Reproductive tourism, fertility tourism, cross-border reproductive care (CBRC) or IVFabroad is a type of medical tourism that consists in traveling from where you live to another country or state in order to undergo a fertility procedure.
Another definition is the one provided by the American Society for Reproductive Medicine (ASRM) is the one which describes it as moving from one jurisdiction to another.
The various sections of this article are assembled in the following table of contents.
Why undergoing IVF treatment abroad?
Couples suffering from infertility who need to access assisted reproduction may find the treatment they need is not allowed in their home country. In such case, they have no choice but to travel abroad in the pursuit of overseas IVF clinics.
Regulations governing assisted reproductive technologies (ART) vary greatly from country to country. Factors that contribute to such variations are, for instance, the type of technique used, the family type, or the requirements that must be met.
Although to a lesser extent, the cost of a fertility treatment is another aspect that couples bear in mind when it comes to make up their mind as to where they are going to travel to undergo the fertility treatment they need.
Donor-egg treatment abroad
While many fertility treatments can be performed overseas, having donor-egg treatment abroad is one of the most common reasons why people decide to resort to fertility tourism. In other countries, IVF with donor eggs can be:
- Known or anonymous
- Altruistic (with or without economic compensation)
- Allowed to new family types (gay families and single parents)
Those who prefer to choose who will be the one delivering half the genetic load of their baby-to-be by themselves have to choose a country where known donation is allowed. There, they can request the physical characteristics and personality traits they wish for their donor. Furthermore, in some countries such as the United States, the parents have the chance of getting to know their donor, meet her/him in person and even become friends with her/him.
Within Europe, given that donors have the legal right to remain anonymous, some European countries have greater amounts of prospective donors willing to donate their gametes. For example, while egg donors shall not remain anonymous in countries such as Sweden or United Kingdom and therefore they receive a lower amount of potential donors, other countries like Spain, where the donor ID must be confidential, count on a greater donor database.
Some experts recommend patients to hire a special travel insurance for fertility treatment abroad, as normal travel insurances are unlikely to cover you if anything goes wrong. There exist the so-called “specialist travel insurances” designed for fertility tourists exclusively, although they vary depending on the treatment you are about to undergo abroad.
Top destination and departure countries
Within the European continent, the top destination countries for fertility tourists are Spain, Ukraine, Greece, the Czech Republic, and Russia. The USA is the most sought-after country for those seeking egg donation with a gestational carrier, especially California for being the most surrogacy-friendly state.
Reproductive tourism is becoming a real phenomenon across countries from all around the world. In a 2010 survey conducted across Europe, most remarkable data showed that:
- 24,000-30,000 cycles are done by international patients annually
- The average age of women undergoing CRBC is 37 in Europe
- 55% survey respondents declared the reason why they chose CRBC 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 the vast majority had a preference for preserving their anonymity. While most patients were from Italy, Spain was the leading destination for them.
In France, the compensation given to donors is so low that only a few young people are willing to undergo egg donation. As for Spain, the economic compensation is just adapted to the process, but it is not too high to avoid getting money becomes the sole motive. It is neither too low, since it is also aimed at rewarding all the efforts and risks taken during the process.
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.
As for the United States, statistics indicate that:
- 4% of all fertility cycles provided in the country is delivered to non-US domiciliaries
- Most patients are from Latin America (39%), followed by European patients (25%)
- The rate of US citizens traveling abroad for fertility care is estimated to be far 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 nuisances and risks the donor may experience during the process, something that is not considered to be ethically acceptable by some people.
Benefits of reproductive tourism
The reasons why people choose to travel abroad are varied, but often interrelated. Firstly, access to anonymous donors is a major factor when patients make the decision of pursuing IVF abroad. A high percentage of patients from the USA, Norway, and the UK decide to seek care abroad because of their desire for access to anonymous egg donors.
Also, treatment failure is a major reason when it comes to making the decision of seeking an infertility treatment abroad. This and the common perception that foreign clinics employ more highly-trained specialists and use more cutting-edge technologies incentivize ART patients to seek IVF in other countries.
In many countries, the high cost of assisted reproductive technologies turns out to be a well-described barrier to its use, so seeking affordable IVF overseas is a major motive behind fertility tourism. Global price variations are a fact, being the United States the country with the highest cost of an in vitro fertilization (IVF) cycle. Also the fiscal impact of ART on patients varies across the globe.
As for the legal issues surrounding egg donation and IVF abroad, there are no formal laws regarding their legal regulation. This means it varies from country to country, each one having more or less lax laws on gamete donation, surrogacy, and ART in general. The most commonly banned ART services are:
- Preimplantation genetic diagnosis (PGD)
- Sex selection
- Commercial or compensated egg and sperm donation
- Embryo cryopreservation
Fertility tourism is also the preferred option because it allows patients to combine cultural comfort with their fertility cycle. This reason is further reinforced if they have family connections/support or a certain degree of cultural familiarity in the destination country.
Finally, thanks to fertility tourism, patients can benefit from low cost egg donation programs while they see their chances of success improved. In turn, they can increase the number of cycles they are able to undergo. Availability is often related to better treatment decision-making, e.g. fewer embryos transferred.
New family types and IVF
Today’s society is not composed of traditional families comprising a dad, a mom, and a child anymore: new family types have arisen in the past few years and are becoming increasingly common.
Single men and women as well as same-sex couples are able to find the way to create a family now thanks to assisted reproductive technology. However, society is progressing even faster than legislations in this field.
The USA has the least restrictive regulations when it comes to including these family types also in the group of patients who need a fertility treatment to create a family. Nevertheless, requirements to undergo a fertility treatment are not the same nationwide. While some US states allow every assisted reproductive technology (including surrogacy), regardless of the family type, others place some restrictions in this area.
As stated hereunder, Spanish regulations are Europe’s best defined, which makes Spain the most popular destination for fertility tourism in this continent. It should be clear though, that Spain presents a series of shortcomings as well, given that surrogacy is illegal even if it is the only way through which single men and gay couples can become parents.
Russia, Ukraine and Greece are further examples of countries that, despite having advanced reproductive policies, new family types are not yet fully accepted.