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How German reproductive laws are pushing women to seek therapy abroad

High costs and restrictions around egg donation are driving international women in Germany to seek reproductive therapy abroad. But the traffic-light coalition has promised that change is on the way.

Published: 25 April 2022 17:23 CEST
Updated: 4 May 2022 09:09 CEST
A woman takes a pregnancy test.
A woman takes a pregnancy test. Photo: dpa/CLARK

Berlin resident and freelance writer Laura Rosell is currently 37, and “always wanted kids,” but isn’t ready to have them yet.

As a compromise, this spring she bit the bullet and underwent egg extraction for the purpose of freezing eggs for the future. It wasn’t her first choice.

“I never thought I’d be pushing 40 while having to inject myself with a pricey cocktail of hormones to preserve any sliver of a chance of maybe being able to make babies one day with the love of my life,” she wrote in an essay on Medium. 

And she struggled with the decision: in a much-discussed post in International Women In Berlin, Rosell spoke frankly about her worries regarding the costs of the procedure, which isn’t covered by German health insurance.

“Financial struggle has been my entire adult life,” she said candidly. Freezing eggs meant losing what little financial cushion she had.

“I go back to being broke: unable to travel, unable to take time out to write my book, unable to socialise much (and meet men) — basically all the things I want to do before I’d feel ready to have kids in the first place,” she explained.

But other avenues to motherhood are difficult in Germany as well—with Rosell’s age, she foresaw potentially impassable obstacles to any attempt to adopt. Meanwhile egg donation remains illegal in Germany, both with regards to availing oneself of donor eggs, and to altruistically donating extra eggs from an expensive extraction-and-freezing procedure to other women.

“I asked about donating my eggs to someone else if I don’t use them, and the doctor told me this is one of the countries that prohibits donating eggs,” she recounted.

In the end, to preserve her chance of having children further down the road, Rosell accepted the costs. “Two weeks of prep, thousands of dollars… and I got just three eggs,” she wrote.

READ ALSO: OPINION: Germany, we need to talk about sexism

Labyrinthian procedure

The dilemma that Rosell was faced with is a familiar one for women in a country in which reproductive issues are tangled up in a labyrinth of laws and high costs.

In-vitro fertilisation (IVF), while legal, is comparatively expensive in Germany, a fact that drives many women to seek care elsewhere.

While IVF and egg freezing were often cheaper in countries like Poland, Bosnia and the Czech Republic, it isn’t merely a question of cost—the freedom to avail oneself of donor eggs, or in turn to donate away excess eggs from an extraction procedure for personal freezing, remains out of reach in Germany.

Expat women who responded to Rosell’s post on Facebook spoke of traveling to Denmark, for instance, to be able to have egg donation as an option.

Eggs are prepared at a fertility clinic in Berlin. Photo: dpa | Rainer Jensen

But Germany’s new centrist coalition plans to bring about changes. At least regarding the cost of basic IVF and which constellations of parental units are able to benefit, hope is on the horizon.

The coalition agreement promises improved financial support for IVF, with full coverage of the costs, independent of familial status and sexual orientation. Restrictions on age will also be up for critical review.

Yet the question of enabling egg donation remains a matter for a new special commission to explore, along with strictly altruistic surrogacy.

‘Swift implementation’

The Free Democrats (FDP) have introduced drafts of legislation in the past in support of legalising egg donation, but these failed to make it past the previous coalition of Union and SPD.

In public debates surrounding the issue, the German Medical Association (Bundesärztekammer) came down in favour of regulated legalisation, while assorted lobbying groups, including organisations with theological ties, argued against it.

“Other parties are still going through the process of consolidating their opinions on these topics,” Katrin Helling-Plahr, legal spokeswoman for the FDP told The Local.

She expressed confidence that the traffic-light coalition’s plan to appoint a commission on reproductive self-determination would “contribute to an open and broad debate” around the opportunities offered by reproductive medicine.

“Then we could also see further possibilities for reforms towards a modern law—with elements like the legalisation of egg donation or surrogacy for purely altruistic reasons,” she said.

“With the coalition contract, we have succeeded in reaching a new beginning in the legal framework for reproductive medicine,” said Helling-Plahr. She promised that her party would work for a “swift implementation” of these goals in the area of reproductive medicine, and would “continue to advocate for the legalisation of altruistic surrogacy and egg donation.”

The timeline for all these intended and potential changes, however, remains up in the air.

“The aforementioned goals are under the aegis of the Federal Ministry of Health,” explained Helling-Plahr. “They are currently working to a timetable that at this point in time I haven’t seen.” 

