I Want a Baby: Travel with a Purpose! – IN MY PERSONAL OPINION

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Whether the travel plan folder is labeled Fertility Tourism, Reproductive Travel, or Cross Border Reproductive Care, women and couples are leaving their home zip codes with “make a baby” at the top of their to-do list.

The desire to have a child is not limited to income, age, sexual orientation, or geography.
The research quantifies the fact that women from low- and middle-income countries (LMICs) as well as from major European and American cities will travel to make a baby.
The World Health Organization estimates that one in four couples in LMICs has fertility problems.

Making a Baby

It is estimated that 186 million couples in these countries (excluding China) have spent at least 5 years trying to conceive without success. While medical conditions are common to fertility problems in countries across the wealth spectrum, in some cultures, infertile women are often shunned by their families and excluded from social activities and cultural rituals. They are more likely to be victims of domestic violence or be divorced by their husbands. While infertility is just as likely to result from problems with the male reproductive system as the female, it is usually women who are blamed for the failure to produce a child.

Health Issue

Infertility is considered a grave health issue and impacts 8-10 percent of couples globally. The Centers for Disease Control (CDC – 2013) and Office of Women’s Health (2019) found that 9 percent of men and 10 percent of women aged 15 – 44 were dealing with infertility challenges in the US and the Reproductive Biological Endocrinology report (2015) determined that approximately 48.5 million couples experience infertility on a worldwide basis.

The Centers for Disease Control and Prevention (CDC) estimates that 750,000 US residents travel abroad for health care each year. Fertility tourism currently controls less than 5 percent of the almost $55 billion (2014) medical tourism market; however, it is expected to nearly quadruple in size over the next few years. It is estimated that the global market of assisted reproductive technology has generated revenues of $22.3 billion (2015) with fertility drugs being a fast-expanding pharmaceutical field.

What is It?

People acknowledge they are facing “fertility issues,” when they are unable to have a clinical pregnancy after 12 months of attempts with intercourse. Infertility, or the inability to get pregnant, affects about 8-12 percent of couples looking to conceive, or 186 million people globally. In some locales, rates of infertility surpass the global average and can go as high as 30 percent depending on the country.

The main procedures are in-vitro fertilization (IVF), artificial insermination at home by a donor as well as surrogacy and associated with Assisted Reproductive Technology (ARTs).

Motivations to travel for medical attention are prompted by inadequate or no healthcare insurance at home and increasing demands for procedures that may not be covered by available insurance plans such as fertility treatment, gender reassignment, dental reconstruction, and cosmetic surgery.

Some travelers engage in fertility tourism when they recognize that better (or improved) fertility doctors are available outside their immediate community while others search for reproductive treatment outside their locale in order to circumvent laws, side-step legal/ethical/religious or other restrictions, and/or avoid long waiting lists.

Many nations don’t allow fertility treatments for same-sex couples or for single women. According to executives at the Institute for Development and Integration of Healthcare (IDIS Foundation), “the reasons why people travel abroad to look for fertility treatments can be classified into categories: cost, quality, and availability of treatment…”

However, even with the best doctors and the most advanced clinics the odds of having a child with the help of medical science are not great. For women under 35, only 36 percent will get pregnant per IVF cycle using their own non-frozen eggs (CDC). By age 41, it is less than two-thirds of that; after 42, the numbers fall by another half to 6 percent. The rates for IVF using a donor egg are higher but still lower than 50 percent. While the rates of success appear rosier on clinic websites, Carolin Schurr, a geographer at the University of Bern who studies the transnational fertility industry is leery of success rates advertised because “it really depends on how you calculate them, and there’s a lot of room to manipulate.”

Regardless of the data, fertility tourism is expanding as better healthcare is available at locales that require travel and the destination medical facilities offer patients state-of-the-art technology, innovative medicines, modern devices, improved hospitality, and personalized care at “value” pricing.

