Alignment, Anticipation, Adaptation, or Lagging Behind? Age-Based Regulations in Assisted Reproduction and Late Fertility

This paper focuses on age restrictions on access to infertility treatments and eligibility for their public reimbursement, exploring their relevancy in contexts of rising late birth rates (40+). I explore how age-based reimbursement policies for in vitro fertilization treatments have responded to these fertility trends in 27 high-income countries and in which regulatory frameworks for medically assisted reproduction (MAR) very late births (45+) have particularly increased. First, I show that while age limits for treatment reimbursement are well aligned with the prevalence of late fertility in some national contexts, in most countries, strict age restrictions are lagging behind the rise in late births. In others, pronatalist policies have prompted permissive age criteria or law revisions, anticipating or adapting to rising trends in late births. Second, the rise in very late births has been limited in some contexts with strict age-based rules. However, the analysis suggests that the impact of MAR on very late births may also be influenced by contextual factors other than regulations.