When a person or couple consider the idea of undergoing IVF abroad, that is, turning to fertility tourism, the first thing they should do is to get essential information and tips on how to choose a clinic and what will be the best country to travel in accordance with their situation, family type, etc.
Regulations vary from country to country, and each clinic operates by different rules depending on its location. Before choosing a clinic, you should ask yourself the following questions:
- In which countries is the treatment you require legal?
- Do you meet the basic requirements? Are you within the legal age limit?
- Does the country you are interested in have a well-defined IVF legal framework?
- Is the cost of the treatment within your budget?
- In case you need a donor, do you prefer an anonymous or a known one?
These questions, along with the crucial information to help you choose the most suitable country we give you hereunder, will help you choose the most ideal destination for you.
The different sections of this article have been assembled into the following table of contents.
Definition of ‘reproductive tourism’
Reproductive tourism, fertility tourism, or cross-border reproductive care (CBRC) is a type of medical tourism that involves traveling from where you live to another country in order to undergo a fertility treatment.
Another definition is the one provided by the American Society for Reproductive Medicine (ASRM), which describes it as follows:
Cross-border reproductive care (CBRC) refers to the activity surrounding patients who travel outside their country of domicile to seek assisted reproductive services and treatment.
Infertile heterosexual couples, same-sex couples, and single persons may find the treatment they need is not allowed in their home country. In such case, they have no alternative but to travel abroad in the pursuit of an IVF clinic that offers the treatment they need.
Regulations governing assisted reproductive technologies (ART) vary greatly from country to country. Factors that contribute to such variations include, but are not limited to, the type of technique used, the family type, or the requirements to meet.
Some experts consider the term reproductive tourism inaccurate because tourism means traveling by pleasure, which trivializes infertility problems. In this sense, the phrase reproductive exile is seen as a more appropriate one, as its meaning is closer to reality.
Why do patients seek IVF abroad?
The reasons why people choose to travel abroad are varied, but often interrelated. What follows is a list with the most common ones:
- A high percentage of patients from the USA, Norway, and the UK decide to seek fertility care abroad because of their desire for access to anonymous egg donors.
- Previous treatment failure
- This, along with the common perception that foreign clinics have more highly-trained specialists and use cutting-edge technologies, incentivize patients to seek IVF abroad.
- Age limits
- Another significant factor shared by CRBC patients is their age: 37 years old on average.
- Reduced cost
- In many countries, the high cost of assisted reproductive technologies is a well-described barrier to its use. The United States is the country with the highest prices for IVF cycles.
- Legal issues
- When the cause of fertility tourism is to avoid the application of prevailing law, some experts prefer to refer to it as circumvention tourism. It is the act of traveling abroad to engage in an activity that is illegal, prohibited, or too limited in the citizen’s home country.
- New family types
- Single men and women as well as same-sex couples are able to create a family now thanks to assisted reproductive technologies. However, society is progressing even faster than legislations in this field.
One should not forget that, additionally, fertility tourism allows patients to combine cultural comfort with their IVF cycle. This reason is further reinforced if they have family connections, support, or a certain degree of cultural familiarity in the destination country.
We recommend that you hire a special travel insurance should you decide to undergo fertility treatment abroad, as normal insurances are unlikely to offer coverage if anything goes wrong. There exist special travel insurances tailored for fertility tourists exclusively.
Most sought-after treatments
Some infertility treatments that increase the popularity of fertility tourism are more controversial than others for either ethical reasons or religious beliefs, depending on the country of origin or even on the patient.
Also, the existence of legal restrictions in these countries contributes to increasing the number of complications that fertility patients might have to deal with. The following are the most sought-after infertility treatments in foreign countries:
Egg and sperm donation
Most of the patients that visit a fertility clinic need to use donor eggs and/or donor sperm to become parents. Poor sperm quality or zero sperm count, along with low egg quality or having a depleted supply of eggs, are the main causes why patients have to move to donor conception. Also, single females and lesbian couples need donor sperm to have a baby.
There exist two types of gamete donor profiles: anonymous or known. While in the former case prospective parents do not know anything about their donor(s), in the latter case they have the chance to choose who they want to be their sperm donor and/or egg donor.
As for the regulations governing donor conception, they vary greatly from an international perspective as one can see below:
- Countries where donor conception is forbidden, such as Germany.
- Countries where donors must remain anonymous by law, such as Spain.
- Countries where the identity of the donors must be disclosed, such as the UK.
- Countries where both types are allowed, such as Denmark or the USA.
As for the financial compensation given to donors, one can find two categories as well: altruistic or commercial donations. The existence of countries where the motivations to become a gamete donor must be based 100% on altruistic grounds, as in France, leads to a shortage in the number of volunteers willing to donate, which makes the waiting lists for receiving treatment almost endless.
