Artificial fertilization

from Wikipedia, the free encyclopedia
Intracytoplasmic sperm injection into an egg cell

Artificial insemination or assisted reproduction is the bringing about of a pregnancy without sexual intercourse and often with the help of a medical intervention or a technique of plant and animal breeding.

Artificial insemination is used with people to help individuals or couples with a desire to have children that they cannot or do not want to fulfill naturally. In over 90% of the affected heterosexual couples there are physical causes for the childlessness . However, lesbian couples also resort to artificial insemination, as do single women who do not have a partner, although the latter sometimes have special legal hurdles to overcome.

history

A controversial pioneer of sperm donation is Berthold P. Wiesner (1901–1972), who together with his partner Mary Barton ran a fertility clinic in London's Harley Street between 1940 and 1960 , in which women, especially from the middle and upper classes, donate sperm with sterile men received. (Wiesner himself had to contribute a considerable part of the donated semen because of the lack of social acceptance at the time, which is why, with an estimated 600 offspring, he is now the most child-rich person who ever lived.)

In 1978 Louise Joy Brown was born , the first test tube conceived “test tube baby ”. Luise Brown is now a mother herself. Unlike her, her children were naturally conceived.

In the past, doctors in Germany were only allowed to perform insemination on married women. Single or homosexual women who wanted to fulfill their desire to have children in this way were allowed to do the insemination themselves without punishment and without risk. Donating sperm for this purpose was not a criminal offense in the past. Anyone who helped an unmarried woman with the process of insemination as such, however, made himself just as punishable as it was the case with a doctor. In some neighboring EU countries (Netherlands, Belgium, Denmark, ...), however, insemination by doctors was also possible for single women and lesbian couples.

The guidelines for performing assisted reproduction have now been revised by the German Medical Association and in Germany, according to the professional code, doctors are now also permitted to perform inseminations on unmarried women, provided that the sperm donor is in a solid partnership with the woman and it is certain that he or she recognizes paternity becomes. To what extent also partnered lesbian women insemination is allowed by doctors, is controversial. According to the LSVD , insemination is allowed for women who have been partnered.

As of July 2014, an estimated five million babies were born this way around the world, with a success rate of around 20-30% depending on treatment type. The prevalence of infertility is reported to be 9% and most assisted reproductive technologies are performed in 30–39 year old patients.

In Germany in 2003 around 20,000 children were born after insemination , in vitro fertilization (IVF) or ICSI , i.e. around two percent of all children born in total. For comparison: In Denmark , the country with the world's highest rate of artificial insemination, the rate in 2005 was almost twice as high at 3.9 percent.

Methods

The question of which methods count for artificial insemination is not always answered uniformly. In any case, in the case of artificial insemination, the egg cell is fertilized without regular sexual intercourse . The actual fusion of the semen and egg can take place outside the body, e.g. B. in a test tube, and the egg can then be used. Often - but not without controversy - the fusion of sperm and egg cell within the body is also regarded as artificial insemination if no normal sexual intercourse has taken place but various technical aids have been used. The transition to natural fertilization can, however, be fluid, since even in the case of ejaculation before penetration, semen can find its way into the body and to the egg cell and fertilization can take place without artificial insemination usually being referred to in such a case , although no regular sexual intercourse took place and possibly also technical aids such as sex toys were used.

The necessary sperm can otherwise z. B. by masturbation or (with functional impotence ) by removal from the testicle . Both sperm and egg cells can be stored until artificial insemination is achieved by cooling to 77  K ( liquid nitrogen ).

Common methods of artificial insemination outside a body (possible in combination with egg donation ) include: a .:

Common methods for artificial insemination within a body are summarized under the term insemination . These are:

Health risks

A 2018 study showed that eight of the 52 participants (16%) but only one of the 43 control participants (2.5%) met the criteria for arterial hypertension (high blood pressure). Other risk factors are low birth weight , premature birth , pregnancy poisoning and diabetes mellitus .

Legal situation

The legal situation in individual countries of the European Union is very different. In 2001, the Max Planck Institute for Foreign and International Criminal Law developed an overview of this .

Homologous insemination

Homologous insemination is fertilization with the sperm of the spouse or partner in a stable, long-term partnership. It is approved in most countries (e.g. Germany, Austria and Italy). Homologous insemination also includes the use of insemination on an unmarried woman in an established partnership.

