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  • 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 thenormalway,

  • 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 firsttest 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 thebaby packagecosts 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 lifethirty 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 cameraabout 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 financiallyand 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 neededand rules that are fair for all.

One in six couples in Germany find they're unable to have children.

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