Considering fertility treatment abroad: issues and risks
A substantial number of UK patients are travelling abroad for fertility treatment. Their motivations may include lower costs for treatment and greater availability of donors.
Many patients have positive experiences of receiving treatment abroad; although, this is not always the case.
What to think about before going ahead
According to various surveys, many patients who travel overseas for treatment are very satisfied with the standard of care and quality of treatment they receive. However, if you are considering travelling abroad for treatment, you are advised to carry out thorough research.
We advise that you only select a clinic that has a proven record on quality and standards.
We suggest you take a number of issues into consideration, including:
- standards and safety abroad
- success rates (and how they are calculated)
- how is patient information stored and who has access to it?
- complaints: what happens if treatment goes wrong?
- donor issues
- surrogacy issues
- multiple birth rates
- availability of treatment/ ethical, social and legal issues
- counselling and support
The Foreign and Commonwealth Office (FCO) has launched guidance on surrogacy overseas to give prospective parents information about the process to help inform them of the sort of issues they may face when embarking on a surrogacy arrangement in a foreign country. The guidance urges prospective parents to ensure they are fully aware of the facts and are well prepared before starting what can be a long and complex process.
Standards and safety abroad
The HFEA licenses and regulates clinics in the UK only - it has no jurisdiction overseas. The level of legal or regulatory standards of clinics in overseas countries varies greatly and not all countries will have organisations equivalent to the HFEA. Some places have no specific laws or regulations relating to assisted reproductive services.
The EU Tissues and Cells Directive sets out standards of quality and safety that should be met within countries inside the EU/EEA. However, not all EU/EEA countries have implemented this legislation and clinics in these countries are not necessarily accredited by a competent body..
Success rates abroad
According to various surveys, some patients have cited high success rates as one of their reasons for travelling abroad for treatment.
There are a number of different ways in which success rates can be calculated and presented, and the overseas clinic may not do it in the same way as the HFEA. It’s important to take into consideration such differences to ensure that comparisons are not misleading.
For example, presenting success rates as a percentage of all treatment cycles (irrespective of whether they reached the embryo transfer stage) will provide a lower figure than if success rates are calculated as a percentage of all embryo transfers.
It is also important to be aware that success rates can be affected by:
- the type of patients a clinic treats eg, their age, diagnosis and length of infertility
- the type of treatment a clinic carries out
- a clinic’s treatment practices
A clinic that treats proportionately more patients with complicated diagnoses may have a lower average success rate than clinics that treat more patients with common fertility issues.
The HFEA publishes data about UK clinics’ success rates on the online Choose a Fertility service. Choose a Fertility Clinic also includes information about the particular services offered by UK clinics and any areas they may specialise in.
If you are considering travelling overseas for treatment, you are advised to find out about:
- what happens to the identifying information you (and others) provide during the course of treatment
- who will have access to it
- if you plan to use donated sperm and/or eggs, whether you (or any child born as a result of treatment) will be able to access information about the donor
- what happens to patient records if that clinic closes
- transferring medical records to the UK.
UK clinics are required to keep all information relating to patients, donors and children born as a result of treatment confidential. Some (but not all) of the information is also passed on to the HFEA and included in a register.
The HFEA cannot include any information about treatment, including any information in relation to donation, on the HFEA Registers if treatment has been provided overseas. We have no jurisdiction to do so, and are not able to verify the information. This also includes cases where sperm, eggs or embryos have been exported from the UK.
Complaints abroad: what happens if my treatment goes wrong?
Because the HFEA’s regulatory powers do not extend to overseas clinics, we are unable to deal with a complaint concerning treatment carried out abroad.
It would also be unlikely that we would be able to take action against a UK clinic if their only involvement with your treatment was the provision of:
- advice concerning an overseas clinic (and you were unhappy with the treatment you received there)
- a referral to an overseas clinic (and you were unhappy with the treatment you received there)
- certain forms of preparatory treatment (where the UK clinic has a shared care arrangements with the overseas clinic) which do not need to be carried out under an HFEA license. Such treatments might include providing blood tests, scans or ovarian stimulation.
However, the General Medical Council (GMC), the body that regulates and licenses individual medical practitioners, has guidance on ‘conflicts of interest’ which could, in certain circumstances, be of relevance.
You are advised to find out in advance how a concern or complaint would be followed up and resolved in the event that something went wrong.
You might also need independent legal advice to clarify the enforceability of contracts and agreements between you and a clinic outside the UK.
If you are planning to use donated sperm, eggs or embryos, you are advised to consider:
The legal issues surrounding parental responsibility
If treatment is provided by a licensed clinic in the UK, the donor does not have any legal responsibility to children born as a result of the donation. This may not be the case in other countries. Seek your own legal advice to clarify your position.
Whether the form of donation is available in the destination country
In some countries, treatment involving sperm donation is allowed but treatment involving egg or embryo donation is not.
The process involved in recruiting donors (including screening to reduce the risks of passing on a medical condition)
You might also want to find out whether there are any limits on the number of families that can be created per sperm donor (in the UK, the limit is 10).
Whether or not donation is anonymous
In the UK, where donation is not anonymous and where donor information is stored on the HFEA Register, donor-conceived children will be able to trace donors and donor-conceived siblings once they reach the age of 18. This may not be the case if you are seeking treatment abroad.
