The recent birth of a baby by a 64-year-old woman in Germany has sparked debate about the Embryo Protection Law, which prohibits egg donation. But with rising infertility rates, Germany may need to rethink its policies.
When fertilization doesn't happen naturally, German couples face tough hurdles
The 64-year-old German woman who recently gave birth to a healthy baby girl made headlines around the world. But her age did not set a precedent. Last year, a 67-year-old Spanish woman became the world's oldest mother when she gave birth to twins, topping the record from the previous year of a 66-year-old Romanian who also had twins.
The unnamed German became pregnant with the help of in-vitro fertilization (IVF), using an egg donated by a 25-year-old and the sperm of the German woman's husband. The treatment was conducted abroad, as donating eggs cells for pregnancies is illegal in Germany.
The prohibition of egg cell donation is part of Germany's "Embryo Protection Law," which was passed in 1990. Sperm donation, however, is permitted.
Mothers more important than fathers?
Fertility rates after 35 drop dramatically
The reasoning behind the ban on egg donation was that both the genetic mother and the woman bearing the baby were presumed to be responsible for the child's existence, said Ulrich Hilland of the Berlin-based Federal Association of German Centers for Reproductive Medicine.
"The law could be interpreted in such a way that it is assumed that mothers have a stronger emotional connection to their children, due to pregnancy, than fathers," Hilland said.
The law aimed to prevent the separation between the genetic and the "social" mother -- the woman who would later raise the child. Surrogacy is therefore also prohibited in Germany.
Several implanted embryos can result in twins or triplets
Christina de Wit of the German National Ethics Council, in Berlin, pointed to another reason for banning the donation of egg cells.
"Harvesting eggs from a donor is an invasive operation requiring extensive hormonal stimulation beforehand, so that many eggs mature," she said. "That means that the whole process involves medical risks; that's not the case with sperm donors."
Some German politicians say the recent case demonstrates that egg donation prohibition in Germany should be lifted. Others point out that the prohibition prompts "reproduction tourism" by forcing women to go abroad to fulfill their wish for children.
"We see risks in quality-control here," Hilland said. "Women who go abroad cannot be assured that the testing and therefore the selection process among egg donor candidates have been sufficient."
Immobile sperm is often the cause of male infertility
The current German law is one of the most restrictive in the world. It stipulates that only as many embryos may be cultivated as may actually be implanted (up to three per IVF cycle).
Embryos may also not be examined to determine sex before implantation, nor is pre-implantation genetic diagnosis (PGD), otherwise known as "embryo screening," allowed -- the latter ban a likely result of Germany trying to come to terms with its Nazi past.
Furthermore, the freezing (cryopreservation) of embryos for later implantation is restricted. Only eggs in the very early stages of fertilization -- the pre-nucleus stage -- may be frozen in certain cases.
The Embryo Protection Law itself was smart, because it defined the legal parameters of in-vitro fertilization and aimed to prevent the manipulation of human life very early, Hilland said.
De Wit agreed.
"The law was originally intended to protect life at its initial stages, but unfortunately, it is rather outdated," she said. "A nearly 20-year-old law no longer corresponds with the huge advancements made in science and reproductive medicine."
Sperm and egg are united outside of the body in IVF
However, it's not just the Embryo Protection Law that is restrictive.
"Even if the law were changed to allow egg donation, only a fraction of women would take advantage of it," de Wit said.
An issue affecting many more women and couples wanting children is the drastic cutback in insurance companies paying for assisted reproduction technology (ART) treatments.
Formerly, Germany's public insurance companies -- or compulsory health insurance funds --covered the entire costs of up to four IVF and ISCI treatments and six intrauterine inseminations (IUI). In the wake of sweeping reforms, however, as of 2004 the funds only pay 50 percent of up to three IVF, ICSI or IUI cycles, and only for married couples when the woman is 40 or younger. Other age restrictions also apply. (ICSI, or "intracytoplasmic sperm injection," is a method involving the injection of sperm into an egg via an ultra-fine needle.)
Unmarried couples must cover all costs themselves. And they are heady.
A married couple's average share per cycle currently runs around 1,300 euros ($1,900). Thus, less affluent couples have been essentially barred from trying to get pregnant through ART.
Assisted reproduction is often ridden with physical and psychological stress
"We have a birth rate of 1.3 children per woman in Germany," Hilland said. "Children are desperately needed in this country, so any measure to improve the birth rate would be desirable."
German doctors say they now perform around 40 percent fewer ART treatments than before the reform, even though the success rate by IVF is around 25-35 percent for each try, meaning that several treatment cycles would likely see a couple's wish for children fulfilled.
The reforms were supposed to save the public health insurance funds up to 100 million euros yearly through sharing ART costs with couples. But according to Hilland, some 10,000 fewer "ART" children have been born each year since the reforms.
Considering that one in seven couples suffer from infertility and that Germany's population is aging dramatically, that number is nothing to sneeze at.