One in six couples in Germany find they’re unable to have children.
"It was the worst thing I could have imagined,
the thought that I might never have a child.
I think we shouldn’t judge people."
Options such as surrogacy or using donor eggs are illegal in Germany.
So, when all else fails, many couples seek help abroad.
"It’s a huge taboo. Everything has been criminalized in Germany..."
But elsewhere it’s become a multi-billion-dollar industry.
"The people who do these things aren’t criminals.
These are just procedures that help people fulfil their dream
of having children."
But many of the surrogates and egg donors
are acting out of financial need.
"I mean 900 Euros —
that’s nearly twice what I earn in a month!"
Egg donation and surrogacy are a lucrative business in Europe.
But at what cost?
Franziska Ferber always wanted children.
But it just never worked.
Like so many, she exhausted all the legal options
for reproductive medicine in Germany.
The hormone treatments caused her to black out and injure herself.
But even that didn’t deter her:
"The thought of not having children was so horrific to me
that no matter what setback I suffered, I’d pick myself up,
reactivate my hope, and try the next thing.
And so gradually we widened the limits that we were prepared to go to,
and said we’ll try again."
With a donated egg, she could have probably got pregnant.
In Germany it’s illegal.
She could have got the treatment abroad
and faced no legal consequences,
but her conscience wouldn’t let her do it.
"Everyone who doesn’t get pregnant in the “normal” way,
so to speak, suddenly faces ethical questions.
And in the end, you have to be able to look at yourself in the mirror
and live with your decision."
Much is possible medically but remains ethically controversial.
Egg donation is legal in many western countries
and a handful of countries allow surrogacy too.
In Germany, only the standard fertility treatments are allowed.
Heribert Kentenich heads up a fertility treatment center,
one of more than 130 in Germany.
It’s been more than 40 years since the birth of the first “test tube baby”,
as the procedure was initially dubbed.
Medicine has come a long way since then.
In Vitro Fertilization is now standard.
110,000 I-V-F cycles are performed in Germany alone, each year.
Germany also allows sperm donation
and passed additional legislation in 2018.
But egg donation is not allowed.
That involves taking the egg of another woman during IVF treatment.
The embryo is then transferred to the prospective mother.
Surrogacy is also banned.
Here another woman is artificially inseminated
and carries the baby to term on behalf of the parents.
The embryo stems from the sperm and egg of the prospective parents,
or donors.
Two years ago Germany strengthened its egg donation laws.
The legal constraints placed on these procedures
have been hotly contested for years.
Germany’s National Academy of Sciences,
has long criticized the restrictions,
which are based on a law dating back to 1991.
"Say I have a 38-year-old female patient
who’s no longer producing eggs.
There’s a medical side to the case and a psychological and emotional one.
I have to tell her that even with IVF she probably won’t get pregnant.
Using a donor egg would be an option for her.
But I can’t advise her on that,
otherwise the state prosecutor will come knocking."
He says every year thousands of women seek help abroad.
For a handful of countries, it’s become a lucrative industry:
"The worst cases are the all-inclusive packages, it’s like
“we’re going on a nice holiday and we’ll get pregnant in the process”,
or maybe not.
It’s mixed with commercial interest."
Trade fairs have even sprung up in Germany,
like this one in Cologne last year before the pandemic lockdown.
Due to a legal loophole,
clinics from abroad can advertise fertility services here
that are actually illegal in Germany.
We’re not allowed to film during the opening hours, in order to
protect the privacy of members of the public attending the fair.
There are also clinics here advertising surrogacy.
The number one choice, for those that can afford it,
are the American clinics,
where prices for surrogacy start at 130,000 euros.
Those with a smaller budget can opt for a Ukrainian clinic,
where the “baby package” costs 64,000 euros.
Some even guarantee a baby.
One clinic made headlines last year
when around a hundred newborns were stranded in Kiev,
because lockdown measures prevented parents from collecting them.
The images,
that were published by the clinic to increase pressure on the government,
were beamed around the world.
Shortly afterwards,
parents from abroad were able to collect the infants.
The case triggered an international debate on the ethics of surrogacy.
The practice is legal in some European countries too,
including the UK, Austria and Denmark,
but only if it’s altruistic and not driven by money.
Greece goes a step further and allows clinics to offer surrogacy
to international clients.
So Lena and her husband decided to seek help in Greece.
We’ve changed her name.
She wishes to remain anonymous because of the social stigma involved.
She says even her friends have criticized her.
"Obviously you can always question the morality of it.
Some say it’s abusing another woman’s body.
But for me, the thought that I might never have a child
was the worst thing I could have imagined.
I think we shouldn’t judge people."
Many struggle with the decision to use a surrogate
because of ethical questions and the cost involved.
