BUDAPEST -- "If it weren't for a private clinic, I wouldn't have him," Krisztina Kazinczy says, pointing at her little boy collecting branches at a playground in a Budapest suburb. Her son, now almost 2 years old, was born after his parents received in vitro fertilization (IVF) treatment at a private clinic.
Such stories could be increasingly rare in Hungary, as from June 30, the government has outlawed all private institutions from offering IVF treatment. Hungary's longtime, right-wing Prime Minister Viktor Orban has justified the move, saying it is designed to make the procedure more accessible and help stop the shrinking of Hungary's population.
The country's population has been in an almost constant decline since 1980 and has been under 10 million since 2010. While the number of births has been rising since 2019, there have also been agrowing number of deaths, severely worsened by the coronavirus pandemic.
The government's ban on private IVF treatment has drastically reduced the options for many women and couples who are having problems conceiving. With private clinics now a no-go in Hungary, they are left with two options: try their luck at state hospitals with long waiting lists or pursue expensive treatment abroad.
Kazinczy, 38, a freelance consultant, had multiple rounds of IVF at a state-run hospital before electing to go private.
"I will never forget, one time they called in five of us…and told us to get naked. When the doctor was done with the first person, the second went right in. And in the meantime, we stood next to each other naked, because they didn't have enough time to wait for us to undress and dress," she says.
Her experience in the private sector was completely different. She didn't, she says, have to explain her medical history from scratch at every appointment and always felt that her doctors were well-informed and knew her case. After two rounds of treatment at the private clinic, she became pregnant.
The first Hungarian IVF baby was born in May 1989 in the southwestern Hungarian city of Pecs. A year later, Steven Kaali, a Hungarian-born, U.S.-based doctor, decided to open a fertility clinic in Budapest. The center, which opened in 1992 in one of Budapest's more affluent neighborhoods, soon became popular in Hungary and well-known abroad.
By 2017, the Kaali Institute (named after Kaali's father, himself a gynecologist) had assisted in the births of over 25,000 children, according to a letter Kaali wrote to Orban. The letter was published in a biography of Kaali, which also includes a signed photograph of the doctor and Hungary's veteran leader, whose Fidesz party won reelection again in April elections.
All eight Kaali Institute centers around Hungary were bought by the government in 2019 for an undisclosed amount. The reason for the sale has never been publicly announced. In December 2019, the Human Resources Minister Miklos Kasler announced that over 10 billion forints ($24.5 million) was to be spent on IVF clinics, treatments, and medications supporting fertility.
In May 2021, the government went further, announcing a ban on private clinics performing fertility treatments starting June 30, 2022. The state bought one more private clinic based in Budapest, the Robert Karoly Infertility Center, and the two remaining private fertility centers in the capital -- the Versys Clinics and the Reprosys Fertility Center -- both closed down, unable to provide services under the new law.
RFE/RL reached out to all three institutions for comment but did not receive any responses.
For people pursuing fertility treatment in Hungary, the shuttering of private services has been a huge blow.
Anita, 41, who for reasons of privacy prefers to only use her first name, lives in Szentendre, a town near Budapest. She has two teenage sons and would like to have a baby with her new husband. She became pregnant twice in the last year but miscarried both times.
"We didn't hear a heartbeat," she says over the phone.
Now, Anita has no other option but to go to a state-run hospital. While the treatment is mostly free, Anita's husband still had to undergo some privately funded examinations.
"When I called the assistant of the doctor in September, they told me the first available slot was in January. But if we pay, we can go as soon as October," she says about her husband's private examinations.
Anita is preparing for her second and last round of IVF within the state system but has doubts about whether she has received the correct diagnostic examinations in advance of the procedures.
"I asked the doctor to at least whisper the name of the [extra] examinations we could do, and we would do them in a private [clinic], but he wouldn't," Anita says. "If I could afford it, I would go to the Czech Republic."
Some Hungarians can afford to go abroad. According to Gabriela Nemethova, an IVF coordinator at the Gyncare clinic in Nitra, a city in western Slovakia, the number of Hungarian patients has "multiplied" in recent years. At the Slovak clinic, a basic consultation is 50 euros ($50) and one full round of IVF costs 1,200 euros.
Nemethova speaks Hungarian and was hired so the clinic could make their services available for Hungarian clients. Both of Gyncare's Slovak clinics have Hungarian-speaking coordinators, and they have nurses, receptionists, and doctors who can speak Hungarian, or at least English.
"We have some patients who didn't want to wait their turn in Hungary," Nemethova says. "But there are others who can't get treatment in these institutions because of their age, for example. And there are some who can afford it, but can't get the treatment they want."
For LGBT people, the challenges are even greater.
Laura, a soft-spoken German woman with a Hungarian wife, splits her time between Budapest and the Austrian capital, Vienna. Now eight months pregnant in the middle of a heatwave, she says that for her and her wife, Zsuzsanna, Hungary was never an option, as IVF is only available for heteronormative couples or single women nearing the end of their fertile years.
