How medical advancement can help managing the demographic shift

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Switzerland, a nation celebrated for its economic stability and high quality of life, is navigating significant demographic shifts. As fertility rates fall, the implications for national policy and reproductive medicine become increasingly critical. The total fertility rate has experienced a steady decline, decreasing from 1.52 in 2021 to 1.33 in 2023. The total fertility rate indicates the average number of children per woman to ensure the replacement of the population, which has been estimated to be above 2.1. This reduction signals an urgent need to address the forthcoming socio-economic challenges posed by an aging population, which, if left unmanaged, could have profound societal implications.

The aging Swiss population initially reduces costs in areas such as education due to fewer children, but this shift also presents long-term challenges. These include a shrinking workforce and increased pension burdens and healthcare expenses, as life expectancy continues to rise.

The Role of Reproductive Medicine

In Switzerland, reproductive technologies such as in vitro fertilization (IVF) and social freezing (cryopreservation of gametes for parenthood postponement) have become central to addressing fertility issues, particularly as couples opt to start families later in life. Although assisted reproductive techniques are relatively recent (the first IVF baby was born only in 1978), they have been undergoing tremendous developments in the last few decades. These innovations affect both the patients› diagnostic workout and their treatment. With reference to diagnosis, new generation ultrasound equipment and hormonal and genetic tests now allow to significantly reduce the time needed to obtain a diagnosis and to personalize treatment based on the specific characteristics of each couple.

«Although assisted reproductive techniques are relatively recent, they have been undergoing tremendous developments in the last few decades.»

Regarding treatment, new developments have been introduced in clinical and laboratory practice equally. New drugs and stimulation protocols, for example, allow to obtain better quality oocytes while reducing risks and discomfort for patients. In addition, embryo cryopreservation and single embryo transfer guarantee excellent success rates requiring less oocyte retrievals. Finally, fertility preservation is now ensuring reproductive options to categories of patients previously condemned to sterility (for example patients undergoing chemo and radiotherapy). With respect to laboratory practice, automation of some critical processes, embryo selection procedures (including Preimplantation Genetic Testing), monitoring of culture condition and use of artificial intelligence are contributing to a further optimization of safety and quality standards. In 2017, medically assisted reproduction, defined as reproduction facilitated through various interventions and technologies accounted for between 3.2 percent to nearly 10 percent of births in European countries. Switzerland has the lowest percentage of babies born through assisted reproduction, which could be also due to the fact that these treatments are only partially covered by health insurance, making them unaffordable to those with insufficient resources. This applies also to social freezing, which has seen an increase in popularity, especially among working women who aim to balance career goals with future family plans. Swiss clinics offer these services widely, acknowledging the growing trend toward delayed parenthood and the challenges it presents due to natural declines in fertility after the age of 35. However, policy changes that could extend coverage and make these services more accessible are essential.

«Switzerland has the lowest percentage of babies born through assisted reproduction, which could be also due to the fact that these treatments are only partially covered by health insurance.»

Lacking awareness

Switzerland’s response to demographic changes requires a multifaceted approach:

• Educational initiatives: Enhancing fertility awareness from a young age can empower individuals to make informed decisions about family planning. In the US, the National Survey of Family Growth highlighted a significant increase in infertility rates, mostly due to the natural decline of fertility with age of which women are often insufficiently aware (rising from 6 percent for women under 24 to over 30 percent for those aged 35-44), but also to lifestyle factors including smoking, exercising and nutritional habits. Early education on reproductive health, family building and family planning can play a crucial role in mitigating these trends.
• Policy enhancements: To combat the challenges of declining fertility, Switzerland must strengthen its policies in order to provide logistic and financial support to families. This includes creating an environment that supports working parents, by means, for example, of more affordable childcare options. As a matter of fact, the high cost of daycare centers in Switzerland – approximately 130 CHF per day – presents a significant barrier to early parenthood.¹
• Workplace adjustments: Employers can play an essential role in the strategic response to demographic shifts. Implementing family-friendly policies, such as flexible work arrangements, parental leaves and support for fertility treatments, can help accommodate the diverse needs of the workforce wishing to start a family.
• Accessible fertility treatments: Developing safe, effective and financially accessible fertility care is also vital. Policies aimed at reducing the cost of fertility treatments and expanding insurance coverage can significantly decrease out-of-pocket expenses for individuals seeking such services.

All these strategies can be useful to mitigate these demographic challenges. However, the growing trend of voluntary childlessness, driven by factors such as global uncertainty, climate change concerns and lifestyle preferences, suggests that economic incentives alone are insufficient to reverse declining fertility rates. Sociological strategies considering these broader societal shifts are also essential for developing effective policy responses.

«The growing trend of voluntary childlessness, driven by factors such as global uncertainty, climate change concerns and lifestyle preferences, suggests that economic incentives alone are insufficient to reverse
declining fertility rates.»

The need for a supportive environment

Switzerland stands at a crossroads, where integrating advanced reproductive technologies with robust policymaking can pave the way for a sustainable future. By fostering an environment supportive of both current and future generational needs through enhanced reproductive health care and proactive policies, Switzerland can effectively navigate the challenges posed by its evolving demographic landscape. This will support not only current but also future generations, ensuring the nation continues to thrive amidst global demographic shifts. However, these policies can only be effective if their implementation is immediately placed on top of the current national political agenda.