By Sue Taylor of IVF Traveler

What does Fertility Tourism mean?

Often referred to as IVF Abroad, IVF vacations, IVF Holidays, medical tourism and a host of other names, it is simply leaving your home country to have IVF or fertility treatments in another country. What countries are most popular for donor egg IVF or donor embryo treatments?

This list changes on a regular basis – but focusing on the countries that tend to get the most attention and fertility tourists, here they are in alphabetical order:

• Barbados
• Cyprus
• Czech Republic
• Greece
• India
• Mexico
• Panama
• Russia
• South Africa
• Spain
• Thailand
• Ukraine
• England
• United States

What is the typical cost of a donor egg IVF cycle overseas?

This varies greatly from clinic to clinic and country to country. The typical range is generally between $6,000 - $12,000 for a single fresh donor egg IVF cycle with an anonymous donor – including the cost for an in-house clinic donor and all of the clinic fees and the donor’s medications. Countries with “open ID” donors tend to be more expensive but offer some additional options. By comparison, a fresh donor egg cycle in the US typically ranges between $25,000 - $45,000.

How does payment work?

If you are working directly with a clinic, normally they will require a deposit and some sort of payments prior to treatment. Usually it is easiest to send funds abroad using wire transfers, however, check with your clinic to see if they can take a credit card payment. Some will accept credit cards only at the clinic.

If you are using a facilitator/agency, you may be able to pay in US dollars and lock in a fixed price (rather than being subject to fluctuations in exchange rates). Usually US based agencies are equipped to handle personal checks, wire transfers, or credit cards. Check with your agency to see exactly what is covered in their fee and if there will be any additional charges due directly to the clinic. This should all be outlined in your contract. How long do I have to be away?

This depends on the country, the clinic’s policies, and what kind of treatment you have chosen. It could be as short as 2 – 3 days, or as long as around 10 - 14 days. A typical fresh donor egg cycle with fresh sperm is around 8 – 9 nights in the country of treatment. The shortest treatment would be for patients who have sent frozen sperm in advance or are using donor sperm and are just going for the transfer, or patients who may be receiving frozen donor embryos or having a frozen embryo transfer of embryos frozen during a previous cycle. Many clinics will allow patients to do their monitoring at home and just arrive a day or so before the expected donor egg retrieval, and leave a day or two after a 5 day transfer. Some clinics prefer for the patient to arrive sooner so they can do their own monitoring for the final few days prior to the donor’s egg retrieval.

How quickly can I have treatment?

It depends on the clinic, their protocol, and whether they have a wait list. The most common timeframe is is between 2 – 6 months from when you select a clinic to when you can come for treatment. With no wait list, you can generally plan on about a minimum of 2 - 3 months from when you decide to go to when you could be matched with your donor and ready for treatment. During this time you will do your pre-treatment tests, obtain medications, do a mock cycle (if required) and sync your cycle with the donor and treatment date. The most popular clinics abroad may have wait lists of 3 – 9 months for donor egg IVF treatments. Sometimes the clinics with long wait lists may offer you an earlier treatment date if you go through an agency/facilitator that has reserved treatment dates in advance.

What are the typical medications I would take for a donor egg IVF cycle?

For a fresh cycle, most clinics start with medications to sync your cycle with the donor. Very often this is a simple birth control pill for one or more cycles or a cycle of hormone replacement therapy as a mock cycle. They may also require Lupron or something equivalent for down regulation or to prevent unexpected ovulation. The most important medication will be the estrogen to build your lining and prepare it for receiving an embryo. Lastly, progesterone is required after egg retrieval to prepare the lining for an embryo to implant and to support the pregnancy through about the first 10-12 weeks until the placenta takes over full production. Some clinics may also use prednisone, low dose aspirin or blood thinners if warranted, and some even use hCG shots. Each clinic has their own protocol that they feel is best, so it is best to trust your doctor and follow their protocol for your case. How do I obtain the required medications?

Each clinic handles this differently. They may ship the medications to you directly. Or, they may assist you in purchasing them through an overseas pharmacy that will mail them to you. They may also provide you with a referral form for asking your local OB/GYN or Reproductive Endocrinologist to prescribe the necessary medications which would allow you to obtain them under your health insurance. In many cases, purchasing the medications overseas may be far less costly than obtaining them locally, so it is a good idea to compare costs in advance if your clinic offers you both options.

How do I get through airport security with medications?

It is best to get a letter from your clinic outlining the medications you have been prescribed that you will be carrying with you on the plane. For items such as injectables, liquids, or gels (such as Crinone), it is usually best to place them in a clear Ziploc bag along with the letter from your clinic and put them through the x-ray machine just as you would your other 3 oz. carry on liquids. Usually you want to pack enough medications for several extra days in your carry-on bag, just in case your checked luggage is lost or delayed. Check with your pharmacy for special cooling packs designed for air travel if you have to keep medication chilled. According to the TSA, gels or frozen liquids to keep medications chilled are okay, so you might be fine with a small cooler and frozen gel pack or limited amounts of dry ice, depending on how far and long you are traveling. It is also okay to carry more than the 3oz. maximum of liquid or gel if it is medically necessary. The full TSA guidelines can be found here: http://www.tsa.gov/traveler-information/what-expect-if-passenger-needs-medication and http://www.tsa.gov/traveler-information/medically-necessary-liquids

Should I be concerned with language barriers?