With the Czech Republic and Slovakia having similar restrictions on same-sex couples, Laura, who prefers to use just her first name, started her IVF in Vienna, which allows non-heteronormative couples to receive treatment. She did have some medical examinations before treatment in Hungary, but these were done in private clinics -- not, she says, because of homophobia from state doctors but because of language barriers.
The shortcomings of the Hungarian state health sector go beyond fertility centers. Due to what critics say is a lack of funding, Hungarian hospitals often have insufficient equipment and a shortage of staff. According to one estimate, Hungary's health-care sector has a shortfall of 25,000 medical workers, which is only expected to worsen in time as fewer young people go into the field.
One hospital in Szolok, a city with 71,000 inhabitants, recently announced that it can only accommodate births on Mondays and Wednesdays, while another rural hospital's maternity ward shut down due to a lack of medics.
I hate the process of the government taking over these institutions with my whole heart. I'm afraid that it will mean them being so overwhelmed and underpaid that it will result in thousands of unsuccessful procedures."
Freelance consultant and mother Kazinczy, who in 2021 organized a protest against the ban on private clinics in front of the Hungarian parliament that attracted some 50 people, says that her dissatisfaction has nothing to do with the qualifications or expertise of doctors in state-run institutions. Rather, she says, it has to do with the large number of patients they receive, the lack of specialists, and the relatively low salaries doctors receive.
"[It's a] production line," says Borbala, 30, a mother of a 5-week-old baby who went through state fertility treatment and who also prefers only to give her first name.
"They are there to make us a baby, even if that doesn't sound so nice. Despite this, everyone was nice and compassionate," she writes in an e-mail.
For Borbala, who suffers from endometriosis and adenomyosis, IVF was successful the first time she tried. She had various surgeries for her health conditions, her IVF treatment, and the birth of her child all at the same state hospital.
"From the beginning, I focused on the expertise and not the surroundings, like the dirty corridors and the old furniture," she says, and her experience, overall, was positive. "I do not doubt that I would come back. I felt safe."
Despite her positive experience in the state sector, she is worried about the government takeover.
"I hate the process of the government taking over these institutions with my whole heart. I'm afraid that it will mean them being so overwhelmed and underpaid that it will result in thousands of unsuccessful procedures. We were lucky, [getting treatment] in the middle of the capital. The real problems are in the rural areas," she says.
Beyond Orban's pronouncements about reversing the Hungarian population decline, many doctors, health workers, and patients are scratching their heads as to why the government has decided to target the private sector. In power for 12 years, Orban's government has long been criticized by the European Union, of which Hungary is a member, for presiding over an allegedly corrupt public procurement system, widespread conflicts of interest, lack of judicial independence, and restrictions on media freedom.
"I simply don't see any logic to this," says Alexandra Toth, a gynecologist and infertility specialist formerly at Budapest's private Reprosys clinic. "I would like to believe that their reason is that they want to make the process available for more people. But I don't really see the truth in that. There are long waiting lists, there isn't any quality control, and there's no competition anymore. I just don't see how this [new system] could be better."
Toth, who is currently working at a private gynecology clinic in downtown Budapest, says she was approached by a state-funded IVF clinic about the possibility of employment. The negotiation "died down," she says, after she communicated her needs from a professional perspective. Having previously studied in the United States, she says she told her prospective employer about the importance of certain practices and protocols, but, she says, she never heard back about whether these things would be available there.
The clinic Toth works at now is bright, full of natural light, with high ceilings and modern, shiny machines. She says many of the women who come to the clinic say they would like to hear a second opinion after consulting a doctor at a state institution. The clinic she works at can undertake certain gynecological examinations and procedures related to fertility treatment but not offer IVF.
It's good that people come for a second opinion, she says, "but there are people who come and ask us to explain what's happening. Because they have only spent two times five-minute [appointments] with a doctor and have plenty of questions before the procedure."
Toth's biggest concern is that there will be even more restrictions in the future. In April, the government announced the need for more oversight of the type of clinic where she now works, where they don't even carry out IVF procedures.
"I have a feeling that they will want to restrict private clinics even more," she says. "And I think they might try to do the same with foreign IVF treatments, too."
In February, the government announced the Directorate of Human Reproduction, which in the future will head the reconstruction of the sector. The president of the directorate is Vesztergom Dora, a doctor and well-known specialist in the fertility field and the sister-in-law of Hungary's president, Katalin Novak. RFE/RL reached out to Dora but didn't receive a response.
For those hoping to become parents, the added layer of insecurity to an already stressful and emotional process is grueling. Many former private patients were upset that their eggs were stored in a clinic that is now state-funded. Others managed to make last-minute transfers to clinics abroad or other state institutions they preferred to the one they were assigned.
For Kazinczy, the issue is pressing, as she plans on having a second child. The private institution that facilitated the birth of her first child is now run by the state, she explains, while chasing her son around the playground.
"This is the most tender part of our lives," she says. Her son stops at the swing and demands his mother join him in the miniature castle. "And we would like to know what's happening in the next few years."
