Between August 2025 and 20 August this year, the Health Insurance Fund received and reviewed 1,883 applications for medically assisted reproduction. Of those, 237 were for a fourth, fifth or sixth attempt - a right that previously did not exist at the state's expense at all.

That is every eighth application.

Broken down: 216 couples sought funding for a fourth attempt, 17 for a fifth, and four families were approved for a sixth.

A change that did not stay on paper

Until the legal amendments, the fund covered a maximum of three attempts. Anyone who wanted a fourth paid for it themselves - and that is an amount at which many families simply stop.

Now the number is six. And the statistics show the measure was taken up immediately, which means those 237 families existed before as well - they were simply not recorded anywhere, because they had no right to apply.

Alongside that, things changed that sound minor but are not. Notification of an approved right now arrives electronically. The deadline for an appeal has been extended from eight to 15 days. And the requirement for an additional referral from one's own gynaecologist has been scrapped - the service is now accessed directly on the basis of the fund's notification.

In 2025, more than 97.3 million denars were paid out for procedures at eight health institutions the fund has contracts with.

Why this is a bigger subject than it looks

In the first quarter of this year 3,380 children were born in Macedonia - a drop of 4.1 percent compared with the same period last year. In those same three months 5,342 deaths were recorded. Natural growth is negative, and in 66 municipalities the number of deaths exceeded the number of live births.

In 2025 there were 15,850 live births, 1.3 percent fewer than in 2024. In 2022 the figure was a little over 18,000.

So while the country has fewer newborns every year, there is a group of people asking only for one more attempt at having their first.

The limit money does not move

There is a part here institutions rarely say out loud. Additional attempts lower the financial barrier, but they do not move the biological one. Female fertility declines with age, and for some women each further attempt also becomes a race against time.

That means the speed of the procedure is not an administrative detail - it is part of the medical outcome. One woman received her voucher in exactly ten days. Another was rejected, resubmitted her documents, and was approved within a week.

The association "To a Baby Through IVF" points out that the financial side is only one layer. The psychological weight before, during and after the procedure is part of the same fight, and there is no voucher for that.

The fund ties the measure to demographic challenges, and it is not wrong about that. But it is worth noting what actually worked here: a concrete right, a concrete budget, a shortened procedure. That produced 237 applications in a single year. Demographic appeals from a podium produce zero.