The Future of Reproductive Research in Germany: a Position Paper by the Reproductive Research Network*)

J. Gromoll1 ,#, H. M. Behre2, U. Eichenlaub-Ritter3, U. R. Markert4, A. Mayerhofer5, A. Navarrete Santos6, F. Tüttelmann7, F. von Versen-Höynck8, C. Wrenzycki9, R. Grümmer10, #

*) Translated Reprint from J Reproduktionsmed Endokrinol 2025; 22 (2): 64–70

From the 1Center for Reproductive Medicine, Albrecht-Schweitzer Campus D11, Münster, 2Center for Reproductive Medicine and Andrology, University Hospital Halle (Saale) / Fertility Center, University Hospital Münster, 3Faculty of Biology, University of Bielefeld, 4Placental Laboratory, Jena, 5LMU, BMC, Cell Biology, Anatomy III, Planegg, Martinsried, 6Faculty of Medicine, Martin Luther University Halle-Wittenberg, Institute of Anatomy and Cell Biology, Halle (Saale), 7Center for Medical Genetics, University and University Hospital Münster, 8Clinic for Gynecology and Obstetrics, Hannover Medical School, 9Veterinary Clinic for Reproductive Medicine and Neonatology, Chair of Molecular Reproductive Medicine, Justus Liebig University Giessen, 10Institute of Anatomy, University Hospital, University of Duisburg-Essen, Essen, Germany

#Corresponding authors

Correspondence address: Prof. Dr. rer. nat. Jörg Gromoll, Center for Reproductive Medicine, Albert-Schweitzer-Campus D11, D-48129 Münster, Germany,
E-mail: joerg.gromoll@ukmuenster.de; Prof. Dr. rer. nat. Ruth Grümmer, Institute of Anatomy, University Hospital, University of Duisburg-Essen, Hufelandstraße 55, D-45147 Essen, Germany, E-mail: ruth.gruemmer@uk-essen.de

Abstract: The future of reproductive research in Germany: A position paper by the Reproductive Research Network (Netzwerk Reproduktionsforschung). Reproductive research explores the biological, medical, and technological aspects of reproduction, as well as their impact on the health of future generations. Germany’s declining birth rate is exacerbated by delayed family planning and environmental factors, contributing to rising infertility – a problem with significant socioeconomic implications. Approximately eight million couples in Germany are affected by involuntary childlessness, making medically assisted reproduction (MAR) an increasingly important topic. However, research in this area faces major challenges, including restrictive legislation and unclear legal frameworks, a lack of university structures, difficulties in recuiting and retaining young researchers, and insufficient research funding, all of which hinder innovation. However, countries such as France and those in Scandinavia demonstrate that sustainable funding models can be successful.

In order to strengthen reproductive research in Germany, the Reproductive Research Network has developed a roadmap set up in a position paper containing five measures. University structures must be expanded to support young researchers and research projects must be funded in the long term. Public awareness must be raised, and the legal framework must be adapted accordingly. National and international networks as well as a National Coordination Center for Reproductive Health (NCRH) are to be established to promote research. These measures are crucial for developing sustainable solutions in reproductive health. By implementing these Germany will regain its international competitiveness and effectively address societal challenges such as declining birth rates and fertility disorders. J Reproduktionsmed Endokrinol 2026; 23 (1): 5–10.

Keywords: infertility, major public health challenge, roadmap

Key Points of the Position Paper

What is Reproductive Research?

Reproductive research examines biological, medical, and technological aspects of reproduction and reproductive health as well as how reproductive disorders affect overall health and the health of future generations.

The Importance of Reproductive Research for the Individual and for Society

Germany is facing declining birth rates and delayed family planning. With around 8 million couples with an unfulfilled desire to have children, infertility must be regarded as a major public health issue. However, its societal significance is still insufficiently recognized. In addition, hormones, genes, diseases, and – increasingly – environmental factors influence fertility and reproductive health. Older age at childbearing is a major risk factor for infertility, affects both men and women equally, and leads to an increase in births through medically assisted reproduction (MAR).

Status of Reproductive Research in Germany and the International Context

Restrictive legislation, a lack of university structures and limited research funding hinder the urgently needed scientific innovations. Sustainable international funding measures, such as those implemented in France and Scandinavia, can serve as models for such research initiatives.

