Cross-border reproductive care in Europe
Dr. Juan Torón of Tahe Fertilidad explores why a significant number of couples are opting to travel abroad for fertility treatment each year.
Although the actual figure of couples opting for fertility treatment abroad is unknown, the couples travel to obtain fertility treatments such as assisted reproductive technology (ART), including IVF with or without ICSI, Pre-implantation Genetic Diagnosis (PGD) and gametes or embryo donation as well as intrauterine inseminations (IUI).
This phenomenon is known as Cross Border Reproductive Care and is a very complex problem.
It is a major phenomenon that involves many different levels of our society. It is not only a medical problem. It is also a legal, financial, political, social and ethical problem that involves patients, doctors, politicians, legislators and many other people.
Cross Border Reproductive Care policy
The different laws in the European countries make Cross Border Reproductive Care possible. These laws take different forms ranging from the prohibitive approach (Italy, Germany and Austria), the cautious regulatory approach (Denmark, Sweden, Norway and France) and the liberal regulatory approach (the UK, Spain and the Netherlands)
European law grants citizens of member states the right to freedom of movement for the purpose of purchasing goods and services abroad. This means that European nations may prohibit certain reproductive procedures at home but cannot prevent or penalize their citizens from seeking those prohibited procedures in other European countries.
It is impossible to know how many people are involved in cross border reproductive care. The lack of an International register and the lack of local registers for cross border reproductive care make it difficult to know the correct numbers.
Analysing different publications we could make an approximate estimation of around 15,000 couples and 40,000 treatments. And it seems to be a growing phenomenon. Spain alone is thought to have around 16,000 cycles per year in 2012 (320% more than those performed in 2006). And there are several other countries that play an active role as destinations of cross border reproductive care, such as Czech Republic, Switzerland and Belgium.
Why seek fertility treatment abroad?
Several reasons account for cross border reproductive care. In some cases a certain kind of treatment is forbidden by law in the couple’s own country or is inaccessible to the couple because of their demographic or social characteristics (like age, sexual orientation or civil status). Other people look for foreign centres reporting higher success rates compared with those of the centres in the country of residence. Sometimes specific treatment may be locally unavailable because of a lack of expertise or because the treatment is considered experimental or insufficiently safe. Other reasons are limited access to the treatment in the couple’s home country because of long waiting lists, excessive distance from a centre or high costs.
The most popular destinations are Spain and the Czech Republic. Around 60% of patients travelling to these countries seek egg donation treatments. These countries have a permissive law which facilitates these procedures. Whereas in Spain and the Czech Republic egg donation is strictly anonymous for donors and recipients (the clinics act as brokers of reproductive substances and keep personal data private), in countries like Denmark, Sweden and the UK, egg donation is possible but has to be performed non-anonymously.
Although in Spain and the Czech Republic the donation of gametes is regulated and marketed as ‘altruistic’, the compensation rate for donors is much higher than what is paid in other countries.
However, the degree of the compensation may not be the only reason for the high number of gamete recipients in these countries, since in Spain there is a strong tradition of donation reflected in the high rate of organ donation (the highest rates in organ donation in the last 30 years according to the EU Health statistics).
Most of the experts who analyse the phenomenon agree that cross border reproductive care will continue to increase in the coming years, but all agree that monitoring travel, analysing the causes, shedding light on the problems and promoting public discussion are necessary to promote measures for patients’ benefit. Currently, two European institutions have started to examine the phenomenon: ESHRE (European Society of Human Reproduction and Embryology) established a task force to specifically study cross-border reproductive care, and the Commission of the European Parliament proposed a Directive to improve the quality, safety and practical aspects of cross border health-care.
About the author
This article was written by Dr. Juan Carlos García Torón of Tahe Fertilidad, Murcia.
Tahe Fertilidad in Murcia, Spain is a modern, state-of-the-art fertility centre that brings together a multidisciplinary team of fertility specialists in a pleasant, intimate and welcoming setting. Over 50% of patients at Tahe Fertilidad come from other European countries and treatments available include artificial insemination, IVF, ICSI, egg donation, pre-implantation genetic diagnosis (PGD), egg vitrification and embryo freezing.