Abstract
Background
Fertility centre websites are a key sources of information on medically assisted reproduction (MAR) for both infertile people and the general public. As part of a global fertility market, they are also a window to attract potential future patients. They give formal and practical information but in the way the information is displayed, they also convey social representations, and in particular, gender representation in its intersectional dimension. The objective is to analyse the sex, class and race representations regarding reproduction and parenthood that are embedded in the content of fertility centre websites in eight European countries.
Methods
The 5 most visible fertility centres that appeared in the first places on Internet search were selected for each country under study, except for one country which has only three fertility centres. In total, 38 fertility centre websites were considered for a thematic analysis using an iterative approach and a comprehensive perspective.
Results
Each centre details its services and techniques according to the legal provisions in force in its country. However, on all the websites studied, the fertility centres demonstrate a strong gendered representation. The logos generally depict women or parts of their bodies, as do the photos, which mainly show white women with light eyes. The description of the causes of infertility and the techniques offered by the centres also highlights gender differences. Sperm donation, where MAR is reserved for heterosexual couples, is included among the techniques for women with the comment that it will enable them to fulfil their dream of becoming mothers.
Conclusions
MAR, and through it the project of having a child and procreative work, is presented as a matter for white, cisgender and heterosexual women, thus fueling stratified reproduction and limiting reproductive justice. The research team formulated guidelines for fertility centres to encourage them to adopt a more inclusive approach in terms of sex, social class and race, so that the diversity of infertile people feel involved and welcome in these centres, to avoid misperceptions about infertility in the general population and to reinforce autonomy and justice in reproductive matters.
By this author
Exploring MAR perceptions in Kosovo - disparities in knowledge about MAR among young people
Dimitrievska V et al., 2025 · Open research Europe · Free full text on PubMed Central
Research on knowledge and perception about (in) fertility and Medically Assisted Reproduction (MAR) techniques among young people in Kosovo is lacking. Part of the European Project's B 2-InF's team conducted a qualitative study in Kosovo with young adults (18-30) in 2021 assessing perceptions and views related to MAR and information provided by the MAR clinics in Kosovo. Main objective of this study is to explore perceptions about motherhood/fatherhood and to understand (in) fertility issues among young people in Kosovo. It is focused to delve more into MAR knowledge and techniques of young people in Kosovo and in general. Fifteen interviews with young people living in Kosovo were conducted between June and July 2021. A total of 3 themes emerged during the qualitative analysis and were grouped in three main theme levels. The first level, perceptions about motherhood and fatherhood among young people in Kosovo is about different views of young people, desires about becoming parents, and what is their personal attitude towards parenting. The second, analyzing how (in) fertility is perceived by young people from a gendered perspective. The third, MAR perceptions and new techniques that are prevailing in the global sense as different access opportunities are present. The findings from our interviews demonstrated that parenthood is still gender related. Male (in) fertility is often considered a taboo among the young people in Kosovo. A substantial amount of lack of knowledge was found in relation to MAR techniques, highlighting the importance of detailed information about the whole process of MAR treatments.
Policy and Regulation · Professional Standards
Information and misinformation on assisted human reproduction techniques in Europe: a normative analysis of the information provided on the websites of medically assisted reproduction clinics
Albert M et al., 2026 · BMC medical ethics · Free full text on PubMed Central
As part of the European Be better informed about Fertility project (B2-InF), we carried out a normative analysis of the information provided online by assisted reproduction clinics to the European public. This analysis aimed to determine the degree to which this information complies with regulations of medically assisted reproduction (MAR) and commercial information, and the main ethical implications related to the duty of information. Information was gathered from the websites of 33 clinics across 8 European countries (Albania, Belgium, Spain, Italy, Kosovo, Northern Macedonia, Slovenia, Switzerland). Nearly 2000 pages of information were reviewed and checked for compliance with relevant frameworks of national and international law. The assessment revealed significant inconsistencies in how clinics present information online, with particular concerns regarding transparency about success rates, associated risks, add-on techniques and the legal and ethical issues that may arise during the use of these techniques. The results of our analysis indicate an urgent need for enhanced regulatory oversight and standardized information requirements for assisted reproduction clinics across Europe. These findings suggest the necessity for harmonized legal frameworks that mandate comprehensive disclosure standards and establish effective enforcement mechanisms to ensure transparent and accurate information provision to potential patients.
