1. Is access to medically assisted procreation (MAP)
a. restricted to heterosexual couples? No
b. possible for women not living in a heterosexual couple? Yes
Surrogacy is not allowed but donation of sperm is allowed and therefore homosexual female couples can use sperm donation or adoption of frozen embryos
6. Is donation of sperm/oocytes/embryos permitted in your country? Yes.
Regarding ‘embryos’ this is when the couple do not use the remaining frozen embryos; government can then take custody through the Authority set up by the Embryo protection Act and give them up for adoption.
Donation of gametes is only possible by a ‘confidential agreement between the donor and the licensee:’
7. Are there specific compensation arrangements for donations of sperm/oocytes/embryos? No
8. Are there specific criteria for donation of sperm/oocytes/embryos? Yes.
No age limit stated
The Embryo Protection authority ensure high standards. In the case of adoption of embryos a medical practitioner must declare the prospective parent physically fit.
See also 6 above.
Donation of embryos remains confidential and anonymity of the biological parents is entrenched into the law. Besides, all parental and filial rights are relinquished. That is to say, for example, the donated embryo would have no right to inherit the biological parents who gave up the embryo. Conversely the former would have no right on the latter.
9. Are there specific non-medical criteria for selection of gametes/embryos to be used for MAP? No
10. Are there special measures for the prevention of consanguinity? Yes. There is an official register kept by the Authority. Article 4, Section 3 states that ‘the Authority shall make all reasonable efforts to match prospective adoptive parents with the embryos who require an adoption placement’.
11. In a homosexual couple, is a legal relationship possible between a child and the partner of the legal parent? Yes
1. Is access to medically assisted procreation (MAP)
a. restricted to heterosexual couples? Yes
b. possible for women not living in a heterosexual couple? No
6. Is donation of sperm/oocytes/embryos permitted in your country? No. There is no legal regulation in the country therefore no gamete banks aiming to this are functioning.
7. Are there specific compensation arrangements for donations of sperm/oocytes/embryos? No
8. Are there specific criteria for donation of sperm/oocytes/embryos? NA
9. Are there specific non-medical criteria for selection of gametes/embryos to be used for MAP? NA
10. Are there special measures for the prevention of consanguinity? With the exception of the occasional donations for inseminations with fresh sperm which may be done outside of any control, other donor procedures have not been performed in the country.
11. In a homosexual couple, is a legal relationship possible between a child and the partner of the legal parent? No. No legal regulations.
19. Is there an important current debate in your country on these or related issues? Some debates have just started in many professional organisations - obstetricians/gynaecologists.
20. Delegations are invited to provide information, in this section, on particular cases encountered in their country, and especially their case-law.
Current healthcare law predates the era of MAP. No updates concerning MAP have been made.
In family law there are standard articles addressing the contesting of the paternity but not in relation to MAP.
3. Are MAP procedures covered by the social security system? Yes. Infertility is classified as a medical condition.
4. Are there specific criteria for such coverage? Yes. As public funding for medical services has to cover priorities within a set budget, there are conditions for access to National Health Service (NHS) funded treatment. The UK’s National Institute for Clinical Excellence (NICE) has provided guidance on access to NHS funded treatment which can be found on this page: https://www.nice.org.uk/guidance/cg156
5. Is the financial coverage limited to a number of MAP procedures? No. Although guidelines exist on access to NHS funded treatment for IVF and IUI, it is for local clinical commissioning groups (CCGs) or health boards to decide the appropriate health care services to fund for their communities. Patients who pay for their own treatment are not limited in the number of procedures they can have.
Law n°2021-1017 of 2 August 2021 on bioethics
Order n°2008-480 of 22 May 2008 transposing Directive 2004/23/EC of the European Parliament and of the Council of 31 March 2004 on gamete donation and medically assisted procreation
Decree n° 2021-1243 of 28 September 2021 setting the conditions for the organisation and management of medically assisted procreation procedures
Decree n° 2021-1933 of 30 December 2021 setting the conditions for authorising gamete self-preservation activities for non-medical reasons in application of article L. 2141-12 of the public health code and carrying various adaptations to the regulatory part of the same code with regard to the provisions of law n° 2021-1017 of 2 August 2021 relating to bioethics
Date of adoption and entry into force
First bioethics laws adopted in 1994, last revision: Law No. 2011-814 of 7 July 2011, which entered into force on 9 July 2011
Ordinance No. 2008-480 of 22 May 2008, which entered into force on 24 May 2008.