Reproduction. Do It Yourself

In some societies a child is considered to be “priceless” however, the global fertility market (since the 1990s) has led to the commodification of reproductive capacities, bodily tissues, body parts and babies.

Sociologists have observed that reproduction has morphed into a product engaging consumers/ buyers and sellers. Just as other services have been outsourced to low-wage countries to reduce costs within a global commodity chain, reproductive labor is frequently outsourced in global fertility chains to women living in deprived socioeconomic conditions in low-wage economies to reduce the price for a baby conceived with the help of a third party.

Is It Ethical?

I Want a Baby: Travel with a Purpose!

Even if it is legal is fertility tourism ethical or just another variation of the increasing marketization of everyday life and body? When considering the history of wet nursing, adoption and child trafficking, the baby market is nothing new; however, there is a profound growth in the trade for human bodies, body parts and body resources, including the bodies of babies. What has made this possible? Technology, the rise of cheap air travel, new forms of communication and information and the accumulation of biocapital has increased the speed in the trade of bodies, body parts and babies across borders.

Controversy has surrounded the use of assisted reproduction technologies (ART) since it was initiated. Almost every aspect of the process/procedures have been controversial including the initial use of artificial insemination with donor sperm (AID) to the use of fertility drugs to increase the frequency of multiple births, to in vitro fertilization (IVF) permitting conception outside the human body.

The Catholic Church identifies human dignity with conception by a married couple within a woman’s body and therefore opposes IVF and government support of IVF. Other organizations express concern about the health effects of fertility drugs, the hormones used in IVF, the increased incidence of multiples and other ART practices.

The combination of religious objections to the procedures and concern that government intervention would result in restrictive measures, ART has not been included in insurance schemes and has limited the research that would contribute to better understanding of the long-term health risks with these procedures.

Increased competition and fertility tourism has expanded the availability of services by making them affordable and making it easier to evade ethical restrictions that limit the availability of controversial services. In the United States the “Dickey Amendment” is attached to every Health and Human Services appropriation bill since 1996 and forbids federal funding for “research in which a human embryo or embryos are destroyed, discarded or knowingly subjected to risk of injury or death.”

As fertility travelers scan the globe looking for the “best package,” putting a price on human life, looking at conception as a business transaction, ethical considerations enter the conversation. In addition, the for-profit clinics working in a competitive market environment may cut corners in their desire to recruit more patients. Others view the fertility clinics as models of good business practices for they offer patients informed choices with transparent pricing, allowing clients to select their preferred course of treatment.

Other Considerations: Is It Tourism

Medical Tourism in general and fertility tourism specifically is not without controversy. Traditionally tourism refers to traveling for recreational purposes and the fertility tourist is looking for something exotic, strange, and possibly illegal in their own community. The restrictions at home may not necessarily be laws but may include personal moral convictions by health care providers, institutional policy guidelines and committee recommendations. In countries without legislation on assisted reproduction, each doctor and clinic can decide autonomously whether or not to provide a certain type of treatment and/or office service to a certain type of patient.

In some countries surrogates can be compensated, while in other locales it is prohibited. There are places where there is a lack of laws or guidelines for surrogacy resulting in custody battles. In countries where surrogacy is banned there are instances where the intended parents go to different destinations but have difficulty bringing back their new children to their home country. In countries where commercial surrogacy is prohibited, there may be an allowance for “altruistic surrogacy” and may include contracts to the involved parties.

Many countries express religious concerns surrounding surrogacy that include lineage and heritability, motherhood and marital fidelity. Judaism, Hinduism, Islam and other Christian denominations outside of Catholicism generally approve of surrogacy but have concerns.

Judaism: concerns regarding legitimacy. Most tend to believe that motherhood belongs to the person who actively delivers the child.

Hinduism: views infertility as a curse to be cured by any means necessary, generally approving surrogacy.

Islam: concerns center on the importance of and confusion of lineage and inheritance.

