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Reproductive health and IVF


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Reproductive health and IVF

  1. 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. 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