Fertility tourism

From Wikipedia, the free encyclopedia
Jump to: navigation, search

Fertility tourism or reproductive tourism[1] is the practice of traveling to another country for fertility treatments.[2] It may be regarded as a form of medical tourism. The main reasons for fertility tourism are legal regulation of the sought procedure in the home country and lower price. In-vitro fertilization and donor insemination are major procedures involved. Other legal regulations may also contribute. For example, couples from the People's Republic of China seek fertility treatments abroad to circumvent the one-child policy.[3]

It has been proposed to be termed reproductive exile to emphasise the difficulties and constraints faced by infertile patients, who are "forced" to travel globally for reproductive procedures.[4]

IVF destinations[edit]

About 20,000 to 25,000 couples annually seek assisted reproductive technology services abroad.[5] Israel is the leading fertility tourism destination for In-vitro fertilization (IVF) procedures, having the highest number of fertility clinics per capita in the world.[6] The United States is chosen by many Europeans because of the higher success rates and lenient regulations. In turn, India and other Asian countries are the main destinations for U.S. women leaving the country for their fertility care, being the destinations for 40% of U.S. women seeking IVF and 52% seeking IVF with donor eggs.[7] Many travel from countries like Germany and Italy, which are very restrictive of the number of eggs that may be fertilized and how many embryos can be used for implantation or cryopreservation. Even small countries such as Barbados provide JCI-accredited IVF care aimed at patients from abroad.

Risks[edit]

Many countries have no restriction on how many embryos may be transferred into the uterus at the same time, increasing the risk of multiple pregnancy and resultant potential complications.[8] The burden of multiple births generated by placing too many embryos is carried by the patients and the home country.

Egg donation[edit]

Egg donation is illegal in a number of European countries including Germany, Austria, and Italy. Many couples then will seek help in places where the procedure is allowed such as Spain and the United States where donors are paid for their service.[5] Almost half of all IVF treatments with donor eggs in Europe are performed in Spain.[5] IVF with anonymous egg donation is also the main assisted reproductive technology sought by Canadians traveling to the U.S, and is the sought procedure for 80% of cross-border treatments by Canadians.[7] In traditional medical tourism countries like Czech Republic egg donation cycles usually have very good success rate when using modern methods like ICSI, PICSI and PGD that significantly increase success rate of birth.[9][10]

Sex selection[edit]

There is fertility tourism from the United Kingdom to the United States for sex selection, because preimplantation genetic diagnosis (PGD, a potential expansion of IVF), which can be used for sex selection, is prohibited in the UK, except when it is used to screen for genetic diseases, while the laws in the US are more relaxed in this subject.[11]

Donor insemination[edit]

Fertility tourism for artificial insemination by donor is influenced by different attitudes and different sperm donation laws by different countries.

There is generally a demand for sperm donors who have no genetic problems in their family, 20/20 eyesight, with excellent visual acuity, a college degree, and sometimes a value on a certain height, age, eye colour, hair texture, blood type and ethnicity .[12][13][14] Anecdotal evidence suggests that the inventory of taller men who are blonde and blue eyed is most popular.[15]

Destinations[edit]

Denmark has a well-developed system of sperm export. This success mainly comes from the reputation of Danish sperm donors for being of high quality[16] and, in contrast with the law in the other Nordic countries, gives donors the choice of being either anonymous or non-anonymous to the receiving couple.[16] Furthermore, Nordic sperm donors tend to be tall, with rarer features like blond hair or different color eyes and a light complexion, and highly educated[17] and have altruistic motives for their donations,[17] partly due to the relatively low monetary compensation in Nordic countries. More than 50 countries worldwide are importers of Danish sperm, including Paraguay, Canada, Kenya, and Hong Kong.[16] Another emerging destination for fertility tourism is Barbados [1]. More and more Caribbean couples and couples of African origin are in need medical help to conceive, and often require eggs and sperm that match their genetic composition. For a long time, their only option was the United States; however for over 11 years Barbados [2] has been providing couples with the latest in cutting edge technology and has introduced new techniques.

