Increasing number of couples with infertility, law on in vitro fertilization urgently needed

Official statistics show alarming data that in Bosnia and Herzegovina, 83 babies are born per 10,000 inhabitants annually, and according to the birth rate, BiH ranks last in the region. This alarming data indicates that the birth rate in Bosnia and Herzegovina is constantly declining, writes the Bosnian news agency Patria.

Statistical data show that in Serbia, 90 babies are born per 10,000 inhabitants each year, and in Croatia, 94.

Analyzing demographic trends in Bosnia and Herzegovina, a drastic decline in the birth rate has been established, primarily in the Republika Srpska and then in the Federation. Data for 2013 show a negative natural increase rate in 8 out of 10 cantons of the Federation of Bosnia and Herzegovina, and the situation was no better in 2014.

These data also indicate an epidemic of sterility (infertility) in BiH, and it becomes clear that without concrete medical, social, and political steps, this „crisis“ could deepen. Some estimates also suggest that the population of BiH could completely disappear between the years 2500 and 2600.

Causes of infertility in BiH

In the Bahceci Center for Infertility and In Vitro Fertilization, a study was conducted from June 1, 2012, to June 1, 2014, involving 826 couples from BiH diagnosed with marital infertility.

Infertility or sterility is defined as the inability to conceive after one year of unprotected intercourse.

However, the main reason for infertility among married couples is later entry into marriage and postponement of the first pregnancy and childbirth. The highest reproductive capacity and possibility of conceiving is between the ages of 20 and 24 for women.

Statistical data indicate that the cause of infertility is equally distributed between women and men, and there are also cases where the cause of infertility lies with both partners, while idiopathic or unexplained infertility is defined as a condition where medical examinations cannot determine the true cause of infertility.

The main factors associated with infertility are body weight, smoking, and age, while other factors such as diet, physical activity, psychological stress, caffeine, and alcohol affect general health to a greater or lesser extent, and consequently reproductive ability.

Analysis of respondents by age groups established that the largest number of respondents belonged to the age group 36-39 years, a total of 293 (35.47%), followed by the age group 30-35 years, 245 (29.66%). In terms of frequency, third place were respondents from the age group ≥40 years, a total of 179 (21.67%), followed by the age group 25-29 years, a total of 98 respondents (11.86%).

In 42% (n=350) of couples diagnosed with marital infertility, it was established that it was female infertility, in 36% (n=294) it was male infertility.

Infertility in both partners was established in 11% (n=92) of couples, while in the remaining 11% of couples no diagnosis was made, and they belonged to the group of unexplained infertility.

The most common cause of infertility in women is reported as diminished ovarian reserve (DOR) in 38.57% of respondents. This diagnosis is directly correlated with the woman's age.

In male infertility, problems with spermatogenesis (reduced sperm count and motility and problems with sperm morphology), oligoasthenoteratozoospermia, dominate in 81.61% of patients.

Recommendations of the European Parliament

In 2008, the European Parliament warned about the importance of treating infertility. In cooperation with the European Society of Human Reproduction and Embryology (ESHRE), main guidelines were given to reduce this problem.

The main recommendations relate to creating macroeconomic conditions to increase the birth rate, as well as the availability of diagnostic and therapeutic methods for infertile couples. It is also recommended that assisted reproduction methods be incorporated into the population policy of all countries.

However, BiH still does not have a Law on Medically Assisted Reproduction, as this procedure is regulated differently in the entities of FBiH and RS, while in FBiH the procedure for refunding costs for in vitro fertilization varies from canton to canton.