In August of 2005, Shauna Anderson treated herself to a vacation of sorts: three weeks in Cape Town, South Africa, more than 10,000 miles from her home just outside Seattle, for a little respite, a safari ? and a round of in vitro fertilization (IVF).
Not your typical vacation itinerary, but one that?s becoming increasingly popular among American women struggling with infertility issues and overwhelmed by the cost of IVF in the United States. By traveling abroad for fertility procedures, women can pay thousands of dollars less than what they?d spend at home.
But some experts caution women to look carefully at the standards, practices and success rates of foreign clinics, especially those that are located in poorer countries and offer donor eggs. By going overseas, women may be paying for a procedure that has a lower chance of success than in the U.S. And there?s been at least one reported case of a Romanian clinic recruiting illiterate donors and failing to take appropriate measures to make sure that those donors were giving fully informed consent.
Anderson, now 35, says the path that took her beyond borders began four years ago when she decided to become a single mom and underwent inseminations using sperm from an anonymous donor.
Crossing the line ?Cycle after cycle, I kept having negative results on the pregnancy test,? she says. ?Then I started to add drugs to the protocol, and that didn?t work. I had a couple of surgical procedures to make sure the pipes were clean, and that didn?t help. Before I knew it, I?d crossed the line into IVF.?And a new realm of financial commitment. Anderson ?s insurance would cover only the diagnosis of infertility, not any treatments, so she paid out of pocket for two IVF procedures in Seattle. Neither produced a pregnancy. By that point, she was down more than $15,000 ? still, a drop in the bucket compared to what some U.S. women end up paying. The average cost of IVF in the U.S. is currently about $12,000 per cycle, according to Pamela Madsen, executive director and founder of the American Fertility Association, a patient education and advocacy group.
Anderson first got the idea to investigate IVF abroad after reading an article on the rise of medical tourism for procedures such as hip replacement and cataract surgery. She was inspired to investigate South Africa, among other countries, as she?d been following the blog of a South African woman who?d been navigating her own fertility problems.
After two weeks of Internet research and several late-night phone calls to clinics around the world ? seeking information on everything from success rates to lab controls to sanitation standards to their willingness to treat a single woman ? she chose a clinic in Cape Town, booked a flight and headed south.
The cost of her three-week IVF vacation? About $6,400, including airfare and hotel stay. Anderson?s IVF ? including drugs, procedures, and lab and hospital fees ? accounted for just $3,600 of that total.?
While there are no overall statistics collected on overseas IVF, the Cape Fertility Clinic, where Anderson underwent her IVF, reports 10 to 15 patients from the U.S. per month so far in 2007, roughly double the numbers it saw in 2006. And last month?s media reports on the 60-year-old New Jersey woman who gave birth to twins, produced after a visit to a South African fertility clinic specializing in older patients, will likely serve to increase those numbers ? especially among women who seek to have children later in life.
The American Society for Reproductive Medicine (ASRM) hasn?t issued an official stance on this trend, but for women who are looking into the overseas option, Dr. David Adamson, the fertility organization?s president-elect, warns them to be aware of what they may be giving up ? namely the oversight and standards that apply to IVF clinics in the U.S.
The federal Centers for Disease Control and Prevention validates and reports clinic success rates, for instance, and the Food and Drug Administration requires registration of all clinics providing sperm and egg donation services.
Adamson also points to the success rates for IVF in the U.S., which, he says, are quite high, compared to other countries in the world.
Shopping for donor eggs In addition to less costly IVF, the prospect of cheaper donor eggs is also sending American women abroad. In the U.S., introducing donor eggs to the equation typically means adding thousands of dollars to the cost of IVF, in the form of donor and agency fees and costs associated with donor screening (for genetic issues, STDs, etc.) and care.That?s what Fran, who asked that her last name not be used, discovered as she contemplated her first IVF cycle earlier this year. Unable to conceive after a year of trying, the 44-year-old began researching IVF at clinics near her home in Massachusetts. Like Anderson, Fran and her husband were faced with paying for the treatment out of pocket, as their insurance wouldn?t cover it due to Fran?s age. Doubting that she?d have success with her own, Fran and her husband decided to use donor eggs, but after researching the local options, she says they learned they could expect to pay about $30,000.
Through a friend of a friend, Fran heard about a clinic in the Czech Republic. Naturally, she had questions. ?I didn?t want to be on someone?s couch in an alley,? she says. She contacted ivfvacation.com, a Web site run by an Ohio-based husband-and-wife team that helps American women arrange and take IVF vacations to the Czech Republic. Their services include helping women fill out medical questionnaires prior to departure, booking accommodations and car rentals, planning tours and arranging translating services for clinic appointments.
They referred Fran to past clients and pointed her toward an Internet bulletin board, where she found postings about the agency and the clinic it uses, the Clinic for Reproductive Medicine and Gynecology in Zlin. The facility, about three and a half hours from Prague, reports having treated 40 women from the U.S. last year, and, on average, seven to 10 American women each month in 2007.
