Let the European Institutions lead the way forward, not hold us back with outdated rules. In a world where medical science is advancing rapidly and professional careers increasingly shape personal timelines, the EU institutions and their Joint Sickness Insurance Scheme (JSIS) must ensure policies keep pace with technical and societal advances and follow the best practices seen in Member States [1]. Commission Decision C(2023) 7673 [2], updates its 2007 predecessor in order to broaden access to parenthood, but does it go far enough?
‘(3) Both societal perception and medical practice have much evolved, with the acceptance that persons should be able to benefit from medically assisted reproduction, also outside the context of a pathology, including single women or same-sex couples. It is
important to adapt … to these societal developments that favour broad access to parenthood;
(4) Medically-assisted reproduction is now reimbursed to a varying degree in Member States, notably in Belgium where about half of the JSIS affiliates reside;
(5) The current rules need to be simplified by removing the prerequisite of pathology for access to medically-assisted reproduction, in the cases where this is warranted, in order to limit related administrative difficulties and complaints regarding reimbursement….’
While there is progress here in reimbursing treatment without there having to be a documented medical condition and also in recognising national authorities’ actions and societal change on this topic, there are still arguably-outdated age limits [3] in many of the processes. Those same age limits can be extended in the case of a documented pathology, showing that this limitation is not based on outcomes: if egg retrieval is reimbursable by the JSIS beyond the age of 36 where there is a medical pathology, why is the limit 36 in general? Also, that documented pathology can also be restricted with no clear reasoning: while cancer treatment is normally accepted, documented infertility caused by conditions such as blocked or damaged fallopian tubes can be excluded.
Maternal birthday deadlines
| Maternal birthday deadline | Text from Commission Decision C(2007)3195 [2] | Text from staff matters>Fertility treatment [4] |
| 36 (in the absence of a medical indication) | 3.3(d) Outside IVF, even where there is no medical indication: retrieval of spermatocytes, including the costs of analyses and tests, and long-term conservation of selected spermatocytes subject to a ceiling corresponding to category B1 surgical operations; stimulation and retrieval of oocytes, including the costs of analyses and tests, and long-term conservation of selected oocytes subject to a ceiling corresponding to category B1 surgical operations. The reimbursement is subject to the condition that the collection takes place before the 36th birthday. | stimulation and retrieval of oocytes, including the costs of analyses and tests, and long-term conservation of selected oocytes subject to a ceiling corresponding to category B1 surgical operations. The reimbursement is subject to the condition that the collection takes place before the 36th birthday
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| Beyond 36 (In the event of proven medical necessity) | In the event of proven medical necessity, after the age of 36, an egg retrieval remains reimbursable, subject to a prior authorisation, on the basis of a medical report from the specialist.
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| 40 | 3.3(c) Up to the age of 40, the reimbursement of the costs of the first IVF can only be granted after exhaustion of the six attempts of intra-uterine insemination. Exceptions to this rule can be granted subject to prior authorisation when there are medical reasons justifying that intra[1]uterine sperm insemination has no or very limited chance of success. | |
| 45 | 3.3(c) At least the first IVF attempt must take place before the beneficiary’s 45th birthday. This condition shall not apply to persons who will reach their 45th birthday within 18 months of the date of taking effect of this point 3. | The first attempt must have taken place before the age of 45. |
| 48 | 3.3(c) IVF attempts between the 45th and 48th birthdays may be reimbursed
subject to prior authorisation.
3.5 Medical treatments related to fertility and reproduction shall not be reimbursed under the JSIS beyond the age of 48. |
The maximum number of IVF or ICSI attempts allowed is 8 attempts until the future mother is 48 years old (depending on the case, a request for prior authorisation is required). |
Belgium [5] and other Member States have based their age limits on medical evidence showing that many of these procedures remain effective, viable, and safe well beyond the JSIS age limits. Modern medical practice allows hormonal stimulation and egg preservation up to the age of 48.
