In Switzerland, the average number of children per woman was 1.5 in 2019, which represents a fertility rate at the average for Europe countries (1.53 child per woman). These figures have remained relatively stable during the last 30 years. At that time, postponement of childbearing began due to the use of contraceptive methods and the incorporation of women into the labour market. This situation has been reflected in the average maternal age at first birth, which in Switzerland is 32.2 years, one of the highest in the EU (mean of 30.8 years). Furthermore, the fertility rate in the population over 35 years of age has doubled in recent years. The fact of not having biological or adoptive children is a relatively widespread phenomenon in Switzerland, affecting around a quarter of women and men aged 50 to 80 years, significantly among those with higher educational level. Migrant women have higher fertility rates but their impact on aggregate fertility rates has decreased over time.
ART entered the Swiss political agenda in the early 1980s, and from the beginning, the legislation adopted has been very restrictive in relation to in vitro fertilization and, later, on embryonic stem cell research issues. During the 1990s, donor insemination and in vitro fertilization were prohibited for a few years, but the legislation has become gradually more permissive with these techniques. The current legal framework is determined by the Reproductive Medicine Law (FmedG) that was approved in 2016 after a referendum in which it had broad consensus. It states that ART treatments are intended only for heterosexual couples. Public sector funds artificial insemination and tax deductions are possible. The patient covers medical treatment and other expenses. It is allowed to perform in vitro fertilization (IVF) with the gametes from the couple or with donor sperm (only if the couple is married). In addition, procedures for testing for genetic diseases (PGD) in embryos are allowed. Sperm donation is always non-anonymous and couples may bring their own known-donor who donates just for them. Egg donation is not allowed. The maximum number of transferable embryos is three, and the cryopreserved material can be stored for ten years. The maximum number of children born from a donor is 8. Indeed, the law prohibits several treatments such as embryo donation, surrogacy and sperm donation to unmarried couples. It also prohibits access to ART treatments to single women and homosexual couples. Because of the law restrictions, reproductive tourism has increased recently, with Swiss travelling abroad to undergone ART procedures.
There is a total of 31 centres which offer ART treatments throughout the country, most of them private. In 2019, 11,163 cycles were performed, resulting in a total of 2,204 live births.
10 young people from Switzerland were interviewed, their sociodemographic characteristics are described in the table below.
| Participants (n=10) | ||
| n | % | |
| Age in years | ||
|---|---|---|
| 18 – 22 | 4 | 40 |
| 23 – 26 | 3 | 30 |
| 27 – 30 | 3 | 30 |
| Gender | ||
| Male | 5 | 50 |
| Female | 4 | 40 |
| Transgender male to female | 0 | 0 |
| Transgender female to male | 1 | 10 |
| Other | 0 | 0 |
| Sexual Orientation | ||
| Heterosexual | 5 | 50 |
| Homosexual | 4 | 40 |
| Bisexual | 1 | 10 |
| Other | 0 | 0 |
| Occupation | ||
| Student | 2 | 20 |
| Self-employed | 2 | 20 |
| Employed for wages | 6 | 60 |
| Homemaker | 0 | 0 |
| Unemployed | 0 | 0 |
| Unable to work | 0 | 0 |
| Highest educational level achieved | ||
| No schooling completed | 0 | 0 |
| School | 0 | 0 |
| High school | 7 | 70 |
| Bachelor degree | 3 | 30 |
| Doctorate degree | 0 | 0 |
| Residence | ||
| Urban area | 5 | 50 |
| Semi-urban area | 3 | 30 |
| Rural area | 2 | 20 |
| Relationship | ||
| Yes | 6 | 60 |
| No | 4 | 40 |
| Marital status | ||
| Single | 6 | 60 |
| Married or domestic partnership | 4 | 40 |
| Widow | 0 | 0 |
| Divorced | 0 | 0 |
| Separated | 0 | 0 |
| Religious beliefs | ||
| Christian | 5 | 50 |
| Muslim | 0 | 0 |
| Jewish | 0 | 0 |
| Orthodox | 0 | 0 |
| Other | 1 | 10 |
| None | 4 | 40 |
The recruitment of participants was organized by a contracted company based in Switzerland. The company email to its panel with a selection of the relevant age group and telephone potentially participants to ensure respondents meet the inclusion/exclusion criteria. Additionally, an advertisement on Facebook and Instagram was published to recruit LGTBQ affine profiles.
In total, 10 interviews were carried out between 2 and 8 of November 2021. Regarding language, 4 interviews were conducted in French and 6 in German. Interviewees were from Canton Zurich, Aargau, Valais & Vaude. Because of the COVID-19 pandemic, all the interviews took place online using Zoom. This facilitated coverage of several regions of Switzerland, without reporting major issues related to internet connections or engagement of participants in the conversation.