Donogenic or heterologous insemination

If the sperm donor is not the husband or partner of an established partnership, the procedure is also known as heterologous or donogenic insemination . In common parlance, the term sperm donation is understood to be such an external donation. It is ethically and legally not unproblematic, especially if the origin has been anonymized . According to § 1592 No. 1 BGB, the child conceived with foreign sperm is considered a legitimate child of the husband or partner of the mother who has recognized paternity . The Latin principle applies: Pater est quem nuptiae demonstrant. (Father is who the marriage refers to) The child can contest his marital status according to § 1600 , § 1600d BGB within a period of 2 years from the age of 18 or from knowledge of his conception through a sperm donation. If the patient's husband has consented to the heterologous insemination, he is not entitled to appeal ; neither is the mother.

The Federal Constitutional Court ruled in 1989 that everyone has the right to know their own parentage ; According to the current legal situation in Germany, a sperm donor therefore has no right to anonymity . However, the donor is in no way exposed to maintenance and inheritance claims, as knowing the identity of the biological donor does not per se cancel the legal and social paternity that has existed to date. For this purpose, upon application of the child after the age of 18, the previous paternity must first be revoked, and only then could legal and financial claims be made against the sperm donor. Most sperm banks regularly secure themselves and the sperm donor by contractually regulating in such a case that possible payments to the child are made at the expense of the intended parents and must be replaced by the doctor or the sperm bank. The practice legally required up to 2007 of destroying treatment data after ten years (at the end of the statutory retention requirement for documents for outpatient treatment) is no longer permitted in connection with sperm donation. However, there are currently no legally unambiguous regulations regarding the duration of the storage of donor data. However, it can be assumed that from 2007 treatment data from heterologous insemination were no longer destroyed. In the future, this will ensure that the child will be able to realize his claim to knowledge of his or her genetic ancestry. In Germany, the legal relationships between sperm donors, intended parents and children are unclear in many areas. Many children describe it as stressful not to know who their genetic producer is. According to estimates, there are around 100,000 children in Germany who have resulted from heterologous insemination. It is unknown how many of them were informed about their origins by their parents. However, the position that early disclosure of the truth about the procreation path can prevent later identity crises in the child resulting from sperm donation is increasingly gaining ground.

On January 28, 2015, the Federal Court of Justice issued a ruling on this subject with Az. XII ZR 201/13 and also referred to the BVerfG ruling of 1989.

Special features in Germany

Requirements for artificial insemination

As a federal law, fertility centers and sperm banks must comply with the Embryo Protection Act . The guidelines of the German Medical Association establish legally non-binding criteria, but they are part of the professional code of doctors.

Is very controversial in the non Embryo Protection Act , but rather in a policy of the German Medical Association requirement contained on marital status individuals should have access to a sperm bank, according to which only married or living in a firmly established partnership. In particular, lesbian , civil partnerships demanded access to artificial insemination, as was already allowed in several EU countries ( Denmark , the Netherlands , Belgium , the United Kingdom , ...). The law on same-sex marriage , which was passed in the Bundestag on June 30, 2017, has given married, lesbian couples access to a sperm bank since October 2017.

In Germany there are doctors who perform inseminations on single persons or women with a partner. Single women or unmarried lesbian couples can also get pregnant with the help of a sperm bank abroad, for example in Denmark, Spain, Sweden, the United Kingdom or the United States.

In 2010, a young widow in Neubrandenburg won the second instance of a trial against a clinic that withheld the woman's fertilized egg cells after she learned that the woman's husband had a fatal accident shortly after fertilization. The clinic justified its behavior by stating that, according to the Embryo Protection Act, artificial insemination with the semen of the dead is prohibited. She feared that she could be prosecuted for complicity in a criminal offense. The district court of Neubrandenburg gave the clinic right in the first instance. However, the judges at the Rostock Higher Regional Court stated: Because the semen had already been inseparably enclosed by the egg cell, it was no longer possible to speak of the use of a man's semen after his death if the plaintiff's preserved egg cells were thawed and those during his lifetime the man's induced IVF continues.

Assumption of costs by health insurance companies and grants

This article or the following section is not adequately provided with supporting documents ( e.g. individual evidence ). Information without sufficient evidence could be removed soon. Please help Wikipedia by researching the information and including good evidence.

In 2004, after the health reform, only half as many couples could be treated, as most health insurances only covered 50% of the costs of their insured persons for a maximum of three attempts, in the past it was 100% for up to four attempts. Some statutory health insurance companies have now found a more patient-friendly regulation in line with the new legal situation. Private insurance companies, on the other hand, usually pay the full costs if the privately insured person is the "cause" of childlessness.

