Title of the legislation: Law 12/2019, of the 15th February, described as techniques of assisted reproduction
Date of adoption and of entry into force: adopted on 15.02.2019 and came into force on 21.03.2019
Published in the Official Bulletin of the Principality of Andorra (B.O.P.A)
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
2. Are there specific criteria for access to MAP?
Adults between 18 years and – 50 years subject to exceptions. For example, if necessary, minors could cryopreserve gametes for their own use at a later stage, in order to preserve fertility in situations of pathological procedures. Always under medical guidance.
2. Are these specific criteria for access to MAP?
Medical reasons:
a. Infertility
i. for a heterosexual couple? Yes
ii. for women not living in a heterosexual couple? Currently no, but envisaged for single woman in the new draft legislation.
b. Risk of transmission of a disease (please specify the risk and/or disease)
i. for a heterosexual couple? No
ii. for women not living in a heterosexual couple? No
1. Is access to medically assisted procreation (MAP)
a. restrictd to heterosexual couples? Yes
b. possible for women not living in a heterosexal coupe? Currently No, but envisaged in the new draft legislation.
Bosnia and Herzegovina still have no specific legislation on MAP covering entire country. Currently, MAP is regulated by the Health Insurance legislation bylaws (in both B&H entities: Federation BiH and Respublika Srpska and Brcko District BiH), mainly regulating the rights of the couple to reimbursement of IVF costs for two procedures.
Date of adoption and entry into force:
Federation BIH: Decision on Establishment of Basic Patients Rights http://mz.ks.gov.ba/sites/mz.ks.gov.ba/files/Odluka%20o%20utvrdjivanju%20Osnovnog%20paketa%20slnFBiH21-09.pdf chapter X (11.,12.)
Adopted on 19. March 2009, in force as of 01.04.2009
Published in: Službene novine Federacije BiH”, 21/09 of 01. 04.2009.
In the entity Republika Srpska and Brcko district, Health Insurance Fund endorse the budget for MAP each year, depending on the funds availability
Indicate if process of revision is ongoing and, in your answers, provide information on provision in the draft law
MAP as a medical procedure is well established both in public and private sector in Bosnia and Herzegovina.
A draft Law on Medically Assisted Reproduction in the entity Federation B&H, after two years of preparation by the Federal Ministry of Health, and extensive public debate, has been rejected by the Parliament of Federation B&H in June 2014 https://www.google.ba/#q=+nacrt+zakon+o+biomedicinski+potpomognutoj+oplodnji
In 2016. B&H state level Parliamentary Group on Gender Equality drafted the B&H Framework Law on MAP (Setting standards for the entire country); however, despite support by the Council of Ministers of B&H, it has been rejected by Constitution-legal Commission of the House of Representatives, not for the content, due to for political reasons . http://static.parlament.ba/doc/46496_ZAKON%20O%20LIJE%c4%8cENJU%20NEPLODNOSTI_BIH%20%20nacrt_%20pre%c4%8di%c5%a1%c4%87eni%20(1). (July 2016)
Currently (January 2017) the new draft law on MAP (proposed by the Socialist Democrat Party MS) is in the Parliamentary procedure in B&H Entity Federation BIH, while the Draft of the MAP law prepared by the competent Ministry of Health will be on the Parliament agenda in 2017 as well.
6. Is donation of sperm/oocyte/embryos permitted in your country?
No
7. Are there specific compensation arrangements for such donations?
NA
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 teh prevention of consanguinity?
NA
11. In a homosexual couple, is a legal relationship possible between a child and the partner of the legal parent? MAP legal only for heterosexual couples
3. Are MAP procedures covered by the social security system?
Unfulfilled desire to have children is not considered as a disease. A fund is established to cover 70% of costs of IVF – treatments under specific conditions.
4. Are there specific criteria for such coverage?
Yes:
5. Is financial coverage limited to a number of MAP procedures?
Yes, limitation to four IVF procedures; if a pregnancy is achieved further four IVF procedures are possible.
Are there specific criteria for access to MAP?
Yes, Access permitted for heterosexual and homosexual couples, no access for single women. Access in case of high risk of transmission of a serious disease, e.g. HIV.
1. Is access to MAP
Access for homosexual and heterosexual couples, no access for single women.
Des critères spécifiques sont-ils retenus pour l’accès à la PMA ?
L'accès à la PMA est ouvert aux couples hétérosexuels et homosexuels, mais pas aux femmes célibataires. Accès en cas de risque élevé de transmission d’une maladie grave, par ex. VIH.
Title of the law: No specific law, but different articles in the Code make a reference to it:
Law of population health protection
Date of adoption: 26 June 1997; entry into force: 24 September 1997.
Chapter 5.
Article 29 Artificial insemination and embryo implantation.
Article 40. The usage of semen and human organs for transplantation.
The Criminal Code of Azerbaijan Republic
Date of adoption: 30 December 1999; entry into force: 01 September 2000
Chapter 8.
Article 136. Illegal Artificial insemination.
