The rise of fertility tourism across Europe has provided countries such as Spain, the Czech Republic and Greece with a lucrative income at a time when other industries have fallen by the wayside and economies have struggled. With demand for cost-effective IVF treatment as high as ever, countries that have established a strong reputation in the sector have been joined by a number of new, lesser-known destinations. Although not part of the established fertility tourism circuit, many of these new countries are offering unique benefits to fertility tourists, ranging from less stringent regulations to more cost-effective treatments.

Here is our top five guide to fertility tourism’s new frontier:

1. FINLAND
Finland is not well-known as a fertility tourism destination and yet the country’s impressive health and safety record is attracting more couples each year. There are currently 10 privately funded fertility clinics and five hospitals offering treatment in Finland and as mentioned, the sector is well regulated and fully licensed, including adhering to the European Union Tissues and Cells directives which regulate standards across all European Union countries.

Fertility clinics in Finland are regularly inspected by the Finnish Medicines Agency, Fimea and all require a licence to operate. Every IVF clinic in the country is bound by law to send its fertility success rates to Fimea, as well as the National Supervisory Authority for Welfare and Health (Valvira). Some clinics also send their results to the European Society of Human Reproduction and Embryology (ESHRE), though this is not required by law.

Unlike many other European countries offering IVF treatments, egg and sperm donors in Finland are anonymous only to the recipients of the treatment but not to a child born from that treatment. This is quite novel and may attract some people who do want to provide the opportunity for their child to find out more about their donor.

Egg donors in Finland must be between 18 and 36 years of age and sperm donors between 18 and 45. Donors are tested psychologically and genetically, as well as for infectious diseases such as: HIV, HCV-Ab, HBs-Ag, HBc-Ab, Chlamydia, Gonorrhoea and Syphilis.

Embryo donation is allowed in Finland from both fresh and frozen eggs and sperm, as well as the donation of surplus embryos from other couples. However, not all clinics offer both types of embryo donation.

2. TURKEY
With over 140 clinics offering IVF, Turkey is growing in popularity as a destination for fertility treatment abroad. Legally, the country does not allow egg, sperm or embryo donation, meaning clinics can only offer ‘own egg’ IVF. Patients must also be married to qualify for treatment. It is illegal to treat single women and lesbian couples and surrogacy is strictly prohibited. The plus side is that IVF in Turkey is up to 50% cheaper than the UK.

PGD and PGS are allowed in Turkey, but sex selection for non-medical reasons is prohibited. There is also no legal age limit for treatment, however many clinics won’t treat women 46 or older due to complications associated with using the patient’s own eggs.

There are also laws regulating the number of embryos that can be transferred. For example, women less than 35 years old are allowed one embryo transferred for the first and second cycle, and two embryos for the third cycle.

Because Turkey is not part of the European Union, clinics do not fall under the EU Tissues and Cells Directive. However, fertility clinics in Turkey do adhere to government legislation on IVF treatment.

It’s also worth noting that most UK visitors require a visa to enter Turkey, though securing one is a relatively cheap and painless process. Most visitor visas cost around £20 and are valid for three months, which is plenty of time for the majority treatments.

IVF clinics in Turkey are inspected every six months by the Ministry of Health, where checks are carried out on equipment, staff, the physical environment and health records. The Ministry of Health will licence the clinic if it is deemed fit to practise. IVF success rates are also submitted to the Ministry of Health, although frustratingly the public does not have access to this data.

3. RUSSIA
Russia is steeped in history and culture and is a great place to visit. As it gets easier and cheaper to travel to the country, many people are visiting not only as tourists, but also for medical reasons. Russia currently has over 140 fertility clinics, many of which are found in Moscow and St Petersburg.

Treatment prices in Russia are lower than in the West, and waiting lists for egg and sperm donors are significantly shorter. In Russia, only anonymous donation is permitted. There is a possibility of finding out a lot more about your donor (at a price) e.g. childhood photos or audio recordings of their voice. However, the donors name, address and phone number are never available.

Like many other countries, there is no central register of donors in Russia so, in theory, a woman can donate many times at different clinics but whether this happens or not is a matter of debate. Sperm and egg donors in Russia are aged between 18 and 35 and by law, thorough screening of donors is undertaken. Egg donors undergo testing for infectious diseases as required by law. Urine analysis, ultrasounds, cardiograms, smear tests and many other tests are also available.