"The US or Canada would have been our first choice,
they felt like the safest options.
But we just couldn’t afford it.
Then there was Ukraine, which would have been the cheapest,
but we didn’t have a good feeling about it.
So, Greece was the middle path.
It was affordable and we felt that it was legally well-regulated
and the surrogates well cared for."
Lena and her husband were actually halfway through the procedure
when Lena suddenly got pregnant naturally.
Back to the trade fair.
I’ve arranged to meet with a doctor from a clinic in Greece.
He’s helped a number of German couples have a baby through surrogacy.
So, what motivates the surrogate mother to go through a pregnancy
for a couple she’s never met?
"You shouldn’t underestimate people’s desire to help others.
As a doctor working in this area,
I always try to understand why a woman would decide to do this.
And over the years,
I’ve noticed that the desire to help other couples
is a very powerful motivation."
"OK. But another incentive for the surrogates
is the financial compensation that they get, isn’t it?"
"To be honest, I would disagree.
My experience has shown that
money doesn’t play a major role in these cases."
"OK, but you talked about compensation, 10,000 Euros."
"That’s legally fixed."
"That’s real money in Greece."
"I don’t think that all women would undergo this procedure,
it’s not about the money."
"OK, but isn’t it the case that a business model has developed,
because there’s money involved?"
"You know, as a doctor who’s been involved
in reproductive medicine for more than 20 years,
I can assure you that it is not a form of business.
It’s a form of medical care and help that makes people happy."
But is it really just about making others happy?
I decide to head to Greece, to find out for myself.
Every year, some two hundred babies are born in Greece to surrogates.
The law permits the practice as long as it’s altruistic.
Back during the national economic crisis, that started in 2009,
Greece began promoting medical tourism to generate income.
In 2013, Athens opened surrogacy to international patients.
Since then, childless couples have come from all over the world.
But there appears to be no independent checks
into the welfare of the surrogates.
My contacts on the ground can’t even put me in touch
with any experts in this area.
But I can speak to someone who wants to be a surrogate.
She asked not to be filmed.
A clinic has told her she can sign up for surrogacy
once her youngest child is a little older.
She’s a single parent with three children,
but emphasizes repeatedly that her motivation is merely to help.
She dismisses all talk of possible health risks:
"God sees us.
And when you’re doing something good,
maybe the next day those good things will return to you."
She has no job.
The family of four lives from child benefits — 280 euros a month in all.
Surrogates are allowed to receive 10,000 euros in compensation.
But she tells us the sums involved are much higher,
she’s been told 30,000.
"That’s a good start in life — thirty thousand euros!"
30,000 Euros would be a lot of money — a powerful incentive.
I join forces with another journalist and fly to the Greek island of Crete,
where we’re going to pose as a couple in their mid-to-late 40s
who are desperate to have children.
Greece offers parents that use surrogacy an advantage —
a court process guarantees them the parental rights
before the pregnancy begins.
We inquire at a fertility clinic and get an appointment right away
But obviously we can’t take a camera in.
A doctor and his assistant told us that couples from all over the world
manage to have babies here, evidently for a lot of money.
The cost for us would be between 78 and 85,000 Euros,
of which 20 to 25,000 would go to the surrogate.
And he says we shouldn’t try to develop any emotional bond
with the surrogate as she was mainly doing it for the money.
"It was incredible he said right away she was doing it for the money."
"She gets up to a thousand euros a month."
"...which she’s allowed to get."
"But then another 10 to 15,000 euros when the baby is delivered."
"Yes, both the doctor and the assistant said the surrogate
gets another 10 to 15 thousand euros at birth.
It doesn’t sound that altruistic."
I report our experiences to someone from the body
responsible for drawing up Greek law in this area:
Katerina Fountedaki
is vice president of the National Authority of Assisted Reproduction.
I tell her that we’ve heard from multiple sources
that surrogates are motivated by the money
and may receive 20 or even 30 thousand euros.
This is totally illegal.
Because the total amount of money she could receive is 10,000.
Twenty-thousand is illegal,
20,000 is a payment!
The payment of course would be against morality,
it would be against human dignity.
This could not be allowed,
it’s contrary to the unavailability of the human body.
I tell her that as prospective parents
we were supposed to pay up to 85 thousand euros.
85?!?!
85!
8-5! Yes, eight, five, zero, zero, zero.
This is not possible!! I mean I learned things from You.
This is not possible,
this is an extraordinary amount I’ve never heard!!
So, I am shocked, really.
I’m very sorry that they treat foreigners like that.
Because we didnt mean that when we said
that we could open the Greek clinics for reproductive tourism.
We didnt mean that they should exploit people.
Katerina Fountedaki promises to have the case followed up.
Some clinics have clearly turned surrogacy into a business.
But what about the practice of egg donation?