Other Christian denominations have a wide variety of news from encouraging surrogacy as it shares the blessing of parenthood to viewing surrogacy as a means of confused identity in a child and a disruption in traditional marital practices and procreation. In some countries, religious beliefs have led to legal bans on surrogacy (i.e., Costa Rica).

Who Wants a Baby?

Celebrities want babies. Paris Hilton decided on IVF, determining it was “the only way” she could ensure that she could have “twins that are a boy and a girl.” Hilton learned of IVF from friend Kim Kardashian who had two children via surrogate and stated that she was “happy that she told me that advice and introduced me to her doctor.”

Other celebrities selecting fertilization methods include Amber Heard who wanted a baby “on my own terms,” welcoming Oonagh Paige Heard via surrogate. Queer Eye star Tan France and his husband Rob had their child via surrogate (April 2021). Anderson Cooper welcomed his first son Wyatt via surrogate and Sarah Jessica Parker and Matthew Broderick welcomed their twins, Tabitha and Marion, via surrogate (2009).

I Want a Baby: Travel with a Purpose!

There is a global demand for fertility services – primarily from wealthy and sophisticated patients who scan the world for a place willing to provide surrogacy services for older or non-traditional couples as well as those who are infertile, single, or identify as part of the LGBTQIA community. It also includes those who would like to employ new techniques to select a child of a desired sex, to avoid the transmission of hereditary diseases, or to conceive a “savior sibling” capable of providing a bone marrow transplant to a family member whose life depends on finding a compatible donor.

Approximately 20,000 to 25,000 women (often accompanied by their partners) seek cross-border assisted reproductive technology (ART) services.

Price of a Making a Baby

I Want a Baby: Travel with a Purpose!

An IVF cycle at clinics in the USA can run from $20,000 – $60,000 depending on the clinic, the services required, the age of the patient, etc. (ivfoptions.com). The average baseline cost for IVF in the Czech Republic is approximately $3,000, almost half the cost of the service in Spain.

According to the National Health Service IVF costs in UK can be relatively expensive with one treatment cycle priced at approximately US$6,950. However, this may not include additional costs associated with blood and virology screening or stimulation medication. Clinics frequently suggest further “add-on” treatments that may increase the potential success of any cycle.

The total cost of one round of own-egg IVF (and should that fail), an additional round of donor-egg IVF in Prague, including medication, airfare, food and several months of hotels is approximately $12,000 (less than half the cost of one cycle in the USA) (undark.org).

I Want a Baby: Travel with a Purpose!

A 2020 study asked couples at a fertility clinic to track all their out-of-pocket expenses over a period of 18 months, including what they paid for (the IVF itself) as well as medications and monitoring. The average couple spent $19,234. For every additional cycle, couples spent on average on additional $6,955. So, according to this study, in a couple went through three cycles, their expenses ran to over $33,000.

In Barbados, treatment costs can include:

IVF: $6250.
IVF with ICSI: $7250.
Pre-Genetic testing (Embryo fee – $300 for first embryo; $250 for each additional embryo): $2000.
PGTA transfer cost: $750.
Embryo Storage (first year): $275.
Embryo Storage (per additional year): $550.
Embryo Thawing and Transfer (including Assisted Hatching: $1500.
Embryo Adoption cycle: $4750.
Plus, multiple additional fees.

(barbadpsivf.com)

Before making a decision on where to go to make a baby, get a quote from the clinic(s) including:

Additional costs for assisted reproductive technologies that may be needed (i.e., ICSI, PGT, assisted hatching, testicular sperm extraction).
Any pre-IVF fertility testing or consultations (the clinic may require repeat tests).
Cryopreservative on extra embryos (if any).
Fertility drugs.
Mock embryo transfer.
Pregnancy testing (HCG beta blood work) to measure specific levels of HCG in the blood. HCG is a hormone produced in the body during pregnancy.
Yearly storage fees for frozen embryos.
If the clinic requires travel, include air/ground transportation, hotel accommodations, meals and time – off from work.

