Although IVF is no longer a taboo, “going abroad” is not widely associated with medical treatments unless we are talking about plastic surgeries. Things are looking differently in the “fertility strangling” demographic group. Here, “going overseas” is not marginally connected with fertility procedures. The number of patients forced to have fertility treatment in the private sector is constantly growing and for this reason, “the medical tourism business” is expanding, changing our way of thinking about our health care options.
Why on earth British go for IVF abroad?
The United Kingdom is perceived as one of the top developed countries and it is rather surprising to see how many British citizens are travelling for treatment overseas. We are kind of used to cosmetic treatments being done, for example, in Mexico but “getting a baby” seems to be completely different.
Those surgeries are a luxury, not a life-saving, improving quality of life – simply not a necessity where having a child is a natural process, coded in our DNA. Not being able to have offspring has an impact on mental and often physical health…and there is also the aspect of “generational replacement”. So, why do patients decide to go for IVF abroad instead of continuing the IVF treatment at home? The most intuitive answer would be because of the “cost” but could we compare the extravagance of breast augmentation with having a baby? Why travel then?
NHS IVF funding, rules, regulations and patients’ stories behind it
To qualify for the IVF treatment on the NHS you need to meet certain… which are not always as clear as one would expect. In England, local Clinical Commissioning Groups (CCGs) are the ones to decide who and for how many IVF treatments can apply. No governing body regulates those commissions and they are advised to follow the guidelines from NICE.
“there have been very strict NHS guidelines which vary with postcode which is the most challenging thing because nobody can understand that and it’s impossible to explain to people why if they lived five miles down the road they might be eligible for two or three cycles of IVF but where they live, they’re only eligible for one, I mean that’s lunacy in anybody’s book but that’s been part of the repro-med world in the UK for all of my working life”Stephen Davies, BSc MBBS DCH DRCOG Gynaecologist, IVF specialist at CREATE Fertility & retired NHS GP
Even though you will qualify, after completing testing, scans, check ups, you end up on the waitlist. The list is even longer if you need egg donors and when it comes to non-caucasian donors, then that’s a real challenge in the UK.
To make matters more complicated, the change in the law to non-anonymous donation shrunk the list of potential donors in the UK and this is one of the reasons of the high egg donation costs in the UK.
Is it better to use an external egg donor bank or an in-house egg bank at the clinic while looking for a specific egg donor?The insight provided by Saghar Kasiri, Director of European Operations, Cryos International
There is no right answer to the question regarding choice of external egg bank or the clinic’s in-house egg bank. You need to choose the egg bank that fits your needs, eggs banks usually have a higher number of donors with variety of phenotypes and characteristics that could suit you If you want a donor with similar physical appearance or personality as you, you need to choose an egg bank with such a donor. The same goes for choice of egg donor profile, whether you prefer a Non-ID Release (anonymous) or ID Release (non-anonymous) donor.
What else is there to make treatment on the NHS less attractive? Well, hearing patients’ stories after the funded IVF treatment, you have the impression that they are not all that keen on getting you pregnant, not as determined as you are.
- Often you need to pay for additional testing and even ask to be referred for them.
- There is no investigation after failed IVF…or after 3 failed cycles. The miscarriage is considered “something odd” when 3 of them happened.
- Add-ons to IVF treatment are either not widely offered or not an option at all,
- Counselling oh yes, you can get support after miscarriage or failed IVF…you can sign up, be on the waiting list and most likely you will get there… in 6 months.
What options do you have if you do not “meet criteria”’? If that was about your BMI, lose weight and to do so, it takes sometimes a couple of years and meanwhile, your fertility status could change, so your options and again waiting list…The alternative is private care.
IVF in the private sector in the UK
We could play a game “what if”…NHS had the same funding as the private sector….what if NHS would make money with getting the results…” What risks with that would be there? The game is theoretical and possibly no answers would lead us in terms of outcome. Private IVF clinics providers have fundamentally different attitudes.