Title of the law: Law on Medical Assisted Reproduction “Fortpflanzungsmedizingesetz”
Date of adoption: 14 May 1992 entry into force 1 July 1992
Published: in Federal Gazette “Bundesgesetzblatt” BGBl. Nr. 275/1992
Amendment: Fortpflanzungsmedizinrechts-Änderungsgesetz 2015
Date of Adoption: 23 February 2015, entry into force: 24 February 2015
Published in: Federal Gazette “Bundesgesetzblatt” BGBl. I Nr. 35/2015
Revision concerning egg donation, sperm donation and PGD
3. Are MAP procedures covered by the social security system?
No
4. Are there specific criteria for such coverage?
No
5. Is the financial coverage limited to a number of MAP procedures?
Yes
Is donationn of the sperm, oocytes and embryos permitted? Yes
Are there specific compensation arrangements for such donations?
No. The 2007 Act states that only donations of supernumerary embryos and gametes which are made free of charge are lawful.
The Act does allow the King, however, to specify an allowance to cover the travel expenses or loss of earnings of the person from whom the gametes are being obtained. This allowance can also cover the hospital fees arising from the retrieval of oocytes from the donor. So far, however, no decrees have been issued to this effect.
In practice, all costs arising from medical examinations and procedures during treatment are borne by the recipient. Sometimes, too, the fertility centre requires the woman receiving the oocytes to pay the donor an “allowance” while sperm donors receive a small amount of compensation for each usable sample.
Are there specific criteria for donation of the sperm, oocytes and embryos?
The 2007 Act states that gamete retrieval is available to adult women up to the age of 45 years. Retrieval of gametes, supernumerary embryos, gonads or gonad fragments for cryogenic storage may be carried out, on medical advice, on a minor, however.
Donations of supernumerary embryos or gametes for eugenic purposes or for the purposes of sex selection are prohibited.
There must be a written agreement between the donor and the accredited fertility centre. The law does not specify any medical criteria for harvesting.
Are there specific non-medical criteria for selection of gametes/embryos to be used for MAP?
In practice, the centres try to avoid too great a dissimilarity between donors and recipients.
The law of 2007 specifies that pairing between donor and recipient may not be considered as a practice with eugenic character.
Are there special measures for the prevention of consanguinity?
The 2007 Act states that supernumerary embryos from the same donor or couple of donors or gametes from the same donor, must not result in births in more than 6 different women.
In a homosexual couple, is a legal relationship possible between a child and the partner of his or her legal parent?
The Act of 18 May 2006 amended certain provisions of the Civil Code to allow same-sex adoption.
2. Are there specific criteria for access to MAP?
Medical reasons:
a. Infertility:
For a heterosexual couple? No; For women not living in a heterosexual couple? No
b. Risk of transmission of a disease
For a heterosexual couple? No; For women not living in a heterosexual couple? No
There are no legal restrictions for access to medically assisted procreation. However, the law of 2007 specifies that the fertilization centers may refuse to comply with a request for MAP, either by specifying the medical reasons for the refusal or by invoking objection of conscience.
c. Other NA
Is donation of the sperm, oocytes or embryos anonymous?
Yes. In the case of gametes, anonymity is the rule. The law does, however, allow non-anonymous donations if they are based on an agreement between the donor and the recipient or recipients.
Is it possible to obtain information about the biological origin of a child born after gametes or embryo donnation?
The law provides that once supernumerary embryos or gametes have been implanted, the parentage rules set out in the Civil Code operate in favour of the author or authors of the parental project. No parentage suit may be filed against the donor by the recipient or by the child born through the use of supernumerary embryos or gametes.
There are no specific legal provisions that would apply to the courts in this area. It cannot be ruled out that a court might obtain information about the biological origin of a child born through gamete or embryo donation if it deemed this necessary.
Is it possible to obtain information about the identity of the donors ?
No for the child and the parents, yes for the court
The fertility centre is legally bound to render inaccessible any data that could be used to identify the embryo or gamete donor. Anyone working for or in a fertility centre who becomes aware of information that could be used to identify the donor is subject to the professional secrecy requirement (Art. 458 of the Criminal Code). Non-anonymous gamete donations are permitted, however, if they are based on an agreement between the donor and the recipient or recipients.
Is it possible to obtain certain health information concerning the donors?
For the child, for the parents, for the court: yes
The Act specifies that the center registers specific data concerning the donor, such as the physical characteristics of the biological parents, in case of an embryo, or of the gamete’s donor but provides for the parents and the child to have access only to the necessary medical data that can be important for the child’s health.
Is it possible to obtain other information?
For the child, for the parents no, for the court yes
The law requires the centre to record certain data relating to the donor, including the physical characteristics of both embryo providers or of the gamete donor. The law only allows the parents and child access to such medical data as are necessary for the child’s health, however.
Is it possible to contest maternity and paternity of children born utilising MAP and under which conditions?
No, the law states that once supernumerary embryos or gametes have been implanted, the parentage rules laid down in the Civil Code operate in favour of the authors of the parental project.
No lawsuit relating to parentage or to its effects on property rights may be brought by donors of supernumerary embryos or gametes.
3. Are MAP procedures covered by the social security system? Yes. In Lithuania infertility considered as a disease therefore MAP services are paid for in accordance with the Law on Health Insurance of the Republic of Lithuania. The compensation is available to people who have entered into a marriage or registered partnership agreement in accordance with the law and have been diagnosed with infertility (female, male or both). Age limit of woman for compensation - 42 years old.
4. Are there specific criteria for such coverage? Yes. Infertility is the condition for the coverage of MAP. Woman age limit for treatment of infertility with MAP is 42 years.
5. Is the financial coverage limited to a number of MAP procedures? Yes. A maximum of 2 treatment cecles per couple is reimbursed.