Origins[edit]

Some countries such as United Kingdom and Sweden, have a shortage of sperm donors.[18][19] Sweden now has an 18 month long waiting list for donor sperm.[20]

As a consequence, British women travelled to Belgium and Spain in the late 1990s and in the early years of the 21st century for donor insemination,[21] until those two countries changed their laws and imposed a maximum number of children one donor may produce. Prior to the change in the law, the limit in the number of children born to each donor depended upon practitioners at fertility clinics, and Belgian and Spanish clinics were purchasing donor sperm from abroad to satisfy demand for treatments. Anonymous donation was permitted in Belgium and is a legal requirement in Spain. Ironically, at the time, many Belgian and Spanish clinics were buying sperm from British clinics donated by British donors whose local limit of ten families in the UK had not been reached, and they were able to use that sperm according to local laws and limits. British fertility tourists must therefore now travel to other countries particularly those that do not include children born to foreigners in their national totals of children produced by each donor. Britain also imports donor sperm from Scandinavia but can only limit the use of that donor's sperm to ten families in the UK itself, so that more children may be produced elsewhere from the same donor.[22]

At least 250[20] Swedish sperm recipients travel to Denmark annually for insemination. Some of this is also due to that Denmark also allows single women to be inseminated.

It is illegal to pay donors for eggs or sperm in Canada. Women can still import commercial U.S. sperm, but that's not true for eggs, resulting in many Canadian women leaving the country for such procedures.[23]

Surrogacy destinations[edit]

India[edit]

Further information: Commercial surrogacy in India

India is a main destination for surrogacy. Indian surrogates have been increasingly popular with fertile couples in industrialized nations because of the relatively low cost. Indian clinics are at the same time becoming more competitive, not just in the pricing, but in the hiring and retention of Indian females as surrogates. Clinics charge patients between $10,000 and $28,000 for the complete package, including fertilization, the surrogate's fee, and delivery of the baby at a hospital. Including the costs of flight tickets, medical procedures and hotels, it comes to roughly a third of the price compared with going through the procedure in the UK.[24]

Surrogacy in India is of low cost and the laws are flexible. In 2008, the Supreme Court of India in the Manji's case (Japanese Baby) has held that commercial surrogacy is permitted in India. That has again increased the international confidence in going in for surrogacy in India.

There is an upcoming Assisted Reproductive Technology Bill, aiming to regulate the surrogacy business. However, it is expected to increase the confidence in clinics by sorting out dubious practitioners, and in this way stimulate the practice.[24]

Russian Federation[edit]

Liberal legislation makes Russia attractive for “reproductive tourists” looking for techniques not available in their countries. Intended parents come there for oocyte donation, because of advanced age or marital status (single women and single men) and when surrogacy is considered. Gestational surrogacy, even commercial is absolutely legal in Russia, being available for practically all adults willing to be parents.[25] Foreigners have the same rights as for assisted reproduction as Russian citizens. Within 3 days after the birth the commissioning parents obtain a Russian birth certificate with both their names on it. Genetic relation to the child (in case of donation) doesn’t matter.[26] On 4 August 2010, a Moscow court ruled that a single man who applied for gestational surrogacy (using donor eggs) could be registered as the only parent of his son, becoming the first man in Russia to defend his right to become a father through a court procedure.[27] The surrogate mother’s name was not listed on the birth certificate; the father was listed as the only parent.