Even in countries where donation is not anonymous, you should find out if the clinic is able to provide you with any information about the donor (for example, a physical description and medical history). In addition, their systems of recording donor information may not be the same as in the UK and you should be aware that if you receive donor treatment overseas, this information cannot be entered on the HFEA Register. This has implications for accessing donor and sibling information.
If you are planning to enter into a surrogacy arrangement overseas, you are advised to find out about the legal issues surrounding parental responsibility. These differ from country to country.
You should also be aware that if the child is born abroad, the commissioning couple can only apply for a parental order if they are living (or domiciled) in the UK. A parental order officially transfers parental responsibilities to the commissioning couple.
While waiting for the parental order to be processed, the child born abroad will require a visa in order to enter the UK.
If you are considering surrogacy abroad, we advise you to seek your own legal advice beforehand to clarify your position.
Other issues you may want to consider:
- the processes involved in recruiting surrogates
- what financial agreements are in place to compensate the surrogate
- if treatment involves in vitro fertilisation (IVF) or hormonal stimulation, whether the risks of a multiple pregnancy are being minimised by the clinic.
Multiple Birth rates
A multiple pregnancy (twins, triplets or more) is the single greatest health risk associated with fertility treatment. It carries risks to both mother and baby, including the risk of prematurity and below-normal birth weight.
In IVF treatment, these risks can be minimised by avoiding multiple embryo transfer and, where suitable, opting for single embryo transfer.
In the UK, all clinics are required to have multiple births policies in place to avoid any unnecessary risks.
You are advised to discuss the risks of a multiple pregnancy with the overseas clinic and find out whether they have any policies in place to help minimise such risk.
Availability of treatment and ethical, social and legal issues
Many countries have different laws or rules in relation to the various forms of treatment. This may have a bearing on various ethical or social considerations that are important to you. It may also have implications for the availability of treatment, given your specific circumstances, in the destination country.
- some overseas countries do not allow single women or same sex couples to have access to IVF treatment
- sex selection for non-medical purposes with pre-implantation genetic diagnosis (PGD) is illegal in the UK, but is permissible in a number of overseas countries
- different countries may have different laws with regards the rights of individuals to withdraw consent to the use of an embryo created using their sperm or egg
- different counties have different laws or rules with regards to donor anonymity and compensation for or payment to donors.
Counselling and support
In the UK, all clinics offer counselling prior to treatment involving donor gametes. This may not be offered by a clinic abroad.
It is vital to understand that if you choose to travel abroad for treatment, there may not be the support you would expect if you are being treated in the UK. Any problems or questions will be dealt with by phone, fax or email, and the HFEA cannot deal with complaints or problems which occur abroad.
A list of patient organisations in other countries can be found on the Infertility Network UK website.
Researching overseas clinics
If possible, you are advised to speak to someone who has been treated at the clinic or in the country you are intending to go to and find out about their experiences. Patient organisations such as Infertility Network UK have chat rooms and forums where you may be able to contact others.
If you don’t know anyone who has travelled abroad for treatment you will have to do your own research. Look carefully at the clinic’s website, at the sort of information and statistics they include.
You may want to check the qualifications and experience of the staff, and whether the clinic is accredited in any way. Your initial contact with the clinic will probably give you some insights into how it is run. Are there English-speaking staff available to answer your queries? How much time are they willing to spend talking to you about the treatment they offer.
You should be wary of a clinic that is so eager to take you on as a patient that they are not interested in asking about your own medical history. A good clinic should want to see all your relevant test results and know about your medical history.
Questions you can ask the overseas clinic
You are advised to ask:
- whether fertility treatment is regulated in their country and are there any rules clinics have to follow and regular inspections?
- what is the clinic’s record of standards and safety?
- does the laboratory have to follow set procedures?
- how are patient records kept to ensure confidentiality?
- in the UK, all clinics offer counselling prior to treatment involving donor gametes, is this the case at your clinic?
- could language barriers cause any problems at the clinic?
- how frequently and at what stages of treatment would you be required to travel to the overseas clinic?
- will the clinic provide you with a costed treatment plan, or an equivalent?
- is the treatment you seek available?
- what are the clinic’s success rates, and how they are calculated?
- does the clinic have a particular specialism and is it relevant to your treatment needs or to the clinic’s overall success rates?
- what is the clinic’s multiple birth rate and do they have policies in place to minimise risks?
- does the clinic store embryos, and for how long?
- what would happen to embryos in the event that one party in a couple changes their mind about continuing with treatment?
- if you are planning to enter into a surrogacy arrangement, how does the clinic recruit surrogates and what sort of agreements will be in place with them?
If your treatment will involve using donated sperm, eggs or embryos, ask:
- what is the clinic’s recruitment and screening process?
- what screening processes do they carry out on donated sperm to make sure it is free from any infections?
- how do they recruit egg donors?
- what information will you be able to have about the donor?
In the UK, a donor has no legal responsibility, or rights, towards the child conceived using their donation, because donations are made through HFEA licensed clinics. This is not necessarily the case in other countries, so you will need to get independent legal advice.
Page last updated: 06 March 2014