Requirements for the assumption of costs by health insurances for medical measures to induce a pregnancy (insemination, in-vitro fertilization with embryo transfer ) are:

  • conventional treatment measures such as hormonal stimulation alone or a fertilization operation have already remained unsuccessful,
  • there is a reasonable prospect that these measures can lead to pregnancy,
  • People who want to take on the cost of the measure must be married to each other or have been in a stable relationship since a legal reform since 2012,
  • only egg cells and sperm cells of the respective spouse or, since 2012, of the partner of a firmly established cohabitation may be used,
  • the insured must have reached the age of 25,
  • Women must not have reached the age of 40 and men under 50.

The legal basis is Section 27a, Book V of the Social Code (SGB V).

In October 2007, the Federal Fiscal Court in Munich ruled that, in addition to married women, unmarried women who are incapable of conceiving can deduct the costs of artificial insemination from taxation . On March 3, 2009, the Federal Social Court confirmed that the age limit of 40 years for the wife for health insurance benefits. On January 27, 2009 the Federal Constitutional Court ruled that the (only) 50% cost subsidy from the statutory health insurance companies for artificial insemination is constitutional. There are plans to reintroduce full cost reimbursement. On March 2, 2012, the Federal Council approved a draft law in some federal states that provides for at least a 25% subsidy to be borne by the federal government would.

Costs for donogenic insemination (unknown third party donor as father) are not covered by statutory or private health insurances.

Cost subsidies from the federal states

Some federal states have switched to increasing the reimbursement of statutory health insurances from 50% for a maximum of the first three treatment attempts to 100%. North Rhine-Westphalia, Berlin, Mecklenburg-Western Pomerania, Lower Saxony, Saxony, Saxony-Anhalt, Thuringia, Hesse and Brandenburg take on up to 50 percent of the remaining co-payment. Rhineland-Palatinate would also like to introduce a financial support program for unwanted childless couples in 2020.

The federal government will assume the costs for unmarried couples

Since January 2016, the federal government has also covered part of the cost of artificial insemination for unmarried couples.

Private insurance companies cover the costs for single women

In a ruling by the Karlsruhe Higher Regional Court , a private fund is obliged to pay the unmarried mother the artificial insemination. A limitation of the reimbursement of benefits to married couples by the private health insurance company is ineffective. The judgment is not final, an appeal to the BGH was allowed.

The child's legal right to information and legal leave of maintenance for the sperm donor

Since July 2018, children in Germany have a legal right to information about the biological sperm donor. A sperm donor register was set up for this purpose. Sperm donors are legally exempted from maintenance claims and other legal financial claims by the children who have learned the name of the donor.

Other countries

The legal situation in individual countries of the European Union is very different. The Max Planck Institute for Foreign and International Criminal Law has developed an overview of this :

Belgium

Belgium legalized artificial insemination in March 2007 and codified its regulations on artificial insemination in the following law: “Law on medically assisted reproduction and the determination of surplus embryos and gametes”, Belgian State Gazette, July 6, 2007.

France

In France , anonymous sperm donation by a third party is allowed. Since July 2020, artificial insemination has also been open to lesbian couples and unmarried women.

Italy

In Italy is surrogacy prohibited. Egg donation and heterologous insemination by a third party were also prohibited until April 2014. A referendum to abolish this ban failed in 2005 due to insufficient participation . In April 2014, the Italian Constitutional Court lifted the ban on gamete donation.

Netherlands

Anonymous sperm donation is allowed in the Netherlands .

Austria

Sperm donation by a third party is permitted in Austria . Since 2015, sperm donation has also been legally accessible to partnered lesbian couples.

Switzerland

In Switzerland , heterologous insemination is only allowed for married couples. The Swiss health insurances bear the costs of artificial insemination. A corresponding popular initiative aimed at ending the costs of the health insurance companies was not accepted by the Swiss population in February 2014.

Spain

In March 2007, a comprehensive decree came into force in Spain that allows heterologous sperm donation: Ministerio de Sanidad y Consumo, Real Decreto 1301/2006, de 10 noviembre 2006, No. 19625, BOE núm. 270, 11 noviembre 2006, 39475 and Tribunal Constitutional, CONFLICTO positivo de competencia n.º 1301-2007, no. 5437, 27 de febrero de 2007, BOE núm. 64, 15 March 2007, 11007.

United Kingdom

In the UK , anonymous sperm donation by a third party is allowed.

