[Reproductive medicine in Germany--peculiarities and dilemmas]

Technological progress, as well as increasing success, of reproductive medicine may lower the threshold for childless couples to initiate infertility therapy. However this development may aggravate unsolved problems (e. g. multiple births) and may not increase the pregnancy rate, due to the present unsatisfactory legal situation in Germany (e. g. ban on selective blastocyst culture).

Based on a systematic review of the literature, we studied actual problems of German reproductive medicine under three public health-related topics: (1) the decline in population in Germany, (2) criteria for success in reproductive medicine and (3) new treatment options in the light of legal and ethical aspects.

In Germany (and other industrial nations), reproductive medicine has emerged parallel to an ever-increasing rate of childlessness. Today, 2 % of all births result from treatments using the techniques of reproductive medicine. Nevertheless, the actual extent of involuntary childlessness is lower (below 8 %) than commonly suggested (between 10 and 15 %). Frequently, the success of treatment depends upon a series of treatment cycles and is, especially in Germany, accompanied by a high rate of multiple births (more than 30 %). Hence, a more adequate success rate may be the healthy, i. e., term, singleton baby. The use of selective blastocyst culture, currently not permitted in Germany, could further improve therapy or, at least, reduce patient stress and discomfort.

Reproductive medicine, as seen from a public health perspective, needs to pursue patient-oriented requirements more in-depth. An open discussion of new technologies which could improve reproductive health but are at present not permitted, would be imperative.