Title of the law: There are no general laws or regulations on medically assisted procreation in Poland
If no legal instrument please describe the practice: In view of the lack of specific legal provisions, MAP may be practised under the general rules of medical law and in particular those governing the practice of medicine (duty to inform patients of the medical and legal consequences, confidentiality with regard to the MAP itself and the identity of the donor of the gametes, due care in the choice of the donor and examination of the genetic material to be used, the duty to obtain free and informed consent, etc), the corresponding rights of patients, the general laws on families, descent and registration, and the Medical Code of Ethics (which does not address this issue specifically). Some questions are addressed in the Opinion of the Polish Association of Obstetricians concerning the MAP techniques used in the treatment of infertility, and others by the internal regulations of the clinics practising MAP (practice may therefore vary from one place or establishment to another).
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
Since the law n°2021-1017 of 2 August 2021 on bioethics, access is reserved for couples composed of a man and a woman or two women or any unmarried woman, alive, who has already consented to embryo transfer or insemination.
Recourse to MPA is now conditional on the existence of a parental project. The medical criteria relating to medically established pathological infertility or the transmission of a particularly serious disease, which previously conditioned access to MAP have been removed. Obstacles to insemination or embryo transfer include the death of one of the members of the couple, the filing of an application for divorce or legal separation, the signing of a divorce or legal separation agreement by mutual consent, or the cessation of cohabitation, as well as the written revocation of consent to the doctor in charge of implementing medically assisted procreation or to the notary who received the consent.
6. Is donation of sperm/oocytes/embryos permitted in your country? NA
7. Are there specific compensation arrangements for such donation? NA
8. Are there specific criteria for donation of sperm/oocytes/embryos? NA
9. Are there specific non-medical criteria for selection of gametes/embryo to be used for MAP? NA
10. Are there special measures for the prevention of consanguinithy? NA
11. In a homosexual couple, is a legal relationship possible between a child and the partner of the legal partner? NA
3. Are MAP procedures covered by the social security system? NA
4. Are there specific criteria for such coverage? NA
5. Is the financial coverage limited to a number of MAP procedures? NA
2. Are there specific criteria for access to MAP? NA
6. Is donation of sperm/oocytes/embryos permitted in your country? Yes
7. Are there specific compensation arrangements for donations of sperm/oocytes/embryos? No. Only direct costs are allowed to be reimbursed (such as: traveling costs)
8. Are there specific criteria for donation of sperm/oocytes/embryos? Yes. Donors are assessed according to the requirements of the EU Tissues and Cells Directives and other professional standards comprising at least: assessment of the risk for transmission of blood-borne diseases (history of behaviour and testing), medical history, physical examination, genetic testing.
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? Yes. Official Registry is about to be established. Number of donations is limited up to 3 children born (after 3 births donations from donor that is biological parent shall be discarded).
11. In a homosexual couple, is a legal relationship possible between a child and the partner of the legal parent? NA. Homosexual couples are not permitted to access MAP
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? Yes. Sperm donation is being done in practice but not under the provisions of any law. For oocytes and embryos the situation is unknown as there are no cases referred to.
7. Are there specific compensation arrangements for donations of sperm/oocytes/embryos? It is not possible to say whether there are specific compensation arrangements for such donations as it is not a legally regulated issue.
8. Are there specific criteria for donation of sperm/oocytes/embryos? No for sperm. It is not possible to say whether there are specific criteria for oocytes and embryos donations, as they are not legally regulated issues.
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? It is unknown whether there are special measures for the prevention of consanguinity.
11. In a homosexual couple, is a legal relationship possible between a child and the partner of the legal parent? It is not possible to say whether in a homosexual couple, a legal relationship is possible between a child and the partner of his or her legal parent. There are no referred cases of homosexuals having a child.
3. Are MAP procedures covered by the social security system? Yes. Infertility is defined as a disease.
4. Are there specific criteria for such coverage? Yes. 4 IVF cycles up to the age of 40 of the woman are covered.
5. Is the financial coverage limited to a number of MAP procedures? Yes. 6IUI cycles/year, IVF cycles/life
1. Is access to medically assisted procreation (MAP)
a. restricted to heterosexual couples? Yes. In April 2021, negotiations on an amendment to the Civil Code allowing "marriage for all" progressed to the next round in Parliament. Adopting the change would be a step towards homosexual couples' access to assisted reproduction, surrogacy and changing the birth certificates of the child.
b. possible for women not living in a heterosexual couple? No.
16. Is donation of sperm/oocytes/embryos anonymous? Yes. According to the Czech Act on Specific Health Services (Act No. 373/2011 Sb.)
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. Only some very basic health, psychosocial and appearance information.
a. Identity of the donor(s)
i. For the child him or herself No, ii. For the parents No, iii. For a court Yes.
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 Yes, iii. For a court Yes. No exact legal framework for that.
18. Is it possible to contest maternity and paternity of children born utilising MAP and under which conditions? No. According to the Civil Code, the mother is the woman who gave birth to the child and the father who agreed with the treatment.
3. Are MAP procedures covered by the social security system? Yes. Estonian Health Insurance Fund covers 6 consecutive attempts for women until age 40. In general MAP is allowed for women until age 50. Reason is not defined by law or other legislative documents.