Five-Point Action Plan to ­Strengthen Reproductive Research in Germany

1. Expanding and strengthening university structures and supporting early-career researchers

2. Securing sustainable funding for forward-looking projects

3. Strengthening public awareness and adapting the legal framework

4. Promoting national and international collaboration

5. Establishing a National Coordination Center for Reproductive Health (NCRH)

Conclusion

Reproductive research is essential for the health of our society. It should develop innovative solutions to address current and future challenges in reproductive health. Targeted funding through expanded structures, dedicated programs for early-career researchers, and the establishment of a coordination center can make Germany internationally competitive and enable it to effectively address these challenges.

Preamble

The Reproductive Research Network (Netzwerk Reproduktionsforschung, NR, https://reproduktionsforschung.de) is an association of independent physicians, veterinarians and natural scientists, engaged in clinical and scientific research. Its members are committed to strengthen­ing reproductive research in Germany. Since 2020, the network has published two mani­festos – the Essen Manifesto [1], and the Marburg Manifesto [2] – which emphasize the importance of reproductive research and call for improved funding and support.

Since then, initial funding measures have been established to advance reproductive research and improve reproductive health care in Germany. Since 2023, the BMBF has funded five interdisciplinary junior research centres specializing in reproductive health. In 2023, the network established the DFG Young Scientists’ Academy FertilAGE, offering young scientists the chance to conduct their first independent research projects in reproductive science. Against the backdrop of a growing deficit in reproductive research in Germany, however, and given the rapidly evolving state of knowledge, emerging issues in the field, and new social and political challenges, sustainable funding strategies and the expansion of reproductive research are of paramount importance.

For this reason, the Reproductive Research Network has developed this position paper, which presents a five-point action plan designed to strengthen reproductive research, its infrastructure and its public relations. This will enable Germany to address the substantive, social and political challenges associated with reproductive health and establish itself as a global leader in this forward-looking field. The plan is intended to serve as a roadmap for coordinated efforts in research, education, and public awareness.

What is reproductive ­research?

Reproductive research is an interdisciplinary scientific field focusing on biological, medical, technological, ethical, and psychosocial aspects of reproduction and reproductive health. Its aim is to improve our understanding of the processes of natural and assisted reproduction and to explore how reproductive health at different stages of life affects overall health, helps to improve medical treatments, to develop new technologies, to safeguard the health of future generations, and address ethical and social implications. An integral part of this is the interdisciplinary and translational collaboration between human and veterinary physicians and natural scientists who conduct research using animal and in vitro models, and ethicists and health scientists, given that human reproductive research is severely restricted by legislation such as the German Embryo Protection Act.

The core areas of research in reproductive medicine and biology as shown in Figure 1 are:

The biology of reproduction

• Endocrine (hormonal) control of the gonads (ovaries and testes) and the formation of germ cells (sperm and eggs)
• Mechanisms of egg maturation, fertilization, and embryonic development during pregnancy
• Genetic and epigenetic foundations of reproduction and reproductive health at all ages, in relation to environmental, genetic, disease, and lifestyle factors
• Development of novel contraceptive methods

Maternal-fetal interactions during pregnancy

• Implantation and placental function
• Influence of maternal diseases on the fetus
• Miscarriages and implantation failure

Medically Assisted Reproduction (MAR)

• Treatment of infertility in men and women
• In vitro maturation (IVM) of oocytes, in vitro fertilization (IVF), and intracytoplasmic sperm injection (ICSI)
• Cryopreservation of gametes (oocytes and sperm) and gonadal tissue (ovarian and testicular)
• Genetic testing and preimplantation genetic testing (PGT)
• Communication pathways and information exchange between practitioners and patients

Disorders of reproductive endocrino­logy, genetics, and epigenetics

• Polycystic ovary syndrome (PCOS), hypogonadism, and endometriosis
• Impact of environmental factors on the endocrine system
• Environmental influences, lifestyle, and genetic factors that affect reproduction, reproductive health, and the health of offspring
• Germline changes at the epigenetic level
• Influence of epigenetics on reproduction and transgenerational health outcomes

Consequences for reproductive health

• Transmission of genetic diseases to offspring
• Consequences of reproductive diseases for overall health
• Implications of aging germ cells for offspring health

Animal models in reproductive research

• Further development of reproductive technologies
• Animal models for human reproduction
• Research on stem cells, organ transplantation, and genetic modifications

Artificial reproductive systems and relat­ed stem cell research

• In vitro gametogenesis: the differentiation of embryonic/adult stem cells into germ cells
• Organoids for reproductive research

Legal and ethical aspects

• Assessment of emerging technologies in reproductive medicine
• Recommendations and draft legislative proposals in the field of reproductive medicine
• Genetic counselling and risk assessment before and during MAR

  The significance of reproductive research for society and the individual

Reproductive research is of paramount importance for public health in Germany, addressing both individual and societal challenges.

