Leader: Cinzia Castagnaro (ISTAT)
This ask aims to integrate the longitudinal register on reproductive histories with socio-demographic, health and economic information obtained from other thematic surveys. Currently this register contains the main demographic information on the reproductive history of women with at least one child from 1999. Through a linkage between births and mothers from micro-data source with the Resident Population Register it is possible to recover information on all the sons from those women before 1999. The integration with social, health and economic surveys will allow to thoroughly describe reproductive behaviour and provide elements to face the intergenerational imbalance of Italy’s demographic situation.
Brief description of the activities and of the intermediate results: The 2016 FSS survey was integrated with the Base Register on Individuals (31/12/2022) to study fertility achievements. In the Register, 5433 women were traced (around 98% of the women interviewed in 2016) and for each of them the family composition was reconstructed to link any children they had between 2016 and 2022. Studies are currently underway to monitor the determinants which increase the probability of realizing the reproductive projects declared in 2016, or which constitute risk factors for the realization itself. To study the aging of the reproductive age a new study has been carried out through the preliminary analysis on the latest microdata available on Delivery Birth Certificates referred to 2021 from the Italian Ministry of Health.
Medically Assisted Reproduction (MAR) is exerting a growing impact on childbirth in wealthy nations, especially on fertility at advanced reproductive ages. It is observed that 3% of Total Fertility Rate is due to MAR in 2021; moreover, studying the contribution on age-specific fertility rates, it is highlighted how it raises to 13% for women after the age of 40, pointing out the importance of MAR for the recovery of births at older reproductive ages.
This study addresses this oversight by analysing the contribution of MAR to total and age-specific fertility rates, separately for first births and subsequent births.
Main policy, industrial and scientific implications: Referring to contribution of MAR to fertility Italy presents a unique –and so far unexplored– case-study. No study has yet analyzed the impact of MAR on fertility in Italy, a country well-known on the international scene for its lowest-low fertility levels and latest-late age at first birth.
Brief description of the activities and of the intermediate results:
Mar impact on fertility is growing over time. The study is based on age structures and birth order.
Main policy, industrial and scientific implications: Referring to contribution of MAR to fertility Italy presents a unique –and so far unexplored– case-study. No study has yet analyzed the impact of MAR on fertility in Italy, a country well-known on the international scene for its lowest-low fertility levels and latest-late age at first birth.
Brief description of the activities and of the intermediate results:
This study addresses this oversight by analysing the contribution of MAR to total and age-specific fertility rates in the next 10 and 20 years, according to 3 scenario: - unchanged scenario compared to what was observed in 2022; - trend scenario that follows the recent trend of MAR in the last 4 years; - increasing scenario which predicts an increase in MAR reaching the levels of Spain (9% of total live births).
Main policy, industrial and scientific implications: Referring to contribution of MAR to fertility Italy presents a unique –and so far unexplored– case-study. No study has yet analyzed the impact of MAR on fertility in Italy, a country well-known on the international scene for its lowest-low fertility levels and latest-late age at first birth.
The development of a longitudinal statistical register on reproductive histories continues, integrating demographic, health, and economic data to provide a comprehensive understanding of fertility behaviors and their implications for Italy’s demographic balance. The register enables the reconstruction of life trajectories of women and the analysis of factors that influence family and reproductive choices, crucial in a context where births are increasingly delayed and fertility rates remain critically low.
Data Integration and Analysis
The integration of the 2016 FSS survey with the Base Register on Individuals (31/12/2022) has been successfully utilized to track the reproductive histories of 5,433 women, identifying children born between 2016 and 2022 and reconstructing family compositions. Ongoing studies are focused on analyzing determinants that facilitate or hinder the realization of family and reproductive plans.
To further investigate aging and fertility trends, a new preliminary analysis of 2021 Delivery Birth Certificates (from the Italian Ministry of Health) has been conducted. The study highlights the growing role of Medically Assisted Reproduction (MAR) in fertility outcomes:
A more in-depth analysis of MAR's impact on both total and age-specific fertility rates is underway, differentiating between first births and subsequent births. This research is crucial as Italy remains an underexplored case study in MAR-driven fertility trends, despite being characterized by some of the lowest fertility rates and the latest-late maternal ages in the world.