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. Limits are set by law - 6 consecutive procedures are covered by EHIF
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 Human Fertilisation & Embryology Act 1990 (HFE Act) does not prohibit treatment for same sex couples or single women
2. Are there specific criteria for access to MAP?
Medical reasons:
a. Infertility:
For a heterosexual couple? No; For women not living in a heterosexual couple? No
b. Risk of transmission of a disease
For a heterosexual couple No?; For women not living in a heterosexual couple? No
c. Other N/A
Provision of treatment on the National Health Service (NHS) varies across the UK with different local clinical commissioning groups (CCGs) or health boards having differing levels of provision and different eligibility criteria. The National Institute of Clinical Health and Excellence (NICE) is the NHS body who developed the overarching guidelines which CCGs then apply locally. Guidelines can be viewed here: https://www.nice.org.uk/guidance/cg156. Private fee-paying (non-National Health Service) patients can have treatment for purely non-medical reasons if they wish.
As the UK’s regulator for assisted reproduction, the HFEA requires licensed fertility clinics to follow screening requirements to avoid the transmission of diseases. Donors have to be screened for infectious diseases such as HIV, Hepatitis B and C and Cytomegalovirus (CMV). Among the criteria to be considered is the patient’s age, health and ability to provide for the needs of a child/children. Further information on screening requirements can be viewed in the HFEA’s code of practice: http://www.hfea.gov.uk/498.html
Clinics ultimately must decide fairly whether to offer or refuse treatment. Further information on guidance to treating people fairly when receiving fertility treatment is included in the HFEA code of practice: https://www.hfea.gov.uk/media/2793/2019-01-03-code-of-practice-9th-edition-v2.pdf
16. Is donation of sperm/oocytes/embryos anonymous? Yes
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
The law provides for access to the donor's non-identifying medical information for the treating physician and in the event of a therapeutic necessity concerning a child conceived from donated gametes. Since the law n°2021-1017 of 2 August 2021 on bioethics, the child born from a MAP can, at their majority, if they so wish, access the non-identifying data (age, general state, physical characteristics, family and professional situation, country of birth, motivation for the donation) and the identity of the donor. As of 1 September 2022, the donor's consent to this communication becomes a sine qua non condition of the donation and the persons born of these donations are therefore guaranteed to be able to access this data when they reach the age of majority if they so wish. As regards donations made before 1 September 2022, the legislator allows the donor to consent to this disclosure after the fact, either by a simple spontaneous expression of interest or by means of a procedure for contacting the donor. These donors retain the possibility of refusing the communication of their data. The anonymity of the donation between donors and recipients is not called into question.
a. Identity of the donor(s)
i. For the child him or herself Yes; ii. For the parents NA; iii. For a court NA. See answer to the previous question
b. Certain health information concerning the donor(s) See answer to 1st question of table 17
i. For the child him or herself; ii. For the parents; iii. For a court
c. Other information See answer to 1st question of table 17
i. For the child him or herself; ii. For the parents; iii. For a court
18. Is it possible to contest maternity and paternity of children born utilising MAP and under which conditions? Yes. It is not possible to establish a parent-child relationship between the child resulting from MAP and the donor, or to bring an action for liability against the donor. No action may be brought to establish or contest parentage on behalf of the child unless it is argued that the child is not the product of medically assisted procreation or that consent has been rendered ineffective.
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).
a) The law of Georgia on Health Care (LHC) - Chapter XXIII Family Planning
b) The Draft law on Reproductive Health and Reproductive Rights (DL-RHRR)
a) LHC - Adopted by Parliament of Georgia on 10 December 1997
b) DL-RHRR– Submitted to the Georgian Government in December 2003
Later the document was sent to the various Ministries, Departments and governmental agencies and their comments have been taken into consideration as well.
The next steps should be: (a) discussions within the apparatus of the President and later (b) debates in the Parliament.
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
3. Are MAP procedures covered by the social security system? No
4. Are there specific criteria for such coverage? No
5. Is the financial coverage limited to a number of MAP procedures? No. It is not possible to produce more than 3 embryos to transfer to the uterus for each attempt except where there are obvious problems of development.
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? No
The Law on MAP of the Republic of Lithuania states that MAP can be applied to infertile couples when infertility cannot be treated by any other methods.
b. Risk of transmission of a disease
For a heterosexual couple? Yes; For women not living in a heterosexual couple? No
According to the above-mentioned Law, MAP can also be used if there is a high probability of transmitting a disease, which could cause severe disability to a future child.
c. Other No
6. Is donation of sperm/oocytes/embryos permitted in your country? sperm Yes/oocytes Yes/embryos No
7. Are there specific compensation arrangements for donations of sperm/oocytes/embryos? No
8. Are there specific criteria for donation of sperm/oocytes/embryos? sperm Yes/oocytes Yes/embryos No
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
11. In a homosexual couple, is a legal relationship possible between a child and the partner of the legal parent? No. The law limits access to MAP to heterosexual couples, married or living under the same roof (Art 5).
2. Are there specific criteria for access to MAP?
Medical reasons:
a. Infertility:
For a heterosexual couple?; For women not living in a heterosexual couple? NA
b. Risk of transmission of a disease
For a heterosexual couple?; For women not living in a heterosexual couple? NA
c. Other
3. Are MAP procedures covered by the social security system? Yes.
Hungarian legal regulation considers infertility a pathological condition attaining families or even single women desiring to be mothers. The legal model of the treatment of MAP is the same as that of any other disease. (Act and Decree 49/1997 of the Minister of Welfare on Medical interventions against infertility to be financed by the social security system).