Demographic change and individual lifestyles

Germany has one of the lowest birth rates in Europe, with an average of 1.38 children per woman in 2023. In the long term, this will lead to a shrinking population [3]. One major factor contributing to infertility is the increasing tendency to delay parenthood. Reproductive research can help to preserve fertility in older age groups and reduce the associated risks for parents, fetuses, and offspring. Furthermore, it enables individuals to make informed decisions about family planning, for example providing improved information on risk reduction, the development of innovative contraceptive methods, the establishment of fertility preservation strategies, and the extension of reproductive lifespan.

Infertility and the unfulfilled ­desire to have children

Around 15% of couples in Germany experience involuntary childlessness [4, 5]. This means, alongside common diseases such as diabetes and obesity, infertility represents another major public health issue that is stigmatized by society. These conditions are interconnected; for instance, obesity has been linked to reduced fertility [6].

Reproductive research can improve the diagnoses and treatment of infertility, making them more accessible. However, the rapid adoption of artificial intelligence (AI) and machine learning (ML) by both practitioners and patients alike is creating new challenges in information management.

Both groups face new challenges in accessing and communicating information, as well as in clinical decision-making. These issues require scientific evaluation and monitoring [7].

Health aspects: prevention and treatment

Reproductive research can improve our understanding of the impact of endo­genous and exogenous factors (e.g., hormonal disorders, environmental exposure and climate change) on fertility, intrauterine fetal development, and the health of offspring. This can support the development of preventive measures [8–10]. In this way, it can significantly contribute to the health of individuals and future generations.

International competitiveness

Against the backdrop of the above factors, reproductive research is expected to play an increasingly important role in the health policies worldwide [11, 12]. By implementing targeted support measures, Germany can establish itself as a leading center of excellence in reproductive science. At the same time, legal and structural frameworks can be harmonized in an international context.

Conclusion

Reproductive research is crucial for the health and wellbeing of individuals, couples, and their offspring. By helping to prevent and treat infertility, a significant public health issue, it plays a pivotal role in safeguarding population health and promoting societal wellbeing.

The status of reproductive research in Germany and its position in the international context

Situation of university-based ­reproductive research

Reproductive research at universities in Germany operates within a field that is shaped by rapid scientific progress, on­going ethical debates, and strict legal constraints. Compared to other countries, the restrictive legal framework makes it difficult to conduct research on embryos or apply innovative techniques [13, 14].

One structural problem is the small number of professorships dedicated specifically to reproductive medicine at German universities. The absence of a robust, autonomous field of study impedes research, university teaching, and the development of early-career researchers in this highly specialized interdisciplinary domain spanning medicine, biology, ethics, and law [1, 2].

In light of international competition and technological progress, research conditions must be continuously adapted. Reproductive medicine requires stronger institutional support at universities. This is crucial to maintain Germany’s competitiveness as a center for innovation in reproductive medicine innovation and for ensuring optimal, evidence-based patient care.

Promotion of young scientists and medium- to long-term financing options for projects

Fortunately, various DFG research networks in reproductive biology and medicine have recently been established in Germany to strengthen reproductive research. These include the DFG research group in Giessen/Marburg (“The role of immune cells in the function of the normal and pathologically altered testis and epididymis”), as well as the SFBs in Lübeck (“Sex Diversity: Determinants, Meanings, and Implications of Gender Diversity in Sociocultural, Medical, and Biological Contexts”), Hamburg (“Maternal Immune Activation: Causes and Consequences”) and Münster (“Reproduction.MS”).

In addition, the Reproductive Research Network successfully established a DFG Young Investigators Academy on the topic of “Aging Processes in Reproduction – Consequences for Fertility and Health”. In 2023, the BMBF, together with the project management agency DLR-PT and the network, set up five junior research centers for reproductive health (Hamburg, Jena, Leipzig, Münster and Ulm) [15]. This funding enables the creation of structures that promote excellence in reproductive research within university faculties. It provides an opportunity for reproductive biology and medicine to be recognized once again as essential academic disciplines at universities.