French Bioethics Law n°2021-1017 of 2 August 2021 on bioethics, entered into force on 4 August 2021.
Adoption on 29 June by the National Assembly and promulgation on 2 August 2021
Staggered entry into force according to the implementing texts.
3. Are MAP procedures covered by the social security system? Yes. Medically assisted procreation is considered a health care activity. Law N°2021-1017 of August 2nd 2021 provides for the possibility of reimbursement of MAP by social security under the same conditions for unmarried single women, female couples and heterosexual couples. The MAP procedure is covered by national solidarity. The beneficiaries are exempt from the co-payment.
4. Are there specific criteria for such coverage? Yes. The law of August 2, 2021 removed the criterion of infertility, MPA procedures are covered at 100% by the Assurance Maladie for a maximum of : - 6 inseminations (only one artificial insemination per cycle) to obtain a pregnancy; - 4 in vitro fertilization attempts to achieve a pregnancy. This coverage is the same for everyone (heterosexual couple, couple made up of 2 women, unmarried woman) Knowing that, for the retrieval or the collection in a project of AMP, there are conditions of ages: - oocyte retrieval can be performed in women up to their 43rd birthday; - Sperm collection can be performed in men up to their 60th birthday; And for the performance of MPA: - until her 45th birthday for the woman, unmarried or within the couple, who will carry the child; - until his 60th birthday for the person in the couple who will not carry the child.
5. Is the financial coverage limited to a number of MAP procedures? Yes. The health insurance system will cover six inseminations and four complete cycles, i.e. concluded by embryo transfer. Any IVF cycle broken off before embryo transfer, irrespective of the stage at which it is abandoned, will not be counted by the health insurance system. Reimbursement is subject to a preliminary agreement procedure.
Should pregnancy and delivery occur, the count restarts from zero, and coverage is provided for four new attempts. This does not apply to miscarriages or extrauterine pregnancies.
16. Is donation of sperm/oocytes/embryos anonymous?
LHC: no specific provisions are included in the LHC on this issue.
*DL-RHRR:
Donation of gametes and embryo is not anonymous; however information on the identity of a gamete donor is confidential. Also, any personal data collected about a couple or single women applying for MAP is confidential.
United Register of Gamete Donors will include data about the identity of gamete donors as well as of couple.
These data are confidential. However, the law may make exceptions for specific cases; e.g. “when the disclosure of information on the donor’s genetic characteristics is necessary for the health purposes of the child, born as a result of medically assisted reproductive technologies”.
17. Is it possible to obtain information about the biological origin of a child born after gametes of embryo donation?
i. For the child him or herself; ii. For the parents; iii. For a court Yes. LHC: no specific provisions are included in the LHC on this issue. The answers given to question 17 are based on DL-RHRR.
a. Identity of the donor(s)
i. For the child him or herself; ii. For the parents; iii. For a court No
b. Certain health information concerning the donor(s)
i. For the child him or herself; ii. For the parents; iii. For a court Yes. Health data of the gamete donor, particularly information about the donor’s genetic characteristics, could be disclosed from the register of gamete donors if this is necessary for the health purposes of the child, born as a result of MAP.
c. Other information
i. For the child him or herself NA; ii. For the parents; Yes. A couple or a single woman has the right to request and receive information on the donor’s age, appearance, ethnic background, and health condition.
According to the DL-RHRR gamete donors are obligated “to give the medical personnel complete and comprehensive information on his/her health condition prior to gamete donation.”
According to the DL-RHRR gamete donors are entitled to receive “information concerning his/her own health, which may be discovered as a result of monitoring the child born after utilizing assisted reproductive technologies.”
iii. For a court NA
18. Is it possible to contest maternity and paternity of children born utilising MAP and under which conditions? There are no specific provisions on this subject in family law at present.