Most clinics that specialize in offering treatment for out of country patients have one or more English speaking contacts and at least one English speaking doctor. The language barrier may become a challenge if you have questions about medications, protocols, etc. Even for those clinic staff who speak English, if it is not their primary/first language, you may find phone and email communications may be short and very direct rather than the more detailed answers you may desire. Sometimes using a third party (agency or consultant) to coordinate your treatment and travel can help minimize this concern.

How are egg donors normally selected?

There are only a few countries and clinics that allow known egg donors or open ID donors (where you could bring your own egg donor, use a known egg donor, or meet and get to know your egg donor or request future contact or release of donor information in the future). The majority of countries that offer low cost donor egg IVF have mandated laws that require only anonymous donors. This means that the clinic will take information from you about your preferences (usually blood group, age, height, weight, hair color, eye color, skin tone) and will use that, along with a photo of you, to match you with a suitable donor. In most cases, the clinics will provide limited details about the donor once she is confirmed – most do not include a photo.

How are donors screened?

Each clinic generally has its own donor screening guidelines, so it is prudent to inquire on an individual basis. Many of the clinics use the same ASRM (American Society for Reproductive Medicine) guidelines that are used in the United States, along with whatever local requirements are for STD testing, genetic screening, etc.

How do I check clinic statistics?

There is not a single governing body that collects statistics for clinics in all countries. Most clinics are self-reporting their success rates. It is recommended that you ask about positive pregnancy test rates, as well as clinical pregnancy rates (pregnancy with a confirmed fetal heartbeat). Many clinics working with patients from other countries are not able to verify live birth rates simply because patients do not report back to them. For that reason, most clinics are not able to report live birth rates. The added benefit to comparing clinical pregnancy rates is that the information is much more current than waiting for live births to be reported. What local laws should I consider or ask about before deciding which country or clinics to research?

The legal restrictions may vary from country to country and even clinic to clinic in the country based on local/national laws and how they are interpreted and implemented by the clinics. Here are the most common restrictions:

Are egg donor treatments allowed in the country?
Do they allow known donors or only anonymous?
Will they treat singles or non-married couples (same sex or straight)?
Do both partners need to come together for treatment?
Is there an age limit for patients undergoing treatment?
Are there limits on the number of embryos that can be transferred?
Do they allow frozen sperm (known or donor) to be shipped to the clinic for egg fertilization?
What options are available for leftover embryos?

• Are they yours to use for a later treatment?
• Can they be donated to someone you know?
• Can they be donated anonymously for another family to use them?
• Can they be shipped to your home country?
• Can they be used for science?
• Under what circumstances can or would they be destroyed?
• What happens to “abandoned” embryos?

Do they offer family balancing options (such as PGD for sex selection)?
Can you use a gestational surrogate legally? Are you required to get approval for it as a medical necessity?

What passports, visas, or other documents will I need prior to traveling?

It is always best to check with your home country embassy in the country where you are seeking treatment to see what documents will be required. E.g. if you are a US citizen, contact or look online for the embassy in the country you will be visiting. In most countries, you simply need your passport and perhaps proof of health insurance coverage abroad (usually included in Travel Insurance, or may be included in your own health insurance plan). For other countries (such as India) a special visa may be required for medical treatments. Usually the clinic can assist you with determining what travel documents will be required.

What is the best way to get money when I am traveling?

In many countries, the cheapest option for getting the local currency is to use your ATM card. Generally you will just need to alert your bank that you will be traveling in advance. Another option is to order foreign currency in advance from your local bank. Although airport exchange booths are convenient, you often pay a premium for their services and they do not always offer the most competitive exchange rates. There is no one answer for this in all countries, so it is often best to check local travel guides for guidance about this specific to the country and area where you will be traveling. Be aware that using a credit card may incur foreign transaction fees of up to 3% unless your bank waives those fees.

Is it possible to travel alone for treatment?

If you have shipped sperm in advance, are using donor sperm, or will be receiving donor embryos, it is very easy and often more cost effective to travel alone for your treatment. Since you are generally just having an embryo transfer, you don’t really need assistance to get to and from the clinic and usually it is unlikely that you would be sedated or unconscious at any time that would require someone to assist you. If you are traveling alone and plan on bedrest after transfer, you may wish to select a hotel that offers room service, so you can just rest and relax after transfer. You may also want to pack lightly, and ask for assistance from those around you so that you are not lifting more weight than is allowed by the clinic after transfer.

Some countries have regulations limiting the treatment of singles. If this is the case, the clinic can advise what documentation they will require from your “partner” to meet those regulations. Often, a notarized document may be all that is required from your partner, but in some cases, the clinic may require that your partner accompany you for treatment.