That’s much cheaper than surrogacy.
Every year, several thousand couples from Germany
go abroad to use donor eggs.
The number one destination in Europe for this service is Spain.
Here too, it’s supposed to be altruistic.
Clinics across the country use thousands of donor eggs
in fertility treatments every year, and the trend is increasing.
But what does it involve for the donors? And who profits?
I visit a fertility clinic that’s very popular on German forums.
A doctor from Austria is responsible for German-speaking patients.
"I have three initial contact meetings a day.
Of those, around 80 percent opt to receive donor eggs.
So over the entire year, it adds up."
Under Spanish law, the egg donors have to remain anonymous.
So, I can’t meet any of the women who come here.
A member of staff explains the medical procedure.
"This is the operating room where
both the patients and donors have the treatment."
The donor is injected with hormones
so that she produces multiple eggs instead of just one.
These are then harvested in an operation.
Though relatively safe, it’s not completely risk-free.
And in rare cases, there can be serious complications,
resulting in injury to inner organs or subsequent infertility.
The group that the clinic is part of claims
to have one of the largest egg banks in the world.
They began storing donor eggs and patient embryos 30 years ago.
I ask how many they have.
"Oh lots! I can’t tell you exactly how many we have right now.
But we can store more than sixty thousand embryos at any one time,
and we can keep them for many years."
So where do all the eggs come from?
Jakob Doblinger says egg donation is a part of the culture in Spain.
"When I arrived here that was one of the first things that surprised me.
There really is this idea of altruistic egg donation.
In the same way people in Germany or Austria donate blood.
The financial aspect is there too, of course,
the donor receives between 1,000 and 1,500 euros
depending on how many eggs we get, so it’s not that much.
But if a student from the university of Valencia does it
to treat herself to a weekend in Ibiza,
I personally don’t have any problem with that."
Still, a thousand euros is a lot of money for many people.
And presumably it’s rarely used to finance a short break.
The average young woman in Spain lives on a lot less than 1000 a month.
In fact, nearly forty percent of young people are unemployed.
Surely many women feel compelled to give eggs for the money.
Naturally the clinics won’t pass on the details of any donors.
And it’s not a subject that women in Spain talk about openly.
But eventually,
I manage to find someone prepared to talk publicly for the first time
— and on camera — about her experience of donating eggs.
Five years ago, 30-year-old Elia
was a student and didn’t have enough to live on.
Like so many her age, she couldn’t find a decent job.
She donated eggs six times in all, earning 900 euros each time.
"Back then, I had a job with very few hours,
so my only secure income was 200 euros a month.
From that I needed to pay both my rent and my food.
The first time I donated eggs,
I can remember getting paid and the first thing I did when I got home
was pay my rent for the next three months."
Elia knew what to say to be accepted as a donor:
"The man then looked at me and asked:
So, what’s your motivation for doing this?
And I said, oh my motivation is altruistic,
I just want to help people!
And that was it.
And I honestly thought, either I’m a very good actress,
or a sociopath or I don’t know what...
Or he’s a very bad psychologist.
I mean just look at me!
And all the people who go there lie to him, and he just accepts it?!"
For years now, egg donation in Spain has been on the rise.
One of the few critical voices is scientist Consuelo Alvarez Plaza.
She’s studied the practice both in Spain and internationally
and believes the reason for the increase here is purely financial.
She says the clinics have become very skilled in advertising.
"On the one hand,
the clinics direct their advertising at women who need financial help,
who lack money.
Then on the other, they highlight the altruistic side,
the idea that those who respond are helping others.
They also offer comprehensive gynecological checkups,
so that in the end they can say the donation
wasn’t purely for financial reasons,
even though those reasons are obviously there!
Without that, no one would undergo hormone treatment
and take the risk that is clearly involved."
On the one hand, there are women in financial need.
On the other, couples desperately wanting children.
So, what’s it like for couples visiting the clinics?
Once again, we pose as a couple wanting children
and immediately get appointments in two clinics.
Once again, we’re unable to film.
Both clinics assure us that with this method we’ll be able to have children.
The health risks for the donors, and for me as the mother, are played down.
We’re also encouraged to have a DNA test done
to rule out any hereditary illnesses.
One of the clinics is even running a special offer.
"She said:
This is how much it’s supposed to cost, then crossed it out,
but we’ll offer you..."
"Yeah hilarious — a special deal!
For you, it’s just 7,500.
But only if you do it this month, then the DNA test is free.
But come one day later and it’ll be three thousand euros more."
What would German doctors say about the price?
Hallo
Ulrich Hilland is part of two working groups on reproductive medicine
that are linked to the German Medical Association.
He says the price isn’t that high.
But he feels special offers and unnecessary extras like the DNA test
suggest a money-making outfit.
