Reproductive medicine: need for regulation and discussion

Louise Brown was born in England in 1978. The first baby to be conceived using artificial insemination. A sensation: a human embryo outside the womb had never been seen before. Nowadays, more than 100,000 artificial inseminations are carried out in Germany every year - more and more frequently in the case of homosexual or single women.

Freedom of reproduction is enshrined in the Basic Law. The state must therefore justify the prohibition of certain reproductive methods. However, some German couples abroad make use of procedures that are prohibited in Germany, such as egg donation or surrogacy. Others, such as embryo donation, are largely unregulated.

In addition to new legal regulations, it is also important to initiate a broad social debate on the topic of reproductive medicine.

In order for women, men or couples to be able to make a good decision ("informed consent"), comprehensive, independent information is required. However, this is lacking, the authors of the statement criticise. Clinics and centres are not honest enough about the success and failure of treatments, there is no state register, no research and no reliable figures on the methods in Germany.

The Embryo Protection Act often forces practitioners to provide treatment that is no longer in line with current international standards and leads to unnecessary risks for mother and child. In practice, there is growing resentment at the legislator's inaction. This apparently also applies increasingly to the courts, some of which feel compelled to openly pursue legal policy themselves.

The following points are particularly in need of regulation:

• Medical practice in many countries follows the international state of knowledge, according to which only the embryo with the greatest developmental capacity is selected and transferred. This elective single embryo transfer avoids risky and unhealthy multiple pregnancies without significantly reducing the individual chance of pregnancy. However, this procedure is punishable by law in Germany.
• Sperm donation is permitted in Germany, but egg donation is prohibited. So while infertile men can start a family with the help of a germ cell donation, women who can no longer produce their own eggs as a result of cancer, for example, are not allowed to do so. This unequal treatment is difficult to justify.
• Due to the legal situation, many couples feel compelled to make use of egg donation abroad. There, anonymous donation is often practised, which denies the child the constitutional right to know its parentage. In this respect, the ban on egg donation in Germany indirectly impairs the child's welfare.
• Surrogacy, which is prohibited in Germany, raises particularly difficult ethical and legal questions. In any case, there is a need for regulation for children born abroad to a surrogate mother but who grow up in Germany.
• Egg cells are also cryopreserved at many reproductive medicine centres in Germany. In some cases, this is done for medical reasons, for example before chemotherapy. In the interests of the woman, the couple and the future child, the framework conditions for storage, fertilisation and transfer should be regulated.
• Restricting the funding of reproductive medical measures for couples with statutory health insurance to married couples and to narrow age limits is hardly justifiable from a medical and social perspective.