"EU faces fertility tourism threat," a BBC headline warns. "Fertility tourism may be next European boom," declares Reuters. But what is it, and why is it booming?
Fertility tourism occurs when aspiring parents travel from their home country in which assisted reproductive procedures are expensive and legally awkward to nations where the procedures are cheaper and legally comfortable. In-vitro fertilization (IVF) is particularly popular. IVF involves fertilizing a woman's eggs with sperm in a lab dish and, then, placing the fertilized eggs in the aspiring mother's uterus. The eggs and/or sperm may be donated by a third party. These days, the term "fertility tourist" most often describes women from the UK who travel to Eastern European countries -- such as Slovenia and Hungary -- in order to become pregnant at a fertility clinic.
Thus, the media and medical authorities in the UK have proclaimed the birth of another "social problem": foreign fertility clinics are not sufficiently regulated. The "problem" is made worse since both Slovenia and Hungary have just joined the European Union, making their clinics even easier for British women to access.
In one particular, at least, the "problem" is not being exaggerated. Given that one in 10 couples fail to conceive naturally after trying for a year -- this, according to the American Society for Reproductive Medicine -- the potential customer base for foreign clinics is huge. But the reason those customers travel is because they are ill served by fertility clinics and laws at home.
Consider the choices confronting a British woman who has difficulty conceiving. An IVF procedure in the UK typically costs from £2,000 to 4,000 ($3,750 - $7,500); the same procedure in Slovenia or Hungary will cost around £1,608 ($3,000). The success rate for impregnation from one cycle of IVF treatment in the UK is 28.4%; Slovenia's success rate is 36%; Hungary's is 31.9%.
Changes introduced by the British National Health Service (NHS) may influence the popularity of fertility tourism to some extent. The NHS recently approved IVF coverage for women from ages 23 to 39 who have been trying to conceive for more than three years but that coverage is limited to one free procedure. Moreover, the NHS-funded treatment is being made available first only to couples without child.
Currently, an estimated 3 out of 4 couples undergoing IVF in the UK pay for the procedure directly. Despite the "one-free procedure," there are reasons to believe that the ratio is unlikely to change significantly. NHS-funded IVF still faces severe moral, political, and economic hurdles in its implementation.
Pro-life advocates challenge the morality of creating more embryos, some of which they claim will be killed or used in experiments. Political opponents decry the diversion of tax-funds away from major disease to infertility. Those responsible for implementing the "one-free procedure" warn that it could take years for the policy to achieve wide implementation.
Another little-discussed reason for fertility tourism looms large. Many aspiring parents dislike the laws that control fertility in the UK and are attracted by the more flexible foreign policies.
Consider 'Mary', whose story was told by The Telegraph. For years, British women have traveled abroad to find egg donors; Mary joined their ranks. She went to a Spanish clinic and became pregnant at the first try. She preferred the Spanish clinic for two reasons. First, there was the issue of anonymity. As of April 2005, the identities of British sperm and egg donors will be a matter of record, allowing children conceived from those donations to track down their genetic parents.
Mary stated, "I would hate to think that she [her daughter] would ever find out. As far as I'm concerned, she is my daughter. I carried her and my partner is her biological father." But the anonymity involves more than merely maintaining parental control over information. With the UK's family law in flux, a biological parent could possibly press for visitation rights or similar intrusions.
The second reason Mary preferred Spanish clinics was the wide availability of donated eggs in contrast with the shortage in the UK. Anonymity plays a role in the supply of eggs as well.
Donors are reluctant to abandon anonymity. Dr Paul Rainsbury, who runs a fertility clinic in London, claimed, "There is now a waiting list for two to eight years in this country for egg donations. Ten years ago when we put out an advert asking for egg donors we would get 20 replies. Now we get none. The loss of anonymity is major problem. Will women go through an egg donation for a woman she doesn't know if there's a risk that the child will turn up 20 years later?" Such a child might use the courts, for example, to establish a claim on inheritance or support. Where anonymity is maintained, donated eggs are more abundant.
Economic factors also determine availability. For example, under UK law, donating women can be paid only £15 plus "reasonable expenses." The Telegraph reported that "in Romania, where the average income is £1,100 a year, women get around £150 [for an egg donation]." Predictably, medical authorities in the UK are loudly and publicly worrying that Romanian women are donating eggs for the "wrong" motives.
There is currently a clear attempt to stem foreign involvement in British conceptions. For example, the Bridge Centre in London is in the habit of sending frozen British sperm to Bucharest to fertilize eggs provided by Romanian women. The frozen embryos are shipped back to London where they impregnate British women. Although the Romanian clinic has been examined and approved by Bridge Centre, the Human Fertilisation and Embryology Authority which regulates fertility treatment in Britain is planning an inquiry. Inspectors have informed Bridge Centre that future licences to export sperm and import embryos "should not be taken for granted".
The fertility tourists don't seem to be complaining, however. Mary described the Spanish clinic to the Telegraph. "When we went out to Valencia, they were so quick, and so professional. The tests were more thorough than in England and, unlike British clinics, there was no waiting.... Criticisms of so-called fertility tourism are nonsense."
Mary's daughter "cost" several thousand pounds, which is only a bit steeper than one IVF treatment in the UK. And there was no wait. If Mary's high level of satisfaction with a foreign clinic is an indication of the general response, it will difficult to impossible for authorities to clamp down on fertility tourism.
Smuggling an embryo back home in your womb is a difficult crime for a customs official to detect. And even if he does, how will he prove it is a forbidden foreign good?