"Medicine is not just a product that you sell.
Of course we live from our income.
And it’s not unusual to have bad practices here and there.
But the focus for me is always the patient and not my wallet.
But that’s not the impression I get from what you’re saying."
The other aspect is that risks to the donor and to myself were played down.
"It needs to be an informed decision,
both sides need to be clear about it.
It’s a low-risk procedure but not risk-free.
And that needs to be clear.
And the donor is not even having the eggs harvested
to fulfil her own dream of a family, but for others.
So, there’s a certain moral obligation
to think about the welfare of the woman who donated her eggs."
Physical risks are the one aspect.
But what about the emotional side?
Do donors experience long-term after-effects?
Nilsa is another former donor willing to go public.
Ten years ago, she donated eggs repeatedly
and now feels cheated by the clinic.
She says no one explained to her the risks involved.
She tells me her body reacted so badly to all the hormones
that her life was in danger.
With the progress in medicine since then, that wouldn’t happen today.
But she’ll never donate again.
"I honestly donated because I thought it couldn’t be a bad thing.
I thought I was doing something good for another woman,
someone who couldn’t get pregnant would receive eggs from me.
And I would benefit financially — and I needed the money back then.
But afterwards I thought about it a lot
and I don’t see it that way anymore."
Ten years on, Nilsa is still struggling.
She tries hard to suppress thoughts of her biological children.
"I guess a part of me tries to believe that nothing happened...
I just can’t imagine it!
I prefer to think that my eggs didn’t work and weren’t fertilized.
But now when I start talking about it all these bad feelings come up.
I’m just not ready for it.
It’s easier to think that nothing happened.
That my eggs didn’t develop fully
and there are no children out there with my DNA."
Passing on part of your own identity
is clearly more than a quick operation.
Spanish sociologist Sara La Fuente-Funes
has studied the practice of egg donation in Europe.
She’s critical of the Spanish system,
saying while childless couples benefit and the clinics earn well too,
the losers are the donors.
This in between situation is not really working
for the women that are actually sharing their reproduction capacity.
Because neither their part of altruism is very clear
because they are forbidden to have any relation with the family
and at the same time, they are not paid what it costs,
and they are not having the rights.
So it’s a very hypocritical situation.
She believes society needs to decide:
either egg donation is altruistic, or paid properly.
If as a society
— either German society, Spanish society or European society —
we decide that we don’t mind commercializing reproductive capacity,
then we need to find a proper framework
in which to do that with the rights of the people
who are actually willing to contribute with their eggs,
with their reproductive capacity, and to have a good income to do that.
So, she’s calling for a clear decision
on whether it’s an act of kindness or a commercial service.
But opinions differ, both on egg donation and surrogacy:
The debate in Germany has been going on for years.
The National Academy of Sciences which Heribert Kentenich is a part of,
wants egg donation to be legalized.
"Egg donations have been carried out for more than thirty years now.
These days the ban is hard to justify legally, ethically or medically.
I regret that it can’t be carried out in Germany in an orderly way.
It could be well regulated, so that couples are advised properly,
the donors are advised properly
and that only a limited amount of money is given to the donor."
But others disagree.
Political scientist Kathrin Braun belongs to a network of scientists
that actively opposes any legalization of egg donation or surrogacy.
She says the altruism argument is unrealistic
and there aren’t enough women who would donate voluntarily.
"That means a certain level of compensation will be needed.
But then we still won’t have enough,
so the compensation will be increased, and before you know it,
you have a line of business where women are risking their health
for the benefit of others."
Are egg donation and surrogacy unethical or perfectly acceptable?
Is legalization long overdue?
What are governments doing to clarify these questions?
The German justice ministry refers me to the health ministry,
which in turn points to a memorandum written
by the German Medical Association.
It says:
So the German government doesn’t have the issue on its agenda
and neither is it triggering any new debate on those complex legal,
ethical and societal aspects.
Those affected will have to wait.
Franziska Ferber never had a child.
Instead, she’s devoted her life to advising other couples
wanting children and calling for Germany to finally make a decision
on egg donation and surrogacy.
She says the silence surrounding these issues
and the ignorance of many politicians is a disaster.
"We’re too afraid to broach the subject.
We get round it by saying:
It’s banned in Germany, please go abroad.
And we abandon tens of thousands to a situation
where there’s no proper legal framework, no support and no advice —
because that’s not allowed.
We just abandon people and then wonder why there’s problems."
Both on surrogacy and egg donation,
medical experts in the EU talk a lot about altruism —
but often the surrogates and egg donors just have financial needs.
Potential problems - both physical and emotional —
frequently go unmentioned.
Meanwhile those wanting children face a dilemma,
with nowhere to turn for objective advice.
Clarity is needed — and rules that are fair for all.