It should be noted that, thanks to fertility tourism, patients can benefit from low cost egg donation programs while they see the success rates improved. In turn, they can undergo a greater number of cycles. Availability is often related to better decision-making—for instance, fewer embryos transferred.
Preimplantation genetic diagnosis (PGD)
Preimplantation genetic diagnosis or PGD is an assisted reproduction technique indicated for patients with risk for transmitting a genetic disease to offspring, or with DNA-based alterations in their gametes that prevent them from having a full-term pregnancy.
In some countries, like Germany, PGD is forbidden because it is considered a non-ethical technique, as it involves the removal of a cell from the developing embryo in order to analyze it. This is the only possible way through which we can find out whether an embryo carries a genetic abnormality or not.
As for Italy, destroying those embryos diagnosed as genetically abnormal via PGD is not allowed due to religious beliefs. Taking this into account, couples are forced to store these embryos even if they are never going to use them. For this reason, they prefer to travel abroad to undergo PGD in another country.
Choosing the sex of an unborn baby merely for social reasons is not allowed in the majority of countries, given that PGD is required. Given that it is considered to be a highly-invasive method, using it for non-therapeutical purposes is not an option.
Still, there are couples who wish to have access to PGD for selecting the gender of their unborn child. In most of the cases, it is due to the fact that they want to balance their family, that is to say, they already have a child and want to have another one of the opposite sex.
The USA is the most popular country for those who want to choose the sex of their baby. In Europe, PGD for gender selection is allowed in Belgium. Learn more about this technique here: Gender selection methods.
From an international point of view, surrogacy is the most controversial technique due to the number of ethical and moral concerns surrounding it. Many people oppose a process in which a woman carries a pregnancy and delivers a baby for another couple.
Today, those who need a gestational carrier (GC) to become parents have no alternative but to travel to countries where it is allowed, including Canada, Greece, Ukraine, and Russia, as well as some US states. These countries offer a favorable legal framework for becoming the legal parents of a child born by surrogacy.
If you want to learn more about gestational surrogacy with donor eggs, do not miss the following post: Using an egg donor and a gestational carrier.
Best countries for IVF
As one can see in the map below, the top destinations are concentrated across Europe, but also the United States, Russia, and South Africa are popular areas.
What follows is a summary of the causes behind this phenomenon in these parts of the globe, along with the most sought-after countries:
Italy, France, Germany, Norway, and Sweden are the European countries where the regulation of reproductive care is considered to be the strictest for reasons such as religious beliefs, historical background, or ethical considerations.
On the other hand, experts have revealed that, either because of the easy of travel or the existence of affordable prices, the following are the most popular destination countries chosen by patients:
- Czech Republic
These six countries have in common the existence of fertility clinics equipped with state-of-the-art technologies, as well as a more or less lax legal framework. Still, religious beliefs, along with the historical background of each country, determine to a great extent the approach each one gives to fertility care and the set of treatments which application is permitted by law.
Dr Javier Díaz-Donato provides an overview of the situation regarding gamete donation in different European countries. Here are a few examples:
- In Germany, sperm donation is allowed but only in insemination techniques. That is, IVF is possible but only with the husband's sperm. Sperm donation is only allowed in cases of insemination.
- In Turkey, there are no plans to create and use sperm or oocyte banks.
- Portugal, for embryo adoption or oocyte donation, it is necessary for the woman to be accompanied by a male partner.
- In Italy, the use of gamete donations is totally prohibited.
- In England, oocyte donation is accepted if a man requests it. In other words, a woman alone cannot use it.
The USA is the most sought-after country for those seeking egg donation with a gestational carrier, especially California, as it is considered the most surrogacy-friendly state. The country is mainly sought as a location for surrogacy due to the following reasons:
- Better quality of assisted reproductive technology (ART) in general
- The child can get birthright citizenship in the USA
- The child can apply for Green Cards for the parents after turning 21 years of age
- Higher level of legal protections
- Regulations that allow same-sex and single parents use IVF and surrogacy to start a family
The United States, along with Cyprus and Greece, has become the preferred destination of Turkish patients who need fertility care, too. This European country established a series of legislative barriers to access ART in March 2010. This, along with the presence of Sunni Muslims against assisted reproduction, leaves childless couples no choice but to pursue fertility treatment abroad.
How much does it cost?
More often than not, the treatments sought by fertility tourists are the most expensive ones, regardless of the country that best fits their needs. In fact, and as mentioned earlier, one of the reasons why they decide to pursue IVF abroad is to compare between clinics to try to find lower prices that remain within their actual budget.
The following is a list with the average cost for the fertility treatments mentioned above:
- IVF with donor eggs: €7,000-15,000.
- IVF with donor sperm: €900-1,700.
- IVF with PGD: €8,000-9,000.