1. Is access to medically assisted procreation (MAP)
a. restricted to heterosexual couples?
LHC: Insemination-No; IVF-Yes
a) At present the law gives access to artificial insemination to heterosexual couples as well as to single women.
b) However in vitro fertilization (IVF) is accessible only to couples.
DL-RHRR: No. Draft law gives access to medically assisted procreation (artificial insemination as well as in vitro fertilization procedures) to heterosexual couples as well as to single women.
b. possible for women not living in a heterosexual couple?
LHC: Insemination-Yes; IVF-No
a) Law gives access to artificial insemination to single women. However, the Law does not specify whether women should be living in heterosexual couple or not.
b) IVF is not accessible for single women.
DL-RHRR: Yes. Draft law gives access to medically assisted procreation (artificial insemination as well as in vitro fertilization procedures) to single women.
2. Are there specific criteria for access to MAP?
Medical reasons:
a. Infertility:
For a heterosexual couple? LHC: Yes, DL-RHRR: Yes;
For women not living in a heterosexual couple? LHC: No, DL-RHRR: Yes
2bi
LHC: Yes
“Risk of transmission of a genetic disease”
DL-RHRR: Yes
a) “Proven likelihood of the transmission of a serious genetic disease to a naturally conceived child from a woman or man, that may result in a child’s severe disability and/or premature death.”
b) “Proven likelihood that a child from natural insemination will be born with a non-genetic disease that may result in grave disability and/or premature death.”
b. Risk of transmission of a disease
For a heterosexual couple?; LHC: Yes “Risk of transmission of a genetic disease” DL-RHRR: Yes
a) “Proven likelihood of the transmission of a serious genetic disease to a naturally conceived child from a woman or man, that may result in a child’s severe disability and/or premature death.”
b) “Proven likelihood that a child from natural insemination will be born with a non-genetic disease that may result in grave disability and/or premature death.”
For women not living in a heterosexual couple? LHC: No, DL-RHRR: Yes
a) “Proven likelihood of the transmission of a serious genetic disease to a naturally conceived child from a woman or man, that may result in a child’s severe disability and/or premature death.”
b) “Proven likelihood that a child from natural insemination will be born with a non-genetic disease that may result in grave disability and/or premature death.”
Accordingly, the draft law of Georgia on Reproductive Health and Reproductive Rights permits access to medically assisted reproductive technologies for heterosexual couples or single women only if at least one of the conditions listed below are met:
c. Other There is one more medical criterion, but only for accessing surrogacy: existence of a disease due to which the pregnancy may endanger the woman’s life and/or health.
19. Is there an important current debate in your country on these or related issues?
Debates took place about the draft Law on Reproductive Health and Reproductive Rights among the representatives of various professionals, especially medical professionals, representatives of church and religious groups, representatives of Ministry of Health and Social Affairs, etc.
As the above draft Law is more specific than the Law on Health Care it will change existing legal situation (details are already specified throughout the questionnaire).
20. Delegations are invited to provide information, in this section, on particular cases encountered in their country, and especially their case-law.
English versions of the following legislation related to MAP are presented in the Addendum:
16. Is donation of sperm/oocytes/embryos anonymous? No. After reaching the age of 18 a person born from the MAP procedure is allowed to have access to data on identity of biological parent(s).
17. Is it possible to obtain information about the biological origin of a child born after gametes of embryo donation?
i. For the child him or herself Yes; ii. For the parents No; iii For a court Yes
After reaching the age of 18, every person born from a MAP procedure is allowed to have access to data on identity of biological parent(s).
Parents do have a right to access the donor data in the case of medical indication.
Both, child and parents should require data access from the MAP Registry.
a. Identity of the donor(s)
i. For the child him or herself, ii. For the parents, iii. For a court NA
b. Certain health information concerning the donor(s)
i. For the child him or herself Yes; ii. For the parents Yes; iii For a court Yes
c. Other information
i. For the child him or herself Yes; ii. For the parents No; iii. For a court Yes
18. Is it possible to contest maternity and paternity of children born utilising MAP and under which conditions? Yes. Contest is regulated within the Family Law. It is possible to contest maternity or paternity only in the cases when MAP procedure was performed without consent.