Services Available by Locale

Reproductive treatments can include in vitro fertilization (IVF) treatment with gamete (a mature sexual reproductive cell, as a sperm or egg, that unites with another cell to form a new organism) donation can be accessed in many parts of the world; however, in Spain, Denmark, and the Czech Republic gamete donation is strictly anonymous. In some countries (i.e., Germany, Italy, Norway, Austria and Switzerland)) egg donations are prohibited.

I Want a Baby: Travel with a Purpose!

Spain

Forty percent of European travelers searching for fertility treatments select Spain for medical facilities, encouraged by the law that allows treatments of single women and anonymity for donors. In 2016, 138,553 IVF cycles and 38,463 artificial inseminations were performed in approximately 307 public and private clinics. Many of the foreign travelers came from France and Italy visiting the country because of the more favorable laws and high-quality treatments. According to the IDIS Foundation “Spain is the leading European nation for Assisted Human Reproduction in number of clinics and cycles…Fertility tourism is growing in popularity.”

Denmark

Many of the children in Denmark are born through IVF or donor sperm resulting in the country leading the world in the use of Assisted Reproductive Technology (ART) to build families (estimated 10 percent of all births involved these techniques). Many Danish women, failing to find a suitable or interested partner to father their children have decided to go it alone choosing to become pregnant when they want to.

Denmark is an important destination for fertility services for single women, lesbians, and heterosexual couples as well as women/couples from Sweden, Norway, Germany, Italy, France, Ireland, Austria, New Zealand, and the UK seeking donated sperm.

It is interesting to note that infertile Danish women as well as heterosexual couples leave Denmark and travel to Spain and the Czech Republic, the Ukraine and Greece for donated eggs because of age and/or age restrictions.

Czech Republic

The Czech Republic offers low costs (as low as US $2,968) for IVF and egg donation (US $4,512) at over 43 clinics. The Czech Ministry of Health report on assisted reproductive technology found that more than a quarter of IVF cycles and nearly 90 percent of donated egg transfers were performed on foreigners. The liberal national legislation allows genetic screening and egg donation which is not true in some European countries.

Amy Speier, a medical anthropologist at the University of Texas Arlington who has studied reproductive tourism in the Czech Republic, found that people searching for “white” children will “…chose the Czech Republic over Spain because they imagine Spain only has Brown babies, which is totally wrong” (undark.org).

Belgium

In Belgium policies concerning assisted reproduction differ between secular and catholic hospitals. Patients who fear (or know) that they will not be accepted in a catholic clinic request medical assistance in a fertility center with a different moral viewpoint even it this means traveling to another city or another country.

Israel

Reproduction is an important market segment for Israel tourism, offering more than three decades of major technology in the assisted reproduction industry. In Israel a cycle of private treatment runs between $6,000-$7,000. In Israel the system really wants you to have a baby – and it is offered free to citizens and at a relatively low cost to private patients.

United States

People travel to the USA for surrogacy procedures because of the availability of high-quality medical technology plus legal protections to surrogacy via contract. Increasingly, same-sex couples facing restrictions using IVF and surrogacy procedures in their home countries travel to the US where it is legal. It is also a selected destination for surrogate mothers by couples seeking a green card in the US since the resulting child can get birthright citizenship in the US and can apply for a green card for the parents when the child turns 21 years of age.

Mexico

Cross-border fertilization has become increasingly important to the Mexican economy and its success can be attributed to its liberal ART and egg donation policies. The destination features over 50 clinics that use assisted reproductive technology. Mexico does not have legal regulations that restrict or prohibit IVF or egg donations in their clinics, making it a preferred destination for infertility treatment for people living in the United States.