Progress depends on the budget, always
This policy could go further than it has already: even between 2023 and 2025 the technology is better and societal attitudes continue to change. Nevertheless, the 2023 decision is rather frank in its declaration that here (as elsewhere) the deciding factor is money [6]. So, for example, surrogacy (point 5) is not yet an option for anyone: the same-sex couples mentioned in point 3 of the 2007 decision [2] as quoted above are not all included here.
‘…However, it is appropriate to exclude the costs of surrogacy;
(6) The limited number of beneficiaries would not jeopardise the financial balance of the
JSIS budget;…’
The deadlines are not the deadlines: check the prerequisites!
On a practical note, Generation 2004 highlights that the JSIS age deadlines given in the table above for the different parts of the process often have prerequisites, whether medical or form filling, meaning that the real deadline might be long before the age deadline. While it is always possible to complain about or appeal [7] an unfavourable decision, this can further run down the clock while you await a response or provide clarification or additional paperwork.
Yet another thing for women to have to think about
In general, women are having children later in life. The age of recruitment to the EU institutions continues to approach 40 years old and there are currently only some 10% of staff [8] at the Commission are women below the age of 36. This means that many highly skilled women in the EU institutions, for whom assisted fertility might be medically possible, would still be unable to make use of the JSIS provisions even if they started the process as soon as they entered. , many of whom are committed to long-term public service and professional growth. So, the option is there, the vast majority of those who might wish to are unable to. Is this really progress?
An egg freezing cycle might cost between €2,700 and €3,500 [9], a price which is in no way the final price. The option of paying for this treatment privately, without involving the JSIS is beyond the reach of many women working within the EU institutions.
Demographics speak louder than policy
Europe faces a growing demographic crisis. Birth rates continue to fall across the EU, while the average age at which women have their first child is rising. Research shows that the longer women wait to have children, the fewer they are likely to have, and some never get the chance at all.
In this context, egg freezing should not be a luxury. It is a smart public policy tool. Giving women the option to control their future. It empowers them, both personally and professionally.
Those undergoing fertility treatments are not asking for favours. They are acting responsibly and should be supported with all available means. They are contributing to society’s future. They deserve help, not penalties.
One colleague put it simply:
“I postponed motherhood because of my role and responsibilities. Now, when I am ready, I am told it’s too late to be supported.”
Align policy with values
This policy undermines the Commission’s Action Plan on Work-Life Balance. It calls into question its commitment to the right to family life. Reproductive health and support for parenthood cannot be exclusive to those who fit a an artificially-narrowed age profile.
As a global standard-setting institution, the Commission cannot afford to lag behind on health and reproductive rights. This policy undermines its credibility and leadership in general. Other international organisations and progressive national governments have already adapted to modern standards. The EU institutions and the JSIS must do the same.
Lead by example
We are proud to have a Commissioner for Demography [10], but we must do more than acknowledge the challenges. We must act ! The EU institutions should lead by example and update the JSIS medical reimbursement policy to reflect current reproductive health standards in Member States and the realities of modern working life.
While we acknowledge that success rates decline significantly after age 38, medical guidelines from the European Society of Human Reproduction and Embryology [11] confirm that egg freezing remains a viable option up to age 45, with proper counselling on reduced outcomes. Aligning reimbursement eligibility with this medical window ensures that women can make informed choices without financial barriers up to the point at which that window of possibility closes.
Extending the reimbursement age limit for egg freezing, ideally aligning it with the actual medical feasibility window, would send a clear message: the EU institutions supports its staff who want to be parents, its workforce, and the future of Europe.
A clear way forward
We urge the EU institutions to further revise its JSIS reimbursement rules to extend eligibility for fertility assistance in general and egg freezing treatments in particular (up to at least age 45), in line with current medical feasibility. This would reinforce the EU institutions’ credibility and commitment to our common future.
Those wanting to be parents deserves this support and need this change.
Our policies must evolve with science, with society, and with the people they are meant to serve. Because action delayed is opportunity denied.
Let us act fast to still give this possibility to a generation of potential parents.
As always, we would love to hear from you. Please do not hesitate to get in touch with us [12].