By: Dr. Ed Coats
Increasingly people are choosing to have IVF treatment abroad. This trend has been growing for a number of reasons. Fertility treatment can be cheaper abroad with shorter waiting times and different legal implications when having treatment with donor eggs and sperm. The freedom of movement of people and business around the EU has made this easy.
However, this can be a difficult area to explore as there are so many different fertility clinics abroad and they may follow different processes and procedures to those regulated by the HFEA in the UK. There is a lot to consider when travelling abroad for treatment and we hope this article will help you ask the right questions early on and help you to select the fertility clinic that is best suited to your requirements. There is no certainty yet on what the impending BREXIT decisions will mean for fertility treatment in Europe for UK citizens but we will write again soon as this evolves.
Most people will start with a personal recommendation based on success. This is always a great place to start especially if friends can describe their experience in detail, but it is also important to look at your specific treatment requirements and consider the country and clinic options carefully.
Here are our 10 top tips to cover when choosing a fertility clinic abroad:
If you don’t want your fertility treatment to become a caricature of the 1987 US hit movie, “Planes, trains and automobiles”, then you need to make robust travel plans. It is worth considering the entire journey from your home to the fertility clinic itself and where you will stay during time away. Many clinics will help you make these detailed plans so it is worth asking about their past experience with patients, whilst exploring how reliable the transport systems are in the country and the routes to the clinic. How many visits will you be expected to have during a typical treatment cycle is an important consideration. Check whether the clinic offers any help with transfers from the airport or perhaps any travel packages as this can certainly add significantly to your costs.
Whether you desire budget or luxury digs your main concern should be accommodation that is going to allow you the space to get away from your treatment and relax, yet close enough to the IVF clinic so that you are able to easily attend appointments and not face a challenging journey through traffic. It may suit you better to find an apartment rather than a hotel as this will allow you access to more familiar home comforts and give the option to even cook rather than eat out which can be more expensive. Make sure that your accommodation has access to a fridge as some medication will need refrigeration.
- Regulation of fertility treatments overseas
Unlike the UK where assisted conception treatments fall firmly under the umbrella of the Human Fertilisation and Embryology Authority (HFEA), fertility treatments are not regulated in the same way overseas. Different countries have different systems of regulation and there is no international standard that clinics must adhere to. We try to give you an overview of the basics in different European countries where you may choose to have treatment. You may want to ask if there is a National fertility ‘regulatory code’ that is followed in the clinic. Don’t forget to check what procedures are followed for handling confidential records, as your personal details and payment must be secure in the digital world we all live in. Your safety is paramount too and essential IVF procedures like egg collections will require anaesthetic or sedation and this must be considered when looking at treatment options abroad. The level of expertise of the clinic performing these procedures should be checked and you may need to enquire about this.
- Legal implications in different countries
An essential question to confirm and one that we will help you explore before you spend money, is whether you can access the fertility treatment you need in specific countries outside the UK. It might seem a simple concept but some countries will not allow ‘same-sex’ couples for example or surrogacy arrangements to take place. Check that the clinic you are visiting is working within the legal framework of that Country. We would advise you carefully consider the legal implications of undertaking fertility treatment such as IVF with donors eggs or sperm before committing to a clinic in certain countries.
- Communications and Languages
Communication is key in any medical treatment. Undertaking an IVF cycle can be stressful and it is not easy if the staff you are dealing with struggle with spoken English. Always check what languages the majority of staff speak in the clinic that you are considering and if this includes the doctors, nurses, embryologists and administrative staff. You may wish to see a counsellor during treatment and this a valuable service that many fertility patients use. However, you will need to check if the clinic offers counselling in English if this is your only spoken language. Most communications today are done by email and so therefore the ability of the clinic to communicate in written English is an important consideration. You may travel between the UK and the clinic a few times so need to know whether email communications will be successful in English between yourself and the clinic. Will you be given copies of your clinical notes and treatment instructions in English?
- Clinic success rates
Checking that the clinic you are attending has previous experience of UK patients is a must. It is worth asking how many cycles per annum are performed in total and what proportion of these are on overseas patients at the clinics you consider. A clinic that treats predominantly residents of their own country may not have the experience to manage overseas visitors with ease and you don’t want to find this out during you treatment to your detriment. A big consideration for anyone having IVF treatment is the success of a clinic. In the UK this success rate data, as you will have seen displayed on our Total Fertility UK clinic pages, is aligned with the tightly regulated HFEA reported data. It is essential to ask the clinic directly their success rates and how are they calculated? Next months article on ‘Success Rates and Avoiding the Pitfalls of Data Interpretation” will help with understanding IVF success rates. If the rates look grossly better than UK rates then you need to question why this is. Challenge your clinic to explain why success rates are so different and remember the regulation of publish ed success rates is not the same in as in the UK.
- Multiple birth rates
In the UK fertility clinics are carefully monitored to ensure that their multiple birth rates are not too high, with a target set at < 10% cycles resulting in multiple births. It is a HFEA regulatory standard that clinics do not create too many multiple pregnancies. You should always consider a clinic’s multiple birth rate alongside their success rates. Some overseas clinics still believe that replacing multiple embryos dramatically improves success rates but research would suggest this is not the case. Read our Total Fertility article “One embryo or Two… a look at the evidence”. If clinics have high success rates do check they also have multiple birth rates that are high.
- Cost of treatment
The cost of treatment is one of the many reasons people will travel abroad as there are often savings to be made. Always check though for hidden extras and it is a good idea to ask the clinic to provide you with a comprehensive ‘costed treatment plan’ before you commit. This is probably the one area where you may find treatments are cheaper than in the UK, but it is important to be sure that the quality and level of care is not compromised. Most IVF clinics looking after overseas visitor will put together fairly comprehensive packages, which is helpful but it is important to look at the details and check all costs are covered.
- Treatment options available
Always enquire first as to whether a clinic offers a full range of treatments as some clinics may not provide the exact treatment you require. Whilst there are not many IVF ‘add-ons’ that are in use in IVF today with a good evidence base, do check what the clinic advises and offers. You can read about ‘add-ons’ in more detail in our Total Fertility article, “Add-ons Don’t Always Add Up”, to be clear about which treatment add-ons do have evidence behind their use. Also don’t forget to check what the clinic allows if eggs, sperm, and embryos are to be frozen. The UK permits freezing of embryos for up to 10 years but check if the same rules apply abroad and check the costs and success of freezing and thawing embryos in the clinic.
- Donor eggs and sperm
Many people travel abroad to gain better access to donor gametes (eggs or sperm), but not all clinics recruit donors in the same way as the UK, based on a strictly regulated system. The anonymity of donors in clinics abroad is an attractive option for many people from the UK and this is why they travel to Europe to seek treatment. In the UK children from assisted conception cycles using donor gametes can access the data of the donor held by the HFEA at the age of 18 years old. In many European countries donation is completely anonymous. Is this is the case it is important to know how egg and sperm donors are recruited and screened for infection. Check what information you will be able to have access to about the donor that you use and whether that donor has any legal rights to the child under that countries legal system. Many people travel to Europe every year to seek treatment with donor eggs as it is often quicker, cheaper and anonymous compared to the UK. See our list of European clinics that offer this service.
Choosing a European Clinic doesn’t have to be a struggle. A clinic outside of the UK may well offer you the best treatment option but do ask the important questions before you commit financially. It is so much easier to ask the hard questions at the outset than later in the process. Visit our European clinic pages today to understand more about what clinics have to offer as there are some great clinics out there with really engaging staff.
By: Dr. Ed Coats