For many of us in the “fertility challenged” camp, it’s hard enough to come to terms with the fact that we will need to use egg donation to create or complete our families. To add insult to injury, after receiving that often-devastating news, we’re then given the price tag. In the United States, egg donation (including agency fee, egg donor fee, clinic fee, medications, etc.) can cost anywhere from $25,000 - $45,000 depending upon one’s choices. For some, this signals the end of the road. Financially, egg donation is an unrealistic option for many.
But it doesn’t have to be. There are many high-quality clinics overseas that are set up to help international patients become pregnant through egg donation, with cycles that cost under $10,000 total. And while you may not know it, there are probably thousands of people walking amongst us who have pulled out their passport, traveled abroad and returned home pregnant.
So what is Fertility Tourism or IVF Abroad?
It’s likely you’ve heard the term “medical tourism” in the news. Most of the time it is used in context of knee replacements, cosmetic enhancements and even heart surgery. But in the last few years, infertility treatments have been added to the ever-growing list of procedures that are sought out by patients going abroad.
Now, frankly, “tourism” may not be the right term when it comes to taking daily shots, schlepping medications halfway around the world, putting your legs up in stirrups, and then spending up to two days holed up inside a hotel. Plus, medical tourism tends to imply elective procedures. As fertility patients know, there’s little that is elective about having a baby via egg donation—it usually feels like a last resort. Still, any time a passport gets stamped, it’s bound to be called tourism. And, if viewed in the spirit of adventure, traveling for IVF treatment is perhaps not such a bad idea. You do get to stay in a hotel (or at least a foreign apartment), you will usually hear a foreign language spoken, and you may get some exotic food. And maybe, just maybe, you’ll come home pregnant. So call it what you will – medical tourism, IVF vacation, IVF abroad, cross border reproductive care, global IVF travel, etc. It’s all the same idea.
Why would you leave the comforts of home?
The United States has some of the top IVF clinics in the world, with egg donors of every shape, size, and ethnicity available. You can pick just about any donor and find out whatever information about her you want if you have the means. You can meet your egg donor, stay in ongoing contact with her, or at least get it in writing that she will be open to meeting your future child. So, the logical question is—why go anywhere else other than the United States? Here’s the simplest answer: money. To be honest, there’s really no other reason (unless you have relatives who live in a foreign country or you want a donor from a particular country). You do give up some things when traveling abroad for egg donation, but you may not be giving up as much as you fear. And for some, the savings of $15,000 or more is the difference between becoming a parent or not.
How does egg donation differ in other countries?
We’ve already mentioned the cost savings. That’s because the savings are so significant that they warrant being highlighted. The overall prices are cheaper for quite a few reasons, but rest assured that lower fees do not necessarily mean lower standards of care. In fact, in some countries the technology is more advanced than in many clinics in the United States. That being said, you might be wondering how international clinics can afford to stay in business if their overall fees are so much lower than in the U.S.
Firstly, international clinics are often affiliated with their governments, and the government sets the rates clinics can charge. In general, even those not affiliated with their government have to stay competitive in their home country in order to attract patients, and many people in other countries cannot afford the fees that clinics can get away with charging here in the United States. Let’s face it, America is still the land of fair market prices – and as long as patients are willing to pay top dollar fees, there’s no reason to expect clinics to go lower. Not so in the international market – clinics are mainly drawing on their own home country or neighboring countries for most of their patients – and fair market value doesn’t play out in quite the same way as it does in the United States.
In addition, donors are not legally permitted to charge the same fees that they charge in the United States. While the ASRM recommends that donors charge $5,000 per cycle with a small increase for each additional cycle, fees can easily run from $5,000 - $15,000 in the US when contracting through an egg donor agency – and that does not include the agency fee, legal fees or fees for the evaluation and travel. In other countries, donors are generally reimbursed for travel and pain and suffering. Their overall compensation tends to be about $1,000. The rates don’t increase with experience because the clinics are the ones who coordinate the donors and they don’t allow for the increase. For the majority of clinics in other countries, there are no donor agencies, so therefore there are no middleman fees (agencies, lawyers, outside psychologists, etc.). Plus, clinics abroad generally use local donors. This means that there are no hidden costs like travel, per diem fees, lost wages, or additional insurance. Those are the costs that can easily add up in the U.S. if you are using an egg donor agency rather than using a U.S. clinic’s in-house donors.
Legal paperwork (if it even exists) is also done by the clinic. Generally they offer generic contracts that are part of their clinic paperwork and they do not charge patients extra for lawyers. Finally, medications are less expensive overseas. In the United States, you can anticipate spending approximately $3,000 for the stimulating hormones for a donor, but it is a fraction of that cost abroad. How does egg donation in other countries stack up against the U.S.?
Pursuing egg donation overseas may be considered a bit of a tradeoff. There are substantial financial savings, but there are some things you may not be getting. It’s best to understand what the tradeoffs are in order to make an educated choice.
Here are some of the differences between U.S. and overseas egg donation:
Most countries legally require donor anonymity. In most cases, you do not get pictures of the donor. Although in South Africa there are agencies that offer full profiles along with childhood and baby pictures, and in Panama it is possible to meet your egg donor, in most other popular ED countries (such as the Czech Republic, Spain, Cypress, and Greece), that is not the case. In the United States, some donors are anonymous but information about them is typically available—including adult and baby pictures, family pictures, lists of hobbies, likes and dislikes, and personal characteristics, school information, SAT scores, IQ tests, and so on. Some donors are also open to talking, meeting and even staying in contact after the birth, or allowing the child to contact them when they are older. In contrast, it’s highly unlikely that you will ever get to know your overseas donor—and even more unlikely that there will ever be future contact. Plus, information about her may be very limited, including just the basics of coloring, height and weight.
