Access to medically assisted procreation - Search
Country
Germany
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
a) Act on the Protection of Embryos [Embryonenschutzgesetz – ESchG];
b) Section 27a of Book V of the Social Code [Fünftes Buch Sozialgesetzbuch – SGB V];
c) Sections 1591 to 1600d, 1682, 1685, 1741 and 1742 of the Civil Code [Bürgerliches Gesetzbuch – BGB];
d) Section 9 of the Act on Registered Life Partnerships [Lebenspartnerschaftsgesetz – LPartG];
e) Section 8b of the Transplantation Act [Transplantationsgesetz – TPG];
f) Tissues and Cells Regulation of the Transplantation Act [TPG-Gewebeverordnung – TPG-GewV];
g) Sperm Donor Register Act [Samenspenderregistergesetz – SaRegG]
a) 13 December 1990; 1 January 1991
b) 26 June 1990; 1 January 1989 (as amended)
c) Civil Code as amended by the Act to Law on the reform of guardianship and care law [Gesetz zur Reform des Vormundschafts- und Betreuungsrechts]: 4 May 2021; 1 January 2023
d) 16 February 2001; 1 August 2001
e) 20 July 2007; 1 August 2007
f) 26 March 2008; 5 April 2008
g) 17 July 2017; 1 July 2018
a) German: http://www.gesetze-im-internet.de/eschg/
b) German: http://www.gesetze-im-internet.de/sgb_5/
c) German: http://www.gesetze-im-internet.de/bgb/
English: http://www.gesetze-im-internet.de/englisch_bgb/
d) German: http://www.gesetze-im-internet.de/lpartg/
English: http://www.gesetze-im-internet.de/englisch_lpartg/
e) German: http://www.gesetze-im-internet.de/tpg/
f) German: http://www.gesetze-im-internet.de/tpg-gewv/
g) German: https://www.gesetze-im-internet.de/saregg/
Ongoing revision of Sections 1591–1600d of the Civil Code and the Sperm Donor Register Act to implement the requirements of the coalition agreement (parenthood agreements prior to conception, automatic assignment of the mother's wife, gender-independent recognition, determination procedure without status consequences, and opening of the Sperm Donor Register Act to sperm donations made before 2018, home inseminations by known donors and embryo donations).
On the basis of paragraph 16b of the German Transplantation Act the German Medical Association has published Guidelines on the Procurement and Transfer of Human Germ Cells or Germ Cell Tissue in the context of Assisted Reproduction dated 11 March 2022 (Richtlinie zur Entnahme und Übertragung von menschlichen Keimzellen oder Keimzellgewebe im Rahmen der assistierten Reproduktion; https://www.bundesaerztekammer.de/fileadmin/user_upload/BAEK/Themen/Medizin_und_Ethik/RiLi-ass-Reproduktion.pdf).
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.
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.
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
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
On the basis of Section 3a(2) of the Embryo Protection Act a pre-implantation genetic diagnosis is exceptionally permitted where the genetic predisposition of the woman from whom the egg cell was collected, or that of the man producing the sperm cell, or both, suggest that their offspring will be highly likely to have a serious genetic illness or to identify an abnormality that would be highly likely to lead to still-birth or miscarriage. With regard to the further requirements for a pre-implantation genetic diagnosis, reference is made to Section 3a(2) and (3) of the Embryo Protection Act. The execution of the MAP, in these cases, depends on the result of the pre-implantation genetic diagnosis.
c. Other
Pursuant to Section 6(2) of the Tissues and Cells Regulation of the Transplantation Act, the use of sperm cells for heterologous fertilisation, as a medically assisted procreation technique requires that the sperm donor is medically assessed as suitable for sperm donation, regarding his age, state of health and medical history and that the use of the donated sperm will not pose any health risks to others. Sperm donors are selected according to the criteria and laboratory tests laid down in Annex 4 Numbers 2 und 3 of the Tissues and Cells Regulation of the Transplantation Act. Annex 4 has implemented the selection criteria and laboratory tests for donors of reproductive cells laid down in Annex III of the Directive 2006/17/EC of 8 February 2006 as regards certain technical requirements for the donation, procurement and testing of human tissues and cells in national law. For this purpose, in particular, the donors’ serum or plasma samples must be tested and found negative for HIV 1 and 2, HCV, HBV and syphilis. Furthermore, urine samples of sperm donors must be tested and found negative for chlamydia by the nucleic acid amplification technique (NAT).
