24 January 2025 – Masaryk University
The programme of event
Presentation by the Professor Zdeňka Králíčková on the topic Assisted Reproductive Technologies in Czechia, information about the research by the professors connected in the Central European Professors´ Network on this topic and about the conference held in Budapest in November 2024
Description of the event
Zdeňka Králíčková opened the event.
First of all, she informed about the Project on the topic Assisted Reproductive Technologies in the legal orders of the Central European Countries: Czechia, Slovakia, Poland, Hungary, Croatia, Serbia, Slovenia. She gave information about research by the professors connected in the Central European Academy’s Central European Professors´ Network on this topic and about the conference held in Budapest in November 2024.
Then, she presented paper devoted to Czechia. Her presentation was not focused only on Assisted Reproductive Technologies in Czechia, but on the best interest of the child as well.
Presentation was opened by the statement that the first “test-tube” baby that was born in Brno in 1982 was the first “test-tube” baby born in the former Eastern Europe. This information was followed by statistical data, numbers of assisted reproductive cycles, family policy and fertility forecast by the Czech Statistical Office as follows.
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 Labour 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.
Key attention was focuses on legal framework of assisted reproduction: constitutional level and special acts, namely:
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). It was stressed that it is the basic source regulating assisted reproduction, but not surrogacy, which 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.) and
Civil Code (Act No 89/2012 Sb., as amended).
Then, the concept of Assisted Reproductive Technologies according to the Act on Specific Health Services was presented. In particular, the PowerPoint presentation was concentrated on definition of infertility and its treatment, its prerequisites, conditions, issue of anonymity of donors, providers of the new technologies and financing.
It was stressed that 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 foetus 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 was added that it is significant that assisted reproduction may be performed on a woman of childbearing age, provided that she is under 49 years of age.
Regarding donors, anonymity was stressed and added that anonymous donor may be
- only a woman who has reached the age of 18 and has not exceeded the age of 35 and
- 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 centres.
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 authorisation to provide health services in the field of reproductive medicine or, in the case of assisted reproduction in the field of gynaecology 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 organisations.
A total number of providers of assisted reproduction, or registered centres in 2020, it was 48. The increase in the number of centres covers the significant demands of foreign women coming to the Czech Republic for treatment.
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 gynaecology and obstetrics in connection with artificial insemination in the form of in vitro fertilisation
- women with bilateral fallopian tube incompetence aged 18 years and over until the date of their 40th birthday,
- 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 fertilisation 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 Fertilisation (IVF) cycle, 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.
In addition, the concept of status law was presented, namely the issue of legal motherhood and fatherhood.
Special attention was paid to legislative proposals on surrogate motherhood in Czechia. It was stressed that the proposed legislation on surrogate motherhood by the Czech Ministry of Justice is based on the following principles:
- altruism, which means that surrogacy will only be possible on a non-commercial basis, with no financial remuneration for the surrogate mother, except for reimbursement of costs associated with pregnancy and childbirth;
- infertility, or adverse health conditions or health indications or health obstacles on the part of the “intended” mother;
- 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 fertilise the surrogate mother;
- genetic link to the “intended” parents which means that the germ cells of at least one of the “intended” parents must be used;
- 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.
Conclusion of the presentation addressed especially so-called burning issues, mainly the reality of surrogate motherhood in Czechia, reproductive tourism etc.
