Therapy requirements

a) legal framework and reimbursement of costs

. The legislator has changed the requirements for those insured by the German statutory health insurance concerning the cases when they need a fertility treatment by means of intrauterine insemination (IUI), In-Vitro-Fertilisation (IVF) or ICSI (Intra Cytoplasmic Sperm Injection). (Health care system modernisation law).

. This law took force on January 1, 2004. According to it, the competent statutory health insurance companies reimburse only 50% of costs for the medical treatment, the medications and the so-called “need for consultations”. The couple undergoing treatment must pay the remaining costs. The legislator believes this percentage of contribution to be reasonable.

. The number of treatment cycles, that are pro-rata reimbursed by the statutory health insurance is limited. It reimburses the maximum of:
8 insemination cycles without hormonal stimulation
3 insemination cycles with hormonal stimulation
3 IVF or ICSI treatment cycles

. After the birth of a child, the patient is again entitled to pro-rata cost sharing. Further entitlements in this regards are now controversially discussed.
Lawyers experienced in social law say that a new entitlement emerges when a so-called clinical pregnancy occurs, even through it ends in miscarriage or it is a fallopian tube pregnancy.
Should you have any doubts in this regard, please turn to your treating doctor.

. The pro-rata reimbursement of costs by the statutory health insurance companies is subject to certain conditions. These are the following::

the partners must be married to each other* both partners must be older than 25
both partners must be HIV-negative

the treatment plan must be approved by the insurance company

special consultations of the couple before IUI, IVF or ICSI treatments must take place

. Please pay attention to the fact that the entitlement to pro-rate reimbursement ends with the 40^th birthday of the women and with the 50^th birthday of the man. Decisive is the age on the 1^st day of the cycle, on the 1^st stimulation day or on the first day of so called “down regulation”.

. After sterilisation, reimbursement of costs is possible only in exceptional cases after a special application and a medical assessment. Should you have any doubts in this regard, please turn to your treating doctor.

b) Treatment plan

. According to the above-mentioned description, the doctor must develop a treatment plan in detail. It contains information about the determined causes of the involuntary infertility, about the introduced treatment measures and the estimated therapy costs.

Separate treatment plans must be developed for both partners. Your treating doctor will give them to you and they must be sent to the competent insurance company for approval. The treatment can only begin after all requirements have been met and the treatment plan has been approved.

. You will see the estimated costs in the treatment plan. You will have to pay 50% of these costs. Please mind that the treating doctor can make only an approximate estimation of the expected costs. It is possible that the treating costs in your individual case will deviate from this estimation.
We will be glad to answer your questions.

c) As a woman

. … as a rule you should be younger then 40 and older then 24. Your infertility cannot be treated with the help of other treatment methods. Your uterus and at least one of the ovaries must be functional. Your rubella (three-day measles) prophylaxis has been proved. You are HIV-negative.

d) As a man

… the main requirement is that you have sperms at all. When this has been proved, the further treatment depends on the quality of your sperms. In the case of a very bad quality ICSI, the intracytoplasmic sperm injection can be a feasible method for you.