Registries and Reporting · Success Rate Reporting
Analysis of online information about success rates in fertility clinics in Spain. An urgent call for action
De Bayas Sanchez A et al., 2025 · Open research Europe · Free full text on PubMed Central
The medically assisted reproduction (MAR) industry is a booming sector of the economy, and Spain is proving to be a notable example of this industry's rise. Marketing strategies in the healthcare sector are shaped by the constant tension between providing clear, complete and appropriate information about treatments and providing information to attract and retain customers. We conducted a systematic analysis of success rate information published on the websites of Spain's five with the strongest online presence MAR clinics as of November 2023. The analysis examined terminology, certifications and audits by external bodies, references to data sources, age-specific success rates, and generalised claims about treatment effectiveness. We identified significant deficiencies and ambiguities in how clinics present success rate data. Common issues included vague definitions, lack of certification details, absence of reliable data sources, and failure to differentiate outcomes by age or treatment type. Several clinics used overly optimistic or potentially misleading statistics, making it difficult for patients to assess their realistic chances of success. We provide recommendations aimed at improving consumer protection and regulating advertising practices. We also emphasise that presenting clear and truthful success rate information is not only a legal requirement but also an ethical duty in reproductive healthcare. Stronger regulation of success rate reporting in Spain's fertility sector is urgently needed. We recommend that external authorities oversee and standardise data reporting to ensure transparency and prevent misleading practices. A centralised public body should be responsible for monitoring, collecting, and managing this data to protect patient rights and improve trust in fertility care.
Cancer and Fertility · Fertility Preservation Before Treatment
Review paper on fertility preservation in children and prepubertal adolescents with gynaecological cancer
Errasti T et al., 2025 · European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology · Free to read
Gynaecological cancer incidence in children and prepubertal girls is low but the risk of losing fertility potential is high due to the oncological treatments' toxicity. Consequently, fertility preservation is a top concern for survivors. This narrative review aims to summarize the best way of approaching each tumor treatment during prepubertal age with the goal of preserving fertility, and to discuss the latest methods used for fertility preservation for each gynaecological cancer. These procedures do not lack risks or uncertainities and offer a broad area of research.
Related research
Reproductive Ethics · Third Party Reproduction
Oocyte provision as a (quasi) social market: Insights from Spain
Degli Esposti S et al., 2019 · Social science & medicine (1982)
The provision of oocytes plays an important role in human fertility treatments. Spain alone performs half of oocyte provision cycles in the European Union whilst all other European countries face an oocyte shortage. How do Spanish fertility clinics manage to match the increasing domestic and foreign demand for female oocytes? Adopting a weak performativity approach and drawing insights from interviews carried out with 20 fertility clinic representatives, this study suggests that Spanish clinics are successful thanks to an egg provision system designed as a (quasi) social market. In the absence of traditional market mechanisms based on price fluctuations, the combination of fixed monetary compensation for providers and altruistic framing of oocyte provision as an act of donation, are used to mobilize relatively high numbers of women. Fertility clinics optimize this supply through a set of supplementary strategies to ensure oocyte supply always meets oocyte demand. Though successful, this market design reinforces gender stereotypes and relies on manipulative notions of altruism. A clear but unacknowledged appropriation of women's bodies and reproductive labour are also operated, which reinforces and reproduces racial and social stratifications. Therefore, we ask whether alternative mechanisms to promote female solidarity across different generations, to raise awareness of the risks of advanced maternal age, and to explore alternative market designs should be considered.