4. Are there specific criteria for such coverage? Yes.
Infertility is the condition for the coverage of MAP. Age can only be considered in respect of the health condition preventing fertility.
Decree 49/1997 specifies more closely the conditions to be applied.
5. Is the financial coverage limited to a number of MAP procedures? Yes. Interventions ending with embryo implantation can be covered five times maximum for the same patient.
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? No
c. Other NA
Art 4, para 1 of the 3305/05 Law refers to:
The law does not provide anything for women not living in a heterosexual couple.
Art 4, para 2 refers to an obligatory examination for HIV-1&2, hepatitis B & C and syphilis before submission to MAP procedures. People with an HIV infection who wish to undergo MAP, need special permission from the National Authority of MAP.
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
The law stipulates that all adult persons have the right of access to methods pf MAP and for women the age limit is 50 years of age. Persons under 18 years of age have exceptionally the right of access only in case of a very serious disease. The law only refers specifically to married heterosexual couples who wish to have a child and to unmarried women either single or living as part of a heterosexual couple. It does not refer to homosexual couples, but it does indirectly forbid their access to fertility services.
According to the 2002 Law [3089/02]:
A. the written consent of the married couple is required before the MAP procedure
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
Restricted to health condition (infertility) or age consideration connected with health
3. Are MAP procedures covered by the social security system? Yes. Article 28, para 1 of Law 3305/05 refers to the reimbursement of MAP procedures by Social Security, the presuppositions of which will be defined by a presidential decree to be published. The same presidential decree will assess the conditions under which reimbursement by the Social Welfare is given to people who wish to participate in MAP procedures and who are not insured. Therefore, as far as security coverage is concerned, the situation in Greece remains variable, depending on different social security funds. The Opinion proposed for full coverage of all necessary medication.
4. Are there specific criteria for such coverage? Yes. The presidential decree which will be published according to the provisions of Law 3305 will cover terms, conditions and procedures for financial coverage by social security organisations.
5. Is the financial coverage limited to a number of MAP procedures? Yes. In the Opinion submitted by the National Authority it was proposed to cover 4 IVF/GIFT/ZIFT attempts. The Opinion also included a variety of medical criteria and age limits. As far as sperm injection is concerned the Opinion proposed for financial coverage of 6 attempts.
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
Regulated in paragraphs 167, (3) and (4) of the Act, paragraphs 1 (2), (3), 1/A, 1/B, 1/C of the Decree.
b. Risk of transmission of a disease
For a heterosexual couple? Yes; For women not living in a heterosexual couple? Yes
Prohibited in risk of transmission of a disease endangering the viability or health of the child, and in risk of transmission of an infection
c. Other NA
6. Is donation of sperm/oocytes/embryos permitted in your country? Yes. Donation of gametes (sperm and oocytes) and fertilized ova (only supernumerary fertilized ova) is allowed only with consent of the donors.
7. Are there specific compensation arrangements for donations of sperm/oocytes/embryos? Yes.
According to Law 3305/05, (Art 8, para 1) “Reward or compensation for donation of gametes and fertilized ova are prohibited. However, medical, nursing or laboratory expenses travel and accommodation expenses as well as compensation for absence from work are possible.”
The National Authority for Medically Assisted Reproduction with a subsequent Decision (Decision No 36, State Journal 670 B’ 16.4.2008) provides for compensation of medical, laboratory and nursing expenses occurring before and after donation. It also provides for accommodation and transportation expenses. This amount must not exceed 200E for sperm donation and 600 E for oocyte donation. Compensation is also provided for absence from work.
8. Are there specific criteria for donation of sperm/oocytes/embryos? Yes.
Donors must have reached the age of majority with full judicial capacity. Regarding sperm donors must be under 40 years of age whereas for oocytes donors must be under 35 years of age. These age limits can be extended to 50 and 40 years of age respectively in case of donation of fertilized ova or when there is a serious reason, after authorization by the National Authority on MAR. In these cases, special information to the recipients is required regarding increased risk for genetic diseases as well as the need for prenatal testing.
Donors are submitted to special medical and laboratory tests defined (due to scientific developments) by the National Authority.
9. Are there specific non-medical criteria for selection of gametes/embryos to be used for MAP? Yes. According to the Law the selection of the donor is the responsibility of the MAR Unit. During this selection other criteria like blood group (Rhesus) as well as phenotypic characteristics are taken into consideration. The same criteria apply to fertilized ova donation.
10. Are there special measures for the prevention of consanguinity? Yes.
The number of children born from gametes by the same donor must not exceed 10, unless it is about the birth of a new child of a couple which has already had a child from the gametes of this particular donor. The National Authority may determine the exact number of children resulting from the use of gametes by the same donor, depending on the population of a certain region and other special conditions.
[Comment: the law refers to the actual number of children born and not to the number of cycles of treatment attempted].
11. In a homosexual couple, is a legal relationship possible between a child and the partner of the legal parent? No. This law does not include any provisions for homosexual couples.
6. Is donation of sperm/oocytes/embryos permitted in your country? Yes
7. Are there specific compensation arrangements for donations of sperm/oocytes/embryos? Yes. Financial rewards are explicitly prohibited. Compensation for travel costs, administrative burdens and loss of earnings are legal under conditions (Act § 170 (3))
8. Are there specific criteria for donation of sperm/oocytes/embryos? Yes.
For a. and b. In a concrete intervention with gamete donation only one and the same person can be the donor.
