U.S. women crossing globe for fertility help

In August of 2005, Shauna Anderson treated herself to a vacation of sorts: three weeks in Cape Town, South Africa, more than 10,000 miles from her home just outside Seattle, for a little respite, a safari — and a round of in vitro fertilization (IVF).

Not your typical vacation itinerary, but one that’s becoming increasingly popular among American women struggling with infertility issues and overwhelmed by the cost of IVF in the United States. By traveling abroad for fertility procedures, women can pay thousands of dollars less than what they’d spend at home.

But some experts caution women to look carefully at the standards, practices and success rates of foreign clinics, especially those that are located in poorer countries and offer donor eggs. By going overseas, women may be paying for a procedure that has a lower chance of success than in the U.S. And there’s been at least one reported case of a Romanian clinic recruiting illiterate donors and failing to take appropriate measures to make sure that those donors were giving fully informed consent.

Anderson, now 35, says the path that took her beyond borders began four years ago when she decided to become a single mom and underwent inseminations using sperm from an anonymous donor.

Crossing the line
“Cycle after cycle, I kept having negative results on the pregnancy test,” she says. “Then I started to add drugs to the protocol, and that didn’t work. I had a couple of surgical procedures to make sure the pipes were clean, and that didn’t help. Before I knew it, I’d crossed the line into IVF.”

And a new realm of financial commitment. Anderson ’s insurance would cover only the diagnosis of infertility, not any treatments, so she paid out of pocket for two IVF procedures in Seattle. Neither produced a pregnancy. By that point, she was down more than $15,000 — still, a drop in the bucket compared to what some U.S. women end up paying. The average cost of IVF in the U.S. is currently about $12,000 per cycle, according to Pamela Madsen, executive director and founder of the American Fertility Association, a patient education and advocacy group.

Anderson first got the idea to investigate IVF abroad after reading an article on the rise of medical tourism for procedures such as hip replacement and cataract surgery. She was inspired to investigate South Africa, among other countries, as she’d been following the blog of a South African woman who’d been navigating her own fertility problems.

After two weeks of Internet research and several late-night phone calls to clinics around the world — seeking information on everything from success rates to lab controls to sanitation standards to their willingness to treat a single woman — she chose a clinic in Cape Town, booked a flight and headed south.

The cost of her three-week IVF vacation? About $6,400, including airfare and hotel stay. Anderson’s IVF — including drugs, procedures, and lab and hospital fees — accounted for just $3,600 of that total. 

Interactive Learn more about the techniques used to help infertile couples conceive a child.

While there are no overall statistics collected on overseas IVF, the Cape Fertility Clinic, where Anderson underwent her IVF, reports 10 to 15 patients from the U.S. per month so far in 2007, roughly double the numbers it saw in 2006. And last month’s media reports on the 60-year-old New Jersey woman who gave birth to twins, produced after a visit to a South African fertility clinic specializing in older patients, will likely serve to increase those numbers — especially among women who seek to have children later in life.

The American Society for Reproductive Medicine (ASRM) hasn’t issued an official stance on this trend, but for women who are looking into the overseas option, Dr. David Adamson, the fertility organization’s president-elect, warns them to be aware of what they may be giving up — namely the oversight and standards that apply to IVF clinics in the U.S.

The federal Centers for Disease Control and Prevention validates and reports clinic success rates, for instance, and the Food and Drug Administration requires registration of all clinics providing sperm and egg donation services.

Adamson also points to the success rates for IVF in the U.S., which, he says, are quite high, compared to other countries in the world.

Shopping for donor eggs
In addition to less costly IVF, the prospect of cheaper donor eggs is also sending American women abroad. In the U.S., introducing donor eggs to the equation typically means adding thousands of dollars to the cost of IVF, in the form of donor and agency fees and costs associated with donor screening (for genetic issues, STDs, etc.) and care.

That’s what Fran, who asked that her last name not be used, discovered as she contemplated her first IVF cycle earlier this year. Unable to conceive after a year of trying, the 44-year-old began researching IVF at clinics near her home in Massachusetts. Like Anderson, Fran and her husband were faced with paying for the treatment out of pocket, as their insurance wouldn’t cover it due to Fran’s age. Doubting that she’d have success with her own, Fran and her husband decided to use donor eggs, but after researching the local options, she says they learned they could expect to pay about $30,000.

Through a friend of a friend, Fran heard about a clinic in the Czech Republic. Naturally, she had questions. “I didn’t want to be on someone’s couch in an alley,” she says. She contacted ivfvacation.com, a Web site run by an Ohio-based husband-and-wife team that helps American women arrange and take IVF vacations to the Czech Republic. Their services include helping women fill out medical questionnaires prior to departure, booking accommodations and car rentals, planning tours and arranging translating services for clinic appointments.

They referred Fran to past clients and pointed her toward an Internet bulletin board, where she found postings about the agency and the clinic it uses, the Clinic for Reproductive Medicine and Gynecology in Zlin. The facility, about three and a half hours from Prague, reports having treated 40 women from the U.S. last year, and, on average, seven to 10 American women each month in 2007.

There is no international body regulating fertility clinics on issues such as donor recruitment practices and safety standards. In the European Union, a law was passed last year setting standards for the donation, testing, storage and so on of human cells and tissues; however, it’s up to individual member countries to regulate compliance. IVF patients who, like Fran and Anderson, choose to go abroad often rely on the Internet to hunt for information on the services and standards of individual clinics outside their home countries.

Video: In pursuit of fertility Conceivable? June 27: Is a fatherless child conceivable? Recently London's Dana Center hosted an evening to learn more about the topic from the experts. NBC's Chapman Bell reports.  Pregnancy and the risk of anti-depressants How to tell the boss you're expecting Masche sextuplets update Widow gets pregnant with fallen soldier's frozen sperm 'I want a baby' 60-year-old Mom did this ‘to help others’ Why can't I stay pregnant? Questions about infertility Is there a male biological clock?

Guido Pennings, a professor of ethics and bioethics at Ghent University in Belgium and co-coordinator of the Task Force on Ethics and Law of the European Society of Human Reproduction and Embryology (ESHRE), cautions that women researching their options this way should be careful. Success rates published on a clinic’s Web site, for example, may not be accurate. If a country doesn’t have a central registry that monitors fertility clinics’ reported rates, “there’s no way they can prove it to you,” he warns. And while a country may have laws seeking to regulate clinics in these and other matters, Pennings says, “You can have a good law, but if no one checks it, you won’t know if clinics are following the rules or not. That is the case in a lot of European countries.”

Pennings also notes concerns over donor consent in poor countries, such as the case in Romania where illiterate donors were reportedly recruited. He warns that the poorer the country, the greater the risk of this sort of practice.

The AFA’s Madsen echoes Pennings’ concerns regarding reported success rates. She advises women looking at clinics abroad to check to see if rates are verified by a government body or a private auditor. In addition, she encourages women to ask, “‘Are rates divided by age, or do they give one number’ — which means there could be patients under 25, and you are a 37-year-old woman.”

MORE FROM BABYQUEST

BabyQuest Section Front

Pass it on: Sons of infertile men may be next Dad with CF beats infertility, hits a double Getting off the infertility-treatment treadmill Not giving up hope for a biological baby Readers share their own ‘baby quests’ Will science render men unnecessary? His biological clock is ticking, too Should kids be conceived after a parent dies? Dads don’t come from labs, readers say 2-for-1 is no baby bargain BabyQuest Section Front   Add BabyQuest headlines to your news reader: