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HEALTH

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.

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

Klinik-Atlas: What to know about Germany’s new hospital comparison portal

The German government has launched a ‘Bundes-Klinik-Atlas’ which provides information on services and treatment quality at almost 1,700 hospitals throughout Germany. Here's what you need to know.

Klinik-Atlas: What to know about Germany's new hospital comparison portal

Whether you’re a foreign resident or a local, it can be tricky to navigate hospital care in Germany. 

Now the German government has launched a new nationwide ‘Klinik-Atlas’ aimed at making it easier for people to compare different services in hospitals. 

If a patient needs care at a hospital or clinic, such as a knee operation, cancer treatment or to get their tonsils out, they can look through the state-run comparison portal to compare the services offered and their quality. The portal is intended to help patients make a decision on where they want to access care. 

It was launched on Friday May 17th and so far includes details on 1,700 hospitals throughout the country. 

Why has the Klinik-Atlas been launched? 

The German government believed there was a need to get more information on hospitals out there to the public. 

Health Minister Karl Lauterbach, of the Social Democrats (SPD), said comprehensive information on how to find good care is now more accessible to everyone with the new portal. 

He said that transparency was needed in view of the 16 million hospital treatments that take place in Germany per year and the 500,000 new cancer patients per year alone. Most patients are unsure which clinic or hospital is best suited for their treatment, he added. 

Compared to existing information portals, the Klinik-Atlas is particularly unique in the way it prepares data for patients, Lauterbach said: “With just a few clicks, they can compare clinics and find the best clinic in their area for the treatment they need.”

READ ALSO: Which of Germany’s hospitals are among the ‘world’s best’?

Patients can see and assess hospitals side by side instead of having to “hop from clinic to clinic”, added Lauterbach. He called it “clear guide” to help people sift through the maze of health care. 

However, there’s been a mixed reception to the project, with hospitals raising some concerns.

How does it work exactly?

One thing to keep in mind is that the site, which is located at www.bundes-klinik-atlas.de, is only in German, but it is fairly simple to use. 

– On the site you can see a map with all the clinics in your area, as well as the number of beds they have and treatments they offer. Each clinic is scored on the quality of its care. The score is based on the number of patients per nurse, taking into account the severity of the cases. Lower values equate better scores in this case.

A sign at a Charité Campus points to the Central Emergency Department.

A sign at the Berlin Charité points to the Central Emergency Department. Photo: picture alliance/dpa | Sebastian Gollnow

– You can also enter your place of residence and an illness or a very specific treatment in the portal. The system offers search suggestions if you don’t know the specialised term. According to the ministry, 28,000 treatment and 13,000 disease definitions are stored.

– There is a kind of speedometer display to help patients categorise their cases. The ‘faster’ you go, so to speak, i.e. the further the needle moves to the right, the better. For the time being, there are two speedometers – for the number of annual cases of a treatment and for the number of nursing staff in the hospital. The speedometers have five coloured elements to which the needle can point – from ‘very few’ to ‘very many’ cases, for example. 

What else can you find out?

A comparison shows that there are “huge differences within a very small area”, said Lauterbach. For example, there are 48 hospitals in Berlin and the surrounding area that perform bowel cancer operations, but only 18 of them are certified as specialist centres.

In the case of severe bowel disease in children, there are clinics that perform more than 70 operations a year, while others only perform four.

It is not the case that large clinics are automatically always ‘the winners’. There are also small clinics that are extremely specialised.

The portal is to receive its first update in a few weeks’ time and will then include complication rates for treatments. Figures on the number of specialised doctors will follow.

The information will be updated regularly, according to the Institute for Quality and Transparency in Healthcare, which is coordinating the implementation. At the moment the data is lagging, featuring case numbers from 2022. The information comes from several sources, including clinics and health insurance company invoices.

READ ALSO: How could Germany solve its worsening GP crisis?

How’s the reaction so far? 

According to the ministry, there were more than five million hits in the first three hours of the comparison launching, with some page views also experiencing a brief hitch due to the volume of traffic. 

But not everyone is for it. The German Hospital Federation said the portal does not provide patients with any additional information and even adds more bureaucracy to hospitals’ workloads. The hospital sector recently expanded its own online overview portal. The Deutschen Krankenhaus Verzeichnis’ or ‘German Hospital Directory’, which has existed since 2002, was updated to include more search functions. 

The German Patient Protection Foundation said that people want to know about the range of services and quality. “But the ‘hospital atlas’ lacks crucial information,” said CEO Eugen Brysch. “The quality of patient management in the clinic is not recorded.”

The German Social Association welcomed the comparison site, but added: “It remains to be seen how great the added value for patients really is.”

READ ALSO: How Germany is planning to save its ailing hospitals 

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