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Cross Border Reproductive Care: Is it for you?
Why it's not fertility tourism and, if you're in the U.K., why it may be for you.
Cross-border reproductive care - often referred to as 'fertility tourism' - is the booming phenomenon of individuals and couples travelling overseas for fertility treatment.
“There are no palm trees or hammocks,” begins lawyer Amy Demma, Founder and Principal of Prospective Families, an egg donor agency in Wellesley, Massachusetts, “so let’s not call traveling to another country for infertility treatment ‘fertility tourism’ or 'reproductive tourism.'” It’s a medical procedure, she emphasizes, which is why she’s adamant about calling the emerging trend “cross border reproductive care.” A word of advice from Demma, “If you’re being offered treatment that’s being portrayed as any kind of a vacation, be skeptical.”
Advantages of U.S. Treatment
While U.S. residents have been enticed by promises of inexpensive, less-restrictive fertility treatments abroad, cross-border reproduction is also occurring as patients from other countries travel to the U.S. for treatment. Because regulations in the U.K. restrict egg donors from being paid for their services, for instance, the small pool of available eggs is forcing British women to come to the U.S. for treatment.
In addition to having a larger supply of egg donors, there are several other reasons a U.K. patient would choose treatment in the U.S.:
- Choice of Donors In the U.S., a recipient can choose her own donor; not so in many other countries. “In the U.S., you get access to a level of information you don’t get elsewhere,” explains Demma. “A recipient gets about 25 pages of information about her donor, including photos,” By comparison, in most other countries, the donor is selected for you; you aren’t able to choose. “You just have to be willing to take whatever donor is available,” explains Demma. At most U.S. agencies, you even get to look at photos of your donor so you can really see what she looks like.
- Anonymity Can Be Preserved In the U.K., legislation mandates that the identity of a donor is lifted when a child created with a donor egg turns 18 years old. In the U.S., there is no such requirement, the parties can agree to what bests suits their needs. “The bottom line is that you should find a donor that is on the same page as you and then have a lawyer memorialize your decisions,” recommends Demma.
- Single Embryo Transfer is Preferred There is a growing push in the U.S. towards Single Embryo Transfer. In fact, recent ASRM Guidelines recommend doctors transfer one embryo in patents under 35, two cleavage stage (usually 2 or 3 days after fertilization) embryos in patients 35-37, three cleavage stage embryos in patients 38-40, and no more than five cleavage stage embryos in patients 41-43. While Northern Europe has widely adopted single embryo transfer (SET), Southern Europe and other countries -- such as India and China -- have yet to implement this policy.
- A Strong Euro Given the current economy, the timing is right for European women to receive treatment in the U.S. “The relative strength of the Euro versus the dollar and recent discounts in air travel is making treatment in the U.S. for British women even more compelling,” adds Dr. David Kreiner, Medical Director of East Coast Fertility in Plainview, New York.
At East Coast Fertility, Kreiner treats U.K. patients in two visits to New York. During the initial visit he performs an initial workup and helps the patient select a donor. ECF physicians and staff then coordinate the patient’s IVF cycle with her U.K. physician. During a second trip, the embryo transfer is performed after which the patient returns promptly to the U.K. where hormone levels and pregnancy results are monitored through the patient’s local physician. The average recipient spends 2-7 days in New York depending on whether she provides a fresh semen specimen on the day of the donor’s retrieval or elect to use a frozen specimen. “We’re helping women who are not being adequately served,” says Kreiner.
Talk to a Lawyer
Whether you are a U.K. citizen coming to the U.S. for treatment or a U.S. citizen thinking of traveling overseas for treatment, you should talk to a lawyer to make sure you and your future child’s rights are protected. “With cross-border reproduction, you need even more legal coverage” than third-party reproduction in your home country, advises Demma. In addition to a contract regulating the basics with your donor, “you will need to add a layer of citizenship and immigration law to your legal protection,” she warns.
According to Demma, seeing a lawyer and doing things the protected way won’t add that much to the cost of your treatment. In general, she says, the cost for getting a consultation and contract for egg or sperm donation is “approximately $1,000.” The recipient also has to pay for the cost of the donor’s legal counsel which is about another $500 (though the cost for covering a surrogacy is higher, she notes). In any event, paying for legal help in advance will be worth it. “The devastating cases you’ve been hearing about in the media lately all happened because of a void in legal management,” she says.
At least in Demma’s mind, it's up to the doctors themselves to make sure their patients get legal advice. “Doctors should compel their patients, before they move forward, to establish legal parameters” whenever treatment involves a third party, she says. Equally important is psychological clearance. “No party – donor or recipient – should be permitted to cycle without it,” says Demma, who sees any third party treatment as “a partnership between the medical, mental health and legal professions.”
Vet Your Donor Agency
Before you choose an agency to work with, “make sure the agency practices good housekeeping,” advises Demma. The best way to judge of an agency's competence is to look at whether it is complying with ASRM’s Egg Donation Practice Guidelines.
Demma offers the following checklist:
- Does the agency limit its donors to six cycles?
- How many families has the egg donor donated to?
- How old is the donor or surrogate?
- Has she ever donated or given birth before?
- How is the donor being compensated?
(In the U.S., ASRM Guidelines suggest that appropriate compensation for an egg donor's time and inconvenience during a cycle be in the $5,000 range, that compensation above $7,000 requires justification and that compensation requests above $10,000 be deemed unacceptable.)
“The savvy consumer should shop around,” recommends Demma. “Look at what other agencies, lawyers and egg donor are charging and how they are treating their recipients and donors."