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1. INTRODUCTION
Reproductive tourism, where childless couples
travel abroad to seek fertility treatment, is an
increasing phenomenon. The reasons for seek-
ing treatment in other countries are varied_
Many countries simply do not have advanced
IVF programs in place or do not allow it legal-
ly. Other reasons include lower costs of treat-
ment and a desire to find sperm and egg do-
nors of similar ethnic make-up aS the infertile
couple. Foreign couples also appreciate not
having to wait long for an appointment, even
if it means traveling to lndia.
WOFLDWIDE INCIDENCF
The extent of "ln-vitro fertilization (lVF) tour-
ism" is unknown since smuggling an embryo
back home in ones womb is difficult for a cus-
toms official to detect. ln this way IVF Tour-
ism differs, for example, from international
child adoption which is easier to monitor, and
is subject to both national and international
law standards. Most of the available data on
reproductive tourism is therefore based not
on methodical assessments, but on anecdotal
reporting by specific clinics. For instance, it
has been estimated that over 1000 .Japanese
couples travel every ye€r to California alone
seeking reproductive care. This is mainly a di-
rect consequence of the restrictions imposed
on egg donation and surrogacy in Japan.
FATIONALE
The recent increase in the extent of interna-
tional travel for reproductive technology serv-
ices has been attributed to several factors (Ta-
ble 1). First, following the current revolution
in information technology patients can readily
obtain data and compare figures regarding
the cost and the availability of different infer-
tility services in countries around the world.
second, patients are now more used to inter-
national travel which has become in some
ways more comfortable and affordable in re-
cent years. Third, IVF clinics in many countries
are more aware of their relative advantages in
terms of price and type of services rendered
compared to other countries, and are actively
seeking to attract patients from foreign coun-
tries. These centers now often offer compre-
hensive packages to facilitate access by for-
eign patients. Such packages often include
not only the reproductive procedures, but also
flight tickets, local escorted transfer, hotels,
interpreters and local recreational tours.
Fourth, the improved use of the internet of-
fers IVF clinics, through their multi-ianguage
Web sites, a very cost-effective and efficient
way to disseminate information regarding the
clinic's services and unique merits in terms of
cost, expertise in reproductive technologies
and local policies. Moreover, it is currently
not rare to find business advertisements post-
ed by fertility clinics in airline magazines or
international satellite TV channels aimed at
luring clients worldwide.
CLINICAL DISCUSSION
We at our center decided to retrospectively
analyze the trend in the influx of patients
coming from abroad, over a period of three
years, from January 2004 to December 2006.
The study included all overseas patients who
had visited our center for treatments like lUl,
lVF, lCSl, Donor Egg IVF and Gestational Sur-
rogacy. Those availing of Surrogacy included
patients with MRKH Syndrome, Asherman's
Syndrome, those with history of Recurrent
New informoiion lechnology ollows eosy disseminotion of informotion on reproductive procedures in foreign countries.
lnternotionol trovel currently more comfortoble ond offordoble.
IVF clinics in certoin countries ore now octively seeking potients from foreign countries through odvertisements in oirline
mogozines or internotionol sotelliie TV chonnels.
Feriiliiy centers now offer convenient oll-inclusive pockoges thot include not only ihe reproductive procedures, but olso flighi
tickets, escorted tronsfer, hotels, interpreters ond locol recreotionql tours.
The internet ollows o very cost-effeciive ond efflcient woy for poiients to compore the foreign clinic's services ond unique
merits in terms of cost, expertise in reproductive technologies ond locol policies.

2. Pregnancy Loss, single parents, as well as les-
bian and gay couples from abroad. In the year
2004, out of a total of '120 cycles, 9 cycles
were done for patients coming from abroad
(7.5%). Out of these 9 cycles, 3 (33.3%) cy-
cles were of regular lVF, 1 of lCSl (1 1.1%) and
5 (55.6%) of Donor Egg lVF. ln 2005, the per-
centage of cycles for patients from abroad in-
creased Io 10.6% (17/160). Of these, 5
(29.4%) were regular IVF cycles, 2 (11.8%o)
were lCSl, 7(41 .2%) were Donor Egg lVF,
2(11.8o/o) were for Surrogacy and 1(5.8%) for
lUl. ln 2006, out of a total of 200 cycles,30
(15.0%) were done for overseas patients. Of
these, 7 (23.3%) were IVF cycles, 3('l 0.0%)
were lCSl cycles, 1 1(36.7o/o) were Donor Egg
IVF cycles, 7 (23.3o/o) were for Surrogacy and
2 (6.7%) were for lUl.
CONCLUSIONS
Cheaper prices, high-quality health care and
the availability of donor eggs and surrogates
are drawing an increasing number of couples
to Thailand, Eastern Europe, Russia, China
and lndia. ln the English-speaking world, lndia
has a big advantage because of the availabili-
ty of English-speaking doctors. The real bene-
fit for many couples is relaxed laws. Whereas
countries such as UK allow only two embryos
to be transferred, in lndia this number is al-
most three times as much, increasing the
chances of success in the first attempt itself.
One of the biggest attractions offered by ln-
dian ART clinics is maternal surrogacy. The ln-
dian Council for Medical Research permits
surrogates to claim monetary compensation in
addition to routine expenses and antenatal
care, a facility not provided for by many coun-
tries. This makes it easier for couples to find
willing surrogate mothers in India. The
number of surrogate births here has more
than doubled in the past two years. lndian
ART centers are also willing to treat women
who have been deemed too old or overweight
by the British National Heath Service (NHS) for
IVF treatment. Consequerltly lndian clinics are
performing a growing number of IVF treat-
ments for foreigners frustrated with disap-
pointing results and soaring costs at home.
Medical tourism in IVF serves couples in
many ways. It allows patients to seek centers
with better results and often at more afforda-
ble prices. Occasionally international travel
merely presents the wish of immigrants to re-
turn to their country of origin in order to re-
ceive care within a more supportive family en-
vironment and ethnic background. The most
controversial aspect of reproductive tourism is
when it takes place in order to seek services
that are locally banned for religious of ethical
reasons (Table 2). Since the demand for the
ability to become a parent is extremely strong
it is very doubtful that new laws and regula-
tion are likely to succeed in limiting interna-
tional travel for reproductive services. This is
especially true among those barred from
treatment in their own country including sin-
gle women, homosexual men and women or
older women. Even more contentious repro-
ductive services, including sex selection, sur-
rogacy and egg donation are likely to follow
the laws of demand even if unacceptable to
many. As long as some people are determined
to obtain certain reproductive services such as
donated eggs or surrogate wombs, and oth-
ers are willing to sell them, the trade will be
impossible to stop. So it makes better sense
to regulate the business than io drive it un-
derground or to limit it to countries, like the
USA, where few limitations exist but repro-
ductive procedures are affordable only to a
selected group of very well-off people. t(
Country of origin
lsroel
Sweden
USA
Austrolio. Chino
Germony
Itoly
Moslem countries
Ugondo/Kenyo
Britoin
Cquniry of destinotion
Romonio, Cyprus
Denmork
lndio
USA
Belgium
Spoin
Europe
South Africo
lndio
Reproductive procedure
Egg donotion
Anonymous sperm donotion
Ethnic lndion egg donors
Sex seleciion
PGD
IVF for non morried women
Sperm donoiion
tvF & tcsl
Surrogocy