Fertility treatment remains a taboo subject in many countries.
Germany's history of eugenics — where Nazi doctors forcibly sterilized or euthanized people in an attempt to eliminate hereditary illnesses and handicapped people — makes officials nervous about any procedures that handle embryos. It was only last year that Germany approved an embryo test commonly used elsewhere to spot genetic problems. The test, generally used only in IVF pregnancies, is still banned in Austria and Italy.
In other countries, religion carries more weight. France and Italy both have strong historic ties to the Roman Catholic Church, which forbids IVF, primarily because the procedure may involve the destruction of embryos. The church is also against artificial insemination because it believes procreation should only be by a husband and wife through the natural act of sex.
Until 2004, Italy's fertility laws were fairly lax, leading to pregnancies in women as old as 60, and a proliferation of woman "renting" their wombs. A law supported by leading Catholic groups that year clamped down on egg and sperm donation, limited the number of embryos transferred, and outlawed the practice of freezing embryos. The law restricts IVF to "stable, heterosexual couples who live together and are of childbearing age."
Italy says allowing donated eggs could exploit women and that the practice "would lead to a weakening of the entire structure of society."
Most couples seeking fertility treatments don't need donated eggs and sperm. And many government health systems will pay for fertility treatments for those who have been trying at least three years to conceive.
People in Western Europe who seek medical treatment elsewhere cannot be prosecuted at home even if the treatment is illegal in their own country. But there can be other complications. For example, in France, children born through surrogacy are not entitled to a French passport.
Still, authorities are struggling with how to deal with the complexity of IVF families. Last month, France's Court of Appeal upheld a decision to grant civil status — similar to nationality — to twins carried by a surrogate mother in India for a French couple. But in 2011, the French Supreme Court denied civil status to twins born to a surrogate mother in the U.S.
For gay and lesbian couples in France, Italy, Switzerland and elsewhere, only one partner can be the child's legal father or mother.
"These restrictions imply that gays and lesbians are second-class citizens and that a child has to be raised in a conventional family," said Angelo Berbotto, a lawyer and acting secretary of NELFA, Europe's largest organization for gay and lesbian families.
Opponents say national health systems are not obligated to allow artificial reproduction techniques for same-sex couples.
"The desire to be a parent does not create the right to have children," said Gregor Puppinck, director general of the European Center for Law and Justice, a Christian group that lobbies European lawmaking bodies.
"What's lost is the best interests of the child," Puppinck said. "The child has a right not to have two fathers or two mothers."
Dr. Heinz Strohmer, a fertility doctor at a Vienna clinic, said most of his clients needing egg or sperm donations were more concerned about the logistics of getting treatment abroad than challenging Austria's law banning them.
"The only question they have is if we can organize everything for them," he said. Strohmer often works with clinics in the Czech and Slovak republics and Spain to get around the Austrian rules on IVF.
When Italian residents Giuseppina La Delfa and Raphaelle Hoedts decided to have a baby, they knew that would mean crossing borders. Needing a sperm donation for IVF that they couldn't get in Italy, the lesbian couple went to Belgium for more than a dozen cycles of fertility treatment. La Delfa gave birth to daughter Lisa-Marie in 2003.
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