“they make money from treating you. It’s to their advantage to a) investigate but then b) as quickly as possible get on and treat and if you’re not having to worry about NHS criteria and as someone as long as it’s clinically reasonably safe to treat that lady then, why would you mess around and if there’s a simpler treatment, for example, insemination are you going to offer that when actually IVF statistically clearly does better but also IVF clearly statistically is where the money is and that’s a challenge”.Stephen Davies, BSc MBBS DCH DRCOG Gynaecologist, IVF specialist at CREATE Fertility & retired NHS GP
You may be interested in reading: IVF cost in the UK guide
Here we are, looking at private UK IVF clinics… care, approach, waiting time, the success rate of live birth – all great. The independent body, HFEA, has a report on that clinic on the website and you can later on even find the fee on your treatment bill – the charge clinic is paying for HFEA auditing. You are getting the estimated cost of the treatment and we come to the number one reason for patients selecting fertility clinics abroad.
“Cost is high very frankly and I say this as I am working in a London-based IVF clinic. Having treatment here is very expensive especially when you are doing it privately and the NHS is not funding too many cycles or withdrawing funding for IVF for couples which is making it difficult for these couples. Going abroad for treatment, the cost is practically half of what they have to pay here so I think going abroad is because of the costs.”Malini Uppal, MBBS, DGO Diploma Prenatal Genetics and Foetal Medicine, Gynaecologist, Medical Director and PR to HFEA, GENNET City Fertility
There are of course secondary reasons for looking at the treatment options abroad like legislation, add-ons, holidays at same time, family & friends (recommendations or place to stay), personal approach.
IVF treatment: What I need/want … and what I will get…?
What are then the real reasons why patients decide to go out of the UK for the treatment? As with most things in life, the answer is not as simple as one would think. The fertility treatment is not only one option of “simple” IVF but also egg, embryo or sperm donation, and surrogacy.
You can also look at the process from a different angle: are you a single, same-sex couple, with a male partner, do you need an ethnic donor, want a donor to be your close one etc. You can be in need of additional services: genetic testing, immunological therapy, specific screening, semen extraction etc…list is long. We are talking here not only about patients’ specific needs but also about expectations and things that cannot be measured.
“they look at options within the private sector in the UK, they then compare them with eastern Europe or the Mediterranean or whatever and off they go and I must admit, you can understand why they do that, it’s but it’s very frustrating, absolutely very frustrating”.Stephen Davies, BSc MBBS DCH DRCOG Gynaecologist, IVF specialist at CREATE Fertility & retired NHS GP
The irritation comes mainly for the safety side of the treatment. Which is right and patients need to exercise common sense in that matter, if you are declined in your home country and in a reputable clinic abroad – do not look for a clinic which agrees to something that was categorized as the risk to you or the baby. Yes, you may find a clinic and doctor who will say and do what you want to hear but at the end of the day, you do not want to see your baby/babies in the intensive care unit and understand that doctors are frustrated because no consequences are taken by such irresponsible clinics.
Why do patients not select local IVF clinics?
People providing fertility services are forgetting that this is a very specific field, it is the most intimate, unique aspect of human life. It cannot be simply put as “figures and statistics”. At the end of the day, yes, it is a business and you are making money; yes, the outcome – baby- is not as predictive and because it is so challenging on so many levels, we need to protect patients, put them in shell and make the process as comfortable as we can.
“I had one lady who had come down, flown down from Aberdeen to Manchester to have embryos put back. She previously had NHS treatment in Edinburgh (…) and another lady had driven from virtually the Isle of Skye six and a half hours to have embryos replaced (…) those ladies had chosen clearly horrendously unsatisfactory from a geographical point of view but they’d chosen to come for varied reasons, often related to previous dissatisfaction and they’d almost both of them took the view I don’t mind”.Stephen Davies, BSc MBBS DCH DRCOG Gynaecologist, IVF specialist at CREATE Fertility & retired NHS GP
When you are doing the research or have some close ones sharing horror stories of the treatment in local clinics and then you check other recommended clinics…you calculate time, cost etc. The alternative of selecting one of the clinics in another country is not looking that unattractive after all. Perhaps the advantage of “abroad” is also perceived in “vacation mode”. You leave behind work, the stress of following a timetable, any everyday responsibilities and you have only one focus: get from the hotel to clinic and back…and no juggling between work, home, clinic and any social activities.
“I also think they get a very nice experience in some of these clinics when you talk to people who’ve been abroad, they’ve had a very very good experience being away. Sometimes if they’re going abroad to a sunny place, they can fit in a holiday around their treatment which makes it much less stressful and sometimes it’s cheaper”Sheena Lewis, Professor of Reproductive Medicine, Andrologist, CEO Examen, Executive committee ARCS
Who and why is going abroad for IVF from the UK?
