'Fertility tourism': risk or choice?

Last week, the European Society of Human Reproduction and Embryology (ESHRE) released data on IVF and ICSI success rates across Europe. This showed, among other things, that fertility clinics in some eastern European countries that have recently joined the European Union have success rates equal to or better than those in the UK. While the data collected from some of these countries may be collected differently from that in the UK (therefore not necessarily reflecting an accurate comparison), two countries in particular, Hungary and Slovenia, have what ESHRE called 'a good system of collecting data' and reported very good pregnancy rates after embryo transfer.

Good news, one might think, especially when fertility treatments are also cheaper in these countries. But the media - perhaps unsurprisingly given the title of ESHRE's own press release - pounced on the fact that impressive success rates, together with reduced cost, may encourage infertile people to travel abroad for treatment. Generally, such 'fertility tourism' from West to East was presented negatively in the media reports, with 'hidden risks' and 'threats' cited in headlines. But why should this be? What is wrong with travelling to another country for IVF treatment, when you may have as much chance of being successful, for less financial cost?

Suzi Leather, chair of the Human Fertilisation and Embryology Authority (HFEA), was worried that 'fertility tourists' may not receive the same standard of care in foreign clinics. 'I can understand why people would want to go abroad', she said, but qualified this, saying 'But where treatment is not regulated there is no way that patients can be sure of the safety or the results advertised by clinics'. And, according to some reports, doctors warned that 'the experience of spending many weeks in a foreign country during treatment might be 'miserable' and increase stress. Professor Karl Nygren, co-author of the ESHRE report, said 'the general care of a patient is just as important as the treatment, and this can be disrupted if you go abroad'.

None of the arguments presented seem to be a good reason to stop - or even to try and stop - people travelling for treatment. Cheap flights and cheap, but successful, fertility treatment, seem like an attractive option. And reports in last week's Lancet show that Slovenia, for one, has an excellent healthcare record and the highest healthcare expenditure in central and eastern Europe. Hungary follows not far behind, coming third out of the fifteen countries compared. So exactly what are the increased risks? The risk of having your luggage lost by a no-frills airline? The risk of struggling with the language while abroad and being a bit more stressed because of it? Perhaps even the risk that in clinics regulated differently, or who collated their results differently, the success rates aren't quite what they seem?

When balanced against the potential benefits, not least actually having a baby, this is an area where patient choice should prevail. For some patients, the risks may be ones worth taking. They might consider that it is better (or less stressful) to go abroad for treatment than to spend years on a waiting list for free IVF treatment (if it's even available in their area at all), or to pay around £4000 for private treatment. Travelling to eastern Europe for treatment might enable a couple to afford three cycles of treatment, for the same price as one in the UK.