Across Europe, millions of people aspire to build the families they have always dreamed of. Yet increasingly, barriers stand between Europeans and their reproductive goals, leaving many facing involuntary childlessness. Some want more children than they ultimately have. Others face medical challenges that make conception difficult. Some delay parenthood due to career pressures or financial constraints, only to discover that time has narrowed their options.
Official statistics highlight this growing divide. Europe's fertility rate stands at just 1.38 live births per woman, far below the 2.1 needed to sustain population levels.¹ In 2022, 3.88 million babies were born across the EU, compared to 6.79 million in 1964, despite the bloc's population growing from 367 million to 447 million over the same period.²
This gap between family expectations and demographic reality has a profound impact on people and families across the continent. Behind the statistics are deeply personal stories: the monthly cycle of hope and heartbreak, the quiet grief of interrupted pregnancies, the silence that so many endure because fertility struggles remain shrouded in stigma. Those on the journey often feel unable to share their experience, carrying the emotional weight alone.
Ultimately, many will not achieve the number of children they desire, not for lack of wanting, but for lack of support. This is not just a demographic drag, but also a significant blow to Europe's prosperity and competitiveness. By 2027, Europe's population is projected to enter sustained decline.⁴ The Letta and Draghi reports warn that demographic challenges will fundamentally reshape the continent's economic and social fabric.⁵
Why Europe's fertility challenge matters
The decline in birth rates cannot be attributed to a single factor. Rather, shifting cultural attitudes, rising education levels and older first-time parents, ranging from 26.9 in Bulgaria to 31.8 in Italy⁶, are reshaping Europe's demographic landscape. Other factors, such as financial pressures, housing costs, and the challenges of balancing careers with family aspirations, all play a role.
This doesn't mean that family structures are disappearing; instead, surveys reveal that many Europeans want more children than they have. This suggests that structural barriers, rather than changing preferences alone, are hindering people from forming the families they envision.⁷
Infertility, the medical incapacity to conceive, and involuntary childlessness represent significant components, alongside profound barriers in accessing treatment. Globally, one in six people face infertility, translating to approximately 25 million EU citizens.⁸ With fertility declining sharply after age 35, and 45 per cent of young Europeans knowing little or nothing about age-related fertility limits, a concerning knowledge gap compounds the biological realities.⁹
Infertility is a topic often ill-considered, but a stark reality. Too frequently, payers treat it as a secondary or lower-priority condition, resulting in limited reimbursement that forces many patients to pay out of pocket for treatment. Those undergoing cancer treatment, for example, may face fertility loss from chemotherapy. Fertility preservation options, such as gamete freezing before treatment, can provide hope, but the infrastructure to provide this remains underdeveloped, and awareness about these options is low.
The broader implications
Beyond shaping the composition of the European family, declining fertility poses a pressing and immediate challenge to the European economy.
With the working-age population projected to decline dramatically in 22 of the 27 EU Member States by 2050,¹⁰ the European Central Bank expects population ageing to reduce growth across the euro area to levels below those seen during the 2007 financial crisis.¹¹
The pressures of this fertility gap are already being felt in some member states. This is not about assigning blame to any generation but about maintaining a sustainable balance between those at work and those in retirement. In Spain, citizens aged 65 and over contributed 12 per cent of total tax revenues in 2023, but consumed over 40 per cent of government spending, primarily for pension payments and healthcare.