These research networks and the support for early-career researchers could provide an initial boost to reproductive research, as both projects and positions for scientists and physicians have been created in the short to medium term. However, more comprehensive measures are needed to ensure these projects contribute to the long-term strengthening of reproductive research within academia. The focus should be on long-term programs that facilitate the establishment of research groups and departments within university faculties. Additionally, stronger nationwide networking of expertise is essential in order to promote scientific excellence and create synergies in a targeted manner.

The significance of reproductive health for society and individuals

Infertility cannot be regarded as an isolated disease. Rather, reproductive health is closely interrelated with general health. Various studies have shown an increased mortality risk among infertile men, as well as strong associations with other common diseases such as diabetes, heart disease, and cancer [16]. The underlying causes of these associations remain unclear. Infertility poses a considerable psychological burden on women [17] and is also associated with an increased risk of various common diseases. Infertile women are at a higher risk of developing cardiovascular disease, type-2 diabetes [18], and certain cancers, such as breast, ovarian and uterine cancer. Those with hormonal disorders such as polycystic ovary syndrome (PCOS) or endometriosis are particularly affected, as these conditions both impair fertility and are associated with metabolic and inflammatory processes that can have long-term health consequences [19]. In addition, recurrent miscarriages and implantation failure are associated with an increased risk of hypertension and cardiovascular disease. As with men, the exact biological mechanisms are not fully understood and require further intensive research.

A key area of reproductive research is preserving fertility before gonadotoxic treatments, such as those used in cancer therapy. This involves developing and applying cryopreservation methods for gametes. Cases involving prepubertal children undergoing gonadotoxic therapy present particular challenges. In such cases, preserving germ cells prior to therapy poses a significant scientific and clinical challenge, given that reliable in vitro methods for their subsequent development and maturation have yet to be fully established [20, 21]. Reproductive health is therefore of pivotal social importance. It affects not only the wellbeing and quality of life of individuals, but has long-term implications for social structures. The growing number of couples who are unable to conceive, as well as the increasing awareness of fertility-related health risks for both men and women, highlight the importance of comprehensive, interdisciplinary research. Such ­research is necessary to ensure optimal care for the population and to better ­address both medical and social challenges.

Integrating reproductive health into national health initiatives and international networking

According to a recent WHO study, infertility affects one in six people worldwide [22]. This makes infertility more prevalent than other well-known widespread diseases such as cancer and diabetes.

However, this issue has not yet received sufficient attention in the public sphere, and there is a general lack of public educational initiatives. Furthermore, long-term structural and organizational strategies to promote reproductive health are largely absent in Germany. Several European countries have already implemented successful initiatives, such as France’s national infertility strategy, which was funded with several million euros, and projects like ReproUnion [23] in Scandinavia and the Male Reproductive Health Initiative of the European Society of Human Reproduction and Embryology [24].

Therefore, it is necessary for Germany to develop medium- and long-term strategies to establish a comprehensive and sustainable framework for reproductive research. Close cooperation with existing European initiatives is crucial in order to exploit synergies and ensure a coordinated, comprehensive international strategy for promoting reproductive health.

A National Coordination Center for Reproductive Health

The necessary interdisciplinary activities and concepts, such as long-term scientific studies, data and biobank organization and management, and political initiatives, cannot be implemented by individual institutions alone. The network therefore proposes establishing an interdisciplinary and translational “National Coordination Center for Reproductive Health” (NCRH). This center could serve as a beacon and hub at both the national and international level, assuming key functions that would make reproductive research in Germany sustainable and competitive.

An NCRH could coordinate interdisciplinary research and the management of data and biobanks, as well as advising policymakers on the development of evidence-based recommendations for improving health policy. Additionally, it could support early-career researchers, undertake public relations activities, establish international collaborations, and further develop innovative technologies in reproductive medicine.

Conclusion

Reproductive health is essential for the wellbeing of individuals and their offspring, as well as for the long-term health of society as a whole. Over the past two years, promising short- and medium-term funding measures have been introduced to strengthen reproductive research at universities and increase public awareness of the issue. However, to remain competitive at the international stage, Germany requires more far-reaching, long-term measures to promote reproductive research. The establishment of a “National Coordination Center for Reproductive Health” (NCRH) could play a pivotal role in elevating reproductive research in Germany to a sustainable and globally competitive standard, both nationally and internationally.

