy will only be possible on a noncommercial basis, with no financial remuneration for the surrogate mother, except for reimbursement of costs associated with pregnancy and childbirth; • b) infertility, or adverse health conditions or health indications or health obstacles on the part of the "intended" mother; • c) strict medical and other conditions for surrogate mother, including age, and the rule that the surrogate mother's own eggs must not be used to fertilize the surrogate mother; • d) genetic link to the "intended" parents which means that the germ cells of at least one of the "intended" parents must be used; • e) the prior court approval of surrogacy which means that the "intended" parents will be legally recognized as the child's parents from the moment of the birth and the surrogate mother will not have a "legal" parental relationship to the child Conclusions - Regulation of assisted reproduction is well balanced - „burning issues": • Low fertility • Hidden childbirths and baby-boxes • Surrogate motherhood - Gender neutral marriage/parenthood? Amendment civil code - The best interest of the child is respected and protected