“It was one of the saddest moments of my life,” said Mariette, who did not want her last name used to protect her privacy, about the moment she was told it would not be possible for her to conceive without medical intervention. “I sat on the floor in my best friends’ apartment with them and their baby and cried for six hours.”
When Mariette was in her 30s, she had surgery to remove cysts from both her ovaries. Unbeknownst to him at the time, his stock of eggs was depleted as a result. After a breakup, newlywed Marriott began experiencing hot flashes at age 36 and was diagnosed with premature ovarian insufficiency and was already in perimenopause.
What ensued was what she calls a “shockingly unjust” battle to conceive as a single woman in Germany, where the cost of infertility treatment is covered only for married couples, who get 50% of the cost of a maximum of three rounds of treatment by health insurers.
“My first fertility doctor told me to go out and sleep with a lot of people,” Marriott said. “This seems very unfair. I can’t believe that after having health insurance and paying taxes here for 18 years, the solution to my health care problem depends on whether I’m married or not.”
Since starting fertility treatment two years ago, Marriott has had to pay for everything herself: for every injection and medication, for every ultrasound and blood test, even the cost of a postage stamp for a letter she receives from the fertility clinic.
She remembered one incident in particular when she was waiting for surgery in a surgical gown and the anesthesiologist came to her with a syringe filled with anesthesia and a credit card machine. “He told me he would also accept cash,” Marriott recalled. “I can’t believe this is real.”
The experience has been painful. Suffering from burnout after working three jobs and repeatedly failing to conceive, Marriott was eventually forced to take time off work and reevaluate her options.
“The last six months have basically broken me,” he said. “I had nothing to show for all this pain, suffering and hard work. Not only do I have nothing to show for it, but I am €13,000 ($14,000) in debt and now taking antidepressants.”
‘Outdated and discriminatory’ legal situation in Germany
According to Fertility Europe, a pan-European NGO representing patients’ associations dedicated to infertility, Germany has one of the oldest and most restrictive laws on fertility in Europe.
Under the health care system, some states offer subsidies for gay and unmarried couples, but this is the exception rather than the rule. Egg donation and surrogacy are both prohibited in Germany.
“In Germany, less than 3% of children born [assisted fertility treatments]. In Croatia, the number is 5% and in Denmark 10%,” Fertility Europe president Claudija Kordic told DW.
“What you’re doing here is preventing potential parents from having children because they can’t afford it, or they feel embarrassed because it’s not paid for, should there be something wrong.”
Germany’s score is “medium” at 69%, on par with Austria, Bulgaria, Italy, Latvia and North Macedonia. Atlas of Fertility Europe 2021 Ranking of Fertility Treatment Policies On a scale from excellent to exceptionally poor. Only Belgium, France, Israel and the Netherlands are in the excellent category.
“Many countries in Europe complain about low birth rates, but do not have adequate long-term planning to support people who want to have children,” said Anita Fincham, head of advocacy at Fertility Europe.
He said the rules in Germany are discriminatory and those who can afford it move abroad. Others resort to unsafe practices without medical supervision.
“I’m surprised but also not surprised that people still go to Ukraine where there’s a war going on, but you can still get surrogacy there,” Fincham told DW.
“Those who really want to have children and are deprived of publicly funded assistance may resort to risky behavior, such as casual sex or trying to inseminate themselves with a syringe filled with sperm, because doing so in a clinic is too expensive or not even allowed.”
Health Minister’s resignation in surrogacy case
Earlier this week, Jens Spahn, chairman of the ruling centre-right Christian Democratic Union (CDU) parliamentary committee, and his husband announced they had become parents with the help of a surrogate mother in the US – despite a ban on the practice in Germany.
The CDU, which governs together with its conservative sister party, the Christian Social Union (CSU) and the centre-left Social Democrats (SPD), strongly opposes legalizing surrogacy in Germany.
As recently as February, the party passed a resolution reiterating this at its federal party conference.
“In light of the ethical, legal and practical concerns regarding surrogacy, Germany’s CDU confirms its demand that surrogacy, including the altruistic model, remain prohibited in Germany in order to prevent abuse, exploitation and health risks,” the resolution said.
After much opposition from members of his own party, Spahn resigned from his leadership post on Saturday.
“In recent days, I have realized that my personal joy in starting a family with my husband and becoming a father is incompatible with my political office,” Spahn wrote in a letter to colleagues.
Jochen Taupitz is an expert in health law and medical ethics at the University of Mannheim, Germany. He described Germany’s law as “outdated” and said it prevents people from accessing fertility treatments that have long been available in many other countries.
“Back [the current regulations] “There is also an old image of the family, namely the classic heterosexual, married couple, even though in Germany we now have same-sex marriage,” Taupitz told DW in 2024. He said there is a lack of political representation needed to exert real pressure for change.
Taupitz said, “So far, I have not heard any concrete plans from the government to address the issue of funding for infertility treatment or to take any measures to change the current situation. This is clearly not on their list of priorities at the moment.”
Looking for treatment abroad
Marriott said that if money were not an issue she would have kept trying to get her eggs back. But uncertainty and financial burden means this is not a viable option.
She has explored the possibility of adopting a child, but it has proven equally difficult due to long waiting lists and a bureaucratic system that almost always favors married couples with two incomes.
Instead, she opted to go to a fertility clinic in Denmark where she is on the waiting list for a donor egg. he 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 suffering, she is finally feeling excited and positive about her chances of having a baby. Still, the journey to get to this point has been painful. “I’m choosing to do this morally and it feels like I’m being punished for it,” she said.
“I just want single women to get the same things that married couples get. Women’s health is always ignored. It’s shocking that it’s still like that.”
Edited by Reena Goldenberg
This article was originally published in February 2024 and was updated on July 18, 2026 to reflect the resignation of Jens Spahn over the issue of surrogacy.
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