The donation is prohibited (Act §171 (7))
Sperm: if the donor has a pathology excluding donation (Decree, appendix Nr. 3)
Oocytes: the donor refuses giving his/her personal data required (Act §171 (3))
Embryos: if the donor does not appear in person at the center
Age limit is 35 years (Act §171 (1))
Embryo donation is anonymous
Further conditions for embryo donation are detailed in Act §176
9. Are there specific non-medical criteria for selection of gametes/embryos to be used for MAP? Yes.
For gametes, the appearance, as well as eventual illness of the donor are registered data.
For oocyte donation, the level of eventual parent status must be considered (Act § 171 (4)).
For embryo donation, embryos issuing from the same couple may only be implanted in MAP for maximum two different persons. (Act § 175 (4)).
10. Are there special measures for the prevention of consanguinity?
The number of descendants from the same gamete donor with different persons included in MAP intervention cannot exceed 4.
MAP intervention can only be requested by persons who are not in level of parentage that would prevent legal marriage between them (Civil Code § 4:12 (1) a) and b), i.e. between linear relatives and brothers/sisters).
In MAP with persons in other level of consanguinity the physician indicating MAP has to previously consult with the Regional Genetic Center (Decree §1 (3)).
Embryos issuing from the same couple may only be implanted in MAP for two different persons (Act § 175 (4)).
11. In a homosexual couple, is a legal relationship possible between a child and the partner of the legal parent? No. MAP is restricted to heterosexual couples.
16. Is donation of sperm/oocytes/embryos anonymous? sperm Yes and No/oocytes Yes and No/embryos Yes
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; iii. For a court
Detailed provisions in Act § 179 (1)
a. Identity of the donor(s)
i. For the child him or herself Yes; ii. For the parents; iii. For a court
Detailed provisions in Act § 179 (1)
b. Certain health information concerning the donor(s)
i. For the child him or herself Yes; ii. For the parents; iii. For a court
Detailed provisions in Act § 179 (1)
c. Other information
i. For the child him or herself NA; ii. For the parents NA; iii. For a court NA
18. Is it possible to contest maternity and paternity of children born utilising MAP and under which conditions? No, with exceptions.
The assumption of paternity cannot be contested by the father, with the exception if the husband or common-law companion has not consented to the MAP process (Civil Code § 4:108 a)).
The donor of sperm or embryo is excluded by law from fatherhood (Civil Code § 4: 103 (5)).
The donor of oocyte or embryo is excluded by law from motherhood (Civil Code § 4: 115 (4).
The woman delivering the child is considered the mother.
3. Are MAP procedures covered by the social security system? No. Although in vitro fertilisation (IVF) treatment is not provided by the Irish public health service, there is some support available in that patients who access IVF treatment privately may claim tax relief on the costs involved under the tax relief for medical expenses scheme. In addition, a defined list of fertility medicines needed for fertility treatment is covered under the High Tech Scheme administered by the Health Service Executive (HSE). Medicines covered by the High Tech Scheme must be prescribed by a consultant/specialist and approved by HSE ‘High Tech Liaison Officers’. The cost of the medicines is then covered, as appropriate, under the Medical Card or Drugs Payment Scheme.
4. Are there specific criteria for such coverage? Assisted human reproduction is provided for in the private sector and at present there are no standard limits relating to age or infertility. However, most providers of assisted human reproduction services adhere to the guidelines produced by the Irish Fertility Society.
5. Is the financial coverage limited to a number of MAP procedures? No
2. Are there specific criteria for access to MAP?
Medical reasons:
a. Infertility:
For a heterosexual couple?; For women not living in a heterosexual couple?
b. Risk of transmission of a disease
For a heterosexual couple?; For women not living in a heterosexual couple?
c. Other
As previously mentioned, it is proposed that legislation will permit assisted human reproduction services to be available to people irrespective of gender, marital status or sexual orientation. However, in the interests of any child to be born as a result of assisted human reproduction (or any existing children in families wishing to avail of assisted human reproduction), the legislation will provide for child welfare assessments which will afford a way of assessing whether intending parents are suitable for assisted human reproduction treatment. The purpose of these assessments will be used to assess intending parents’ age, health and ability to provide a stable and healthy environment for a child/children.
6. Is donation of sperm/oocytes/embryos permitted in your country? sperm Yes /oocytes Yes /embryos No
7. Are there specific compensation arrangements for donations of sperm/oocytes/embryos? No
8. Are there specific criteria for donation of sperm/oocytes/embryos? sperm Yes /oocytes Yes /embryos Yes. In fact there is neither a collection nor a bank in Luxembourg. The service functions in collaboration with a foreign bank.
9. Are there specific non-medical criteria for selection of gametes/embryos to be used for MAP? Yes. Five classic characteristics (blood group, complexion, eyes, colour of hair, height).
10. Are there special measures for the prevention of consanguinity? No. The straws of sperm come from abroad.
11. In a homosexual couple, is a legal relationship possible between a child and the partner of the legal parent? No. Currently no legislation.
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 No?; For women not living in a heterosexual couple? No
c. Other N/A
In the absence of legal framework, that depends on the moral integrity and the personal values of the practitioners and the researchers.