Can I ship frozen sperm or import donor sperm?

Each country and clinic will have different rules about accepting import of frozen sperm. Some countries require that a certified/approved courier, or require the clinic have a special certification to be allowed to receive frozen eggs or sperm, and not all clinics have this certification. It is important that you ask your specific clinic about their guidelines and whether there are circumstances where frozen partner or donor sperm can be imported. Some countries restrict the import of donor sperm except under very special circumstances.

The cost of shipping sperm from the US to Europe will vary – generally it is around $800 - $1200 for just the shipping costs. A very reliable company for shipping here in the United States is Xytex Corporation Tissue Bank in Georgia. Note: Xytex also has a sperm bank, but they offer just their shipping services as well. They will ship the shipping container to your lab and arrange for FedEx transportation to your clinic on your behalf. Most other sperm banks offer similar services.

If your European clinic allows import of donor sperm and you are planning to use donor sperm from a sperm bank, you may want to explore European sperm bank options. Often shipping from European sperm banks to clinics in Europe is far less than the costs for shipping overseas. Usually using the clinic’s donor sperm will be the most cost effective option if they have sperm that meets your requirements.

How do I know where to stay once I arrive?

Most clinics, facilitators or consultants can offer recommendations for accommodations (apartments or hotels) that are inexpensive and close to the clinic. Many patients turn this into a vacation with treatment, so if you have the luxury of time, you may want to plan a few days of sightseeing locally or in nearby cities while you are traveling. The clinic can tell you what days you need to be available or close to the clinic, the rest of the time you can go explore new parts of the world. Most of the clinics tend to be in university towns and within a few hours of major cities by readily available trains and buses, so the options abound for just being a tourist. What better way to be relaxed and ready for your transfer?

For patients who have never traveled in a foreign country, it may be more comfortable to use a third party (facilitator or consultant) who is available in your time zone (or during your awake hours) that speaks your language that can hold your hand through the entire process and communicate with the clinic on your behalf. They can usually assist you with the travel planning, facilitate communications with the clinic staff and doctors, and provide tips based on an English speaking/American customs and point of view.

What about transportation to and from the clinic and the airport?

If you are traveling on your own, you may want to engage the services of a local English speaking driver to meet you at the airport or train station and also assist you with getting to and from your appointments, but typically the local public transportation options or taxis are just fine too. You may not want to worry about driving in a foreign country when you are supposed to be relaxing after your transfer. One way to find these services is to ask the clinic of your coordinator for a recommendation, or contact a few local airport transportation services that cater to English speaking tourists.

What should I expect during the transfer?

Similar to the United States, each clinic, each clinic has a set of their own protocols and processes. Most do not use any sedatives during a transfer. They may ask you not to wear any scents the day of transfer (this is for the embryos as well as staff who may have allergies). Not all clinics offer a gown for you to wear during the transfer – some may just have you disrobe from the waist down and offer a sheet to wrap yourself. You may find that their sense of modesty is not the same as yours – so feel free to bring something to cover yourself if it will make you more comfortable. Usually they will have you rest for anywhere from 5 – 60 minutes after the transfer prior to getting dressed and going back to your hotel. Some clinics recommend only limited activity for a day or two, others may recommend bed rest, although it is less common in Europe.

Is it safe to fly after embryo transfer?

Yes. Just like here in the US, some clinics may ask you to wait 24 – 48 hour after transfer before you fly home. It is considered to be completely safe to travel during the 2 week wait prior to your pregnancy test. It is a good idea to stay very hydrated while flying, and be cautious not to lift or carry any heavy luggage (most clinics limit you to 10 – 25 lbs).

How soon can I test?

Each clinic has their own policy about what when to test, and what kind of test they require. Generally, they will ask you to wait 9 – 14 days after a transfer prior to testing. Some clinics will require a quantitative hCG blood test (you can get this from your OB/GYN) to ensure that the results are accurate, while some may allow use of a home pregnancy test (aka pee stick).

What happens once I’m pregnant?

Generally, the clinic will provide you with instructions for your local OB/GYN who will be taking over your care. Normally those instructions include what to do if you have any bleeding, and how long to continue taking each medication. The clinic will request that you report the results of your 6 – 8 week ultrasound (with number of heartbeats), and will also ask you to report again once you deliver you baby or babies.

**Sue Taylor is an experienced IVF consultant with a passion for helping others on their journey to parenthood. With over 27 years experience in the healthcare industry, she now assists patients with selecting a clinic, or going abroad for more affordable IVF and donor egg IVF treatments. Ms. Taylor can provide assistance for prospective patients deciding if IVF treatment abroad is a good choice for them, assist with clinic selection, and can provide treatment & travel coordination services. She has assisted hundreds of donor IVF patients from all over the world in seeking treatment abroad. Her blog, www.ivftraveler.com/blog, offers practical details for patients traveling for IVF services or an IVF vacation. Sue Taylor can be reached at sue@ivftraveler.com.