Criticism of artificial insemination

After a woman in California gave birth to eightlings after artificial insemination in February 2009, who already had six children as a single parent, a general debate broke out about artificial insemination, the irrationality of such mothers, legal prohibitions in such a case, the irresponsibility of the treating physicians, in short: about ethical principles. The health authorities are investigating the attending physician Michael Kamrava for a breach of duty of care, including another case where he is said to have implanted at least seven embryos in a 49-year-old woman. The case of the Spaniard María del Carmen Bousada , who gave birth to twins Pau and Christian on December 29, 2006 at the age of 67 with the help of artificial insemination , also sparked violent ethical discussions . The oldest first-time mothers in the world was a single mother and died at the age of 69 years - that is only two and a half years after the birth of her sons - to a cancer . The fact that her sons are now orphaned has reignited the debate.

Recently, the quality of the culture media in artificial insemination has been viewed critically because their composition is not subject to any generally binding regulation. This circumstance is said to cause epigenetic damage to the fertilized egg cell, which can result in relevant vascular damage in the child thus conceived.

The generous indication for IVF treatment is also criticized, since the couples concerned are exposed to considerable psychological stress and, with regard to the stimulation treatment of the woman, also physical stress, and spontaneous pregnancies occur in a high percentage of cases after treatment is discontinued.

In 2002, Canada spent 0.42% of total health care costs on reproductive interventions such as IVF , ICSI, and IUI alone . 2011 US study data show a total cost of $ 61,377 per live birth using IVF. According to country-specific data from 2006, the costs in Germany for a single IVF procedure were around 5000 US dollars, regardless of whether this was ultimately successful and led to a live birth or not. The clear difference between the two amounts can be explained on the one hand by the correspondingly low pregnancy success rate, which is only around a fifth of all attempts even with "natural" conception attempts, and on the other hand by the costs in Germany that are around half lower compared to the cost in the US.

About 30% of IVF treatments are carried out on the basis of the diagnosis “idiopathic sterility”, although the effectiveness of the procedure has only been reliably proven for its original indication “tubular sterility”.

The most common cause of infertility in US women is polycystic ovarian syndrome . Since its first description by Stein and Leventhal in 1935, the pathogenesis of the syndrome has still not been fully understood and no precise therapeutic schemes have been established to date. A general, hard indication for artificial insemination in PCO women who want to have children is not described. Nevertheless, according to the Austrian IVF report, the polycystic ovary syndrome was the most common reason for IVF treatment there in 2016.

Differentiation between sperm donation and egg donation

Unlike sperm donation, egg donation is prohibited in Germany. In many other countries such as Spain, Belgium, the United States or the Czech Republic, however, it is allowed in the context of artificial insemination. There, German couples can also use artificial insemination to fulfill their previously unfulfilled wish to have children. The average age of the women donating is 24 years. At the end of 2007, the approval of egg donation in Germany was discussed in the German media and in politics.

The European Court of Human Rights ruled in March 2010: If a state allows artificial insemination, then it must not prohibit egg donation. The court ruled that it was “ unequal treatment that cannot be justified by objective and reasonable grounds” to exclude couples who need egg donation from artificial insemination. In November 2011 this decision was overturned by the Grand Chamber of the European Court of Human Rights. A ban does not conflict with the right to family planning.

See also

literature

  • Michael Ludwig: fertility clinic. Springer Medicine, Heidelberg 2007, ISBN 978-3-540-70978-7 .
  • Andreas Bernard : Make children. New reproductive technologies and the order of the family. Sperm Donors, Surrogate Mothers, Artificial Insemination. S. Fischer, Frankfurt am Main 2014, ISBN 978-3-10-007112-5 .
  • Iris Semke: Artificial fertilization from a scientific and socio-historical perspective (= Marburg writings on the history of medicine . Volume 34). Lang, Frankfurt am Main a. a. 1996, ISBN 3-631-49443-2 ( dissertation at the University of Marburg 1994).