Canada

Almost half the babies born to Canadian surrogates in British Columbia (2016, 2017) were born to foreign parents. The country is one of the few destinations that allows surrogacy for foreign commissioning parents and does not discriminate on the basis of marital status or sexual orientation. It is considered fairly efficient in granting legal parental rights, declaring legal parenthood and issuing birth certificates within weeks of birth. In addition, its strong and universal healthcare system makes it a favorable international surrogacy destination as pregnant women in Canada receive high-quality publicly funded healthcare throughout pregnancy, during delivery and after birth reducing the risk of pregnancy complications which are often a significant concern of commissioning parents.

Greece

Greece benefits economically from fertility tourism as approximately one thousand women head to Greece each year for assisted reproduction. There are more than 60 facilities in Greece with special ART units. Additional checks and balances in Greece are placed on the producers by the Greek National Authority for Assisted Reproduction (GNAA). The Authority is a national body that introduces and controls the scientific, legal and moral framework in which all clinics and organizations related to assisted reproduction are functioning.

Market Growth

As the demand for babies increases (projected to reach $51.51 billion for 2030), individual clinics are expanding the use of the internet as a source of patients, designing websites favored by international target markets and include such options as sex selection, a service not universally available. The clinics also use word-of-mouth marketing enlisting satisfied customers to help recruit others and an increased in number of brokers (i.e., travel agencies and fertility specialists) who offer information or arrange trips involving clinics abroad.

As clinics become larger, they may establish multi-jurisdictional partnerships or affiliations such as the relationship between an American clinic and a Romanian lab recruiting egg donors in Romania, fertilizing the eggs in Bucharest and then shipped back to the United States, allowing the patient to realize savings both in the price of the eggs and the medical procedures. The Fertility Institute lists offices in New York, Los Angeles, as well as a presence in Mexico, and India including a network of over 240 associated US and international fertility centers.

Know Before You Go

One way to determine the quality and reliability of a fertility clinic is to review the Global Clinic Rating (GCR -www.gcr.org), the leading provider of healthcare clinic ratings worldwide. The organization aggregates and analyzes fertility clinics throughout Europe including Spain, UK, Czech Republic, Cyprus, Poland, Switzerland and Germany. The clinics are compared to other clinics in Europe on the level of apparent expertise, services, facilities, and patient feedback collected by the clinic. The GCR feedback score also includes patient rating scores from Google and Facebook plus other independent rating providers.

In 2018 IVF Spain (Alicante, Spain) took first place with a GCR score of 4.56 based on data from 1,807 fertility/clinics monitored worldwide. In second place – Sanatorium Helois (Czech Republic) with a score of 4.52. Embryolab (Thessaloniki, Greece) took third place with a score of 4.36. All three clinics scored 5.0 for their Facilities score. It is important to note that the scores are very fluid and should be checked for current research.

Research and Plan

Before embarking on a Google tour of fertility clinics around the world, it is important to acknowledge that the decision to use IVF is realistic and may even be affordable. Once there is acceptance of fertility status it may be important to seek counseling and/or coaching to come to terms with the reality of the situation and evaluate the various options. It is critical that individuals and couples understand the diagnosis. research treatments and locales and be realistic about risks and rewards. The next “homework” is to check legislation/regulatory safeguards that apply in different countries (i.e., do they treat single women, same sex couples, do you need a travel or health visa).

Developing a viable budget is the next “to do” and it must be realistic in terms of costs and success rates applicable to the specific diagnosis and age. It is also important to determine if support is provided to international patients and speak directly with former clients of the clinic(s) being considered. Arrange a visit and/or online consult with the clinic(s) of interest and interview the team responsible for your care. As you narrow your clinic selection(s), request a final cost proposal and suggestions/recommendations as to additional expenses that could be incurred. Last, but by no means least consider the costs and time associated with travel and related out -of-pocket expenses as well as time away from work.

Once the decision has been made, create a support group and a team of local healthcare professionals who will be available in the case of emergencies once you return home.