Embryo donation is allowed in Russian and embryos that are donated from couples who have completed their family, or from fresh egg and sperm donation, are also both permitted. There are no laws on how long embryos can be stored for, but it is usually up to 25 years.

IVF success rates are submitted voluntarily to the Russian Association of Human Reproduction. According to the European Society of Human Reproduction and Embryology (ESHRE), the body that collates European IVF data, up to 25% of Russian IVF clinics do not submit their results.

Russian IVF laws are legislated by the Ministry of Health (Regulation 107n), however Russia does not apply the European Tissue and Cells Directive which regulates assisted reproduction in the European Union.

4. POLAND
Just a short flight from the UK and offering low cost fertility treatment options, Poland is becoming an increasingly popular fertility tourism destination. There are currently 39 IVF clinics in Poland, comprising of a mix of state and privately funded facilities. The cost of living in Poland is significantly cheaper than in the UK and USA, with consumer prices up to 75% lower in cities such as Katowice.

Similar to many other European countries, both sperm and egg donors are anonymous in Poland. The recipients can find out about the donor’s blood type and the fertility clinic will match the donor and recipient on the basis of ethnicity, race, hair colour, weight, height, body build, eye colour and blood type. People born as a result of assisted reproductive treatment can find out some information about their donors once they reach 18 years of age.

There is no upper age limit for egg or sperm donation, but most Polish fertility clinics won’t accept a donor older than 32 years of age. Donors must register with the Krajowy Rejestr Dawców (National Register of Donors), which is controlled by the Ministry of Health. This means that no more than 10 babies can be born per donor. By law, egg and sperm donors are screened psychologically and physically before being able to donate.

Fertility clinics in Poland are inspected at least once a year and they all need a license to operate.

Fertility success rates are sent to the Ministry of Health, but they are not made available to the public. Some IVF clinics will publish their success rates on their website, but unfortunately, there is no scope to view success rates for all individual clinics.

5. BULGARIA
Bulgaria is one of the lesser known European countries offering IVF treatment. The country currently has about 30 fertility clinics offering treatment, 26 of which are private. Bulgarian IVF clinic success rates match EU averages and the average cost of infertility treatment is below EU averages.

Egg donation in Bulgaria is well regulated, with treatment permitted up to the age of the menopause. Egg and sperm donors are anonymous by law, however, with respect to egg donation, close relatives (sisters and cousins) are allowed to donate to each other. However, the law around sperm donation is different. Women may not use a sperm donor who is related to her.

Egg donors are only allowed to have five children, including their own, which means fertility clinics are obliged to record the egg donor’s details in a central register, maintained by the Executive Agency for Transplantations. In order to become an egg donor, the woman must have had at least one child.

By law, each donor undergoes a full medical examination – blood tests, urine tests, a genetic consultation and a gynaecological examination. A detailed personal and family history of illnesses is also recorded and all donors undergo a psychological evaluation. Information relating to the donor, such as blood group, physical features, occupation and education is also available to recipients, as long as the identity of the donor is not revealed.

Embryo donation is permitted in Bulgaria, provided all the legal requirements have been met. Couples can donate their frozen embryos to another couple anonymously. There are no laws governing how long embryos can be stored for, however the Ministry of Health advises no more than five years. Fresh egg and sperm donation is also allowed.

Before IVF clinics in Bulgaria can undertake assisted reproduction treatments, they are inspected by the Ministry of Health. The Ministry will only licence them if they are deemed fit to practice. IVF clinics are also obliged to send in detailed reports summarising cycle numbers, number of retrieved egg cells, donors and on-site visits and inspections.

IVF success rates are submitted by law to the Executive Agency for Transplantation. However, the public does not have access to these statistics.

Bulgaria applies the European Tissue and Cells Directive which regulates assisted reproduction in the European Union. Since 2007, there has been legislation in place which defines the medical status of assisted reproduction (Regulation No.28/2007 of Ministry of Health).

6. CONCLUSION

As demand rises from countries such as the UK and USA, more and more countries will be offering fertility treatments to couples who are either seeking more cost effective options or have specific requirements that cannot be met within their own country. Having a vibrant fertility industry is important, not only because it gives couples choice, but also provides access to treatment that would otherwise be out of reach. Having greater access to fertility treatments does however come at a risk. The maintenance of standards, particularly within non-EU countries, is often regulated internally, with some significant variations from one country to the next. As such, patients must make careful choices to ensure their treatment is both safe and successful.