16. Is donation of sperm/oocytes/embryos anonymous? There is no indication for the practice followed by several clinical centers, due to the non-existence of relevant legislation
17. Is it possible to obtain information about the biological origin of a child born after gametes of embryo donation? There are no legal provisions. There is no indication for the practices followed by the IVF centers, due to the non-existence of relevant legislation.
18. Is it possible to contest maternity and paternity of children born utilising MAP and under which conditions? NA
19. Is there an important current debate in your country on these or related issues? The drafting of a law regulating MAP and IVF is currently under consideration. For this purpose a Steering Committee has been established by the Ministry of Health. The Committee is composed of representatives from Services and interested groups on MAP issues.
20. Delegations are invited to provide information, in this section, on particular cases encountered in their country, and especially their case-law. There is no case-law up-to-date.
3. Are MAP procedures covered by the social security system? No. The Ministry of Finance covers the cost of MAP procedures.
4. Are there specific criteria for such coverage? Yes. Specific criteria for such coverage are: (1) infertility (2) for women under 40 years old.
5. Is the financial coverage limited to a number of MAP procedures? Yes. The financial coverage is limited to only one (1) MAP procedure
1. Is access to medically assisted procreation (MAP)
a. restricted to heterosexual couples? No
b. possible for women not living in a heterosexual couple? Yes
There are no restrictions in the access to medically assisted procreation neither to hetero couples nor single women.
3. Are MAP procedures covered by the social security system? Yes. The Region must provide cost-free treatment for MAP to single women who do not have children, and couples who do not have children together.
4. Are there specific criteria for such coverage? Yes. Women over 45 year of age cannot receive treatment.
5. Is the financial coverage limited to a number of MAP procedures? Yes. Practice: 3 procedures with IVF and more if there are one or more spare, frozen embryos from the woman.
19. Is there an important current debate in your country on these or related issues? No
1. Is access to medically assisted procreation (MAP)
a. restricted to heterosexual couples? No
b. possible for women not living in a heterosexual couple? Yes
The national legislation is based on the concepts of a “couple” (that is, a woman and a man living together in marriage or in a relationship comparable to marriage or two women living together in marriage, registered partnership or in a relationship comparable to marriage) and a “person receiving treatment” (a couple or a woman not living in a marriage, registered partnership or a relationship comparable to marriage). The provisions in certain sections of the Act vary depending on whether the treatment is provided to a couple or to a single woman.
Clinics in the public sector have declined to provide MAP to female couples and single women, on the grounds that these services are provided only on the basis of medical indications. Female couples and single women have for this reason sought services from the private sector.
2. Are there specific criteria for access to MAP?
Medical reasons:
a. Infertility:
For a heterosexual couple? Yes; For women not living in a heterosexual couple? Yes
b. Risk of transmission of a disease
For a heterosexual couple Yes?; For women not living in a heterosexual couple? Yes
c. Other N/A
1. Is access to medically assisted procreation (MAP)
a. restricted to heterosexual couples? Yes
b. possible for women not living in a heterosexual couple? Yes
16. Is donation of sperm/oocytes/embryos anonymous? Yes.
The law adopts the principle of anonymity regarding any donation, therefore, the identity of the donor cannot be revealed under any circumstances.
According to Art 8, para 6 of the new law, medical information that concerns the donor are kept in an anonymous codified form in the Cryopreservation Bank and in the National Registry of Donors and Receivers.
17. Is it possible to obtain information about the biological origin of a child born after gametes of embryo donation?
i. For the child him or herself Yes; ii. For the parents Yes; iii. For a court Yes
The child and his legal representative may have access only to medical data which are kept in secrecy and in a codified form in Cryopreservation Banks.
Law 2472/1997 on the “Protection of individuals with regard to the processing of personal data” qualifies health data as “sensitive” kind of information and stipulates special permission of the Data Protection Authority (Article 7).
