IVF after the age of 43: what French law prohibits, what Greece allows

‘I was told it was over. ’ That’s often the first thing I hear on the phone. In France, the French health insurance system’s coverage of assisted reproductive technology (ART) stops on a woman’s 43rd birthday, and most clinics won’t undertake any further attempts beyond that age. Many patients only discover this limit late on: after a divorce, following a late diagnosis of infertility, or when having a second child becomes a possibility at the age of 44.

The French age limit: a reimbursement rule, not a biological one

It is worth distinguishing between two things. The 43-year-old rule is, first and foremost, a reimbursement rule: it is the age beyond which the social security system no longer reimburses treatment attempts. The 2021 Bioethics Act then delegated to a decree the task of setting age limits for access to the techniques themselves, with an upper limit of 45 for the woman carrying the child. In practice, between the ages of 43 and 45, the options exist in theory but are rarely offered, and are never reimbursed.

The authorities’ reasoning is statistical: with her own eggs, the chances of a live birth fall sharply after the age of 42. But the statistics do not account for what is possible with egg donation, where the donor’s age matters far more than that of the recipient. This is precisely where the difference between France and Greece becomes apparent.

What Greek law provides for

Since the 2022 reform (Law 4958/2022, amending Law 3305/2005), Greece has authorised assisted reproductive technologies for women up to the age of 54. Between the ages of 50 and 54, specific authorisation from the National Authority for Assisted Reproduction is required, and clinics carry out a more thorough medical assessment. For women under 50, the decision rests with the licensed clinic, based on a general health assessment: blood pressure, blood sugar levels, a cardiac assessment appropriate to the woman’s age, and a uterine examination.

This age limit is one of the highest in Europe. Spain, which is often cited, effectively stops at around 50; the Czech Republic at 49. For a woman aged 44, 46 or 48, the difference is not merely theoretical.

Whether using your own eggs or a donor’s: let’s be honest

I prefer to state this clearly, because some websites do not mention it. After the age of 43, IVF using your own eggs remains possible in Greece, but the chances of a live birth per attempt are usually below 10 per cent and decrease every year. A reputable clinic will tell you this and suggest a recent ovarian reserve assessment (AMH, antral follicle count) before any decision is made.

With egg donation, the situation is different: pregnancy rates per transfer are commonly between 50 and 60 per cent in Greek clinics, regardless of the recipient’s age, provided that her uterus and general health permit it. This is why the vast majority of French patients over the age of 43 who come to Greece opt for egg donation. And this is also why it is important not to wait: the law does not rule out treatment until the age of 54, but each passing year brings additional tests and obstetric risks.

The practical process from France

1. Initial assessment. Cervical smear, pelvic ultrasound, hysteroscopy if requested by the clinic, serological tests, general health check-up. Most of these tests are carried out in France.
2. Video consultation with the Greek doctor. They confirm the feasibility of the treatment, suggest either egg donation or the use of the woman’s own eggs, and set a timetable.
3. Consents and documents. Written consent from the couple or the woman alone, identity documents, and for those over 50, the dossier for the National Authority.
4. Endometrial preparation carried out from France, with local ultrasound monitoring.
5. The stay. Two to four days for an embryo transfer using donated eggs. Details by protocol are set out in the article on the length of stay.

Reimbursement: what you need to know before you go

The S2 form, which allows for partial reimbursement of planned treatment in another European Union country, requires that the treatment be reimbursable in France. For those aged 43 and over, the health insurance provider will therefore almost always refuse cover. You must therefore budget for the full cost: treatment, medication and travel. The article on the S2 form sets out the circumstances in which an application remains valid.

My advice

If you are aged between 43 and 47 and are unsure, have your ovarian reserve assessed now, not in six months’ time. It doesn’t commit you to anything, but it gives the doctor the only information needed to give you an honest answer. And if egg donation is mentioned, make sure you understand the Greek legal framework regarding anonymity before saying yes or no: it is explained here.

Frequently asked questions

Source: https://fertilitegrece.com/en/blog/ivf-after-43-greece/ — Triada Baloukoudis, IVF patient coordination in Greece. General information, not medical or legal advice. Printed on