When does it count as infertility
The medical definition is simple and poorly known: no pregnancy after twelve months of regular intercourse without contraception, reduced to six months where the woman is over 35. Before that, no investigation is warranted; after it, there is no point waiting, because the one factor no technique can compensate for is time.
Causes split roughly into thirds: a third female, a third male, a third combined or unexplained. That has an immediate practical consequence: the work-up is always done as a couple, and starting by investigating the woman alone loses months.
The techniques, in the order they are offered
| Ovulation induction | Tablets or injections to obtain good-quality ovulation, with timed intercourse. Cheap, minimally invasive, the first step of many journeys. |
|---|---|
| Intrauterine insemination | Laboratory-prepared sperm placed in the uterus at ovulation. Around 10–15 % pregnancies per attempt; rarely offered more than six times. |
| In vitro fertilisation | Egg collection, fertilisation in the laboratory, transfer of one embryo. The reference technique since 1978. |
| ICSI | IVF in which a single sperm is injected into the egg. Designed for male infertility, it now accounts for the majority of IVF cycles in many countries. |
| Gamete donation | Sperm donation, egg donation, more rarely double donation or embryo donation. This is where legislation diverges most. |
| Fertility preservation | Freezing of eggs, sperm or ovarian tissue, for medical reasons (before cancer treatment) or, where permitted, electively. |
Each of these is described in detail, with indications, what actually happens and the risks, on the page covering every assisted reproduction method.
The figures nobody volunteers
A success rate means nothing until three things are stated: per attempt or cumulative, per transfer or per egg collection, and at what age. A clinic advertising "45 %" is almost always quoting a per-transfer rate in women under 35.
- With her own eggs, the live-birth rate per IVF cycle falls from around 30–35 % under 35 to 20–25 % at 35–37, 12–15 % at 38–40, and under 5 % after 42.
- With donor eggs it depends on the donor's age and stays around 40–50 % per transfer, whatever the recipient's age.
- The cumulative rate after three or four complete cycles is far more encouraging than the per-cycle rate: that is the figure to ask for.
- Single embryo transfer has become the norm: it gives almost the same cumulative result as two, without the risk of a twin pregnancy.
Donation: where countries part company
- Is donation anonymous? The global trend is towards lifting anonymity when the child reaches majority. A dozen countries have already done so; others maintain strict anonymity.
- Is donation paid? Most European systems forbid it and reimburse expenses only; other countries allow compensation, and the United States a genuine market.
- Who may use donation? Heterosexual couples only, female couples, single women: this is the main fault line and the leading cause of cross-border fertility travel.
- How many families per donor? Caps run from 1 to 25 depending on the country, and that number matters more every year now that consumer DNA testing lets donor-conceived people find one another.
The practical conditions for donating — age, screening, compensation, timescales, where to go — and the leading centres in each country are set out in the country files below.
Storing embryos
IVF often produces several embryos; those not transferred are frozen by vitrification, which barely affects their chances. Permitted storage runs from five years to several decades depending on the country, with an annual confirmation from the couple. Three possible endings: later transfer, donation to another couple, donation to research or allowing storage to lapse. Almost nobody plans for this decision, and when a couple separates it becomes litigation: everywhere, transfer requires both people's continuing consent.
What the process does to a couple
The studies agree: psychological exhaustion, not medical failure, is the leading reason people stop treatment. The rhythm — early-morning appointments, daily injections, waiting for results — moves into the relationship and reorganises it entirely. Two things genuinely help: deciding in advance, calmly, how many attempts you are prepared to make, and not letting one partner carry all the logistics. Counselling is offered by most clinics and is heavily under-used.
Surrogacy
Surrogacy is not one assisted reproduction technique among others: it raises a question of parentage, not of medicine. It is dealt with separately on the page devoted to surrogacy.
Female couples and male couples
Access to assisted reproduction is, of every subject covered here, the one where the gap between countries is starkest. Three regimes coexist.
- Open access: the statute speaks of “any person” or “any couple”, with no condition of orientation or marital status. Female couples then reach donor insemination and IVF on the same terms as anyone else, and the second mother is generally recognised from birth through a declaration made before conception.
- Access limited to medical infertility: the statute does not exclude female couples expressly, but it requires a diagnosis of pathological infertility, a condition a female couple never meets. The result is exclusion in fact.
- Express exclusion: the statute reserves assisted reproduction to a couple formed of a man and a woman, sometimes married. This is still the majority position worldwide.
For male couples, the biological route necessarily involves surrogacy, prohibited in a great many countries and tightly framed in the others; the page devoted to it sets out where it is possible and what becomes of parentage on return.
Four practical points recur: the number of funded attempts, often calculated for a heterosexual couple; the age limit; whether donation is anonymous, which determines what the child will be able to learn as an adult; and what happens to stored embryos if the couple separates. Each is a matter of national law: the country pages give the detail.
The law country by country
The legal framework, the procedure, the time limits and the costs differ from one country to another. Each country below has a detailed page: governing texts, key facts, the actual procedure, costs, where to go and the traps to avoid.
Select a country to open its detailed page.