Are safety concerns about foreign clinics warranted? It’s difficult to tell, especially from a distance, if a facility is operating properly, since not all countries regulate labs and clinics as closely as the Food and Drug Administration (FDA) does here. But that said, Spar’s research indicates that, in general, fertility technology such as IVF has been proven safe. “The technology has been around for 30 years now, and it’s not that complicated,” she says. As a precaution, the AFA’s Madsen advises that women interested in traveling for IVF contact the country’s patients’ association to see if they can offer any insight into a particular doctor or facility. Women can contact the AFA (www.theafa.org) for the appropriate association contact information for the country they’re traveling to.
Whether the clinic has a good success rate is another matter worth looking into. Overall, the chance of taking home a baby after IVF is greater in the U.S., where the success rate is 30 to 35 percent, than in Europe, where the rate is 20 to 22 percent. (The success rates for IVF with egg donation are 43 and 30 percent respectively.) And that’s true even though patients here tend to be a little older. But look at the individual success rate of a clinic, too. “I wouldn’t over-interpret success rates—a 50 percent program may not necessarily be better than a 30 percent program,” says Adamson. “However, if the clinic has a very low rate I’d think long and hard before going.” Another consideration: How does flying affect a woman’s chances of conceiving? “Nobody knows if it’s harmful, but think about how jet lag affects your body,” says Adamson.
If a woman decides that the odds of IVF being safe and effective in another country are in her favor, she still might ask herself another question. Is it, well, ethical to take advantage of another country’s health care system? And what about using an egg donor from a country where many people are poor? Is it opportunistic?
Guido Pennings, Ph.D., a professor of ethics and bioethics at Ghent University in Belgium, who has written extensively on the subject, wouldn’t discourage traveling for IVF on moral grounds—if someone travels to well-developed countries. “However,” says Pennings, “I would condemn Americans and Europeans going to developing countries for any medical treatment because their health systems are already overburdened and unable to provide basic care.” Pennings also agrees that some caution is warranted when it comes to egg donation. He doesn’t have a problem with “exporting” eggs, but expresses concern that there’s a risk that underprivileged women—from any country, the U.S. included—might be exploited when egg donation is concerned. “The easiest solution would be to forbid payment and to limit compensation to real expenses,” says Pennings.
If countries throughout the world ever agree, then egg donation will undoubtedly become a more affordable and closer-to-home option for everyone. Until then, a Richmond, Virginia, company called GlobalARTusa is trying to bridge the gap by offering low-price eggs donated by Romanian women, with no travel involved. Sperm from the prospective father is shipped to the lab in Romania, and once it’s received the patients choose an egg donor. The embryos are created in the lab, then frozen and hand-carried back to the U.S., where they are transferred to the American mom-to-be by her own doctor. Out of 19 patients who’ve used the process at the Richmond facility, 16 have delivered or are currently pregnant (although some required more than one attempt to achieve pregnancy). As Sanford Rosenberg, M.D., a reproductive endocrinologist and medical director of the program, sees it, this process enables women who require egg donors to afford the process without leaving the local doctor they feel comfortable with. (In fact, U.S. law forbids the importation of eggs alone vs. embryos.) “Yes, you could fly over to Romania, but once you get to a foreign country, it can be traumatic,” says Rosenberg.
For some women, that may be true, agrees Madsen, and the emotional impact is something that needs to be figured into the mix when deciding whether or not to go out of the country for assisted reproduction. “You have to weigh both sides,” says Madsen. “Break down the costs, consider the potential stress and anxiety, then decide whether it’s worth it to go.”