Commission still analysing Hungarian infringement review, nationalisation of IVF centres under scrutiny

The Hungarian government's interventions in fertility care, aimed at addressing falling birth rates, are still under review by the European Commission. The Commission initiated an infringement procedure due to national regulations limiting access to reproductive treatments.

Hungary has been struggling with declining birth rates for years now. The ratio of Hungarian infertile couples desiring children is estimated at 15 per cent, representing around 150 to 200 thousand citizens.

The Hungarian government’s nationalisation and reorganisation of fertility care, though, prompted the Commission to initiate an infringement procedure for breaching Article 49 of the TFEU, which prohibits restrictions on the freedom of establishment, including the right to pursue self-employment and manage undertakings.

“The Commission is currently analysing the content of the [Hungarian] reply and will then decide on the next possible steps in this procedure,” a Commission spokesperson told Euractiv.

“The Government responded to the Commission's formal notice within the deadline, on May 13, 2024, in which it provided a detailed explanation of its legal position regarding the issues raised by the Commission,” the Hungarian Ministry of Interior responded to Euractiv’s request for an update on the procedure.

“If the Commission does not agree with the Government’s response to the formal notice, the procedure may progress to the reasoned opinion stage, which is not bound by any deadline,” the Ministry added.

Violation of EU values and rights

Annually, three to four thousand children are born in Hungary through infertility treatments, representing four to five per cent of total births. The term ‘In Vitro Fertilisation’ (IVF), one of several techniques that help people with fertility problems conceive, has been used as an umbrella term.

In 2019, the Hungarian government started implementing interventions to improve the country’s birth rates and nationalised six private fertility clinics. The fate of the remaining ones was later sealed as a new law passed in 2022 prohibiting fully reimbursed IVF treatments in private clinics.

Budapest initiated a total reorganisation of fertility care and redirected billions of Hungarian forints from the state budget to this cause.

The government also decided to nationalise fertility care, arguing that state management of reproduction procedures is more effective given the significant financial impact. It claims this intervention will address the shortcomings of the previous system.

The letter of formal notice, delivered in March, states that the Hungarian law violates the EU’s democratic values and rights and several primary and secondary EU law provisions.

According to the Commission’s justification, Hungarian regulations limit access to medically assisted reproduction procedures, despite the already constrained range of such services, compared to similar-sized member states. Furthermore, this nationalisation cannot be justified by any objective.

Private clinic treatments are still sought after

The Hungarian health system offers one of the most limited ranges of available services and medical treatments in the EU. Nonetheless, the treatment and medicines in fertility centres are free of charge, showing the government’s focus on increasing birth rates.

Despite the free treatments in the state-run system, though, hundreds of Hungarian couples still prefer to turn to costly and limited private clinic care. On the one hand, the long waiting lists, the impersonal care of the public sector, and several types of extra treatments available in private clinics, on the other, contribute to their decision.

Couples also turn to private care once they have exhausted the five attempts to be fully reimbursed by national health insurance.

The reform remains unsuccessful

There are concerns that government interventions in fertility care could lead to a loss of expertise and an increase in Hungarians seeking treatment abroad. Many already visit IVF clinics in neighbouring countries such as Czechia and Slovakia, with an estimated 1,500 to 2,000 couples receiving fertility treatments outside Hungary each year.

In his latest open letter, the founder of the Kaáli Institute Reproduction Centre, Prof. Dr Géza Kaáli, pointed out that the government interventions led to longer waiting times, fewer children than expected, and dissatisfied patients.

According to Kaáli, many more children should have been born from the state-funded IVF program, “I do not understand why, with generous funding, you have not doubled the number of treatments and children born in four and a half years.”

“We are where we were before the state monopoly,” he added.

Dr Attila Vereczkey noted that the success rate of assisted reproduction procedures has declined since the introduction of government measures due to a more restricted range of available procedures, the complexity of certain cases, and the fact that older women are often advised against IVF treatments in Hungarian clinics.

The efficiency of the Hungarian clinics falls short of the European average. While the average success rate of assisted reproduction treatment in Hungary is around 16 per cent, Germany is at 32 per cent.

[By Zsolt Kopári, Filip Áč, Edited by Vasiliki Angouridi, Brian Maguire]