Unequal access drives fertility tourism, experts say

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Patients who cross borders in search of cheaper, more available fertility treatment can now choose from more than 100 countries but may be putting themselves and their babies at risk, experts said Tuesday.

The European Society of Human Reproduction and Embryology (ESHRE) and the International Federation of Fertility Societies (IFFS) said a survey of reproductive services showed wide disparities between laws and practice in many countries. As a result, patients returning home may face legal or medical problems.

“Although in principle the care of foreign and local patients should essentially be the same and fit the best possible standards, there is evidence that it is not always so,” ESHRE’s Francoise Shenfield told reporters at a briefing.

A survey of 105 countries by the IFFS found that cultural, religious and social differences in attitudes to fertility treatments such as using donated eggs, sperm or embryos mean there are wide variations in the number of clinics that offer treatment, and the services they provide.

In vitro fertilization (IVF) involves removing eggs from a woman’s ovaries and combining them with sperm in a lab. The strongest embryos are then implanted into a woman’s womb. In theory, the eggs, sperm and embryos can all be donated.

The IFFS survey found there are over 500 fertility clinics in India and about 615 in Japan, but only 66 in Britain, 120 in Germany, 200 in Spain and around 360 in Italy.

IFFS education director Ian Cooke said discrepancies in access prompted patients to travel abroad for treatment, but could leave them in medical, financial or legal difficulties.

LEGAL DIFFERENCES

One major problem is the rules on the maximum number of embryos that can be transferred to a woman’s womb after IVF.

In Britain and Scandinavia only one or two are allowed, but other countries have higher limits or none at all - a factor that can increase the number of multiple pregnancies that can pose risks for both mothers and babies.

Freezing embryos is banned in Germany, Italy and Croatia, but freezing eggs before they are fertilized is allowed. In Britain the removal of donors’ anonymity has led to a severe shortage in donated sperm.

Sperm and egg donation is banned completely in many Islamic countries, and in France lesbians are not allowed access to donated sperm. Turkey has recently banned anyone going abroad to receive donated sperm or eggs - a law which the experts said was almost completely unenforceable.

“If a woman goes on holiday and comes back pregnant, who is to tell exactly how or when she got pregnant?” said Shenfield.

Both IFFS and ESHRE support the rights of patients to travel to receive fertility treatment, but said in a joint statement that “ideally, this should take place in their home country.”

They urged national health authorities to try to harmonize standards to increase the safety of patients and offer equal treatment for all those who want it.

“The variation in international laws relating to infertility treatment is one of the reasons that cause couples to seek cross-border treatment,” said Cooke. “Whilst this is unavoidable we call for international standards to ensure these patients receive consistent advice and safe treatment.”

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By Kate Kelland, Health and Science Correspondent

LONDON (Reuters)

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