Patients in need of fertility treatment are aged 18-45+ and as per a survey taken 2 years back, 88% of responders were female. In that age group, the accents are placed differently in terms of the main reasons for having the IVF treatment abroad.
First of all, let us stress that 80% of patients travelling abroad for the treatment are older than 35 and almost half of all patients going abroad are in need of egg donation programs.
In the age group 18-24, the cost was declared as the main reason – to be precise, 70% of them selected that option.
The next age group, 25-34, stated that this is still the main reason but the percentage dropped to 25 and the waiting time was placed in the second position with 20%. The oldest age group, 35+, have already different order and they rated 3 main reasons being:
- 20% – IVF success rate
- 19% – recommendations
- 10% – IVF cost
“ you’re looking at accommodation costs and huge amount of transport costs but I think that kind of illustrates that people will travel, if they feel that they’re getting looked after in a way that that justifies that”Stephen Davies, BSc MBBS DCH DRCOG Gynaecologist, IVF specialist at CREATE Fertility & retired NHS GP
Why the UK patients consider going abroad for IVF treatment?
Let us shortlist the majority of reasons given by patients why they are considering going abroad for the treatment:
- The IVF cost
IVF without medication starts from 3000 Euro, egg donation programs are from 5000 Euro (with medication, for donor and compensation included) where in the UK you are charged on average for the same program respectively 5000 pounds and 9000 pounds.
- Egg donors’ availability
Caucasian donors are widely available, some clinics have available 500+( this is almost a half of the donors available in the whole UK); countries like Spain because of the large student community and international programs have donors of virtually every ethnic population.
- The waiting time
Usually there is no waiting time if there are no very narrow criteria in term of donor, IVF programs are proceeded without any delays and the only slight changes might be during the festive season or summer time because of high demand or simply clinic being closed for holidays (like in Greece, August is the month that some clinics do not book treatments).
- IVF treatment options
For example, ICSI is a standard (no extra charge), treatment with “own” donor, surrogacy for singles, surrogacy program with “own” surrogate mother, ROPA program, sperm donors (both known and anonymous). We need to add that the protocols are tailored and can be modified based on the response or need. If the lining is not “favourable” or hormone levels are not ideal, embryos are vitrified and the transfer is scheduled once all is in place.
- IVF success rates
Although that “number” makes it clear which clinic or county is better, the problem is in how it is calculated. What we are interested in is “live birth” and that is rarely communicated by clinics for various reasons (either marketing or lack of information); Definitely there are more cycles and transfers performed compared to the UK and therefore doctors are more skilled. Egg donation programs are also more successful as the donors are usually below 30, younger donors – better quality of oocytes. Higher success rate is also because of more “skilled lab”, they run more cycles,hence more practice. Also staff have a chance to learn newest techniques, like vitrification or ICSI is simply standard.
- IVF add ons
List is constantly growing and some techniques listed as add-ons in UK-based clinics are included as “standard” in the IVF procedures overseas. In Spain, there are several centres which conduct their own research and develop new techniques and technologies, hence they are introducing changes and they offer them long before they are available in their home country.
- Recommendations from patients
Perhaps because of the much larger number of cycles run abroad, there is a significant amount of reviews found online (coming from English-speaking patients from the UK, Australia, South Africa, USA but also any other European country).
“it just illustrates how difficult it can be and the lengths that ladies will go to end up in the IVF clinic that they’re comfortable with, that they feel perhaps listens to them or perhaps offers treatment options which aren’t widely available”Stephen Davies, BSc MBBS DCH DRCOG Gynaecologist, IVF specialist at CREATE Fertility & retired NHS GP
The list of reasons why going for IVF abroad can be long. It is natural that there is a bit of fear of the unknown and genuine worry of close ones for those selecting such treatment in a foreign country. There are guidelines on how to choose clinics abroad, what questions to ask staff, on what to pay attention to. The process is complicated and we can always try to help others in the challenging situation they are in to make them feel taken care of.
“One of the main reasons why UK patients are looking to go abroad is the waiting time for the egg donor or sperm donor and the cost of the treatment. Also they say that it is far less cost wise when they access it abroad so, these are the two main reasons: the quicker access to the treatment at lesser cost is taking patients over the seas to access treatment.”Madhavi Gudipati, MBBS MD MRCOG Gynaecologist, Obstetrician, Consultant OB-GYN, HFEA ‘Person Responsible’ at Sunderland Fertility Centre