5-Point Action Plan to strengthen reproductive ­research

The action plan includes specific measures to promote reproductive research in the areas of infrastructure, education, and public relations:

1. Strengthening and expanding university structures, and supporting early-career researchers

• Integration of topics related to reproductive research and medicine into the curricula of medical and biological faculties
• Organization of workshops, summer schools, and continuing education courses
• The development of specialized degree programs and courses in reproductive biology and assisted reproductive technologies
• Supporting early-career researchers through scholarships and mentoring programs
• Establishing graduate colleges and postdoctoral programs in reproductive science
• Setting up and promoting innovative research groups, e.g., developing new animal models or AI-based approaches
• Networking of universities, clinics, research institutes (e.g., Max Planck Institutes), private fertility centers, and industry partners to promote translational research and improve patient care
• Re-establishment of professorships and integration of BMBF junior research centers for reproductive health into permanent university structures such as departments or professorships

2. Securing sustainable funding for forward-looking projects

• Initiating, maintaining, and expanding federal and state funding programs for reproductive research
• Providing funding for large-scale interdisciplinary projects, cohort studies, and infrastructure
• Establishing research centers on alternative model systems (e.g., organoids and synthetic embryos)
• Development and implementation of artificial intelligence (AI) and machine learning (ML) technologies for research and clinical practice

3. Strengthening public awareness and adapting the legal framework

• Conducting nationwide campaigns to highlight the benefits and ethical dimensions of reproductive research and to raise awareness of reproductive health issues
• Promoting open dialogue on the social relevance, legal framework, and challenges of reproductive research
• Collaborating with patient organizations to raise public awareness

4. Promoting national and international networking

• Implementing preventive and educational measures that address infertility as a major public health issue, similar to the “National Decade against Cancer”
• Establishing national and international research alliances to foster synergies
• Supporting partnerships with leading research centers worldwide
• International exchange programs for researchers and students
• Harmonization of legal frameworks with other EU countries to facilitate research cooperation

5. The establishment of a National Coordination Center for Reproductive Health (NCRH)

The establishment of a National Coordination Center for Reproductive Health (NCRH) is proposed to ensure interdisciplinary and translational collaboration in reproductive research, providing a sustainable structure for its long-term development. Such a coordination center would coordinate essential research activities and fulfil key functions. It would serve as a link between research and ­clinics, patients, politics, and society. It would support the transfer of science into application (“bench to bedside”) as well as the communication of reproductive research content to society and the public (see Fig. 2). It could, for example, be integrated into existing institutions and expanded through a nationwide competitive call.

The possible tasks of such a coordination center include:

Establishment and management of data and biobanks

Collection and evaluation of genetic data, for example for individualized diagnostics and therapy. This includes centralizing the organization, storage, and access of biomaterials such as blood and tissue samples to enable high-quality scientific studies.

Provision of central infrastructure services

Supporting the implementation of technological innovations and diagnostic services that institutes and clinics cannot provide alone.

Coordination of clinical studies

Initiation and coordination of longitudinal and/or multicenter studies.

Integration of innovative technologies

The rapid development of AI applications and personalized therapies will transform the field of reproductive health significantly, and the coordination center could play a pivotal role in integrating these technologies in Germany.

Networking

As a national hub, the NCRH is able to initiate and coordinate national and international collaborations. It also promotes interdisciplinary and translational collaboration with universities, clinics, research institutes, professional reproductive research societies, and industrial companies.

Adaptation of the legal framework

This involves supporting the reform of the Embryo Protection Act and the Reproductive Medicine Act, as well as developing ethical guidelines for emerging technologies.

Funding

The NCRH should initially receive core funding from the federal and state governments. Subsequently, it could gradual­ly become self-sustaining.

Additional funding could be obtained through EU projects, foundations, and funding organizations such as the DFG and BMFTR, as well as private sponsors. Industrial collaborations for the development of new technologies are also envisaged.

Conclusion

Strengthening reproductive research in Germany is an urgent social task requiring the joint efforts of universities, research funding agencies, and political decision-makers. Sustainable structures must be established, early-career researchers supported, public awareness raised, a national coordination center created in order to develop innovative solutions to current and future challenges. This 5-Point Action Plan can serve as a roadmap to help secure Germany’s leading international role in reproductive research and contribute significantly to the continued advancement of this forward-looking field.

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