In-vitro Fertilization

Payment mechanism

In most European countries, IVF is reimbursed as a part of outpatient specialist care, therefore, the payment model depends on the payment system used in this type of setting: in England, France, the Netherlands, and countries of the Nordic region IVF is reimbursed solely via the diagnosis-related group (DRG) mechanism, whereas in Belgium, Germany, Italy, Switzerland, the IVF is reimbursed via a fee-for-service model via country-specific catalogs for outpatient specialist services. For example, in Germany, there are specific EBM codes for extracorporeal fertilization without ICSI (code 08550 with a tariff of €680) or with ICSI (code 08555 with a tariff of €1,125), including cultivation up to the embryo transfer. The embryo transfer, possibly as zygote transfer and/or as intratubal embryo transfer or intratubal gamete transfer, including the costs for culture media and transfer catheters, is coded separately (code 08558 with a tariff of €160).

The payment model may differ for IVF, which is reimbursed as a part of laboratory services, and oocyte harvesting and embryo transfer are performed by the medical specialist (e.g., gynecologist). For example, in France, the IVF procedure is reimbursed via Nomenclature of Medical Biology Acts (NABM), which is the main reimbursement nomenclature used for regular coverage of in-vitro diagnostics within statutory health insurance via fee-for-service model: There are specific NABM codes for IVF without ICSI (code 0060 with a tariff of €388) or with ICSI (code 0061 with a tariff of €625). The transfer of embryo is reimbursed via the DRG depending on the type of procedure: DRG 13M081 “Medical assistance for reproduction, level 1” with a tariff of €485 for public and private not-for-profit hospitals for intrauterine embryo transfer via the vaginal route or DRG 13C19J “Interventions for infertility or reasons for care related to reproduction, on an outpatient basis” with a tariff of €2,635 for public and private not-for-profit hospitals for intratubal embryo transfer by laparoscopy.

In England, specific bundled payments (packages of care) for IVF services, including IVF with or without ICSI, cover several service components. For example, the package for IVF without ICSI with a tariff of ₤3,534 for women aged ≤37 or ₤3,991 for women aged ≥38 or previous non-responder, covers one fresh and one frozen cycle of IVF, including drugs, scans, and all components of the service, as well as freezing of gametes and embryos for two years. A separate package covers the subsequent transfer of frozen embryos. The tariffs for IIVF packages are not used for actual reimbursement, only as benchmark prices, which can serve as a reference to set global budgets or local payment arrangements in the contracts between commissioners and providers.

Policy considerations

In vitro fertilization as a part of medically assisted reproduction is a subject of a specific complex regulatory framework in most European countries. There are specific policies at the national or local (regional) level that define the eligibility criteria for patients and specific requirements for the provision of IVF services.  For example, in England, access criteria and conditions of provision for assisted reproduction technologies are defined locally by each Integrated Care Board (ICB) individually in their clinical commissioning policies. In Italy, Law №40/2004 regulates the provision of medically assisted reproduction at the national level.

The eligibility and access criteria for IVF reimbursement under statutory health insurance may include age limits, number of IVF attempts, number of embryos transferred, etc. For example, in Germany, IVF can be provided to women aged from 25 to 40 years, with up to three IVF attempts and not more than three embryos transferred within one cycle.

The IVF with donor material (oocytes and/or sperm) is covered in most European countries.

Future challenges 

One key reimbursement challenge is the increasing cost of IVF due to the implementation of novel techniques (e.g., preimplantation genetic testing, or vitrification of oocytes), as well as an increase in the number of IVF cycles due to growing demand.

Innovative techniques (e.g., AI embryo selection, gene editing) challenge existing reimbursement frameworks. Their implementation will require adjustments to existing payment models to ensure appropriate reimbursement that reflects their technological complexity and cost profile.