Treatment Overseas

Having fertility treatment overseas can be very different from having treatment in the UK.

More and more couples are now opting to travel for their treatment, particularly those who need donor eggs or sperm.  It can be difficult to choose where to go when there are so many clinics across the world, often promising high success rates for relatively low costs.

Although many British couples have had very positive experiences of treatment abroad, there are some potential problems you do need to be aware of.  We hope this page will help anyone who is thinking of travelling abroad for treatment, giving you some ideas about the things you may want to take into consideration.

Regulation and inspection

In the UK, all clinics offering IVF are regulated by the Human Fertilisation and Embryology Authority.  They are regularly inspected, and have to maintain certain standards in order to retain their licenses to practice.  In other countries, there are not the same strict regulations about how clinics operate, so you may need to check things you would take for granted here.  It is worth asking clinic staff how fertility treatment is regulated in their country, whether there are any rules clinics have to follow and regular inspections.  You may want to know whether there are set procedures which have to be followed in the laboratory, and how patient records are kept to ensure confidentiality.

Do your research

When you are choosing a clinic, personal recommendation may be particularly helpful, but if you don’t know anyone who has travelled for treatment, you will have to do your own research.  Look carefully at the clinic’s website, at the sort of information and statistics they include.  You may want to check the qualifications and experience of the staff, and whether the clinic is accredited in any way.

Your initial contact with the clinic will probably give you some insights into how it is run. Are there English-speaking staff available to answer your queries?  How much time are they willing to spend talking to you about the treatment they offer?  You should be wary of a clinic which is so eager to take you on as a patient that they are not interested in asking about your own medical history.  A good clinic should want to see all your relevant test results and know about your medical history.

The journey

Before you decide where you will have your treatment, it is important to think about how you are going to get there.  It sounds obvious, but you may need to get to the clinic at short notice during your treatment, and it will cause problems if there aren’t readily-available flights to your chosen destination.  The cost of getting to and from the clinic has to be added to the fees for your treatment, and this can make a huge difference if you choose somewhere with lots of cheap flights rather than somewhere which involves a long-haul scheduled flight.  As you will probably need to stay for a day or two, you should also look at hotel costs and availability – is it always easy to find somewhere to stay?

Language difficulties

Perhaps the most important thing to reassure yourself about when you’re thinking about going to a clinic abroad is communication.  Is there always an English-speaking member of staff available to deal with enquiries and translate for you?  Will you feel comfortable if your doctor has to talk to you through a third person?  How will you communicate with the clinic from home during your treatment cycle?  What happens if there is a problem during the treatment?  How quickly will they be able to get back to you if you are worried about something?  What happens if a cycle has to be abandoned, and does the clinic offer any kind of aftercare once the treatment itself is over?  Don’t feel worried about asking too many questions.  If you are going to feel confident during your treatment, you want to be certain you know the answers to these things.

Finances 

You need to find out how long the waiting lists are for the type of treatment you will need, and what the costs will be.  Check exactly what is included in the figure you are given.  There may be some additional costs to take into consideration back at home. Will all your drugs be prescribed and provided by the clinic, or will you have to get some of them in the UK?  If you have to get them here, how does the clinic advise you to do this?  Most couples only spend a few days of the cycle in the country they have chosen for treatment, and most of the necessary scans and blood tests are done at home.  You need to work out where you will have these done, and how much they will cost. Sometimes couples who have built up good relationships with their local GP and gynaecologist manage to get these provided free of charge, but they can be expensive if you have to pay to have them all done privately.  You should work out how you are going to deal with this before you agree to treatment.  Some couples prefer not to tell their GP about treatment they are having abroad, but if you feel you can, it is best to tell your GP exactly what you are doing and when, as you may find you need their support during your treatment.

The costs of your treatment will be affected by the number of visits you have to make to the clinic, and how long you need to spend there.  Some couples don’t go to the clinic until they start their treatment, but others prefer to make an initial visit to ensure they are happy with the set up before they begin.  You should check when the clinic will need you for your treatment, and how long you will be expected to stay.  It is also important to know how much notice you are likely to be given, and to consider how you are going to cope if you have to take time off work at very short notice.  Will both of you need to be there at all times?   Does the clinic freeze the male partner’s sperm, or do they always want to use it fresh?  Most clinics are happy for you to fly the day after your embryo transfer, but will you be happy to do this yourself?

Embryo transfer

In the UK, there are strict rules about how many embryos can be replaced during a treatment cycle.  This is not always the case elsewhere.  Although it can be tempting to think that a multiple pregnancy would be an ideal solution to your fertility problems, it is important to remember that there are very real risks with a multiple pregnancy.  You are more likely to miscarry or to give birth prematurely, and there are more likely to be long-term health risks for the babies once they are born.  Keep this in mind if you are treated at a clinic where they offer to put back more than two embryos as you could be risking your own health and that of any future children.

Donor gametes

Many couples chose to travel abroad because of the scarcity of donor gametes in the UK, and the long waiting lists for donor treatment.  If you are going to be using donor gametes, there are a number of additional issues you should consider.  In the UK, donors no longer have anonymity which means that a child has the right to find out about their donor parent.  You should check what the legal situation is regarding children born using donor gametes and the anonymity of donors where you are having treatment.  You may want to find out how donors are recruited, whether they are paid and how they are screened.  In the UK, there are very strict rules about screening to prevent infection with HIV or hepatitis, and you should make sure similar rules prevail where you are having treatment.

Finding a donor who shares some of your physical characteristics is a consideration which may affect where you are treated.  If you have dark hair and eyes, you are more likely to find a compatible donor in a Mediterranean country than someone with very blonde hair and blue eyes. You should ask how much the clinic is going to tell you about the donor, and what kind of a match they would expect to get.  You may want to check what their policy is on blood group and Rhesus factor matching and whether there will be a back-up donor.  You should know whether you are going to get all the eggs from the donor or whether they are shared, and whether you can freeze any spare embryos to use at a later date.

Counselling

In the UK, all clinics offer counselling prior to treatment involving donor gametes.  This may not be offered by a clinic abroad.  It is important to have thought through all the implications of using donor gametes before you go ahead with treatment.  Using eggs or sperm from abroad may mean that a child will never be able to find anything out about their donor.  They will also have to deal with the fact that they may be genetically half-Spanish or Russian or Greek, depending on where you have chosen to have treatment. This is something you need to have thought about before going ahead.

Support

It is vital to understand that if you choose to travel abroad for treatment, there may not be the support you would expect if you are being treated here.  Any problems or questions will be dealt with by phone, fax or email, and the HFEA cannot deal with complaints or problems which occur abroad.   However, many couples have now travelled abroad for treatment without any problems by making sure they have done their research thoroughly beforehand

Compiled by Kate Brian on behalf of Fertility Network UK

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