- IVF with PGD for gender selection: €14,000-25,000.
- Gestational surrogacy: €35.000-150.000.
We can consider the United States as the country with the most expensive costs, but at the same time the one with the best conditions, especially in legal terms when it comes to addressing surrogacy agreements. For instance, the average gestational carrier fees in the USA range from $25,000 to $40,000.
If you need to undergo IVF to become a mother, we recommend that you generate your Fertility Report now. In 3 simple steps, it will show you a list of clinics that fit your preferences and meet our strict quality criteria. Moreover, you will receive a report via email with useful tips to visit a fertility clinic for the first time.
So you can get an idea, the ASRM estimates that, only in 2010, more than 30,000 international patients chose an European country to get started with a fertility treatment. As one can see, reproductive tourism is becoming a real phenomenon across countries from all around the world.
In a 2010 survey conducted across Europe, the most remarkable data revealed that:
- 24,000-30,000 cycles are done by international patients annually
- The average age of women undergoing CRBC is 37
- 55% survey respondents declared the reason why they decided to pursue IVF abroad is to avoid legal restrictions in their home countries, followed by access to advanced medical care (43%)
The data shown above also means that almost 5% of all European fertility care involves cross-border travel. It also proved that, while most patients were from Italy, Spain was the leading destination for them.
As for the United States, statistics indicate that:
- 4% of all fertility cycles provided in the country is delivered to non-US citizens
- Most patients are Latin American (39%), followed by people from European countries (25%)
- The rate of US citizens traveling abroad for fertility care is estimated to be way lower than the rate of people choosing the US as their destination.
Money given to donors in the US is usually high, since it is calculated in accordance with the potential inconveniences and risks that donors might experience before, during and after the process. This high pay is not seen as an ethically acceptable practice by some people.
FAQs from users
Is it possible to choose sperm or egg donors in the U.S.?
The options for the recipient are anonymous vs. known egg donation as well as fresh vs frozen egg donation and reviewed the pros and cons of both.
Is fertility treatment cheaper abroad?
It basically depends on the destination country. However, seeking cheaper or low-cost fertility treatment is one of the most common causes why patients decide to pursue IVF or any other procedure abroad. In fact, that is the reason why patients from the USA, in spite of having one of the most permissible and well-developed fertility care systems, travel to countries of similar characteristics but with lower prices.
You can learn more about the cost of IVF and egg donation treatments by visiting the following post: Donor-egg IVF cost in the USA.
How long does IVF abroad take?
Again, it depends on your country of origin and the destination chosen. A typical IVF cycle usually requires a 17-day protocol. Keeping this in mind, you might need to stay abroad for that time period approximately. Yet, if you are undergoing donor-egg IVF, the length of stay abroad might be even shorter, as you would only need to be there on the day of the embryo transfer, and then return after 2-3 days.
How is IVF with gender selection done?
Preimplantation genetic screening, PGS is accomplished by biopsy a blastocyst, sending a few cells to the genetic lab and transferring euploid embryo, i.e. an embryo with 46 chromosomes. The patient will know the gender of the embryo and can elect to transfer the embryo of the preferred gender. PGS allows more efficient treatment and having an elective single embryo transfer.
Is fertility tourism in India exploitative?
The truth is, there exists a broad debate on this subject, particularly when it comes to addressing the situation of surrogacy arrangements in India. This is the reason why the Indian Government changed the policies governing this treatment in 2015.
From that moment on, surrogacy was not allowed to foreign patients anymore unless it is also permitted in their country of origin and they are a heterosexual couple. Such drastic action was taken to prevent India from becoming a main destination for commercial surrogacy arrangements, which contributes to the exploitation of Indian women living beneath the poverty line.
What are the best success rates for donor-egg IVF abroad?
Success rates vary by country, but also from clinic to clinic, so choosing a single destination as the best according to general statistical data is difficult. We recommend you to take a look at this map: Egg donation rates worldwide.
Additionally, our advice is that you choose the clinic that best fits your needs, in accordance with factors such as your particular fertility issue, budget, etc.
Suggested for you
In many countries, the high cost of assisted reproductive technologies is a well-described barrier to its use. The cost of donor-egg IVF procedures is an example. If you want to learn more about it, you are strongly advised to visit this post: How much does egg cell donation cost?
Also, as one can realize after reading this post, third-party reproduction arrangements are the most sought-after overseas, as procedures such as surrogacy or known donor conception are forbidden in a high number of countries. What do you know about this fertility option? Check it out: What is third-party reproduction?
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FAQs from users: 'Is it possible to choose sperm or egg donors in the U.S.?', 'Is fertility treatment cheaper abroad?', 'How long does IVF abroad take?', 'How is IVF with gender selection done?', 'Is fertility tourism in India exploitative?' and 'What are the best success rates for donor-egg IVF abroad?'.