Provision of cross-border reproductive care in Czechia during the COVID-19 pandemic: a population-based study

Background Cross-border reproductive care (CBRC) is shaped by legal frameworks, costs, the quality of care, access constraints and socio-cultural preferences. The COVID-19 pandemic disrupted access to assisted reproductive technology services through lockdowns, travel restrictions and shifting regulations, thus rendering CBRC unstable and affecting access unevenly across countries. This study evaluates changes in the volume and structure of CBRC in Czechia during 2016–2021, focusing on the COVID-19 period (2020–2021), and identifies those origin countries that exhibited the most pronounced changes in demand. Methods A population-based quantitative study of all the assisted reproduction cycles initiated in Czechia between 2016 and 2021, excluding egg donation. Employing anonymised individual data obtained from the National Registry of Assisted Reproduction, 231,363 ART cycles entered the analysis, of which 93,834 (41%) were cycles sought by women who visited Czechia for infertility treatment. A time-series approach based on year-on-year relative changes was applied to capture the temporal dynamics. The pre-COVID trend (2017–2019) for 26 source countries was summarised applying geometric mean growth rates, whereas the COVID years 2020 and 2021 were analysed as distinct periods. Results Cross-border reproductive care represents an important component of the provision of assisted reproduction in Czechia. Assisted reproduction cycles declined by 2% during the pandemic with concern to the domestic population, whereas CBRC decreased by 27%. Although declines were recorded for most countries, increases in demand were registered for other states. Conclusions While the COVID-19 pandemic markedly reduced the overall volume of CBRC provided in Czechia, country-specific trajectories suggest that structural factors in the origin countries appear to continue to shape cross-border demand and treatment choices. From the policy perspective, the results underline the importance of expanding equitable and liberal access to national health system-provided reproductive healthcare. The barriers presented by national systems act to shift the demand for treatment abroad, which fuels CBRC and increases the financial, medical, legal and psychosocial risks faced by couples.