Scientific and Policy Implications
The availability of longitudinal reproductive data provides essential evidence for shaping policies aimed at addressing delayed fertility and improving conditions for family formation. Understanding barriers and enablers of reproductive choices is fundamental for demographic sustainability in Italy.
The development of a longitudinal statistical register on reproductive histories continues, integrating demographic, health, and economic data to provide a comprehensive understanding of fertility behaviors and their implications for Italy’s demographic balance. The register enables the reconstruction of life trajectories of women and the analysis of factors that influence family and reproductive choices, crucial in a context where births are increasingly delayed and fertility rates remain critically low.
The availability of longitudinal reproductive data provides essential evidence for shaping policies aimed at addressing delayed fertility and improving conditions for family formation. Understanding barriers and enablers of reproductive choices is fundamental for demographic sustainability in Italy.
The main findings of this research will be present in:
Upcoming Outputs:
As part of the project activities, a new study was conducted to examine the ageing of reproductive age, through a preliminary analysis of the most recent microdata on birth certificates for 2023 provided by the Italian Ministry of Health. The analysis explored the growing role of medically assisted reproduction (MAR) in shaping fertility patterns, particularly at advanced reproductive ages.
The study found that in 2023, nearly 4% of the total fertility rate can be attributed to MAR. When analysing age-specific fertility rates, results show that almost one in five births to women aged 40 and over occurs through MAR, underlining its increasing relevance in sustaining fertility at older reproductive ages. Among first births, the contribution of MAR becomes even more striking: around one-third of all first births after age 40 result from medically assisted conception.
This study addresses a previous research gap by quantifying the contribution of MAR to both total and age-specific fertility rates, distinguishing between first and higher-order births. Italy represents a unique and previously unexplored case study in this field: until now, no research had examined the impact of MAR on fertility in a country internationally recognized for its very low fertility levels and delayed timing of first births.
Following the inclusion of MAR among the Essential Levels of Care (LEA) as of 31 December 2024, the activities also included the implementation of predictive scenarios to estimate the future impact of MAR on the total fertility rate. These projections were developed using forecasting techniques already adopted by ISTAT and Eurostat, allowing for the assessment of potential demographic implications of expanded access to medically assisted reproduction in Italy.
The main findings of this research have been published on the very prestigious Journal:
The contribution of medically assisted reproduction to total, age-, and parity-specific fertility in Italy Open Access
Alessandra Burgio , Cinzia Castagnaro , Daniele Vignoli , Agnese Vitali
Human Reproduction, deaf137, https://doi.org/10.1093/humrep/deaf137
Published: 10 July 2025
As part of the project activities, a scientific manuscript entitled “The Future of Births via Medically Assisted Reproduction in Italy: Scenarios to 2050” was prepared and submitted for publication to Fertility and Sterility Reports. The study presents forecasts on the future prevalence of medically assisted reproduction (MAR) in Italy up to 2050, representing the first attempt to project MAR trends in the country.
The analysis involved the construction of demographic scenarios based on recent data and trends in MAR utilization and delayed childbearing, as well as the application of forecasting techniques already adopted by ISTAT and Eurostat. The results suggest that, under plausible assumptions, the share of births conceived through MAR could increase from the current 4% to between 8% and 15% by mid-century, depending on the scenario considered.
The activity also included a discussion of the potential demographic and health policy implications of this rapid expansion, highlighting how such growth could significantly affect healthcare demand, costs, and resource planning. The topic was considered of high scientific and societal relevance, given its connection with fertility trends, delayed parenthood, and the increasing reliance on reproductive technologies in low-fertility contexts such as Italy.
The main findings of this research have been submitted on a very prestigious Journal:
The Future of Births via Medically Assisted Reproduction in Italy: Scenarios to 2050
Gustavo De Santis, Alessandra Burgio , Cinzia Castagnaro , Daniele Vignoli , Agnese Vitali
Submission to Fertility and Sterility Reports