READ MORE: Do Germany’s planned changes to abortion laws go far enough?

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HEALTH

Should you take vitamin D supplements in Germany?

With the mornings and evenings getting darker, many people may be wondering if taking a vitamin D supplement is recommended in Germany. Here's what to know.

Published: 13 September 2024 13:12 CEST
Should you take vitamin D supplements in Germany?

Vitamin D is a vital nutrient for overall health and well-being, and most people are aware that it can be absorbed via sunlight. 

But as long-time residents in Germany know all too well, sunlight is often hard to come by in the autumn and winter months. In December, there’s only a few hours of daylight per day, typically when most people are at work (and it often isn’t even sunny).

This makes it much harder to get enough vitamin D. A deficiency in vitamin D can lead to several health problems in the long run. Muscle weakness and cramps, fatigue and depression are among the symptoms of not getting enough of this vitamin. 

How do I get the most vitamin D in Germany?

It mostly involves getting outside in the warmer months. Germany’s disease control agency, the Robert Koch Institute (RKI), says that vitamin D production happens from March to October and this is when the body builds up reserves for the winter. 

“During this time, the body is not only able to cover its acute needs, but also to build up vitamin D reserves in fat and muscle tissue for the winter months,” says the RKI.

READ ALSO: Your guide to getting through the German winter

The RKI adds that to counteract low vitamin D levels all year round in Germany, current recommendations suggest “exposing your face, hands and arms to the sun uncovered and without sun protection two to three times a week between March and October”.

However experts add that sun protection measures, like wearing sunscreen, must be taken when spending longer periods of time in the sun.

Meanwhile, the German Nutrition Society (Deutsche Gesellschaft für Ernährung or DGE) states: “It is recommended to expose the body to the sun for a total of around five to 25 minutes per day with face, hands and large parts of arms and legs uncovered.”

A number of foods provide some vitamin D. It’s mainly found in fatty fish, roe and fish liver, but red meat, egg yolks and liver are other sources.

Vitamin D is also added to some foods in Germany, such as some milk or vegan milk drinks, yoghurt and other snacks. The nutritional label on food packaging will let people know how much vitamin D they are consuming. 

Although eating foods rich in vitamin D is generally recommended in moderation as part of a varied diet, the DGE says the main focus should be on the body’s own production of vitamin D through exposing skin to sunlight.

READ ALSO: Essential phrases and customs to survive the German winter

What about supplements?

Another way to improve your vitamin D status is to take supplements. 

The German Nutrition Society recommends going down this route if an improvement in vitamin D status cannot be achieved through other routes like getting out and about in the sunlight. 

But be aware that experts also say that taking larger doses over a long period of time can be harmful. 

Pictured are Vitamin D capsules.

Pictured are Vitamin D capsules. Photo by Michele Blackwell on Unsplash

During the height of the Covid pandemic in 2021, the Federal Institute for Risk Assessment (BfR) warned of the health risks of taking vitamin D supplements without taking to a medical professional first. 

“Higher doses should only be taken under medical supervision and taking the individual vitamin D status into account,” the institute said.

“Anyone who wants to take vitamin D on their own should only use supplements with a daily dose of up to 20 micrograms (800 international units),” said the BfR. “With this amount, health impairments are not to be expected.”

According to the BfR, regular daily intake of vitamin D via high-dose preparations – for reasons other than medical reasons – increases the risk of health damage such as the formation of kidney stones or kidney calcification. There have also been cases of acute kidney failure as a result of uncontrolled self-administration of vitamin D preparations, experts said. 

There are a number of people deemed to be more at risk of a vitamin D deficiency.

From the BfR’s point of view, a general vitamin D intake of the upper limit of 20 micrograms per day should only be considered for nursing home residents and other risk groups. 

“This is because vitamin D is produced in the skin under the influence of sunlight. However, many older people hardly exercise outdoors,” the BfR said. Vitamin D production also decreases significantly with age.

READ ALSO: 8 tips for enjoying the cold like a true German

The risk groups for an inadequate vitamin D supply also include people who rarely or never spend time outdoors or who – for cultural or religious reasons – only go outside with their bodies completely covered. Some people who suffer from chronic gastrointestinal, liver or kidney diseases or who take medication that impairs vitamin D metabolism are also more at risk. 

If you suspect that you’re not getting enough vitamin D, go to your GP. They can test for various deficiencies, but bear in mind that these tests are not usually covered by statutory health insurance. 

Even if you don’t test, GPs will be able to advise you on whether you should take a supplement in winter – or all year round – depending on your individual case. 

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