Bulgaria has an exceptionally high level of reproductive medicine, experts shared during a press conference on the occasion of European Fertility Week, organized by the Bulgarian Association for Sterility and Reproductive Health (BASRH). The event launched the national information campaign “Invitro in Bulgaria“. Leading specialists, representatives of the Center for Assisted Reproduction (CAR), the patient organizations “Conception“ and “Iskam bebe“ participated in it. They presented current data on demographic trends in our country, the growing role of Bulgarian assisted reproduction clinics and the effectiveness of the state policy for financing IVF procedures.
According to data from the National Statistical Institute, the birth rate in Bulgaria has decreased by 33% in the last three decades – from 79,442 live births in 1994 to 53,428 in 2024 (2). The average age of mothers at first birth has now reached 27.6 years, indicating that more and more couples are postponing parenthood. The fertility rate is 8.3%, and the average number of children per woman remains below the 2.1 required for natural reproduction - only 1.72. Bulgaria is among the countries in the EU with the fastest aging population, with people over 65 already representing 24% of the total population (2).
Assoc. Prof. Dr. Maria Yunakova, chairwoman of BASRZ and AG reproductive specialist at the Medical Complex “Dr. Shterev“, commented that these data show a lasting trend and a serious need for a long-term reproductive policy.
“The change in the age profile of parents is not an episodic, but a systemic trend. In this situation, the role of assisted reproduction clinics and state policy in supporting couples with reproductive problems and infertility will become key. Calculations by the Bulgarian Association for Sterility and Reproductive Health show that in 1994 0.1% of children born were conceived through assisted reproductive technologies (ART), in 2004 this percentage increased to 1.2%. In 2014, after five years of good work by the Center for Assisted Reproduction (the so-called Invitro Fund), the percentage of children conceived after ART out of the total number of babies born reached 5%, and for the past 2024, 6.5% of children born in Bulgaria were conceived after an assisted reproduction procedure“, she emphasized.
Despite the alarming data, experts note that Bulgaria has an exceptionally high level of reproductive medicine. Dr. Teodora Tikhomirova and Dr. Stella Chapanova from the Women's Health Hospital “Nadezhda“ pointed out that our country is competitive not only at the regional, but also at the European level.
“Our clinics comply with all the standards of the European Society for Reproductive Medicine (ESHRE) and regularly submit data on their success rate. Bulgaria has the transparency, professionalism and freedom of choice that patients deserve,“ they noted (3).
Bulgaria was among the first countries in Eastern Europe with successful in vitro fertilization back in 1988, and today 6.5% of all babies in the country are born after an assisted reproduction procedure (4). In recent years, the state has actively supported couples with reproductive difficulties through the Center for Assisted Reproduction.
Dr. Iskra Peeva-Kyurkchieva, Director of the Center, presented data on the Center's work: in 2024 alone, over 5,500 women and couples received funding for in vitro procedures, with 99% of applications being approved. Since its establishment 16 years ago, the CAR has supported over 41,000 couples, and over 18,000 children have been born with state funding.
“The support that the state provides through the CAR is real, timely and accessible. This allows us to help more and more people realize their dream of having a child“, she pointed out (5).
The average time to start a procedure from the date of approval has decreased from 107 days in 2022 to 94 days in 2024, and the CAR budget has already reached 22 million leva (5). Analyses show that every leva spent on financing in vitro treatment returns to the economy 83 times in the form of taxes and insurance contributions to future citizens (5).
Dr. Yana Konstantinova from USBALAG “Selena“ emphasized that Bulgarian reproductive specialists have many years of practice and international qualifications, and the success rate of the clinics is comparable to the European average - about 30% successful pregnancies per cycle. Bulgaria is also distinguished by an individualized approach to patients, which builds trust and satisfaction.
“Our country is among the leaders in the region in terms of embryologist qualifications – 38 specialists in our country are certified by ESHRE, compared to only 14 in Turkey. Bulgarian laboratories meet all European safety and quality standards and work with modern equipment and environments with CE marking, guaranteeing full traceability of the procedures“, said Prof. Plamen Todorov from Invitro AG Medical Center “Dimitrov“.(6).
According to data from the European Atlas of Fertility Treatment Policies 2024, Bulgaria covers a significant part of the key criteria for access and quality of treatment, which places it among the countries with a structured financing program and good safety levels (7). However, experts call for a wider introduction of educational programs on fertility and for increasing public awareness.
„Awareness is the best prevention of infertility. Bulgaria has doctors, a modern base and technologies at the European level. More and more couples understand that it is not necessary to seek treatment outside the country – in our country we have everything necessary to make the dream of a child come true“, summarized Assoc. Prof. Yunakova.
The patient organizations „Conception“ and „Iskam bebe“ also emphasized the importance of joint work between the state, medical specialists and society. Both organizations actively participate in the development of health policies, advisory councils and public discussions, protecting the rights of patients and insisting on equal access to treatment. They are also the main driver of emotional and social support for thousands of patients across the country.
Fertility Europe and its member associations from across the continent are marking European Fertility Week (EFW2025) under the motto “With facts forward – education and information”.(1)
“Invitro in Bulgaria“ is a campaign that unites experts and patients around a single cause – to talk openly about reproductive health and promote awareness. Its message is clear: Bulgaria has all the conditions, experts and technologies for every family to realize their dream of having a child right here.
The press conference was held with the support of Merck.