Web links

Individual evidence

  1. ↑ Unfulfilled desire to have children - no question of guilt or failure. ( Memento from August 1, 2012 in the web archive archive.today ) fertinet.de
  2. ↑ Christine Kensche: A father and 600 children - brothers are looking for "Bio-Dad". In: welt.de . April 10, 2012, accessed February 3, 2015 .
  3. ↑ Louise Brown became a mother. Retrieved September 24, 2019 .
  4. ^ A b C. Hirthammer-Schmidt-Bleibtreu: New version of the guideline on assisted reproduction from November 18, 2006. ( Memento from April 26, 2014 in the Internet Archive ) In: Rheinisches Ärzteblatt. 7/2007, p. 27; see also official announcements. P. 78 ( Memento from April 26, 2014 in the Internet Archive )
  5. ↑ LSVD: Insemination is not prohibited. ( Memento of October 30, 2011 in the Internet Archive ) (Press release of October 27, 2011)
  6. ↑ ART fact sheet (July 2014). (No longer available online.) European Society of Human Reproduction and Embryology, archived from the original on March 4, 2016 ; accessed on October 31, 2015 .
  7. ^ New insights into the role of centrosomes in mammalian fertilization and implications for ART. (PDF) reproduction-online.org, accessed October 31, 2015 .
  8. ^ Théo A. Meister, Stefano F. Rimoldi, Rodrigo Soria, Robert von Arx, Franz H. Messerli, Claudio Sartori, Urs Scherrer, Emrush Rexhaj: Association of Assisted Reproductive Technologies With Arterial Hypertension During Adolescence. In: Journal of the American College of Cardiology. Volume 72, 2018, p. 1267, doi: 10.1016 / j.jacc.2018.06.060 .
  9. ↑ Barbara Reye: Artificially conceived children have an increased cardiovascular risk In: tagesanzeiger.ch, September 7, 2018, accessed on September 7, 2018.
  10. ↑ Legal regulations on reproductive medicine in European countries (PDF file; 132 kB)
  11. ↑ Guidelines for Performing Assisted Reproduction. In: Deutsches Ärzteblatt. 95, issue 49, December 4, 1998, p. A-3166.
  12. ↑ Dr. Christian Lucas: Legal Latin . Muenster.
  13. ↑ Az. 1 BvL 17/87
  14. ↑ Guidelines of the working group for donogenic insemination for quality assurance of treatment with donor sperm in Germany (PDF; 584 kB)
  15. ↑ Even children have a right to know their father's name. In: spiegel.de , January 28, 2015.
  16. ↑ Reinhard Müller: Where do we come from? In: FAZ.net , January 28, 2015.
  17. ↑ Belgium wants to regulate artificial insemination. In: aerzteblatt.de , March 1, 2007.
  18. ↑ GB: Homo parenting made easier. on: queer.de
  19. ↑ Sueddeutsche.de: Ehe für alle, That changes for homosexual couples.
  20. ↑ Sperm or egg donation. on: taz.de , November 2, 2006.
  21. ↑ Assisted Reproduction in Spain: Everything You Should Know. May 10, 2019, accessed on September 24, 2019 (German).
  22. ^ Anne Rentzsch: Right of the single Swede to have a child. on: derstandard.at , March 4, 2016.
  23. ↑ A child from the dead husband. In: Frankfurter Rundschau. April 20, 2010, p. 39.
  24. ↑ Higher Regional Court Rostock 7 U 67/09 2 O 111/09 LG NB Delivered on: 07.05.2010 ( Memento of 7 January 2016 Internet Archive )
  25. ↑ Artificial insemination: which health insurance companies pay more? on: wunschkinder.net , June 24, 2013.
  26. ↑ § 1 of the model conditions of the Association of Private Health Insurance for medical expenses and daily hospital allowance insurance
  27. ↑ In a judgment of February 28, 2007, the Federal Constitutional Court determined the constitutionality of Section 27a (1) No. 3 SGB V, in particular its compatibility with Article 3 (1) of the Basic Law.
  28. ↑ Single women: discontinue artificial insemination. on: n-tv.de , October 2, 2007.
  29. ↑ Federal Social Court media information No. 8/09 of March 3, 2009: No benefits from statutory health insurance for “artificial insemination” after the wife is 40 years old
  30. ↑ Federal Constitutional Court - Press Office - press release No. 24/2009 of March 19, 2009, decision of January 27, 2009 - 1 BvR 2982/07
  31. ^ Judgment text of the Federal Constitutional Court Az. 1 BvR 2982/07
  32. ↑ Andreas Mihm: Schröder wants to subsidize artificial insemination. on: faz.net , November 27, 2011, accessed November 28, 2011.