United States[edit]

The United States is sought as a location for surrogate mothers by couples seeking Green Card in that country, since the resulting child can get birthright citizenship in the United States, and can thereby apply for Green Cards for the parents when turning 21 years of age.[3]

References[edit]

  1. ^ Matorras R (December 2005). "Reproductive exile versus reproductive tourism". Hum. Reprod. 20 (12): 3571; author reply 3571–2. doi:10.1093/humrep/dei223. PMID 16308333. 
  2. ^ Paul McFedries (2006-05-17). "wordspy.com". wordspy.com. Retrieved 2012-11-13. 
  3. ^ a b Wealthy Chinese Seek U.S. Surrogates for Second Child, Green Card by Alexandra Harney, Reuters Health Information. Sep 23, 2013
  4. ^ Inhorn MC, Patrizio P (September 2009). "Rethinking reproductive "tourism" as reproductive "exile"". Fertil. Steril. 92 (3): 904–906. doi:10.1016/j.fertnstert.2009.01.055. PMID 19249025. 
  5. ^ a b c Kovacs P (2010-06-14). "Seeking IVF Abroad: Medical Tourism for Infertile Couples". Medscape. Retrieved 2010-06-24. 
  6. ^ "IMS Fertility Unit". Medicaltourismforyou.com. Retrieved 2012-11-13. 
  7. ^ a b Hughes EG, Dejean D (June 2010). "Cross-border fertility services in North America: a survey of Canadian and American providers". Fertility and Sterility 94 (1): e16–9. doi:10.1016/j.fertnstert.2009.12.008. PMID 20149916. 
  8. ^ Health warning to women over fertility tourism Xpert Fertility Care of California
  9. ^ "Fertility tourism in the Czech Republic". Medicaltravelczech.com. 2012-03-20. Retrieved 2012-11-13. 
  10. ^ "Egg Donation in Spain and the Czech Republic". Fertilityclinicsabroad.com. 2012-03-20. Retrieved 2012-11-13. 
  11. ^ US clinic offers British couples the chance to choose the sex of their child From The Times. August 22, 2009
  12. ^ The Genius Sperm Bank June 2006
  13. ^ Baby steps; how lesbian alternative insemination is changing the world. By Amy Agigian
  14. ^ economics uncut. Books.google.com. Retrieved 2012-11-13. 
  15. ^ Sperm counts: overcome by man's most precious fluid By Lisa Jean Moore, retrieved 22 January 2011
  16. ^ a b c Assisted Reproduction in the Nordic Countries ncbio.org
  17. ^ a b FDA Rules Block Import of Prized Danish Sperm Posted August 13, 08 7:37 AM CDT in World, Science & Health
  18. ^ "HFEA Background Briefing on Sperm, Egg and Embryo Donation". Hfea.gov.uk. 2009-07-31. Retrieved 2012-11-13. 
  19. ^ "HFEA Figures for New Donor Registrations". Hfea.gov.uk. 2012-01-30. Retrieved 2012-11-13. 
  20. ^ a b Ekerhovd E, Faurskov A, Werner C (2008). "Swedish sperm donors are driven by altruism, but shortage of sperm donors leads to reproductive travelling". Ups. J. Med. Sci. 113 (3): 305–13. doi:10.3109/2000-1967-241. PMID 18991243. 
  21. ^ Wordspy In turn citing Madeleine Bunting, "X+Y=$: the formula for genetic imperialism," The Guardian, May 16, 2006
  22. ^ [Shortage of Sperm Donors in Britain Prompts Calls for Change] By DENISE GRADY. Published: November 11, 2008 The New York Times
  23. ^ My scattered grandchildren The Globe and Mail. Alison Motluk. Sunday, Sep. 13, 2009 07:53PM EDT
  24. ^ a b Regulators eye India's surrogacy sector. By Shilpa Kannan. India Business Report, BBC World. Retrieved on 23 Mars, 2009
  25. ^ "jurconsult.ru" (PDF). Retrieved 2012-11-13. 
  26. ^ Stuyver, I.; De Sutter, P.; Svitnev, K.; Taylor, K.; Haimes, E.; Sills, E. S.; Collins, G. S.; Walsh, D. J.; Omar, A. B.; Salma, U.; Walsh, A. P. H. (2010). "Posters * Ethics and Law". Human Reproduction 25: i235. doi:10.1093/humrep/de.25.s1.306.  edit
  27. ^ "surrogacy.ru". surrogacy.ru. 2010-08-04. Retrieved 2012-11-13. 

External links[edit]