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
19. Is there an important current debate in your country on these or related issues? No
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.
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 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
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
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.
Until recently in Ireland the provision of assisted human reproduction (AHR) services was largely unregulated. However, in April 2015 Parliament passed the Children and Family Relationships Act which deals with the limited topic of parentage in the case of donor assisted human reproduction. Under the Children and Family Relationships Act 2015, gamete and embryo donation are permitted on a non-anonymous basis. In addition, this legislation provides for the establishment of a national register of gamete/embryo donors, recipients and donor-conceived children (the National Donor-Conceived Person Register), which will allow donor-conceived children to access certain information regarding the gamete/embryo donor involved in procedures leading to their conception.
Moreover, although AHR services are not currently regulated by any specific health legislation, in February 2015, the Minister for Health received Government approval to draft a General Scheme of legislative provisions which would deal with a wide range of issues from the beginning to the end of the AHR process. Following the completion of the General Scheme, the Government approved its publication and the drafting of a Bill on assisted human reproduction based on this General Scheme. The drafting of this Bill is currently ongoing.
Under the proposed legislation, a number of practices will be regulated, including gamete and embryo donation, surrogacy and the assignment of parentage in such cases, pre-implantation genetic screening/diagnosis, sex selection for medical purposes, and posthumous assisted reproduction as well as associated research. It is also proposed that the legislation will establish a regulator to promote patient safety and good clinical practice in the area of assisted human reproduction. The regulator will maintain the National Donor-Conceived Person Register, establish the National Surrogacy Register and maintain records of all assisted human reproduction activities and services.
In January 2018 the General Scheme was submitted to the relevant parliamentary committee for review as part of the pre-legislative scrutiny process. This committee published the report of its review in July 2019, making recommendations which include proposals related to both broad policy objectives and more technical amendments. Its recommendations are being considered during the ongoing process of drafting the AHR Bill.
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
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.
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
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.
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? NA
b. Risk of transmission of a disease
For a heterosexual couple Yes?; For women not living in a heterosexual couple? NA
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? No.
There is no specific legislation on the subject. In practice only heterosexual couples are concerned.
3. Are MAP procedures covered by the social security system? No
4. Are there specific criteria for such coverage? NA
5. Is the financial coverage limited to a number of MAP procedures? Na
19. Is there an important current debate in your country on these or related issues? NA
20. Delegations are invited to provide information, in this section, on particular cases encountered in their country, and especially their case-law.
Homologous insemination in a married couple has no legal incidence: the mother’s spouse becomes the child’s biological father; the means of conception (natural or artificial) has no legal incidence, nor does consent or the lack of it.
Heterologous insemination, on the other hand, raises legal questions concerning filiation. The donor of the sperm is certainly the child’s biological father, but it is impossible to prove legal paternity as the identity of the donor is in principle unknown to the mother and the doctor is sworn to secrecy. Furthermore, no action to prove paternity may be opened in this case as Article 85 para. 1 of the Code of the Family and Guardianship makes sexual intercourse a prerequisite of such action.
The question of the legal paternity of the child thus remains open. In the case of an unmarried woman, action to prove paternity should be excluded, as the donor has the right to remain anonymous. However, if the child is born in wedlock or within 300 days of the marriage being dissolved or annulled, the mother’s husband is presumed to be the legal father. He may take action to contest his paternity within six months of finding out about the birth (art. 63). This is a peremptory time limit, after which only the public prosecutor may institute such proceedings.
The situation is more complex in the event of heterologous insemination carried out with the husband’s consent. As there are no specific legal provisions in the matter, the husband has the right to contest his paternity even though he did give his consent. Theoretically he only needs to prove that the birth was the result of MAP. However, according to a decision of the Court of Cassation on 27 October 1983: “Action by the spouse of the mother contesting paternity of a child born following MAP performed, with said spouse’s consent, with the sperm of another man may be considered contrary to public policy.” In stating its reasons, the Court stressed the importance of the child’s welfare, arguing that if it were to accept an action contesting the father’s paternity of a child born following MAP carried out with his consent using another man’s sperm, the child would, to all intents and purposes, be fatherless; it would be virtually impossible to prove the paternity of the donor because of the rules protecting his anonymity. And the donor has no interest in proving his paternity. This interpretation also takes into account the interests of the family formed subsequent to the couple’s decision to have recourse to MAP.
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
Any women – even being single and without any sexual relationship, and without infertility can go to a specific ART centre and ask for artificial insemination
16. Is donation of sperm/oocytes/embryos anonymous? Na
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 NA
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 ; ii. For the parents; iii. For a court NA
c. Other information
i. For the child him or herself ; ii. For the parents; iii. For a court NA
18. Is it possible to contest maternity and paternity of children born utilising MAP and under which conditions? NA
3. Are MAP procedures covered by the social security system? Infertility is followed free of charge, the healthcare system covering 2 pharmacological treatment cycles and the pre and post implantation. The gametes extraction techniques, fertilisation, implantation and embryo storage at Italian specialised structures are the responsibility of the couple as well as any subsequent treatment cycles to the two provided free of charge.
4. Are there specific criteria for such coverage? No. See comments on relative legal instruments.
5. Is the financial coverage limited to a number of MAP procedures? Yes. See comment to question 3.