Almost inevitably, when you first mention to anybody that you are thinking about going overseas for fertility treatment you will be faced with a look of disguised horror.  Of course, some hide it better than others but hardly anybody grasps the concept quickly.  Most probably, the person going for the treatment had the same feeling when the possibility was first raised.

So how did it come to this?

In order to understand why someone has chosen to travel to a strange country to seek fertility treatment you have to appreciate that almost anybody doing so will probably have heard the words “I’m afraid that it’s highly unlikely that you will ever be able to conceive a child given your circumstances”.  Pretty devastating.

Many IVF doctors will explain that there is the possibility of getting a donor to donate sperm or eggs (whichever is required) or both but that there is a lengthy wait for donor eggs running to many years unless there is a willing relative or friend who is a suitable donor.  If the hopeful mother has a rare blood group the slim chances virtually evaporate.

Commonly, couples hearing that they won’t be able to continue with IVF in the UK consider adoption and for many this is a comfortable alternative.  For some, however, this is not the desired solution perhaps due to age after having had many years of IVF restricting the likelihood of getting the chance to raise a baby rather than a toddler or child.

Many of the support groups and infertility websites now include sections on going abroad and couples often drop in to satisfy their curiosity and find a significant group of well informed women and couples with a wealth of information ready to offer whatever advice they can.  Before the widespread availability of the internet and its stock of cheap flights and accommodation together with the vast amount of information available it was completely impractical for any individual to research clinics overseas and to feel comfortable enough to go abroad for treatment.

What’s the advantage of going abroad for IVF treatment?

Clinics overseas offer most of the same treatments as are available in the UK.  The difference is in the approach of both governments and cultures towards infertility which differ from country to country.

Issues which can influence a couple’s decision to go overseas include:

• More readily available donor eggs/sperm.
• Donor confidentiality.
• Donors younger than available in the UK.
• Numbers of embryos transferred per IVF cycle.
• Cost of treatment in comparison to the UK.

Other than cost the main reasons centre around countries who offer compensation to women prepared to donate their eggs or men their sperm.  Compensation is usually set by the government of the country at a rate which ensures that donors have their medical expenses met, cover the cost of time taken off of work for scans and appointments and to cover the inconvenience of several weeks of treatment regulating their cycle to match the recipient and the ovary stimulation treatment itself.

Some countries allow more than two embryos to be put back into a recipient’s womb which can increase the likelihood of success (HFEA currently considers two to be the maximum and is considering lowering this to a single embryo).  Most couples going overseas will have taken this into consideration and will choose their clinic tailored to the treatment they intend to pursue.

The first step

Most support websites list various recommendations and feedback for a number of clinics and couples frequently “buddy” up with those with experience of the clinics they are considering and tap into their knowledge.

In many cases Spain is the first choice as it is easy to get to and has many reputable clinics some even sporting British staff to put your mind at ease.  However, some of the Spanish clinics have relatively long waiting lists for donors with northern European features and so couples often find themselves seeking the services of clinics from Russia, Ukraine, Czech Republic, Greece, Poland or even Barbados.

The prospect of travelling to eastern Europe can be daunting but many find that the over-funding of healthcare by former communist countries means that there are plenty of doctors with the latest technology willing to take on private patients.

Usually clinics will have a web site with photographs, qualifications and possibly some indication of success rates.  First contact will be through the overseas liaison officer who will advise on price of treatment, length of waiting (in any) and will make arrangements to meet with you at the clinic for a day or so to fill out the forms, discuss treatment and carry out blood tests and so on.

Getting ahead

Not long after the initial consultation couples will start to get regular e-mails advising on their likely donor’s availability, drugs and treatment required in the UK and how to prepare for treatment overseas.  It varies from clinic to clinic but most will try to give a week or two’s notice of when the donor will be ready for egg collection (assuming that donor eggs is the reason for treatment) and arrangements need to be made to cancel the milk and papers and to re-house the family pet with a tame relative or friend.

Treatment is quite similar to the UK and requires various ultrasounds and blood tests before transfer.  The most exciting period is when the clinic phones to tell you how many eggs have been collected and then updating on how they are dividing.  Many older women are delighted to hear of large numbers of eggs and embryos where they have been used to having more meagre responses during their IVF cycles.

After transfer most wait a day or so before flying home for the worst period of any IVF – the two week wait!

Back home

Every couple goes stir-crazy to some degree and the websites are full of those with symptoms, no symptoms, bleeding, queasiness and every other imaginable feeling.  The hormones given to help sustain pregnancy don’t help much either – no excuse for the blokes though.

Your clinic will give you a definite date to travel to your local clinic for an HCG pregnancy test but many jump the gun with home tests.  Either way within three weeks everybody knows of they have a big fat positive/negative.

If it is a positive you go on as if you had been successful naturally and it is up to you to decide who to tell and what to say.

What if it has gone badly?

Not everybody has a successful time with any type of IVF and some move on to adoption or resign themselves to having a splendid life without children. Most clinics are keen to carry out diagnostics and in many cases these have helped make future treatments successful. Either way, the decision is with each couple as to what they need to do.

What do you have to think about for the rest of your life?

For many, IVF abroad puts them back in control of their treatment.  If they elect to adopt then this will be at the behest of social services; if they continue to try naturally then they are living in hope.

The downside is that with a donor from overseas there will always be one side of the couple whose genes are not represented in their children.  Additionally, couples need to consider who they will tell and whether they will tell their child or not.

Some from the Donor Conception Network believe that the donated egg cells should be treated like adoption and that the resulting children should be introduced to the culture of the country of the clinic in which transfer took place.  This view is not universally endorsed and many consider that donated cells are not culturally aware and, in any event, the donor may well be from a country other than that of the clinic.

However although it should not be entered into lightly, IVF abroad is not something which should be feared.  There are hundreds of success stories in the UK and many more contemplating treatment abroad.

For our part, we had a consultation in Spain at CERAM but due to the wait for a rare blood group match we switched to Altra-Vita in Moscow.  Our initial cycle was unsuccessful but the post-treatment diagnostic has revealed the cause of infertility (unexplained for many years) and we are now about to undergo corrective surgery which could aid us in natural fertility although we intend to go back to Altra-Vita for more IVF next year.  Our faith in the IVF overseas network is robust and, with so many of our contemporaries being successful, we hope we will achieve our goal of children in the months and years to come.

Useful Links

Fertility Friends Overseas Support board

http://www.donor-conception-network.org/