ASRM on traveling for IVF

Are you considering traveling overseas for fertility treatment? Before you decide to opt for IVF treatment abroad, you may want to learn about the concerns and suggestions laid down by the American Society for Reproductive Medicine or ASRM on traveling for IVF. 

Are you getting a better deal, better service or facilities? Does the destination country have restrictions and privacy concerns for IVF treatment? After IVF can you travel?

The ASRM ethics committee notes that even though doctors have no obligation or duty to inform their patients of the opportunities in cross-border reproductive care (CBRC), but when a patient approaches them with questions regarding IVF abroad, they should not misinform or mislead them(1).

For the best outcomes and safety of the patients, the clinics in both departure and destination countries must uphold local standards of care and transparency in all their dealings.

Finding the best fertility treatment abroad

Traveling abroad for fertility treatment and there are three most important factors to consider:

1.    Are you eligible for IVF treatment?

The age limit for IVF varies between countries and genders. The ‘Advanced Reproductive Age’ for women is usually considered 40+ years (2). But for women seeking IVF after 40, there are many options like Spain and Malaysia, where you can get IVF done up to 50 years or even higher. The legal age limit for IVF in Russia, Cyprus, and Estonia is 50 years, while it is 54 years in Greece.

You should find out your eligibility before planning your travels.

2.    Legal restrictions for IVF in different countries

While some countries have more liberal guidelines for IVF practice, others have restrictions for single women and same-sex couples to seek treatment. If you are planning to travel abroad for IVF for affordability and liberal laws, you may consider these destinations:

  1. Denmark: Denmark is an often overlooked but one of the best destinations in Europe for its relatively liberal laws for single women, LGBT couples, and third-party seeking restrictions with donor gametes. While it is an expensive country, IVF in Denmark is relatively affordable.
  2. Spain: Although more expensive than Denmark for IVF, Spain is not only a preferred tourist destination, it is also sought by couples seeking fertility treatments in Europe as it is known for its friendly laws for donor IVF.
  3. India: The low cost of IVF makes India a preferred destination for patients across the globe. The regulatory laws are favorable for most people but the following are banned in India:
    • Commercial surrogacy for foreign nationals
    • Gender selection with IVF
    • Identification of egg or sperm donors
  4. Mexico: For Americans and Canadians, IVF in Mexico is a quick and easy option just across the border. IVF with donor eggs is legally allowed in Mexico and so is surrogacy.
  5. Malaysia: People from China, Fiji, Philippines, Indonesia prefer IVF in Malaysia for the high-quality medical expertise and very organized healthcare system. IVF with donor eggs and PGD/PGS testing with IVF is legally allowed here.
  6. Thailand: IVF in Thailand is a reliable and affordable option and it is a favored tourist destination for people from Australia, New Zealand, the UK, the middle east, China, India, the US and pretty much all parts of the world. Legal guidelines in Thailand are however strict and donor eggs or sperm are not allowed. Thailand has also put restrictions on the export of gametes/embryos.

3.    Cost & Quality Care

There is a vast global disparity in the cost and quality of care for IVF treatment. The average price of an IVF cycle is the highest in the US (3) while it is significantly low in India (4). Apart from the main IVF treatment, you must factor in the cost of investigations, medications, and your travel expenses.

Concerns of ASRM on traveling for IVF

1.    Ethical Concerns

Some of the ethical concerns of ASRM on traveling for IVF are:

  • Practicing transparency and autonomy by the doctors and clinics
  • Awareness about risks and benefits of CBRC
  • The exploitation of egg or sperm donors
  • Follow-up care

2.    Health & Safety

Before Treatment

Patients who seek IVF must begin their journey from home. Before you travel to the destination country it is of vital importance to submit pre-investigated reports and certain test reports as per the medicolegal requirements. Test your fertility levels and get the doctor’s opinion before you travel.

During the Treatment

There are no international laws about quality control and standards of care for CBRC patients. IVF success rates are not dependable and should not be the only deciding factor. The treatment plan should depend on the type, duration, and severity of the fertility problem, the standards of care, and the expertise of the doctor.  

