A laboratory of IVI (centre) where Agustin Ballesteros directs the OB/GYN department
Health tourism is booming. What was once the premise of the rich and/or famous-the only ones who could afford the luxury of having their nips and tucks done away from prying eyes-has become a much more a feasible option for the masses. Only now, it is not just cosmetic surgery for which people are fleeing to sunnier climes. Ever-longer hospital waiting lists and comparatively expensive private treatments have caused many to investigate the option of having hip replacements, laser eye treatments and even heart bypasses done outside their native countries. An EU ruling last year that stated patients have the right to be reimbursed for treatment abroad if they face “undue delay” at home has only added to the appeal. surgery, or a judicial hearing.
The UK's Treatment Abroad website estimates that around 50,000 UK residents now travel overseas for surgery every year. The numbers are even higher from other countries. Low-cost flights, the Internet, increased accessibility and targeted advertising from foreign clinics have all exacerbated the boom.
One of the fastest growing strands of this phenomenon is fertility tourism. A Europe-wide “fertility crisis”, to quote the World Health Organisation (WHO), has seen birth rates fall to unsustainable rates in half of its member countries. The average number of children born in Europe is now 1.07, while 2.1 is thought to be the minimum “replacement” level. Meanwhile, access to reproductive health centres is sporadic, to say the least.
One in six European couples has difficulty conceiving, which means the demand for quality in-vitro fertilisation (IVF) treatment is greater than ever, yet many countries are becoming more, not less, restrictive. A new law banning the anonymity of sperm and egg donors introduced in the UK in 2005, for example, has caused many couples to seek IVF treatment elsewhere, while Italy's once super-liberal approach has now done a complete about-turn. Unsurprisingly, infertile couples are leaving in droves to get the help they need in less restrictive destinations-and this is where Spain comes in.
The country, which now has one of the lowest fertility rates in Europe, is, ironically one of the most successful at getting women pregnant. While other nations struggle with ethical debates, unfathomably long waiting lists and unequal levels of care and access to treatment, Spain has a healthy culture of assisted reproduction and is a pioneer in this field. Clinics such as Barcelona's IVI, the first Spanish clinic to work exclusively in human reproduction, have popped up all over Spain in recent years, generating a significant rise in fertility tourism.
“Spanish legislation is enabling, rather than restrictive, said Augustin Ballesteros, director of the Obstetrics and Gynaecology department at IVI. “Anonymous egg or sperm donation is an acceptable part of the culture, so much so that Spain has the highest number of donors in the world. Everybody is caught up in the issue of genetics and age, but infertility issues are much wider than this. We believe every couple who wants a child has the right to have one.”
This attitude makes for relatively stress-free treatments and higher than average success rates: the Barcelona clinic boasts a pregnancy rate per embryo of 65 percent. In the UK, it is around 30 percent. Some 40 percent of IVI Barcelona's patients are from overseas. In an average week, they will see couples from the UK, Germany, Italy, and a host of more remote places, with patients from around 50 countries worldwide.
The UK's Human Fertilisation and Embryology Authority advises caution when choosing to have treatment done abroad, as it cannot regulate the treatment. However, standards of care in Spain are generally excellent and the IVI takes every precaution with its donors. Their average donor is a 20-25 year old woman at university, but all eggs come from women under 30. Egg donors are paid €900 and medical records of donors are kept on a computerised system, although the process is completely confidential. All have to complete extensive medical, physical and psychological tests, said Ballesteros. “Good general health is of course the most important factor, and we routinely screen for sexually transmitted infections, AIDS, cystic fibrosis and the X-chromosome abnormalities, which can lead to a number of diseases.”
With donors readily available here, waiting times are four to six weeks, almost unheard of in the UK where two years is the norm. That's why Spain appealed to Michelle Stott [not her real name], aged 42, of Milton Keynes in the UK. “After four miscarriages, the doctors found out I have a genetic abnormality which means my chances of carrying a baby past three months is extremely slim- only around 15 percent. So for me, egg donation was the only option. My UK wait would have been two years, so my specialist suggested I go to Spain. I have since heard of another couple who were advised the same, so it seems the UK fertility clinics are more than happy to refer people here.
“After a lot of thought, I e-mailed the clinic and they sent me an appointment for the next week! We were given a list of the tests we would need to have done before we came, so we postponed the visit for a month. The first appointment was fantastic. It has been a very traumatic few years and this is the first time we felt as though we weren't asking for anything abnormal. We were assigned a translator, who was very friendly and warm, and whose services we are able to call on at any stage. The doctor went through the whole procedure of what would happen from start to finish, using diagrams and charts. I was even given a 'dummy' egg transfer, which was completely painless, so I knew what to expect. We were then told to go home and would be advised by the clinic when we could start the treatment.”
The treatment begins when a suitable donor is found. Donors and recipients are matched on blood group and physical characteristics and both are put on the contraceptive pill to synchronise the menstrual cycles. Once in synch, Michelle will undertake a couple of tests with her fertility centre in the UK, and then wait for the clinic to call her to come for the transfer. “The cost will be around €8,000, which compares favourably with the UK,” she said. “It is not an easy decision to come for treatment, but I feel really supported here.”
The IVI provides a counselling service for all its local patients, and advises all international customers to organise counselling in their own countries. “One thing I have noticed is that international customers are usually more emotionally drained than our local ones because of the struggle for good quality care they have had in their own countries,” said Ballesteros. “They often come here as a last resort, whereas the Spanish have access to the services they need at a much earlier stage.”
As couples leave it later to have children, and funding for fertility treatment wanes across Europe, it seems the IVI and its counterparts will only get busier in the years to come. A recent report issued by the WHO stated: “Infertility is a disability and infertile couples deserve the moral, legal and economic support of the society to attain the highest standard of reproductive health.”
IVI Barcelona; Tel: 93 206 3000; www.ivi.es
Institut Marquès; Tel: 93 285 82 16; www.institutomarques.com
Instituto Dexeus; Tel: 93 227 4700
The Treatment Abroad website may also be useful: www.treatmentabroad.net