Difficult births

Same-sex German couples forced abroad for fertility treatments

Human Fertility
A hot potato in Germany. Source: Getty

German cultures of conception and birth are undergoing a quiet evolution. In the last 15 years, the number of children conceived by artificial insemination and other forms of assisted reproduction has almost doubled, with 21,000 children born in 2015.

But growing demand for assisted reproduction is bumping up against Germany’s laws on conception, which are much stricter than many of its European neighbors. Only couples may use donated sperm to conceive, and they can only do so if someone is prepared to accept paternity of the child. And donating sperm anonymously is illegal.

The laws were established to help heterosexual couples with difficulties in conceiving by traditional means. But their discriminatory effect is becoming increasingly clear. Under the current set-up, lesbian couples and women without a partner have little chance of using sperm donations to conceive, nor of having the treatment covered by health insurance.

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The increased demand for assisted reproduction reflects much broader social and demographic changes. Germany’s birth rate remains stubbornly low. For a variety of reasons, including divorce and career demands, people are waiting longer and longer to have children, often encountering fertility problems as a result.

Unwanted childlessness is thought to affect more than 6 million people in the country, and occurs disproportionately in wealthier and more educated social strata. A 2016 survey suggested that 11 percent of childless men and 29 percent of childless women would consider having a child alone if there was no alternative.

Germany’s politicians have largely ignored these changes, with negative effects on fertility research and conception facilities in the country. An estimated 1,200 German children are born each year using anonymous sperm donors, most of them conceived overseas.

The big winners from the situation have been reproduction clinics in countries with more liberal laws, including Spain, Denmark and Israel. These have seen an influx of would-be parents from Germany, prepared to pay large sums out-of-pocket for a chance at assisted conception and pregnancy.

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In Spain, women over the age of 18 have the right to use anonymous donor sperm to conceive, regardless of partnership status or sexual orientation. The laws have led to a land rush, of sorts, with fertility clinics in Barcelona now having websites in German and German-speaking staff to cope with demand.

Overseas fertility treatment is expensive. Combinations of egg freezing, insemination attempts, in vitro fertilization, and hormone treatments can easily amount to tens of thousands of euros, in addition to travel and accommodation costs. Success rates are low, and the psychological toll is substantial, even when the treatment is successful.

But for many single women and same-sex couples, going abroad is the only option. Very few German fertility clinics even have a sperm bank. One exception is the Novum Klinik in the city of Essen, led by Thomas Katzorke, a pioneer in donor pregnancies, who established a sperm storage facility as long ago as 1981. His is one of the few fertility clinics prepared to treat lesbian couples.

Fertility libertarianism

As long as the sperm donor is prepared to be named as father, same-sex couples can legally receive fertility treatment. But the German Medical Association and many regional medical associations advise doctors against offering treatment, given the law’s gray areas. Dr. Katzorke says the only solution is to clarify the law, making explicit reference to female couples and single women.

Political change in this area has been excruciating slow. In 2012, federal subsidies were made available to couples undergoing fertility treatment, but not all federal states implemented the measure. In 2016, the subsidies were extended to unmarried couples. After taking office earlier this year, Health Minister Jens Spahn promised public help for women undergoing chemotherapy to freeze eggs.

The liberal, business-friendly Free Democratic Party (FDP) is pushing for a radical liberalization of fertility policy. This would include subsidies for all those undergoing fertility treatment, regardless of age, marital status and sexual orientation. Arguing that the “state has no place in family planning,” the party also wants to see the legalization of egg donation, anonymous sperm donation and non-commercial surrogate motherhood.

But when they were debated in parliament earlier this year, the FDP proposals were vehemently opposed by conservative parties. Following up, the parliamentary committee on the family recommended some reforms – the removal of age limits on fertility treatments, for example – but refused to recommend health coverage for fertility treatments for single women.

Eva Fischer is a Handelsblatt correspondent in Brussels and focuses on EU politics. Lilian Fiala is a reporter and intern with Handelsblatt and its sister publication, WirtschaftsWoche. Brían Hanrahan adapted this article into English for Handelsblatt Global. To contact the authors: E.Fischer@handelsblattgroup.com

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