Reproductive tourism is the practice of travelling to other countries for availing fertility treatments. This phenomenon includes travel to seek various kinds of infertility treatments like in vitro fertilization, preimplantation genetic diagnosis, gamete procurement, or a host of other services.
Reproductive tourism enables many couples to make their dreams of parenthood come true.
Motives for travel besides quality and cost
The treatment may not be legally available in the home country of patients, or availability may be extremely limited. Many patients travel from countries like Germany and Italy, which have placed stringent restrictions on the number of eggs that may be fertilised and on the number of embryos that can be used for implantation. Limits placed on the number of eggs to be fertilized reduce the probability of a live birth. Patients belonging to countries where these limits are placed rely on other countries where more embryos can be used for implantation.
Egg donation is illegal in a number of European countries like Germany, Austria, and Italy because of which, many couples seek help in countries where the procedure is allowed such as Spain and U.S.A., where donors are paid for their service. Commercial surrogacy is also banned in many countries but is completely legal in India, hence making it an attractive reproductive tourism destination.
Some types of patients are not eligible for treatment by the law of their home country, such as homosexuals, unmarried people, and members of certain religions. For example, many countries like Turkey, China and Indonesia permit fertility treatments for only married couples. The citizens of these countries rely on countries such as Spain, Sweden and USA, which allow IVF for single people and homosexual couples.
Apart from this, some countries have waiting lists that are too long to make childbearing a reality. Canada is a well known example in this situation. Canadian patients often travel to other countries for getting timely treatments, particularly fertility treatments.
Another factor that induces people to undertake reproductive tourism is the unavailability of a procedure or technique at home. Certain fertility treatments like preimplantation genetic diagnosis (PGD), used for sex selection is illegal in some countries where in-vitro fertilisation is allowed.
Certain countries have better options for control over fertilization results. For example, the United States permits (PGD) in-vitro fertilization of embryos, allowing couples to pick and choose which embryos will be implanted in the uterus based on genetic factors, including chromosomal deficiencies and sex. Patients who prefer having more control over their fertilisation results and want to avert the risk of chromosomal deficiencies in their offsprings travel to U.S.A. for getting this treatment.
Trends in various fertility procedures - A statistical analysis
1. In-vitro fertilisation (IVF): In-vitro fertilisation is the process of fertilization by manually combining an egg and sperm in a laboratory dish, and then transferring the embryo to the uterus.
IVF treatment in India is one of the cheapest. It is as cheap as $690.
Success rates of IVF are much higher than what they were two decades ago. Due to advancement in science and technology, the probability of a live birth has risen to more than 50% from a mere 20%. However, couples should not wait beyond their early 30s to freeze their embryos since fertility greatly declines during this time period and reduces the chances of a live birth.
Another good news for aspiring parents is that now they don’t need referrals to consult a medical practitioner for this procedure. This practice has made IVF much more accessible.
Waiting times from the date of referral
England, Scotland and Wales have very long waiting times which can go up to a year whereas waiting periods are nearly non-existent in countries like Brazil, Bulgaria and Israel.
2. Donor insemination: Donor insemination (DI) is the process of conceiving a baby using donated sperm. The semen is normally obtained from someone other than the woman's husband or partner.
Artificial insemination can be used for many kinds of fertility problems. It's a popular infertility treatment for men who have very low sperm counts or sperm that aren't strong enough to swim through the cervix and up into the fallopian tubes. In some women, the mucus membrane surrounding the cervix is unreceptive and hostile to sperms, which prevents sperm from entering the uterus and fallopian tubes. In these cases also, artificial insemination is required. This procedure allows the sperm to skip the cervical mucus entirely and directly enter the uterus.
Success rates for artificial insemination vary. Factors that lessen chances of success include older age of the woman, poor egg quality, poor sperm quality, severe damage to fallopian tubes (usually from chronic infection) and blockage of fallopian tubes.
Waiting times from the date of referral
Countries like Sweden have waiting lists for sperm donation up to 18 months while England imports 40% of its sperm requirements every year. Waiting times in medical tourism countries like Hungary, Lithuania and Brazil are negligible and attract thousand of tourists every year.
3. Surrogacy: Surrogacy is when a woman, other than the mother is artificially inseminated with the father’s sperm, to give birth to a baby for the couple who wants to have a child. Carriers of the child can be found through adoption or surrogacy agencies.
While choosing a surrogate mother, it is important to consider certain factors. A woman who has already given birth to at least one healthy baby should be preferred because she will understand the first-hand medical risks of pregnancy and childbirth and the emotional issues of bonding with a newborn. She should also pass a psychological screening by a mental health professional to uncover any issues that she might face, in giving up the baby after birth.
Surrogate motherhood is illegal in Italy, banned for commercial purposes in Australia, Spain and China and is allowed with restrictions in the United States, France and Germany.
Waiting times from the date of referral
Waiting times go up to months in countries like England and Scotland. However, in countries like India, Spain and Brazil, the waiting times are virtually non-existent.
Favourable destinations for these procedures
More than a million tourists travelled to Israel in 2012 for medical treatment.
Spain: Despite its reputation as a predominantly Catholic country, Spain is a popular destination for fertility tourism, thanks to the open minded attitude that is enshrined in law, allowing anyone access to fertility treatment. Spain has over 200 fertility clinics offering a wide range of fertility treatments.
India: Clinics throughout India are well established and have high standards; relaxed regulations allow treatments for women up to 55 and also for single people. The low cost of these procedures is another aspect which attracts medical tourists to this country.
Malaysia: Malaysia is becoming an increasingly popular destination for fertility tourism as a result of a government initiative to promote and regulate health-care for overseas patients through the Malaysia Healthcare Travel Council. The MHTC works in close collaboration with the Association of Private Hospitals of Malaysia to offer high quality fertility treatment at competitive and affordable prices.
Bulgaria: Fertility treatment in Bulgaria is attractive to foreign patients due to its competitive prices, non-existent waiting lists, good international flight connections and foreign-language speaking doctors and nurses.
Complications and Risks
Like most medical treatments, all fertility treatments also carry risks which should be taken into account before commencing the treatment. These are as follows:
Drug reaction: Sometimes, the drugs given to boost fertility can induce an adverse reaction. The symptoms include hot flushes, feeling down or irritable, headaches and restlessness.
Multiple births: Having a multiple birth (twins, triplets or more) is the single greatest health risk associated with fertility treatment. Multiple births carry risks to the health of the mother and the unborn babies. The babies are more likely to be premature and to have a below-normal birth weight. Studies show that the risk of death before birth, or within the first week of life, is more than four times greater for twins than for a single baby. For triplets, the risk is seven times greater than for a single baby.
Ectopic pregnancy: This happens when an embryo implants outside the uterus. The most common site is in the fallopian tube. Occasionally, an ectopic pregnancy can develop in the ovary. The major risk is that the ectopic foetus will rupture through the tube causing internal bleeding.
Fertility tourism serves as a ray of hope for those couples who can’t have children due to biological or social factors. However, these procedures also come with a few risks which need to be considered while choosing the optimal fertility procedure.