By contrast, Spaniards aged 36 to 45 generated 25 per cent of tax revenue while accounting for just nine per cent of spending. On average, each senior citizen receives €30,000 more in government funding annually than they contribute in taxes, resulting in a collective fiscal gap of €300 billion per year.¹²
As taxes and public debts mount across Europe, governments are finding it increasingly difficult to protect existing pension and healthcare commitments, or even to pursue growth-enhancing investments. As the IMF concluded in its 2025 working paper "Lost Generations?": "Boosting fertility can help lessen the decline in the labour force and raise growth potential. But there are no quick fixes. Demography is not destiny, but it demands action."¹³
Three pillars for action
Addressing Europe's fertility challenge requires coordinated effort across education, workplace policy, and healthcare access. Merck, a Germany-based science and technology company, last year collaborated with stakeholders across the fertility ecosystem to develop a comprehensive plan to address Europe's fertility gap. It resulted in the European Manifesto "Tackling Infertility", centred around three interconnected pillars.¹⁴
First, education and awareness must improve, particularly among younger populations
While 80 per cent of young Europeans report good knowledge of contraception, only 67 per cent feel educated about fertility factors, and 45 per cent know little or nothing about age-related limits on fertility. Just 49 per cent have discussed fertility or preservation options with their doctor.¹⁵ Comprehensive reproductive health education, integrated into school curricula and medical training, can close this knowledge gap and empower people to make informed decisions about their reproductive futures. The FACTS! fertility awareness project has revealed major gaps in teenagers’ knowledge about their own fertility, findings confirmed by recent surveys.
Second, workplaces must become genuinely family-friendly
This extends beyond traditional parental leave to encompass flexible working arrangements and direct support for those building families. Merck's own Fertility Benefit program, available to all employees and their partners worldwide regardless of their marital status, provides financial support for fertility tests, in vitro fertilisation treatments, and hormonal therapies.
"At Merck, we take pride in having contributed to the birth of over six million babies worldwide and in supporting our employees' dreams of becoming parents through our Fertility Benefit program," says Marieta Jiménez, Senior Vice President Europe at Merck Healthcare. "A collective effort of policymakers, healthcare providers, employers, and the private sector is required to empower individuals in making informed and free choices about family planning and reproductive health."
Since its launch in Europe in October 2023, the program has received over 3,000 claims from more than 650 employees. The company hopes that such corporate initiatives can demonstrate to other companies that supporting employees' family aspirations is both feasible and valuable.
Third, access to fertility care must be strengthened and standardised
Merck aims to identify and address issues related to unequal access to fertility options across Europe. According to a study conducted by Fertility Europe, approximately two-thirds of the European countries surveyed had limited fertility treatment capacity at public clinics. In some countries, waiting times can stretch from 18 to 24 months. In some countries, out-of-pocket treatment costs exceed three times the net average monthly salary. Only France reimburses elective egg freezing, while other countries restrict treatments for same-sex couples or single women.¹⁷
"Our assessment of access to Assisted Reproductive Treatments reveals alarming disparities in accessibility and affordability across EU countries," notes Ana Polanco, Vice-President of European Government and Public Affairs at Merck. "It is crucial to ensure that all European citizens, no matter where they live, have equitable coverage and timely opportunities to build families, which will ultimately contribute to Europe's future prosperity."
At the recent multi-stakeholder event “Together for Tomorrow: Addressing EU Fertility Challenges,” hosted in the EU Parliament by MEP Romana Jerkovic (S&D Croatia) and organised by Merck, with the participation of several stakeholders, such as representatives from the United Nations Population Fund, civil society, including Fertility Europe and ESHRE, all raising their voices on the urgent need to act boldly to address the fertility gap.
Discussions focused on the need for equitable access to fertility care and the funding to support it, the importance of comprehensive reproductive education, and the role of family-friendly workplace policies in supporting individuals’ reproductive choices (from both employers and governments).
There was broad support for integrating “Fertility in All Policies” into women’s health strategies, future gender equality initiatives, and potential revisions to work-life balance policies, and the upcoming Multiannual Financial Framework, so to narrow the fertility gap and create an enabling environment that supports individuals and families in achieving their reproductive goals.
Building inclusive by design and family-friendly societies
No single intervention will resolve Europe's fertility challenges. Other factors, such as migration and productivity improvements, are essential components of any comprehensive response, but the benefits of higher birth rates will take decades to materialise. A child born today will only join the workforce 20 years later.