According to Art 20, para 3 of Law 3305, access to the National Registry of Donors and Receivers is permitted only to the child and for reasons related to his health, with the permission of the Data Protection Authority and as long as the conditions of Law 2472/1997 regarding protection of personal data are fulfilled. The parents may have access to information only when they act as representatives of the child. The Court may order access.
a. Identity of the donor(s)
i. For the child him or herself No; ii. For the parents No; iii. For a court No
The law adopts the principle of anonymity regarding any donation, therefore, the identity of the donor cannot be revealed under any circumstances. The child and his legal representative may have access only to medical data which are kept in secrecy and in a codified form in Cryopreservation Banks.
b. Certain health information concerning the donor(s)
i. For the child him or herself Yes; ii. For the parents Yes; iii. For a court Yes
The child or the parents (acting as representatives of the child) can have access to health information which are kept in secrecy and in a codified form in Cryopreservation Banks but not to the identity of the donor. The Court also may authorize access to health information.
c. Other information
i. For the child him or herself No; ii. For the parents No; iii. For a court No
18. Is it possible to contest maternity and paternity of children born utilising MAP and under which conditions? Yes.
Contestation of maternity and paternity: contestation of paternity is not allowed when the father has provided consent at the beginning of the treatment.
Also, according to Law 3089/02, consent before a notary public of a man and a woman living in a free union takes place in order to guarantee their affiliation with the child to be born. As a result of that, contestation of the voluntary affiliation is forbidden.
In the case of surrogate motherhood, according to the law, the woman to whom the Court’s approval has been given is considered to be the legal mother of the child. Exceptionally, either the commissioning, or the surrogate mother, may contest this in Court, under conditions provided for by the law.
3. Are MAP procedures covered by the social security system? Yes
MAP is a medical therapy under Section 27a of Book V of the Social Code.
The medical services covered by the statutory health insurance also include medical interventions aimed to induce a pregnancy. MAP measures must be medically diagnosed as necessary and have reasonable chances of success.
The Statutory Health Insurance Modernisation Act [GKV-Modernisierungsgesetz] reasonably restricted the entitlement to MAP measures from 1 January 2004 onwards. Since then Section 27a of Book V of the Social Code specifies that 50% of the costs are covered by the health insurance fund, so that the insured equally share in the costs of MAP interventions with a co-payment of 50%.
To reduce the financial burden caused by the 2004 cutback in costs covered by the statutory health insurance fund, in 2012 the Federal Ministry for Family Affairs launched the federal initiative “Hilfe und Unterstützung bei ungewollter Kinderlosigkeit” (assistance and support for involuntary childlessness). The funds are paid from both the federal budget and the budget of the Länder in which the couples concerned have their principal residence. Currently, twelve of the sixteen Länder participate in the initiative. Federal funding is generally provided for the first four treatment cycles of in-vitro fertilisation (IVF) and intracytoplasmic sperm injection (ICSI). Couples can be reimbursed up to 25 per cent of the share they have to pay in addition to the costs covered by the health insurance fund.
Until 2015, only married couples were entitled to additional federal financial assistance. Today, also unmarried couples living in a non-marital long-term relationship can receive federal financial assistance under the amended federal guidelines on financial assistance for assisted reproduction procedures (Richtlinie über die Gewährung von Zuwendungen zur Förderung von Maßnahmen der assistierten Reproduktion), which took effect on 7 January 2016. However, pursuant to Section 27a of Book V of the Social Code, entitlement to benefits from the statutory health insurance fund is still restricted to married couples only.
4. Are there specific criteria for such coverage? Yes.
The criteria included in Section 27a of Book V of the Social Code:
Coverage of part of the costs by the statutory health insurance funds is subject to the following requirements:
Any method other than homologous fertilisation is excluded from the mandatory package of benefits and services of the statutory health insurance system.
The restriction of eligibility to married couples is in accordance with the German Constitution (cf. Judgment of 28 February 2007 – 1 BvL 5/03, BVerfGE 117, 316).
Eligibility is subject to age limits of between 25 and 40 years for women and between 25 and 50 years for men.