There is no international body regulating fertility clinics on issues such as donor recruitment practices and safety standards. In the European Union, a law was passed last year setting standards for the donation, testing, storage and so on of human cells and tissues; however, it?s up to individual member countries to regulate compliance. IVF patients who, like Fran and Anderson, choose to go abroad often rely on the Internet to hunt for information on the services and standards of individual clinics outside their home countries.
Guido Pennings, a professor of ethics and bioethics at Ghent University in Belgium and co-coordinator of the Task Force on Ethics and Law of the European Society of Human Reproduction and Embryology (ESHRE), cautions that women researching their options this way should be careful. Success rates published on a clinic?s Web site, for example, may not be accurate. If a country doesn?t have a central registry that monitors fertility clinics? reported rates, ?there?s no way they can prove it to you,? he warns. And while a country may have laws seeking to regulate clinics in these and other matters, Pennings says, ?You can have a good law, but if no one checks it, you won?t know if clinics are following the rules or not. That is the case in a lot of European countries.?
Pennings also notes concerns over donor consent in poor countries, such as the case in Romania where illiterate donors were reportedly recruited. He warns that the poorer the country, the greater the risk of this sort of practice.
The AFA?s Madsen echoes Pennings? concerns regarding reported success rates. She advises women looking at clinics abroad to check to see if rates are verified by a government body or a private auditor. In addition, she encourages women to ask, ??Are rates divided by age, or do they give one number? ? which means there could be patients under 25, and you are a 37-year-old woman.?
There?s also the question of safety.
Dr. John Frattarelli, a reproductive endocrinologist, obstetrician and gynecologist at Reproductive Medicine Associates of New Jersey, says he?s treated two patients who?ve suffered mild ovarian hyperstimulation syndrome (OHSS) as a result of overseas IVF. However, he notes, ?That is not a knock on the provider performing the services. It?s a complication that any of us get.?
The problem, he says, is that OHSS can increase the risk of blood clots, commonly in the legs ? already a concern for anyone on a long airplane flight. Symptoms can also include fluid in the abdomen or lungs, a dangerous situation if a woman is in a country where she can?t get adequate health care.
For women like Fran who are seeking an egg donor, Frattarelli calls out another potential issue: the adequacy of donor screening for genetic and other issues. ?In the U.S., donors are screened very thoroughly,? he says. ?Other countries don?t necessarily have that.?
Do your homework He advises women to do their homework when considering a clinic abroad. ?Look at the credentials of the hospital,? he says.After researching online the staff of the Zlin clinic and corresponding with several American women who?d been there, Fran decided to sign up for a trip to the Czech Republic. Next, it came time to pick her donor.
According to Marcela Fite, one of the co-proprietors behind ivfvacation.com, many donors at the Zlin clinic are college-educated (Zlin is a university town), and, at a minimum, must have completed high school. According to the clinic, donors undergo genetic and STD screening and receive no more than $715, for travel expenses and discomfort associated with ovarian stimulation and egg retrieval. (Legally, donors in the Czech Republic cannot be compensated for the actual eggs produced. According to the Czech Statistics Office, the average monthly wage in the Czech Republic is about $970.)
For Fran and her husband, the most important criteria was that their donor be healthy and have healthy children of her own or have produced a pregnancy through donation. Following that, says Fran, she wanted her donor to be under 30, have hair color and eye color similar to hers and have a college degree.
In April, Fran and her husband traveled to the Czech Republic. Two weeks and about $12,500 later ? including the cost of donor eggs, drugs and procedures, as well as airfare, transportation, food and accommodation for two ? she?d been implanted with three embryos. (According to ivfvacation.com, couples using donor eggs can usually expect to pay about $7,300, excluding airfare; women using their own eggs typically pay $5,700.)
Finally, two weeks later, Fran learned she was pregnant. She's due in January.
Anderson's trip was less fruitful. The procedure in Cape Town didn?t produce a pregnancy.
No regrets After returning home, Anderson decided to give up on using her own eggs, and ultimately conceived her twin daughters, now a year old, using donated frozen embryos. (The frozen embryo transfer, which doesn?t require ovarian stimulation and egg retrieval, cost $4,555.) Nonetheless, Anderson says she doesn?t regret going to South Africa.?It was an incredible experience,? she says. ?You have this nice pleasantness of a vacation wrapped around this very stressful situation. And you get to do it a little more privately, instead of being surrounded by co-workers and friends, pretending it?s your everyday life ? and during an IVF cycle, it never is.?
Fran agrees. IVF treatment is so stressful. You become so focused on it: When?s your next appointment? What day is it in your cycle? Being overseas really gave us the opportunity to have hours and hours not to think about it. We were renting the car, trying to read the road signs, meeting new people, seeing places ... there was so much time we were just tourists.?
?We had a vacation,? she adds. ?Aside from everything else.?
M. Susan Wilson is a Seattle-based freelance writer and editor.
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