Fertility tourism (correctly known as cross-border reproductive care) is a growing worldwide phenomenon. Many studies have been conducted, all aiming to follow the trend and understand the driving forces behind it.
The full extent of its hold within Europe remains unknown, largely because national registers do not record patients’ country of origin, however we do know the trends. For example, Italian citizens commonly seek fertility treatments in Spain and Switzerland, whereas German and British citizens prefer Czechoslovakia and Spain. Similarly, Norwegian and Swedish citizens opt for Denmark, whereas those from the Netherlands predominantly visit Belgium.
Interestingly, the number of patients seeking cross-border treatment consistently increases year on year, with records suggesting that it shows no sign of slowing down. Estimates predict that approximately 10% of all treatments in Europe are now given to patients from different countries. But isn’t just happening in Europe; America is experiencing a similar situation, with records reporting similar rates of non-US citizens undergoing fertility treatments there.
So what are the driving forces motivating patients to seek fertility treatments abroad?
1. LEGAL RESTRICTIONS
A recent European study found that the overriding reason why people sought fertility treatments in Italy, Germany, France, Norway and Sweden was to avoid the legal restrictions imposed on fertility treatments within their own country. This same motivation was highlighted recently, stealing international news headlines, when a courier was apprehended trying to smuggle live human embryos into India.
It has long been suspected that Malaysian couples have been secretly exporting their embryos into India for use in surrogacy treatment, a practice that is forbidden in Malaysia under Islamic law. This too can carry dangers. Whilst India's surrogacy laws do prohibit surrogacy for commercial gain, they do allow altruistic surrogacy among close relatives; however, foreigners and non-Indian residents are banned from seeking surrogacy arrangements in the country. Importing embryos to India is also banned, except for research purposes, which require a certificate from the Indian Council of Medical Research. The confirmation that patients are willing to risk all in flouting, not only Malaysian law but also strict Indian laws, highlights the extent that some patients are prepared to go in their quest for parenthood. Since this is the first time that human embryos have actually been seized entering India illegally, there is considerable interest in the case and the legal ramifications are ongoing.
2. AGE, SEXUALITY & OTHER DESCRIMINATION
Some countries impose legal restrictions on who is / is not eligible for fertility treatments. Age, marital status and sexual orientation are all common factors, which is why older, single, gay and lesbian patients tend to seek treatment in other countries, such as the USA. Interestingly, some US states actually have strict laws that prohibit discrimination by fertility treatment centres on those same factors.
3. INABILITY TO ACCESS TREATMENT AT HOME
Another main factor is that some patients find it extremely difficult to access fertility treatments in their own country. The availability of certain types of treatment, waiting times and costs are all motivating factors in why they opt for treatment abroad.
The UK is a popular choice. Fertility treatment guidelines there are relatively liberal compared to many other countries, but there are still a significant number of UK patients that seek treatment overseas. Why? The most common reason cited is that they want better access to certain types of treatments – an interesting point when so many patients are travelling to them, and they are travelling away.
BUT IS THERE A RIGHT OR WRONG CHOICE IN THIS DEBATE?
There are many who debate the ethics of cross-border fertility care. With a few exceptions, patients who return to their own country after receiving what some regard as prohibited treatments face no legal, medical, or social consequences. Additionally there is little or no support for punishing patients who engage in law evasion in pursuit of parenthood, nor is there widespread advocacy for penalising medical professionals who assist patients in their quest to access cross-border reproductive treatment. There are, however, a handful of countries that deem such conduct as unlawful and this includes the UK.
Personally, my main concern is on the grounds of health and safety. There are no international policies dictating quality control, for example, and potential language difficulties may disadvantage patients in their ability to discover and assess the standard of care in any given foreign jurisdiction. Essential measures of quality such as the expertise of doctors and embryology staff, the sophistication of the screening process, surgical, and laboratory technology, and basic systems to prevent contamination, damage, and misallocation of gametes and embryos can be difficult for a visiting patient to assess. However, given the huge worldwide disparity in the types of fertility treatments offered, what is deemed legal and illegal and the huge variations in the costs involved in treatment this is a phenomena that is only going to get bigger and I am sure we will be seeing more headlines like the ones recently coming out of India.