It is note-worthy that MAP is not currently regulated in Luxembourg, except that:
Indicate if process of revision is ongoing and, in your answers, provide information on provision in the draft law: There is a proposed law, in fact a draft law initiated by Parliament, concerning MAP. Parliament had planned a large general debate but this has not yet taken place.
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 No?; For women not living in a heterosexual couple? No
c. Other N/A
Risk of transmission is possible if donors have not gone through medical examination.
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
Possible for single women; not for persons living in homosexual couple.
If no legal instrument please describe the practice There is no law regulating in particular assisted reproduction techniques, but these methods are generally permitted. As for the insurance, basic problems of MAP are partially solved by the Sanitary Order Law / the definitions of indications, contra – indications for reimbursement of MAP are: more than 38 years of age, tubal sterility or previous interruption for social or personal reasons. Only for 2 cycles of MAP can be reimbursed.
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? No
b. Risk of transmission of a disease
For a heterosexual couple Yes?; For women not living in a heterosexual couple? N/A
c. Other N/A
6. Is donation of sperm/oocytes/embryos permitted in your country? Yes
7. Are there specific compensation arrangements for donations of sperm/oocytes/embryos? No.
Article 28 (paragraph 1-3) regulates Prohibition of Gain from BMAF Procedures
Prohibitions referred to in paragraph 1 to 3 above shall not be applicable to:
1) living donor compensation for loss of earnings or other income for time spent in a medical institution or during recovery, or during temporary inability to work, or compensation for other eligible expenses that the donor has had due to the procedure of retrieval of reproductive cells (transport, accommodation, food costs etc.);
2) eligible compensation in connection with payment for medical or other services related to retrieval of reproductive cells;
3) compensation in the event of excessive damage arising from the retrieval of reproductive cells.
8. Are there specific criteria for donation of sperm/oocytes/embryos? Yes
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? Yes
11. In a homosexual couple, is a legal relationship possible between a child and the partner of the legal parent? No
19. Is there an important current debate in your country on these or related issues? N/A
20. Delegations are invited to provide information, in this section, on particular cases encountered in their country, and especially their case-law. N/A
3. Are MAP procedures covered by the social security system? Yes.
MAP procedures are covered by the National Health care system and by co-payments. The (outpatient) clinic where the MAP procedure is conducted is financed as follows:
4. Are there specific criteria for such coverage? Yes.
All couples that are offered MAP have a right to partial coverage of the medicines and treatment costs for IVF/ICSI treatment, limited to three attempts per child.
As a first step in the process, the woman/couple will consult their family physician. Based on a medical and psychosocial evaluation of the woman/couple the physician will decide whether to recommend the couple to one of the clinics offering MAP. The physician at the clinic decides whether or not the woman/couple will be offered MAP. According to the Biotechnology Act, a clinic offering MAP needs authorisation or approval from the Directorate of Health.
To have access to MAP through the clinics financed by the national health care system, an evaluation of the presumed cost-effectiveness of the treatment for the woman/couple is carried out,
Many clinics have established guidelines for evaluation of couples asking for medically assisted procreation.
Women/couples may also choose to pay for treatment in private clinics, this may provide shorter waiting time, and these clinics are not bound by the same principles of cost-efficiency.
A woman cannot be older than 46 at the time of insemination or implantation of embryo.
5. Is the financial coverage limited to a number of MAP procedures? Yes. Financial coverage is limited to three MAP procedures (three IVF or ICSI procedures - or a combination, where a procedure includes the retrieval of ova). Implantation of stored embryos (FER) is not counted as a “MAP procedure”.
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? No
b. Risk of transmission of a disease
For a heterosexual couple Yes?; For women not living in a heterosexual couple? No
c. Other Yes
Criteria for access to IVF is infertility or that the woman is affected by or carrier of serious hereditary disease.
Lesbian couples and single women have access to MAP by insemination or IVF. Criteria for assisted procreation by insemination to heterosexual couples is infertility or that the man has or is carrier of serious hereditary disease. :
The act does not specify a right to treatment in cases where there is a risk of transmission of diseases such between the woman and her husband/spouse.
Regarding situation where one or both partners have a serious and chronic sexually transmitted infection: Where the woman is infected, an evaluation of the risk of transmitting the virus to the child must be made in each case before it is decided to proceed.
A woman cannot be older than 46 at the time of insemination or implantation of embryo.
The criteria for infertility for access to IVF does not apply in cases where same-sex couple have treatment using partner donation (one of the women donates her egg to the other who carries the child).
