couple.

Foreign couples also appreciate not having to wait long for an appointment, even

if it means traveling to lndia.

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-

WOFLDWIDE INCIDENCF The extent of "ln-vitro fertilization

(lVF) tour-

tries.

ism" is unknown since smuggling an embryo back home in ones womb is difficult for a customs official to detect. ln this way IVF Tourism 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 direct consequence of the restrictions imposed
on egg donation and surrogacy in Japan.

These centers now often offer comprehensive 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 offers 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 posted by fertility clinics in airline magazines or international satellite TV channels aimed at
luring clients worldwide.

FATIONALE
INTRODUCTION
Reproductive tourism, where childless couples travel abroad to seek fertility treatment, is an increasing phenomenon. The reasons for seek-

The recent increase in the extent of international travel for reproductive technology services has been attributed to several factors (Ta-

ble 1). First, following the current revolution
in information technology patients can readily

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.

ing treatment in other countries are varied_ Many countries simply do not have advanced IVF programs in place or do not allow it legally. Other reasons include lower costs of treatment and a desire to find sperm and egg donors of similar ethnic make-up aS the infertile

obtain data and compare figures regarding the cost and the availability of different infertility services in countries around the world. second, patients are now more used to international travel which has become in some ways more comfortable and affordable in re-

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.

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%) cycles were of regular lVF, 1 of lCSl (1 1.1%) and 5 (55.6%) of Donor Egg lVF. ln 2005, the percentage of cycles for patients from abroad increased Io 10.6% (17/160). Of these, 5 (29.4%) were regular IVF cycles, 2 (11.8%o)

most three times as much, increasing the chances of success in the first attempt itself. One of the biggest attractions offered by lndian ART clinics is maternal surrogacy. The lndian Council for Medical Research permits surrogates to claim monetary compensation in

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 regulation are likely to succeed in limiting international travel for reproductive services. This is

were lCSl,

7(41

.2%) were Donor Egg

lVF,

addition
care, a

to routine expenses and

antenatal

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

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 treatments for foreigners frustrated with disappointing results and soaring costs at home. Medical tourism
many

2 (6.7%) were for lUl.

CONCLUSIONS
Cheaper prices, high-quality health care and

especially true among those barred from treatment in their own country including single women, homosexual men and women or older women. Even more contentious reproductive services, including sex selection, surrogacy and egg donation are likely to follow the laws of demand even if unacceptable to
many. As long as some people are determined

the availability of donor eggs and surrogates are drawing an increasing number of couples

to

Thailand, Eastern Europe, Russia, China

in

IVF serves couples in

to obtain certain reproductive services such as donated eggs or surrogate wombs, and others are willing to sell them, the trade will be

and lndia. ln the English-speaking world, lndia has a big advantage because of the availability of English-speaking doctors. The real benefit for many couples is relaxed laws. Whereas

ways. It allows patients to seek centers

to

countries such as UK allow only two embryos be transferred, in lndia this number is al-

with better results and often at more affordable prices. Occasionally international travel merely presents the wish of immigrants to return to their country of origin in order to receive care within a more supportive family en-

to

impossible to stop. So it makes better sense regulate the business than io drive it un-

derground or to limit it to countries, like the USA, where few limitations exist but reproductive procedures are affordable only to a selected group of very well-off people. t(

Country of origin
lsroel

Cquniry of destinotion
Romonio, Cyprus Denmork lndio
USA

Sweden
USA

Austrolio. Chino

Reproductive procedure Egg donotion Anonymous sperm donotion Ethnic lndion egg donors Sex seleciion
PGD
IVF for non morried women Sperm donoiion tvF & tcsl Surrogocy

Germony
Itoly Moslem countries

Belgium
Spoin Europe

Ugondo/Kenyo
Britoin

South Africo lndio

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