Registries and Reporting · Success Rate Reporting
Direct-to-consumer advertising of success rates for medically assisted reproduction: a review of national clinic websites
Wilkinson J et al., 2017 · BMJ Open · Free full text on PubMed Central
To establish how medically assisted reproduction (MAR) clinics report success rates on their websites. Websites of private and NHS clinics offering in vitro fertilisation (IVF) in the UK. We identified clinics offering IVF using the Choose a Fertility Clinic facility on the website of the Human Fertilisation and Embryology Authority (HFEA). Of 81 clinics identified, a website could not be found for 2, leaving 79 for inclusion in the analysis. PRIMARY Outcome measures reported by clinic websites. The numerator and denominator included in the outcome measure were of interest. 53 (67%) websites reported their performance using 51 different outcome measures. It was most common to report pregnancy (83% of these clinics) or live birth rates (51%). 31 different ways of reporting pregnancy and 9 different ways of reporting live birth were identified. 11 (21%) reported multiple birth or pregnancy rates. 1 clinic provided information on adverse events. It was usual for clinics to present results without relevant contextual information such as sample size, reporting period, the characteristics of patients and particular details of treatments. Many combinations of numerator and denominator are available for the purpose of reporting success rates for MAR. The range of reporting options available to clinics is further increased by the possibility of presenting results for subgroups of patients and for different time periods. Given the status of these websites as advertisements to patients, the risk of selective reporting is considerable. Binding guidance is required to ensure consistent, informative reporting.
Policy and Regulation · Access and Coverage Policy
Ensuring human rights in the provision of fertility care and infertility interventions
Van Der Poel S et al., 2018 · Fertility and Sterility
There are reports that define the significant unmet need for access to fertility care and infertility interventions for heterosexual couples - those who experience involuntary childlessness and who desire a biological child. This need for access to care rarely measures those couples in non-heterosexual relationships, single individuals or in key/neglected populations. This disparity in recognition of need, and resultant lack of access to care is glaring. Universal access and attainment of the highest standard of care requires the provision of high-quality information and services that fulfills, protects and respects all individuals. The objective of this study was to identify the key principles that support access to fertility care and infertility interventions, and to provide a human rights framework to guide processes during the development of draft recommendations to the World Health Organization (WHO) for clinical practice. To evaluate the public health and human rights and gender impact on infertility, a literature review and systematic analysis were conducted to look at the following questions. What are the existing policies, public health directives and research evidence gaps impacting gender and human rights in the context of involuntary childlessness and infertility; and, What human rights principles guide the development and implementation of fertility care and infertility related laws, policies and systems? A detailed search strategy in collaboration with the WHO-HQ librarian, introducing various combinations of a predetermined set of terms was undertaken to identify primary literature, systematic reviews and gray literature, including documentation regarding current status of human rights and gender equality within policy and practices. Using the search strategy defined, we were able to identify 488 articles and documents, of which 102 were found appropriate. They were then categorized using 9 principles previously identified by WHO and used to address the topic of contraception. From this process, we generated a list of 12 principles which will be presented that cover issues such as non-discrimination, non-stigmatization as well as informed-decision making and autonomy, sharing of benefits and ensuring provision of care that includes the recognition of the health and well-being of the parent or parents as well as the children born. During the systematic review of the published data and evidence for the development of draft clinical recommendations to be presented to and for the World Health Organization consideration, it was clear that a human rights framework was required. Our systematic review process used research and policy evidence to support the development of a framework of principles that can better ensure different human rights dimensions are clearly and systematically integrated into the provision of fertility care information and fertility interventions and services.
