People seeking IVF are flocking to clinics in southern Europe for lower costs and less strict rules – but there are pitfalls
After struggling to get pregnant, Emma Haslam and her husband were told their chance of success with IVF could be as low as 3 per cent. And they knew they could only afford one attempt.
Desperate, they went to Europe for cheaper treatment. After three cycles costing £8,000 in total, including travel – a fraction of the UK price – Haslam did get pregnant and now has a little boy.
But it was not straightforward. They had to become medical experts just to choose a reputable clinic. They had to source drugs to self-inject at home and try to time clinic appointments and flights around her menstrual cycle.
“I was worried that I was making a massive mistake,” she says. “It was very much a shot in the dark.”
That was eight years ago when Haslam was 35. She and her husband felt at the time they were pioneers and had to find out everything for themselves. Today, fertility tourism is soaring.
While no one is keeping figures, the trend is evident from people sharing their experiences on social media as well as the rise in websites and consultancies that advise on the different rules and costs. Haslam now runs one such advice agency herself, called Your IVF Abroad.
People are drawn to clinics in countries like Greece, Spain and Albania, not only from Britain but also from America and Australia, because of the twin attractions of lower costs and liberal rules.
“I believe that if you go to a safe country and find a clinic that matches your medical needs, then going abroad can be fantastic and can allow you to get more for your money,” says Haslam. “But you shouldn’t just go into this blindly.”
Delaying children means more IVF
The rise in fertility tourism stems partly from people starting families later in life, making them more likely to have trouble getting pregnant. About 3 per cent of British babies are conceived using IVF, double the rate from two decades ago.
NHS treatment is hard to get funded. People may be turned down if they are past a certain age, too overweight, or if either partner already has a child, for instance.
That means going private, costing around £8,000 per cycle in the UK, or more if complex extra treatments are needed. The cost of IVF plus travel and accommodation in southern Europe is typically half or even a third of UK treatments.
Lower cost isn’t the only pull. For one thing, going abroad may allow treatments and choices that are not possible in the UK.
For instance, northern Cyprus lets people choose their baby’s sex, through selecting either male or female-determining sperm before conception. The UK and most other countries allow sex selection only for medical reasons.
Clinics in Spain, which has become a fertility tourism hotspot and carries out the highest numbers of IVF procedures in Europe, mandate anonymous sperm and egg donation, something else not allowed in the UK.
Another draw is that clinics overseas may have more access to donor sperm, eggs and even embryos created from donor sperm and eggs. “In the UK, if you need egg donation, if you’re a person of colour, you could be on a waiting list for years or may never be matched,” Haslam says. “We’ve got very little choice.”
The Haslams learned they needed IVF because tests showed she was perimenopausal, which affects egg quality, and her husband had a low sperm count. The couple were told they could not have NHS treatment because Haslam was overweight.
The Czech clinic suggested they use IVF with donated embryos – and she got pregnant on the third attempt. This approach, she says, wasn’t even offered to her by UK doctors.
Race to get the right drugs and needles
To reduce journeys, the clinic sent Haslam prescriptions for the drugs needed to get her body ready to accept the embryos, which she had to inject in the UK. But sourcing the medications was hard.
Most pharmacies won’t accept prescriptions written overseas. When Haslam found one that would, it didn’t order in the required needles, so there was a race to get them in time for the right day in her menstrual cycle. “There was a lot of going backwards and forwards,” she says. “These things cause added stress when you are already stressed.”
During another cycle, she developed an ovarian cyst that meant they had to pause treatment, and so lost money on flights and accommodation. But in her appointments at the Czech clinic, the staff were professional and caring, she says.
In fact, patients often report getting more personal care than is typical for the UK, where even private patients can feel like they are on a conveyor belt, says Stacy Thomson, who has had IVF in Athens.
“They treat you like a person. I could text my clinical co-ordinator to ask her anything, and they would answer 24/7,” says Thomson.
This may be because the clinics in such countries are increasingly geared to overseas clients, says Professor Nick Macklon, medical director at the London Women’s Clinic. “The business model for some of these clinics is predicated on overseas patients, and they do everything they can to make sure the experience is positive.”
The number of clinics are expanding, driven by recent interest in the market from private equity firms like Nordic Capital and KKR. Demographic trends are thought to guarantee the sector’s growth, according to the Financial Times.
What to watch out for abroad
But treatment abroad has its pitfalls too. People need to do a lot of research to understand how laws differ in the various countries – for instance, more conservative countries may not allow IVF for single women or lesbian couples – and how to choose a reputable clinic.
People also need to research the range of treatments on offer, including “add-ons” – optional medical procedures claimed to boost pregnancy chances, but not always supported by good evidence.
Some clinics promote add-ons that may not be suitable, according to Dr Roy Farquharson, former chair of the European Society of Human Reproduction and Embryology. “Evidence-based practice is sadly lacking in many clinics,” says Dr Farquharson.
Haslam recalls one couple who sought her advice after an overseas clinic they found seemed to be trying a scam. “They started getting emails from their co-ordinator, saying that their egg donor had had an accident and could they contribute to her medical treatment? My advice was to walk away.”
Even without such practice, it is hard for people to compare clinics’ success rates, which can vary markedly.
In the UK, success figures are audited by a government agency called the Human Fertilisation and Embryology Authority (HFEA). Many overseas clinics have no such checks and claim implausibly high pregnancy rates – even 99 per cent. The average pregnancy rate at UK clinics is about 30 per cent for one cycle.
Customers may resort to informal online forums and WhatsApp groups to choose clinics by word of mouth.
Carley Jones, left, with her wife and first child, is pregnant after IVF in northern Cyprus (Photo: Faith Jones)
Carley Jones had IVF in northern Cyprus last year at the same time as her wife, and they were disappointed with the “slapdash” approach of the first clinic they tried.
With no pregnancy after four egg collections and two transfers in total, the couple discovered through a WhatsApp group the clinic had multiple other disappointed customers. Jones switched to a new clinic in the region – and in October got pregnant with twins on the first try.
There is no way to know if the first clinic was doing something wrong, but Jones says she is suspicious. “That’s the thing with northern Cyprus. There isn’t a big regulator watching these clinics.”
Benefits of UK fertility rules
UK fertility clinics are among the most tightly regulated in the world, says Professor Macklon, of the London Women’s Clinic. They have to follow detailed HFEA guides for all their procedures, and submit to regular inspections.
The same strict rules that can put people off the UK also help protect patients. There has been a recent international scandal over a Danish sperm donor with a rare cancer gene whose sperm was used too many times by some European clinics, placing nearly 200 children at risk. In the UK, each sperm donor can give rise to children in no more than 10 families.
The HFEA is also stricter with UK clinics around add-ons. It has a guide for patients that shows their supporting evidence. “Clinics must give patients a clear idea of what any add-on involves, how likely it is to increase their chance of a successful pregnancy, cost, risks, and link to our public ratings system,” said the HFEA’s Clare Ettinghausen.
In fact, UK clinics may experience their own form of fertility tourism, with wealthier individuals travelling here from other countries, such as the US and the Middle East, says Professor Macklon. “We often hear that that they’re coming for the security of the treatment, and the care with which their eggs, sperm and embryos are going to be stored,” he says.
“I’m glad that British patients going abroad are generally having a good experience” he says. “But they need to be aware it is less regulated.”