Your donor’s screening will be different than what is done in the United States, since in the U.S. the FDA requires extensive testing. However, don’t get too nervous. In general, they do all screen for STDs, HIV, and hepatitis. They also generally screen for alcohol, drugs, and nicotine (though you must remember that smoking and/or drinking is often better tolerated in a foreign country). Each country’s laws are different, and clinics will often have different testing policies which may even exceed their country’s requirements. Many clinics follow the same ASRM guidelines for testing that are used here, and European clinics generally comply with the very strict European Union guidelines for STD testing. Since legal requirements vary by country, it is best to ask the clinic specifically what testing they use for screening their donors. Like you, overseas doctors want a healthy donor. The clinics do screen for family genetic illnesses and psychological factors, but you will never get full details on what was ‘screened out’ or what might have passed. In the United States, you almost always get all of these details—so when going abroad you need to take a much greater leap of faith.
The clinics overseas will do the match in-house as opposed to you having to find your own match as is common here in the U.S. Yes, there are several American clinics that operate the same way—they choose the donor for you—but the American trend tends to be that an intended parent chooses the donor as opposed to having one chosen for her. At international clinics, coordinators will often compare pictures of you and the donor and they are mainly looking to match blood type (unless you indicate that this is not important to you) and physical features (hair color, texture, eye color, body shape/size). Sometimes the coordinators will consider and match based on interests, education, ethnic background, and so on, but that’s often not the case especially for clinics that don’t have large pools of egg donor candidates to choose from. That said, many clinics are associated with research institutes and universities and that is where they recruit, so the good news is the donors are often well educated. At some international clinics, you can request an experienced donor, but there’s no guarantee you will get one.
NUMBER OF EGGS:
Most international clinics do a lower-dose egg stimulation protocol with the donor than they do in the United States, so you need to psychologically prepare yourself that you won't get as many embryos. Most clinics are aiming for 8 – 12 eggs retrieved and 6 – 8 embryos on day 3. Some clinics will only guarantee 1 cycle, and some even take any embryos remaining after the transfer (and even eggs prior to fertilization) to put in a bank for others to use. While this may seem unfair, it can actually work to your advantage—if you have arrived at your clinic destination and your cycle is cancelled or the embryos are poor quality, the clinic may have other eggs or embryos available to you to use. In the United States, clinics tend to aim for a higher batch at retrieval – usually between 10 – 15 eggs.
If your first cycle doesn't work, or you want a sibling and you have frozen embryos, you will need to travel back to the clinic. Many times intended parents don’t figure that scenario into the overall cost. However, even in the United States there is no guarantee a cycle will work the first time out, even if everything goes perfectly.
NUMBER OF EMBRYOS TRANSFERRED:
Many international clinics will not put back more than two embryos, no matter what the embryo quality. Some clinics will go up to three. Their goal is one healthy baby—no more. In the United States, REs are a bit more accommodating (and not only concerned with your outcome but their statistics) – and based on circumstances and embryo quality, they can make their own decisions in conjunction with the patient regarding the number of embryos to transfer.
At this time there is no way to get accurate international outcome statistics like those provided by SART and CDC in the United States, and when you examine the self-reported numbers, your clinic’s success rates will invariably be lower than those of American clinics. This is due to number of embryos transferred, whether or not they transfer blastocysts (many do not), and so on. As mentioned above, many countries limit the number of embryos that can be transferred, which can sometimes decrease your chance of success. However, this also decreases your chance of multiples, which is why international clinics have this rule. Twins seems may seem like a great idea when you’re traveling half way around the world and spending a good deal of money—but the reality is that a multiple pregnancy is high risk. Many babies are born severely premature and women often end up on long-term bed rest during the pregnancy. If you are relying on your income during your pregnancy, bed rest can add to the overall cost of a cycle. That said, the international stance on multiples is a very cautious one and, in the long run, even if it ends up taking several tries to achieve a pregnancy, it will likely result in more singleton pregnancies and therefore, medically safer pregnancies.
Overseas, you may have to wait up to six months from the time you decide to cycle until you actually cycle. Some international clinics pool their cycles, meaning that they cycle donors and recipients at the same time. Therefore, it may be several months’ wait to be matched for a cycle. In the United States, it can be as short as 6 weeks from your match with a donor until transfer (depending upon the donor you choose and your clinic). Of course this varies clinic-by-clinic. There are many international clinics that do not ‘pool’ cycles, and there are American clinics that do ‘pool’ cycles.
Is global IVF travel right for you? It’s really a matter of what’s in your bank account and what factors are most important to you. In many cases, the savings is as much as $20,000 to $30,000. But if looking at traveling abroad you need to know if you cringe at the thought of donor anonymity if it provides you with a measure of comfort.
If you do decide that international travel might be the right option for you, just remember to do your due diligence. Keep in mind that international laws, information and costs are constantly changing, so you need to do your homework or have someone knowledgeable on your side to help. Either hire a consultant to help you through the process, or make sure to thoroughly review any potential programs and/or clinics you are thinking of using.
Kathryn Kaycoff-Manos and Lauri Berger de Brito are both mothers via surrogacy and egg donation. After suffering through their own struggle s with infertility, they committed themselves to helping others down the same path. Together they created the highly successful, world renowned Agency for Surrogacy Solutions, Inc. nearly 10 years ago. More recently, they have focused their attention and expertise on fertility tourism. Aside from providing individual consulting regarding travelling for treatment, they are the co-creators of Global IVF, Inc. – an informational website devoted to educating Intended Parents about their global options. Lauri can be reached at firstname.lastname@example.org Kathryn can be reached at Kathryn@globalivf.com.