Additional aspects are set out in the Guidelines of the German Medical Association, paragraph 2.7.
16. Is donation of sperm/oocytes /embryos anonymous? sperm No/oocytes - /embryos No
With regard to the question of whether sperm donations for MAP purposes may remain anonymous, recourse is made to the ruling of the Federal Constitutional Court which states that the general right of personality (Article 2(1) in conjunction with Article 1(1) of the Basic Law [Grundgesetz – GG]) also applies to the child’s knowledge of his/her parentage and protects against the withholding of obtainable information about one’s parentage (consistent past decisions since the Federal Constitutional Court decision of 31 January 1989 – 1 BvL 17/87 - BVerfGE 79, 256). Therefore, the Sperm Donor Register Act provides that the physician who oversees the sperm donation must ensure that the child will later on be able to find out who his/her father is. Anonymising the sperm donation or the use of pooled sperm for artificial fertilisation is not permissible. According to the Model Guidelines of the German Medical Association on the performance of assisted reproduction, the physician must inform the sperm donor that he/she is required to disclose the name of the donor to the child on request and cannot, in this regard, invoke medical confidentiality.
In January 2015, the Federal Court of Justice (Judgment of 28 January 2015 – XII ZR 201/13, BGHZ 204, 54) ruled that children have the right to ask the treating reproductive health physician or sperm bank to disclose the name of the sperm donor from the medical treatment agreement between the parents and the clinic.
These principles were implemented in the Sperm Donor Register Act.
The same rules apply for the donation of embryos, as far as permitted under the Health Law. The coalition agreement provides for the opportunity to submit information about embryo donations to the Sperm Donor Register, this is subject to ongoing legislation.
Regarding oocytes, German Law does not permit any oocyte donation. Therefore, there is no rule in place to identify the genetic mother of a child born by another woman. Section 1591 of the Civil Code determines legal motherhood in terms of gestation only, the woman who gestates is the mother of the child. Whether a court can require a mother to inform the child about his or her genetic mother has not been tested yet in jurisprudence.
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 No
Pursuant to Section 10(1) of the Sperm Donor Register Act a person who assumes to have been conceived through sperm donation has the right to information from the sperm donor register (limited to the child seeking information or his or her parents as legal representatives of the child underage).
a. Identity of the donor(s)
i. For the child him or herself Yes; ii. For the parents No; iii. For a court No
See response to question 17.
Unlike the child, the legal parents are not entitled to learn the identity of the sperm donor. Pursuant to the data protection provisions under the Transplantation Act, the sperm donor and the legal parents are to remain anonymous to one another.
In case of litigation, courts have to decide on the above-mentioned rights; however, the courts themselves are not intrinsically entitled to request information about the parentage of a child.
b. Certain health information concerning the donor(s)
i. For the child him or herself No; ii. For the parents No; iii. For a court No
Pursuant to Section 2(3) of the Sperm Donor Register Act voluntary information about the sperm donor can be recorded in the sperm donor register. Unless the Donor withdraws his consent to store and use this data, the child is entitled to receive respective information upon request.
c. Other information
i. For the child him or herself No; ii. For the parents No; iii. For a court No
See response to question 17b.
In case of litigation, courts have to decide on the above-mentioned rights; however, the courts themselves are not intrinsically entitled to request information about the parentage of a child.
18. Is it possible to contest maternity and paternity of children born utilising MAP and under which conditions?
German law does not provide for maternity to be challenged. A child’s mother is – also where MAP has been used – the woman who has given birth to him/her (Section 1591 of the Civil Code). In rare cases the woman registered as the mother is in fact not the biological mother of the child; in those cases, however, the correction of the birth register (to replace this woman by the woman who has borne this child) is carried out by the civil status authority outside a contestation proceeding.
In contrast, it is in principle possible to challenge the paternity of children born as a result of assisted reproduction (Sections 1599 et seqq. of the Civil Code). The persons entitled to do so are the legal father, the man who declares in lieu of an oath that he had sexual intercourse with the mother of the child during the period of conception, the mother and the child (Section 1600 (1) of the Civil Code). However, any challenge to paternity by the father and the mother is excluded if they have both agreed to the artificial fertilisation (Section 1600(4) of the Civil Code). A challenge to paternity by the sperm donor fails because he cannot affirm on oath that he has had sexual intercourse with the mother. The child, however, is entitled to challenge paternity if donor-assisted MAP has taken place.