International Fertility Tourism

LFM_International_Fertility_TourismBy: Lee Kao MD, PhD

Infertility knows no political boundaries. In many countries, however, cultural norms, laws and, cost limit access to cutting-edge fertility treatments Fortunately, prospective parents are not easily discouraged, and as a result, many will travel around the globe across national borders to obtain care. This practice is commonly referred to as International Fertility Tourism or cross-border reproductive care (IFT/CBRC).

In 2010, researchers estimate that in Europe, 24,000-30,000 cycles of cross-border treatment occurred per year, representing approximately 5% of all European fertility care. Similar survey data from the United States indicates that 4% of all fertility treatment provided in the county is delivered to non-US residents. Amongst patients traveling to the US, the largest groups of patients are from Latin America (39%) and Europe (25%). Additionally, the number of patients leaving the U.S to travel abroad for fertility care is estimated to be far lower than the rate of patients coming into the United States.

The factors that motivate patients to travel beyond the country border for fertility care (IFT/CBRC) typically fall into four basic categories: 1) access to broader and higher quality care, 2) avoidance of local regulations, 3) reduction in cost, and 4) privacy.

Travel to Access Broader and Higher Quality Care

In many countries, the availability of fertility care is extremely limited. Typically, limitations to care are due to an inadequate number of fertility providers, and fertility clinics. As a result, patients are required to wait a significant amount of time prior to receiving care and in some cases this decreases their chances of success. Surveys suggest that this issue of access is particularly relevant in the Middle East, Southeast Asia, and Latin America.

There is also a lack of egg or sperm donors and gestational carriers in countries where payments for these services are forbidden. Thus patients with this need will frequently travel abroad. This represents a large reason for International Fertility Travel amongst Canadian women. Additionally, many national policies require that egg and sperm donors’ identity be disclosed to the recipient couple. Comparatively, it is estimated that in the United States, 70% of donor cycles are performed anonymously. Thus, in countries such as Sweden, the United Kingdom, and Norway, patients indicate that the desire for anonymous egg donation is a cause for international fertility travel.

A patient’s desire to access higher quality care also figures prominently into international fertility travel. The majority of patients who travel abroad for care have already received treatment in their home country. Treatment failures, along with a perception that clinics abroad employ more highly trained personnel, utilize more up-to-date equipment, and offer more specialized services, encourage these experienced patients to seek treatment abroad. In countries that infertility care is part of their national health service, patients have higher tendency to travel to avoid long wait times.

Travel to Circumvent Fertility Treatment Law

Legal regulation of fertility treatment worldwide occurs on a country-by-country basis, with no overarching international treaties or formal laws in place. Fertility regulations that motivate international fertility travel fall into two broad categories: 1) restrictions on who can access fertility care and 2) restrictions on what fertility care can be accessed. In many countries, there are laws addressing ‘‘who’’ may access care based on patient demographics such as patient age, marital status, and sexual orientation. As a result, often older, single, and gay/lesbian patients are forced to travel across borders to access care. Conversely, in the United States, strict nondiscrimination laws prohibit ART clinics from denying care on the basis of a host of demographic factors, including race, ethnicity, marital status, and sexual orientation. Recently, the ability to biopsy embryos and demonstrate genetic normalcy has revolutionized the field of fertility. However, legal restrictions on access to this service in states such as Massachusetts and various countries around the world have been a cause for fertility travel. Other restricted services in certain international jurisdictions include limits on sex selection, compensated egg/sperm donation, and embryo cryopreservation.

Travel to Reduce the Cost of Fertility Care

High cost involved in fertility care is a well-described barrier for many patients. Even patients who start out able to afford the expensive care often incur financial hardship in their quest for parenthood. Globally the price of different fertility services varies widely, with the average price of an IVF cycle in the United States as high as $10,000 and as low as $690 in India. Surveys of patients who travel to access third-party reproductive services indicate cost as a significant factor in their decision to leave home country. For example, the media reports India as being a popular destination country for gestational surrogacy services, with fees to carriers averaging $8,000 compared with $25,000 typically for a US surrogate. Fees to egg donors also vary considerably from country to country.

Travel for Privacy and Cultural Comfort

“Infertility” can engender sociological, emotional, psychological, physical, and financial burdens in many patients and lead them to seek treatment abroad for privacy and cultural comfort. Often these patients seek out a country in which they have extended family or possess a degree of cultural familiarity. Family connections, cultural comfort, and access to racial and ethnic-matched donor gametes can be a reason for choosing international fertility services.

Why the San Francisco Bay Area?

San Francisco is an internationally known tourism hub, with easy international travel access and extremely tolerant cultural diversity. In addition, the San Francisco Bay area is composed of a unique ethnically diverse society, including Asians, Hispanics, Europeans, Pacific Islanders, living in a harmonious yet high tech affluent environment. Paired with client friendly/protective reproductive laws, non-discriminatory social fabric, diversified oocyte donor/gestational surrogate pool, high caliber fertility services, and advanced fertility technology, the San Francisco Bay Area easily and uniquely becomes a hub for international fertility tourism.

How to initiate international fertility care at Lane Fertility Institute

At Lane Fertility Institute, we have designed an experience that specifically meets the needs of our long-distance and international patients. Initial consultations may be conducted by telephone, email or skype. Pre-testing and some evaluation may be done locally prior to travel. Travel to the international facility is required for laboratory procedures including egg retrievals and embryo transfers. Translation services are available to assist in the care of our diverse group of patients.

 

ABOUT THE AUTHOR

Lee Kao, MD, PhD, Reproductive Endocrinology and Infertility specialist.  Dr. Kao joined Lane Fertility Institute in 2012.  Educated at Taipei Medical College in Taiwan, Dr. Kao came to the United States for the remainder of his training.  He completed residency at Georgetown University Hospital and fellowship at the University of Pennsylvania Medical Center.  After completing tenures as faculty at UCLA and Stanford University, Dr. Kao brings tremendous expertise to his patients at Lane Fertility.  Dr. Kao specializes in international fertility care.