Change in UK regulations may reduce infertility tourism

One factor that can affect any aspect of medical travel and medical tourism is that the market sector can be a victim of its own success. Constantine Constantinides has highlighted this previously in his IMTJ article “Medical Tourism and the West's Revenge”, arguing that in effect the success of medical travel is self limiting.

How can this success be self limiting?

Where overseas treatment becomes an attractive option for patients, domestic providers and governments may react to this trend by becoming more competitive (e.g. by reducing prices for local treatment) or by removing the causes and drivers for medical travel (e.g. by changing local regualtion of a treatment). Thus, the more patients travel abroad for treatment, the greater will be the reaction within the domestic market and a “balance of trade” will be reached.

An excellent example of this phenomenon is this week’s announcement by the Human Fertilisation and Embryology Authority (HFEA) that it intends to conduct a consultation over changes to the rules governing egg and sperm donation in the UK. There has been a significant shortage of egg and sperm donors in the UK due to the restrictions on the payments that can be made to donors. The £250 maximum "compensation" payment for both men and women donors has meant that demand for donor eggs and sperm has far exceeded supply. Waiting lists can be as long as two to three years for those patients eligible for NHS treatment.

The removal of donor anonymity has also been a contributing factor to the reluctance of donors to come forward. According to the most recent HFEA statistics (2008), only 1,184 women donated eggs and there were only 396 new sperm donors in 2008. Around 2,000 babies a year are born in the UK using donated eggs, sperm or embryos. As a result, we have seen an increasing number of UK couples seeking infertility treatment abroad; it has been one of the fastest growing areas of medical tourism. (For the background see “New research paper provides insight into infertility tourism”). The response from the HFEA to the increasing number of infertile couples going abroad is therefore to consider how to reduce this ...... by increasing the payments and incentives to egg and sperm donors, AND thus increasing the supply of eggs and sperm. Payments may increase to £1,000 plus.

It’s unlikely that the changes will have any immediate effect on the market sector. No decisions will be made until the end of the HFEA public consultation next year. The three-month public consultation will not start until January 2011 and the HFEA is expected to be subsumed into the UK’s Care Quality Commission as a result of the UK public expenditure cuts. But there’s a clear warning here for those involved in medical tourism businesses and the medical travel sector. Don’t put all of your eggs in one basket..... Or more seriously, be aware that any segment of the medical tourism market may be limited by its own success when domestic providers and governments seek to reverse the trend.

New research paper provides insight into infertility tourism

A recent paper presented at the Annual Meeting of the European Society of Human Reproduction and Embryology in Rome highlights the growth of “infertility tourism” at a time when many medical tourism businesses are feeling the pinch of the recession.

The article, “Cross border reproductive care in six European countries” provides a review of inbound infertility tourism to six European countries receiving patients - Belgium, Czech Republic, Denmark, Slovenia, Spain and Switzerland. Data was collected from 46 centres in these countries. Patients came from 49 different countries, but almost two thirds came form only four countries - Italy (31.8%), Germany (14.4%), The Netherlands (12.1%) and France (8.7%).

Drivers of infertility tourism
Why are these infertile couples crossing borders for infertility treatment? It varies from country to country but the main driver is the law on infertility treatments within the home country. This is the predominant reason for patients coming from Italy, France, Germany, Norway and Sweden. Italian law banned sperm donation in 2004; German law bans egg donation; in France, assisted conception for single women or same sex couples is illegal and there is a ban on advertising for egg donors; regulation regarding donor anonymity affect Scandinavians and British patients; some countries have regulations that limit reimbursement of assisted conception to a maximum age.; some countries have legal limits on the amount that can be paid to donors thus reducing availability of sperm and eggs.

Difficulties in accessing treatment at home were a driver for a third of UK patients, and a wish for “anonymous” donation was expressed by around one in five patients.
There’s also some indication of specific cross border flows: Italians favour Switzerland and Spain, the Germans prefer Czech Republic, the Dutch and French opt for Belgium.
18.3% of patients were looking for semen donation, 22.8% for egg donation and 3.4% for embryo donation.

Market opportunity for medical tourism businesses?
The study estimated that “a minimum estimated number of 11 000–14 000 patients per year” visits the six countries in the study; it may well be much higher than this.

If you’re in the medical tourism business, download the paper; it’s a useful insight into the opportunities in infertility tourism and to the kind of patients that seek it..... which should be a major influence on your marketing. Understanding your market is key to the success of any medical tourism business. For example, the internet was a frequent source of information about infertility treatment abroad in Sweden (73.6%), Germany (65.0%) and the UK (58.5%).

So, it’s good news for my healthcare web publishing business that a Google UK search for “infertility treatment abroad” brings up Treatment Abroad at number 1 and our other sites in positions 2, 3, 4, 6 and 10 in the top ten Google UK results!

Increase in IVF tourism in Europe

At Treatment Abroad, we've seen increasing interest from IVF clinics abroad that are experiencing significant growth in patient numbers from the UK and other European countries.

The latest report from the European Society for Human Reproduction and Embryology confirms an increase in IVF treatment abroad, The report surveys infertility clinics in Belgium, the Czech Republic, Denmark, Slovenia, Spain and Switzerland and is based on a sample of 1,230 patients visiting these infertlity clinics. See details of the report in the Guardian.

Lack of access to IVF services in the home country for the over 40's and legal restrictions on infertility treatment are the prime drivers. Italy was the biggest source of IVF "medical tourists" accounting for 32% of the patients in the survey. Next was Germany (14%), followed by the Netherlands (12%), France (9%) and the UK (5%). The average age was over 37 but 63.5% of the British patients were over 40.

According to study coordinator, Dr Francoise Shenfield from University College Hospital in London, "Spain and the Czech Republic are popular destinations for oocyte donation; Swedes travel to Denmark for insemination, and the French to Belgium." She also highlighted the significant numbers of Italians who travel abroad to receive treatment that was rendered illegal in their home country under recent legislation or because they believe they will receive better quality care.Extrapolating the data, EHSRE estimates that 20,000 to 25,000 cross-border fertility treatments are carried out each year.IVF related medical tourism is a relatively new but growing trend in the UK, as couples delay having children into their 40's and then discover that they have a problem.

IVF treatment is available within the National Health Service in the UK, but access to treatment can be a problem.

• Age and waiting lists can be a barrier to treatment.


• Overweight women are excluded from NHS treatment.


• Demand for egg donation exceeds supply. ( The right of anononymity for egg donors was removed in 2005)

Obviously, private IVF treatment is available in the UK but this may be expensive and the same legal restrictions will apply.

Whereas some areas of medical tourism may be feeling the effects of the recession and the resulting impact on people’s pockets, IVF treatment abroad is an opportunity worth pursuing for those IVF clinics abroad that can demonstrate impressive results and cater for the needs of the “fertility tourist”.