  33. ^ Federal Council press release of March 2, 2012: Financial relief for artificial insemination. ( Memento of August 4, 2012 in the web archive archive.today ) on: bundesrat.de on the draft law of the Federal Council for the law amending the fifth book of the Social Security Code for the assumption of costs by the federal government for artificial insemination measures for couples wishing to have children (Kinderwunschförderungsgesetz - KiwunschG) . (BR-Drucksache 478/11 (decision)) ( Memento from August 3, 2012 in the web archive archive.today ) on: bundesrat.de
  34. ^ Nine out of 16 federal states subsidize fertility treatment. Retrieved November 26, 2019 .
  35. ↑ Unmarried people also receive a subsidy for artificial insemination. on: faz.net , January 7, 2016.
  36. ↑ OLG Karlsruhe Az .: 12 U 107/17
  37. ^ Zeit.de: Artificial insemination, private health insurance company has to pay artificial insemination to single women
  38. ↑ DiNetz.de: Bundestag passes sperm donor government law
  39. ↑ Bundesgesetzblatt.de: Law regulating the right to knowledge of parentage in the case of heterologous use of semen , July 17, 2017.
  40. ^ Reproductive medicine as a subject of criminal law ?, Max Planck Institute for Foreign and International Criminal Law, Freiburg i. Brsg.
  41. ^ Belgium liberalizes artificial insemination. on: aerzteblatt.de , March 16, 2007.
  42. ^ Belgian State Gazette
  43. ↑ NOZ.de: Applause in Parliament: France legalizes artificial insemination for all women , July 31, 2020
  44. ↑ Referendum on bioethics failed. In: Spiegel online. June 13, 2005.
  45. ↑ Italy overturns the ban on donor sperm. In: Rheinische Post. April 10, 2014.
  46. ↑ Opinion of the country Ethics Committee of the Province of Bolzano for heterologous artificial insemination
  47. ↑ Austria: Ban on sperm donation for lesbians is unconstitutional. on: queer.de , January 17, 2014.
  48. ↑ Real Decreto 1301/2006, de 10 November 2006, No. 19625, BOE núm. 270 November 11, 2006, p. 39475. (PDF; 749 kB, Spanish)
  49. ↑ BOE núm. 64 Jueves 15 March 2007 11007 mlop.es
  50. ↑ The price of eight. In: Süddeutsche Zeitung. February 5, 2009, p. 10.
  51. ↑ Controversial US doctor: doctor implanted seven embryos in 49-year-old. on: stern.de
  52. ↑ Panorama: 69-year-old girl died after having twins. In: Spiegel online . Retrieved July 15, 2009 .
  53. ↑ Artificial insemination: Incorrect programming in the retort. In: FAZ . Retrieved October 30, 2015 .
  54. ↑ a b IVF: Is the indication for artificial insemination given too generously? Medscape Germany, accessed October 30, 2015 . (Access data or use of the Google web cache required)
  55. ^ J. Collins: An international survey of the health economics of IVF and ICSI. In: Human Reproduction Update. Volume 8, Number 3, May-June 2002, pp. 265-277. PMID 12078837 .
  56. ^ P. Katz, N. Adler: Costs of infertility treatment: results from an 18-month prospective cohort study. In: Fertility and sterility . tape 95 , no. 3 , March 1, 2011, p. 915-921 , PMID 21130988 .
  57. ^ GM Chambers, GD Adamson, MJ Eijkemans: Acceptable cost for the patient and society. In: Fertility and sterility . tape 100 , no. 2 , August 1, 2013, p. 319-327 , PMID 23905708 .
  58. ↑ Infertility FAQs. CDC , accessed October 31, 2015 .
  59. ^ Treatment for Polycystic Ovary Syndrome: A Critical Appraisal of Treatment Options. Medscape, accessed October 31, 2015 . (Access data or use of the Google web cache required)
  60. ↑ S. Bednarska, A. Siejka: The pathogenesis and treatment of polycystic ovary syndrome: What's new? In: Advances in Clinical and Experimental Medicine . tape 26 , no. 2 , March 21, 2017, p. 359-367 , PMID 28791858 .
  61. ↑ IVF Register Annual Report 2016 Austria. (PDF) Health Austria , accessed on April 24, 2018 .
  62. ↑ Spanish genes, German mother. on: faz.net , December 4, 2007.
  63. ↑ Elderly mom sparked a dispute about egg donation. on: welt.de , December 4, 2007.
  64. ↑ Debate about late motherhood broke out. on: rp-online.de , December 4, 2007.
  65. ↑ European Court of Justice decides: Egg donation must be allowed. on: taz.de , April 3, 2010.
  66. ↑ ECHR: Egg donation is not a human right. In: The press. November 3, 2011.
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