a country · PortugalPortugal

A country whose fertility market was rewritten by its own Constitutional Court. Portugal runs private clinics that treat Portuguese and foreign patients, but the rule on donor identity changed in 2018 and the donor supply changed with it. Portugal is also the one EU country that refused every cross-border reimbursement request it received in 2022.

In Ruling 225/2018 the Constitutional Court examined Law 32/2006 on medically assisted procreation, as amended in 2016, against the Constitution. The challenge ran at two provisions: Article 8 on gestational surrogacy and Article 15 on donor anonymity, which the applicants argued defeated a child's right to know its origins under Article 26. The court's page sets out that framing; what followed in practice is the part the clinics describe — donation in Portugal after that ruling is not anonymous, and a donor pool recruited on anonymity does not transfer to a register.

Inference — the result was a redirection rather than a reduction. A treatment that needs a donor still needs one, and the nearest jurisdiction where donation stays anonymous is across the land border. Spain's registry records Portuguese residents in its 2022 foreign-patient table, though at 93 cycles, 0.3%, they are a small line — and small partly because Portuguese patients in Spain who give a Spanish address are not in that column at all.

On the state side Portugal is an outlier in the Commission's data for a different reason: it received 27 requests for reimbursement of care not subject to prior authorisation in 2022 and refused all 27, the only country in the EU to refuse everything it received. It authorised all seven of its prior-authorisation requests, and it was one of the main countries of treatment for patients affiliated in Luxembourg, with 137 authorised cases.

Private clinics quote fertility programmes in euro with medication outside; the state system treats residents. For a patient needing donated gametes the practical question is not price but supply, and the answer since 2018 has been a register rather than an anonymous pool. Cross-border reimbursement runs through the national contact point, which refused every application it received in the year last reported.

The dated facts are a 2018 ruling and 2022 reimbursement figures. What is not published anywhere this project could read is how many treatment cycles Portuguese clinics have run for foreign patients since the ruling, or how many Portuguese patients crossed into Spain because of it.