This study reviews assisted reproductive technologies (ART) usage and policies across European countries and scrutinizes emerging issues related to cross-border reproductive care (or, ‘reproductive tourism’). Although Europe is the largest market for ART, the extent of usage varies widely across countries. This can be attributed to legislation, affordability, the type of reimbursement, and norms surrounding childbearing and conception. ART legislation in Europe has been growing in the past four years, with all countries now having some form of legislation. Countries with complete coverage of treatments via national health plans have the highest level of ART utilization. Legal marriage or a stable union is often a prerequisite for access to ART, with only half of European countries permitting single women and few granting access to lesbian women. Restrictive national legislation can be easily circumvented when crossing national boundaries for ART treatments, but raises important questions pertaining to safety and equity of treatments.