Yet precisely because demographic shifts unfold slowly, there is a need to act now. When governments design eligibility criteria for fertility care around equality and inclusiveness, reducing waiting times and investing in fertility prevention, early diagnosis and effective high-quality treatments, fertility rates improve. Comprehensive and ambitious family policy, combining generous parental leave and childcare support as in the Scandinavian countries, together with accessible fertility treatments and adequate funding, will also positively influence fertility rates while respecting reproductive autonomy.
As the company puts it, the fertility challenge is about enabling people to live the lives they choose, when they choose. Merck wants Europeans to build the families they desire, access the medical care they need, and ensure both professional ambitions and personal fulfilment.
"Equitable fertility care means leaving no one behind. At Fertility Europe, we envision a continent where everyone, regardless of sex or gender, has equal access to support in facing involuntary childlessness," explains Maciej Śmiechowski, chair of the executive committee at Fertility Europe. "Male infertility must no longer be the silent part of the conversation, and true reproductive justice requires access to accurate fertility information and comprehensive sexuality education."
Merck wants to flip the equation in Europe, encouraging policymakers to view fertility as a fundamental component of the healthcare system and the economic agenda, not an optional luxury. It demands that governments, employers and healthcare providers collaborate to remove barriers that prevent people from achieving their family aspirations.
For more information on fertility policy and access challenges, visit Fertility Counts at www.fertilitycounts.com and the Manifesto Tackling Infertility.¹⁸
1. Eurostat, Fertility Statistics - https://ec.europa.eu/eurostat/statistics-explained/index.php?title=Fertility_statistics
2. Eurostat, Live Births and Fertility Data - https://ec.europa.eu/eurostat/statistics-explained/index.php?title=Fertility_statistics
4. European Commission, Competitiveness Compass and demographic projections - https://commission.europa.eu/strategy-and-policy/priorities-2024-2029/competitive-europe_en
5. Mario Draghi, 'The Future of European Competitiveness Report' (September 2024) and Enrico Letta, 'Much More Than a Market' (April 2024) - https://commission.europa.eu/topics/strengthening-european-competitiveness/eu-competitiveness-looking-ahead_en
6. Eurostat, Fertility Statistics - Mean Age of Women at Birth of First Child - https://ec.europa.eu/eurostat/statistics-explained/index.php?title=Fertility_statistics
7. UNFPA, 'The Real Fertility Crisis' - State of World Population 2025 - https://www.unfpa.org/swp2025
8. World Health Organisation, Infertility Fact Sheet - https://www.who.int/news-room/fact-sheets/detail/infertility
9. Merck FutURe Barometer Survey 2024 - https://www.emdgroup.com/en/research/open-innovation/future-insight.html
10. Eurostat, Population Projections (EUROPOP2023) - https://ec.europa.eu/eurostat/statistics-explained/index.php?title=Population_projections_in_the_EU
11. European Central Bank, 'The Impact of Population Ageing on Potential Growth' - https://www.ecb.europa.eu/pub/economic-bulletin/html/index.en.html
12. McKinsey Global Institute, “Dependency and depopulation: Confronting the consequences of a new demographic reality” (2024), pp. 50-52
13. International Monetary Fund, 'Lost Generations? Labor Force and Output Losses from Population Aging' - IMF Working Paper - https://www.imf.org/en/Publications/WP
14. Manifesto Tackling Infertility - Manifesto-GB_VF-1.pdf
15. Merck FutURe Barometer Survey 2025 - https://www.emdgroup.com/en/research/open-innovation/future-insight.html
17. Fertility Europe and European Patients' Forum, 'European Atlas of Fertility Treatment Policies 2024' - https://fertilityeurope.eu/european-atlas-of-fertility-treatment-policies/
18. Merck Fertility Counts Initiative - https://www.fertilitycounts.com