Post-treatment

IVF is a technique sensitive procedure and there are risks at various stages. Improper treatment can lead to health issues, birth complications, and even loss of life, particularly in the context of multiple pregnancies.

This is especially true in CBRC where limited patient information, time constraints, out-of-pocket payments, desire for rapid success, and competition between fertility centers may push towards more aggressive fertility techniques. High-order multiple pregnancies have forced some countries to limit the number of embryos transferred in any single IVF cycle (5).

3.    Economical concerns

Careful patient selection, proper investigative methods and procedures, and minimizing the chances of multiple IVF cycles can significantly bring down the overall cost of IVF treatment.

As more people travel across the borders for IVF, the ASRM also has concerns over rising costs that the local community may be exposed to.  

4.    Psychological issues

Misinformation and the presentation of false information cause emotional and psychological setbacks to the patient. Always remember that with good quality care, both you and your child would be benefited.

Finding the best IVF doctor who will guide you to early and preventive measures would increase the chances of a healthier outcome.

5.    Legal

As mentioned above, you must check the legal guidelines of the destination country before traveling for IVF.

Finding the right IVF clinic overseas

Selecting the right IVF clinic is imperative to feel safe and comfortable in your IVF journey.

Some of the things to consider are:

  • Is the clinic well-equipped?
  • What do previous patients have to say?
  • Which body has accredited and provided the license to the fertility clinic?
  • Are the doctors well-qualified and experienced?
  • What is the clinic’s pregnancy rate?
  • What is the cost of the IVF treatment?
  • Are there any hidden costs?
  • Are they quick to answer your questions?

When a patient who receives IVF treatment abroad returns to the home country, it is important to resume additional care. In such times, it becomes important to take the help of medical support near you that you can trust while you are away from your destination doctor. Discuss with your local fertility specialist beforehand to avoid finding a doctor at the time of emergency.

Travel during the IVF cycle

Since the initial part of IVF requires self-administration of hormone injections, some people prefer to start the treatment locally before they travel to the destination country for egg collection.

When flying with IVF medications, always carry your prescription. You might be required to inform the security officer at the checkpoint if you are traveling with liquid medications.

Keep the contact information of your fertility specialist handy so, if you need anything while traveling, you can quickly ask. 

Does traveling affect IVF pregnancy after the successful embryo transfer?

Most doctors recommend atleast 24-hours rest after embryo transfer (ET). You may even be asked to do some light activities to cause blood flow in the uterus and increase the chances of pregnancy.

Any abnormality in the embryo, endometrium, or immune system can result in an implantation failure. Therefore, if you are planning to travel to rough destinations or take long-haul flights, it is advisable to wait for a few days.

The pregnancy test is typically done after two weeks of the ET but most patients fly back home before that.

Make sure to ask your fertility doctor for a one-point contact, in case you need any assistance over the phone, after you fly out.

 
All advice of ASRM on traveling for IVF may not apply to each couple or individual but there are some valuable suggestions to consider so as to make your IVF jounrey overseas easier and safer.

References:

  1. Ethics Committee of the American Society for Reproductive Medicine; Cross-border reproductive care: an Ethics Committee opinion: https://www.asrm.org/globalassets/asrm/asrm-content/news-and-publications/ethics-committee-opinions/cross-border_reproductive_care_an_ethics_committee_opinion.pdf
  2. Kimberly Liu, Allison Case, Reproductive Endocrinology and Infertility Committee, 2011 Nov;33(11):1165-1175. doi: 10.1016/S1701-2163(16)35087-3
  3. Wu AK, Odisho AY, Washington SL, Katz PP, Smith JF. Out-of-pocket fertility patient expense: data from a multicenter prospective infertility cohort. J Urol 2014;191:427–32. https://doi.org/10.1016/j.juro.2013.08.083
  4. Pek Joo Teoh and Abha Maheshwari, Low cost in-vitro fertilization: current insights, Int J Womens Health. 2014; 6: 817–827. doi: 10.2147/IJWH.S51288
  5. Practice Committee of the American Society for Reproductive Medicine. Guidance on the limits to the number of embryos to transfer: a committee opinion Volume 116, Issue 3, P651-654, September 01, 2021. DOI: https://doi.org/10.1016/j.fertnstert.2021.06.050

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