"It was one of the most harrowing moments of my life," said Marriette, who didn't want her last name used to protect her privacy, about the moment she was told that conceiving without medical intervention likely would not happen for her. "I sat on the floor and cried for six hours in my best friends' apartment with them and their baby."

When she was in her early 30s, Marriette had an operation to remove cysts on both her ovaries. Unbeknown to her at the time, this resulted in a depleted egg reserve. Newly single after a breakup, at the age of 36 Marriette started having hot flashes and was diagnosed with premature ovarian insufficiency and already in perimenopause.

What began next has been what she calls a "shockingly unjust" fight to conceive as a single woman in Germany, where the cost of infertility treatment is only covered for married couples, who get 50% of the costs for a maximum of three rounds of treatment paid for by health insurers.

"My first fertility doctor told me to just go out and sleep with lots of people," explained Marriette. "It just feels very unjust. I can't believe that after paying health insurance and taxes here for 18 years, for my health care problem, the solution depends on whether I'm married or not."

Since beginning fertility treatment two years ago, Marriette has had to pay for everything herself: for every injection and drug, every ultrasound and blood test, even for the cost of a postage stamp for a letter she received from a fertility clinic. 

She remembered one incident in particular when she was in a surgical gown waiting for surgery and the anesthesiologist approached her with a syringe full of anesthetic and a credit card machine. "He told me he would also accept cash," Marriette recalled. "I just can't believe that's the reality."

The experience has been grueling. Suffering from burnout after working three jobs and repeated failed attempts to conceive, Marriette was eventually forced to take time off work and reevaluate her options.

"Those last six months basically broke me," she said. "I had nothing to show for all this pain, anguish and hard work. Not only have I got nothing to show for it, I'm in €13,000 ($14,000) of debt and now on antidepressants." 

'Outdated and discriminatory' legal situation in Germany 

Germany has one of the oldest and most outdated laws on fertility in Europe, according to Fertility Europe, a pan-European NGO representing patients' associations dedicated to infertility.

Under the healthcare system, some states do offer subsidies for same-sex and unmarried couples, but that is the exception rather than the rule. Egg donation and surrogacy are both forbidden in Germany.

"In Germany, less than 3% of babies are born through [assisted fertility treatments]. In Croatia, that number is 5% and 10% in Denmark," Klaudija Kordic, the chair of Fertility Europe, told DW.

"What you are doing here is stopping potential parents from having children because they can't afford it, or they feel embarrassed because it's not paid for them, there must be something wrong."

Germany scores a "medium" 69%, on a par with Austria, Bulgaria, Italy, Latvia and North Macedonia, on Fertility Europe's atlas ranking of fertility treatment policies on a scale from excellent to exceptionally poor. Only Belgium, France, Israel and the Netherlands rank as excellent.

Many countries in Europe complain about the low birth rates, but there isn't enough long-term planning to support the people who want to have children," said Anita Fincham, head of advocacy at Fertility Europe.

She said the regulations in Germany are discriminatory and that those who can afford it go abroad. Others resort to unsafe practices without medical supervision. 

"I'm kind of surprised but also not surprised that people still go to Ukraine where there is a war, but you can still get surrogacy there," Fincham told DW.

"People who really want to have children and are deprived of publicly funded support can resort to risky behaviors, like casual sex or trying to inseminate themselves with a syringe filled with sperm, because it's too expensive to do it in a clinic or not even allowed."

Guidance on surrogacy, egg donation due in April

When Germany's coalition government of the center-left Social Democrats (SPD), Greens and neoliberal Free Democrats (FDP) first came to power in 2021, it agreed to review the 1990 Embryo Protection Act which governs access to reproductive medicine and the use of donor eggs and surrogates. 

The coalition agreement states that it wants to provide better support for the involuntarily childless "regardless of medical indication, marital status and sexual identity."

The expansion of age limits (women must currently be between 25 and 40, men between 25 and 50 years old) and full coverage for the cost of treatment are also on the agenda.

Just over two years into its term, the government has set up a reproductive health commission to provide independent recommendations, which are due to be published in April.

Jochen Taupitz is an expert on health law and medical ethics at Germany's University of Mannheim and a member of the commission. He called the law in Germany "archaic" and said it prevents people from access to reproductive medicine that has long been available in many other countries.

"Behind [the current regulations] there's also an outdated image of the family, namely the classic heterosexual, married couple, even though in Germany we now have same-sex marriage," Taupitz told DW, adding there's a lack of political representation needed to exert real pressure for change. 

"Until now, I haven't heard any concrete plans from the government to take any measures to address the issue of funding for infertility treatment or to change the current situation. It's obviously not on their list of priorities at the moment," said Taupitz. 

Finding treatment abroad 

If money wasn't an issue, Marriette said she would keep on trying to retrieve her own eggs. But the uncertainty and financial burden means that's just not a viable option.

She has explored the possibility of adopting a child, but that turned out to be just as difficult, with long waiting lists and a bureaucratic system that almost always favors married couples with two incomes.

Instead, she has chosen to go to a fertility clinic in Denmark where she is on the waiting list for a donor egg. She recently launched a crowdfunding campaign to help pay for her treatment and has already received over €10,000 in donations.

After all the pain and anguish, she's finally feeling upbeat and positive about her chances of having a child. Nonetheless, the journey to reach this point has been agonizing. "I'm choosing to do this ethically and it feels like I'm being punished for that," she said. 

"I just want the same thing that is afforded to married couples to be afforded to single women. Women's health is always just ignored. It's just mind-blowing that it's still like this."

Edited by: Rina Goldenberg

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