Registries and Reporting · National Registry Data
ART in Europe, 2017: results generated from European registries by ESHRE
Wyns C et al., 2021 · Human Reproduction Open · Free full text on PubMed Central
**STUDY ** What are the data on ART and IUI cycles, and fertility preservation (FP) interventions reported in 2017 as compared to previous years, as well as the main trends over the years? **SUMMARY ** The 21st ESHRE report on ART and IUI shows the continual increase in reported treatment cycle numbers in Europe, with a decrease in the proportion of transfers with more than one embryo causing an additional slight reduction of multiple delivery rates (DR) as well as higher pregnancy rates (PR) and DR after frozen embryo replacement (FER) compared to fresh IVF and ICSI cycles, while the number of IUI cycles increased and their outcomes remained stable. **WHAT ** Since 1997, ART aggregated data generated by national registries, clinics or professional societies have been gathered and analyzed by the European IVF-monitoring Consortium (EIM) and communicated in a total of 20 manuscripts published in Human Reproduction and Human Reproduction Open. **STUDY ** Data on European medically assisted reproduction (MAR) are collected by EIM for ESHRE on a yearly basis. The data on treatments performed between 1 January and 31 December 2017 in 39 European countries were provided by either National Registries or registries based on personal initiatives of medical associations and scientific organizations. **PARTICIPANTS/MATERIALS ** Overall, 1382 clinics offering ART services in 39 countries reported a total of 940 503 treatment cycles, including 165 379 with IVF, 391 379 with ICSI, 271 476 with FER, 37 303 with preimplantation genetic testing (PGT), 69 378 with egg donation (ED), 378 with IVM of oocytes, and 5210 cycles with frozen oocyte replacement (FOR). A total of 1273 institutions reported data on 207 196 IUI cycles using either husband/partner's semen (IUI-H; n = 155 794) or donor semen (IUI-D; n = 51 402) in 30 countries and 25 countries, respectively. Thirteen countries reported 18 888 interventions for FP, including oocyte, ovarian tissue, semen and testicular tissue banking in pre- and postpubertal patients. **MAIN ** In 21 countries (20 in 2016) in which all ART clinics reported to the registry, 473 733 treatment cycles were registered for a total population of approximately 330 million inhabitants, allowing a best-estimate of a mean of 1435 cycles performed per million inhabitants (range: 723-3286).Amongst the 39 reporting countries, the clinical PR per aspiration and per transfer in 2017 were similar to those observed in 2016 (26.8% and 34.6% vs 28.0% and 34.8%, respectively). After ICSI the corresponding rates were also similar to those achieved in 2016 (24% and 33.5% vs 25% and 33.2% in 2016). When freeze all cycles were removed, the clinical PRs per aspiration were 30.8% and 27.5% for IVF and ICSI, respectively.After FER with embryos originating from own eggs the PR per thawing was 30.2%, which is comparable to 30.9% in 2016, and with embryos originating from donated eggs it was 41.1% (41% in 2016). After ED the PR per fresh embryo transfer was 49.2% (49.4% in 2016) and per FOR 43.3% (43.6% in 2016).In IVF and ICSI together, the trend towards the transfer of fewer embryos continues with the transfer of 1, 2, 3 and ≥4 embryos in 46.0%, 49.2%, 4.5% and in 0.3% of all treatments, respectively (corresponding to 41.5%, 51.9%. 6.2% and 0.4% in 2016). This resulted in a reduced proportion of twin DRs of 14.2% (14.9% in 2016) and stable triplet DR of 0.3%. Treatments with FER in 2017 resulted in a twin and triplet DR of 11.2% and 0.2%, respectively (vs 11.9% and 0.2% in 2016).After IUI, the DRs remained similar at 8.7% after IUI-H (8.9% in 2016) and at 12.4% after IUI-D (12.4.0% in 2016). Twin and triplet DRs after IUI-H were 8.1% and 0.3%, respectively (in 2016: 8.8% and 0.3%) and 6.9% and 0.2% after IUI-D (in 2016: 7.7% and 0.4%). Amongst 18 888 FP interventions in 13 countries, cryopreservation of ejaculated sperm (n = 11 112 vs 7877 from 11 countries in 2016) and of oocytes (n = 6588 vs 4907 from eight countries in 2016) were the most frequently reported. **LIMITATIONS ** As the methods of data collection and levels of reporting vary amongst European countries, interpretation of results should remain cautious. Some countries were unable to deliver data about the number of initiated cycles and deliveries.
Virginie Rozée, María López-Toribio, Juan A Ramón-Soria, Kristien Hens, Joke Struyf, Manon Vialle
V Rozée, M López-Toribio, J Ramón-Soria, K Hens, J Struyf, M Vialle
PMID 39427161 39427161 DOI 10.1186/s12978-024-01890-2 10.1186/s12978-024-01890-2 Rozée et al. 2024, Rozée 2024