Although unmarried heterosexual couples are not entitled to benefits from the statutory health insurance fund pursuant to Section 27a of Book V of the Social Code, they can receive the voluntary financial assistance offered through the federal initiative “Hilfe und Unterstützung bei ungewollter Kinderlosigkeit”.
5. Is the financial coverage limited to a number of MAP procedures? Yes. Pursuant to Section 27a of Book V of the Social Code three attempts to induce a pregnancy are partially covered by the health insurance funds. The payment of expenses by the health insurance funds has been limited to 50% of the costs approved along with the treatment schedule.
6. Is donation of sperm Yes/oocytes No/embryos* permitted in your country? Yes.
*Embryo donation per se is not regulated by law. However, the Embryo Protection Act provides that an oocyte may only be artificially fertilised for the purpose of bringing about a pregnancy in the same woman from whom the oocyte has been obtained (Section 1(1) number 2 of the Embryo Protection Act) and that it is prohibited to remove an embryo from a woman before its nidation is completed, in order to transfer it to another woman (Section 1(1) number 6 Embryo Protection Act). In addition, the Embryo Protection Act incorporates provisions aimed to prevent the creation of supernumerary embryos in the course of artificial fertilisation (especially the ban on the artificial fertilisation of more oocytes than can be inserted into a woman within one cycle – Section 1(1) number 5 Embryo Protection Act). Consequently, permissible embryo donation is only conceivable in exceptional instances where an artificially created embryo can unexpectedly no longer be transferred to the woman from whom the oocyte originated.
7. Are there specific compensation arrangements for donations of sperm/oocytes/embryos? No
8. Are there specific criteria for donation of sperm Yes/oocytes/embryos?
Gametes may be used for medically assisted procreation only after full medical assessment and if their use is medically indicated and the protection of the recipient’s and the child’s health is guaranteed (Section 6(1) of the Tissues and Cells Regulation of the Transplantation Act). The use of sperm cells for heterologous fertilisation as a medically assisted procreation technique furthermore requires that the sperm donor is medically assessed as suitable for sperm donation with regard to his age, state of health and medical history and that the use of the donated sperm will not pose any health risks to others. The necessary donor information must be collected by questionnaire and by means of a subsequent personal interview with the donor by the physician.
An age limit exists for eligibility to cost coverage by the health insurance funds (see response to question 4).
9. Are there specific non-medical criteria for selection of gametes/embryos to be used for MAP? No
10. Are there special measures for the prevention of consanguinity? No. As part of a voluntary commitment physicians, sperm banks and laboratories have limited the number of offspring from a sperm donation to 15 (Richtlinien des Arbeitskreises für Donogene Insemination zur Qualitätssicherung der Behandlung mit Spendersamen in Deutschland).
11. In a homosexual couple, is a legal relationship possible between a child and the partner of the legal parent? Yes.
German law includes the following provisions governing the legal relationship between the child and the spouse of the legal parent:
Pursuant to Section 1741(2) sentence 4 of the Civil Code/Section 9(7) sentence 1 of the Act on Registered Life Partnership, a spouse/registered partner is entitled to adopt his or her spouse’s/registered partner’s biological child. According to Section 1742 of the Civil Code/Section 9(7) sentence 2 of the Act on Registered Life Partnership, a spouse/registered partner may also adopt the child adopted by his or her spouse/registered partner. There is no longer a distinction between heterosexual and homosexual married couples, registered partners or between married and unmarried stable couples in case they want to adopt the child of their partner (Section 1766a of the Civil Code). In addition, married couples regardless of the sex of the spouses may adopt any other child as common parents, whereas unmarried couples and registered partners do not have this option to become common parents of the child simultaneously. They have to adopt the child successively.
19. Is there an important current debate in your country on these or related issues? No
20. Delegations are invited to provide information, in this section, on particular cases encountered in their country, and especially their case-law. See section I above for links to the updated versions of German laws
19. Is there an important current debate in your country on these or related issues? No process of revision is currently foreseen for this Law.
20. Delegations are invited to provide information, in this section, on particular cases encountered in their country, and especially their case-law. NA