Other known genetic disorders
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. NA
6. Is donation of sperm/oocytes/embryos permitted in your country? sperm Yes/oocytes Yes/embryos No
See http://eng.heilbrigdisraduneyti.is/laws-and-regulations/nr/686
7. Are there specific compensation arrangements for donations of sperm/oocytes/embryos? No
8. Are there specific criteria for donation of sperm/oocytes/embryos? sperm Yes/oocytes Yes/embryos *
* See regulation: http://eng.heilbrigdisraduneyti.is/laws-and-regulations/nr/686
(Artificial insemination with donor sperm shall only be carried out if the fertility of the man is impaired, he has a serious hereditary disease or there are other medical reasons to use of donor sperm. (Article 8)
In vitro fertilization shall only be carried out with the gamete of the couple. It is however permitted to use donor gamete if the fertility of the man or the woman is impaired, either of them has a serious hereditary disease or there are other medical reasons to use of donor gamete. It is prohibited to carry out in vitro fertilization unless the gamete of either partner or either cohabitant is used. Donation of embryos and surrogacy is prohibited. (Article 9))
9. Are there specific non-medical criteria for selection of gametes/embryos to be used for MAP? Yes. If donated gametes are used, the doctor in charge of the treatment shall select the appropriate donor. A donor of gamete shall be healthy and have no hereditary diseases. Necessary tests shall be carried out to ensure that the donor is healthy and fertile and to prevent the transmission of diseases with the gamete. If imported gametes are used, the fulfilment of the aforementioned demands must be ensured. A doctor shall endeavour to realize the wishes of applicants that the build, height, colour of eyes and hair and the blood type of the gamete donor is as closely resembling the parent's as is possible . (art.17 reg.568/1997)
10. Are there special measures for the prevention of consanguinity? Yes. Indirectly, see art.18 reg.568/1997 (If a donor wishes to remain anonymous, health workers are obliged to ensure that this is respected. In this case, the donor may neither receive information about the couple receiving the donated gamete or the child, nor the couple or the child receive information about the donor. If a donor does not wish to remain anonymous, the institution shall preserve information about him in a special file. If the donation of gamete leads to the birth of a child, information about the child and the couple who received the gamete shall be kept in the same file. A child born on account of a gamete donation where the donor does not wish to remain anonymous can at the age of 18 gain access to a file pursuant to paragraph 2 for the purpose of obtaining information about the identity of the donor. If a child receives information about the gamete donor at the institution, the said institution shall as soon as possible inform the donor that the information has been given.)
11. In a homosexual couple, is a legal relationship possible between a child and the partner of the legal parent? Yes. Art. 6, Act no. 87/1996 (The provisions of the Adoption Act relating to spouses shall not apply to registered partnership. A person in registered partnership can however adopt a child of the other partner of whom that partner has custody, provided the child has not been adopted from another country. Nor statute provisions on artificial insemination apply to registered partnership. Ni statute provisions involving particular rules depending on the sex of a married spouse shall apply to registered partnership. 1). Provisions of international agreements to which Iceland is a party shall not apply to registered partnership unless approved by the other party.)
3. Are MAP procedures covered by the social security system? Yes. Partially covered
4. Are there specific criteria for such coverage? Yes. The proportion of the payment covered by the social security system differs according to how many times treatment has been undertaken.
5. Is the financial coverage limited to a number of MAP procedures? Yes.
For couples without a child together coverage for first treatment approx. 50%
For second to fourth treatments approx. 70%. No coverage for further treatments.
For couples with one child. Coverage for first to fourth treatment approx. 20%. No coverage for further treatments. No coverage for couples with more than one child.
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? Yes
7. Are there specific compensation arrangements for donations of sperm/oocytes/embryos? No. Compensations are legally limited to only compensation of costs made for the donation.
8. Are there specific criteria for donation of sperm/oocytes/embryos? Yes.
Within the Embryos Act, there are criteria to guarantee the free consent of the donor. In addition to that, the professional Guideline states that oocyte donation is contraindicated for
These contraindications are absolute. In addition, some women have a relative contraindication to oocyte donation, for instance women who have no children themselves and are under the age of 30.
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 a professional guideline that limits the number of offspring of one donor to 25 children or 12 families. Because clinics now don’t have a legal basis to check if a donor also donates in other clinics, there is a legal change in preparation which allows national registration of donors, so that the limited number of offspring can be monitored.
11. In a homosexual couple, is a legal relationship possible between a child and the partner of the legal parent? Yes. When two women are married, the second mother can easily become the legal mother. In other cases, an adoption procedure is required.
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. Na
3. Are MAP procedures covered by the social security system? Yes.
Yes, but partly. In case of IVF, there is a maximum of three attempts.
4. Are there specific criteria for such coverage? Yes. Age limit of woman – 42 years old.
5. Is the financial coverage limited to a number of MAP procedures? Yes. See answer to question 3.
19. Is there an important current debate in your country on these or related issues? Yes.
Yes. The question of surrogacy was delayed due to the controversial nature of abuse of the female body, and legal consequences surrogacy is seen to cause in some cases. However it would seem that the discussion will be raised in the future for both heterosexual and homosexual couples. The Embryo Protection Act as amended does not permit the use of surrogacy and the subject is not even discussed.
Note: Having said that, as article 19, discussed above, indicates, donation of gametes is a private agreement so homosexual couples, for example, may bypass provisions by having sperm donated to them in the case of female homosexual couples, and, male homosexual couples can donated their sperm by a private agreement to a woman, who can be the surrogate (using her own ova by Artificial Insemination by Donor) and then give up the child. Article 19 of the Act seems to prohibit this under my interpretation. In any case, the law does not discuss Surrogacy so at most it can be tolerated but not protected by law when it comes to filiation.
20. Delegations are invited to provide information, in this section, on particular cases encountered in their country, and especially their case-law.
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 No?; For women not living in a heterosexual couple? NA
c. Other N/A
There is not a law or specific articles in the healthcare law addressing MAP or people who are not living in heterosexual couple.
3. Are MAP procedures covered by the social security system? No. MAP is not incorporated in the social security system. The drugs for infertility may be covered (80 %) only if patient is treated by the hospital facilities.
4. Are there specific criteria for such coverage? No
5. Is the financial coverage limited to a number of MAP procedures? No