Making a decision about fertility treatment involves countless questions. We know them well and we might have some of the answers you are looking for. The guest speaker of this webinar is Aleksander Wiecki, Chief Marketing Officer at IVF Media, who talks about IVF Treatment Abroad and asks if popular IVF destinations in Europe are as safe as they should be.
Although the topic of this webinar is IVF Treatment Abroad, Aleksander starts with admitting that it is always best to have IVF treatment as close to your home as possible. However, he realises it is not always possible and there are different reasons why fertility patients decide to go to another country for their treatment. If you are one of them, this webinar provides as much support as possible and helps you to dispel any doubts or hesitations you may have.
At the beginning of his presentation, Aleksander tells about the ‘IVF Abroad Guide’ that was launched at London Fertility Show in November 2019. You can now download it here. He admits that most of his presentation will be based on that particular publication which involved in-depth research on the part of IVF Media team and is a reliable source of information on IVF treatment abroad.
Alexander goes on to explain what the term ‘safe treatment’ means. He believes there are a few factors that may be important when choosing both the right destination and the right clinic to have treatment. The first one is IVF law and legal requirements. It often happens that clinics interpret the existing legislation indifferently. Another factor is clinics’ certification.
Alexander says there is a national body in each country that certifies clinics, cryobanks and embryology labs and in this way assures they operate according to the existing law. Additionally, there are other global certifications for IVF clinics like the ISO. Then there is also the medical quality of the treatment and clinics’ experience. When it comes to the latter, Alexander mentions two areas in which IVF clinics may attract their patients in the most visible way. One of them is the time the clinic is present on the market and the number of patients they support yearly. However, the more important here is the experience and qualifications of the clinics’ doctors and embryologists. These are really the people who are behind each patient’s success.
According to Alexander, ethics is also one of the most important factors relating to ‘safe treatment’. It’s best when patients can find it on the clinic’s website. Presumably, the best would be to have it accompanied by sufficient and reliable information on the clinic’s services and prices. Customer service is very significant as well. It should relate not only to the time before the treatment but also more importantly to the time afterwards. Honesty between the clinic’s doctors, customer service, IVF coordinators and patients is crucial in order to avoid misunderstanding. As IVF treatment is a long and complex process – both from a medical and emotional point of view- the experience that patients derive from the cooperation with the clinic is of highest importance. Moreover, it does not refer only to the time spent at the clinic but also to post-treatment service and care. In Alexander’s opinion, the way the clinic behaves towards the patient after the embryo transfer has been conducted (and the bills have been paid) is what really counts.
At this point Alexander makes an important statement, namely: IVF abroad in the most popular destinations in Europe is safe. However, there is still a lack of information on the IVF law, legal limits, restrictions and the organisation of the whole treatment. It may differ greatly, depending on a country. The most important area of miscommunication (and as a result – misunderstandings) is the way IVF law and international IVF guidelines are interpreted by different clinics. It refers mostly to the issues such as IVF age limit, the number of embryos to transfer, phenotype matching and gender selection. Some information such as IVF age limit and information about donors per country can be checked on eggdonationfriends. Unfortunately, such procedures reflect negatively on the way the whole IVF industry is perceived and result in describing ‘IVF abroad’ as dangerous.
Alexander says that it was the will to clear up the mentioned misconceptions that made him and his team start working on the ‘IVF Abroad Guide’. The Guide compares 8 popular IVF destinations in Europe in terms of, among others, IVF law, prices and success rates. When it comes to the latter, it is important to mention they are based on the data published by ESHRE (European Society of Human Reproduction and Embryology). ESHRE is an international body that collects the IVF data from different countries and thus, their reports are much more objective and reliable than, for example, the data published on IVF clinics’ websites.
Generally speaking, clinic websites do not seem to be informative enough. Alexander says that, in most cases, they are more like a marketing tool rather than the useful source of information for inquiring patients. For example, it is a common practice in Spain not to publish any pricing lists on IVF clinic websites. According to Alexander, it is difficult to understand as such information would be the best proof of clinics’ professionalism and transparency. The same refers to the doctors’ experience. Alexander cannot understand why so few clinics present their fertility specialists in a detailed way, together with the lists of their publications on specialised fertility problems. It is a well-known fact that the more data patients gather during their website experience before coming to the clinic, the better.
Alexander says that while working on the ‘IVF Abroad Guide’, they were trying to look at the accessibility of information from a patient’s point of view and their findings were less than satisfactory. The most important information (such as IVF legislation, certified IVF clinics, IVF/egg donation success rates per IVF centre or national average success rates) was only available online in English in a few cases. Generally, most of the information was provided in a country’s national language – what is quite useless from an English-speaking patient’s perspective.
IVF abroad – the research
So, what to do when you can’t find the answers you’re looking for? Alexander’s advice is: start asking questions. However, it may not be a satisfactory solution either. Alexander admits that, when collecting the information to include into the Guide, they also sent e-mails to the ministries of health in all 8 IVF destinations. And – what came as a huge surprise – they did not receive any answers from the three biggest players on the European IVF stage: Spain, Greece and Russia. Others sent typical marketing replies (although that was better than nothing) or answered after a significant delay. Comprehensive answers were delivered by a few countries only.
In the last part of his presentation, Alexander reminds us that success rates of IVF treatments and low prices are not the main factors one should take into account when choosing their IVF destination and IVF clinic. In fact, there is always a combination of factors that cannot exist without one another. If one expects high success rates, they have to realise that their treatment won’t be quick and cheap. If their goal is low price, then the treatment won’t be quick and – most importantly – effective. And when the treatment is expected to last shortly – then, neither low price nor effectiveness are possible. In case of treatment prices, Alexander advises to always add 30% of what is advertised on the clinic’s website.
Finally, there is one very important thing to realise in relation to the clinics’ success rates – they’re just the average and because of that they do not matter to an individual patient. What each patient should do is to ask IVF clinic about their own chances of getting pregnant – based on their own individual medical history, diagnosis and genetics. That’s why it is always highly advisable to contact clinics and discuss one’s specific medical situation before making the actual decision. IVF abroad is safe when you prepare to it in a meticulous way beforehand. Be careful and not suspicious – these are the words that perfectly sum up the advice Alexanders gives the viewers of this webinar.
I think that every patient should focus on the country first. Depending on your situation, the number of countries you can go to can be limited – either because of your age or treatment options that are available. If you choose a country first, then it will be easier to choose among clinics that are available there. Secondly, I would divide these clinics into two groups: the cheap clinics (below the country’s average) and the ones that are in the average and above. And then I’d exclude all of the cheap clinics. Why? Because being cheap is not a good indicator for IVF. If you’re running an IVF clinic, there are many ways to save the costs – but it won’t make your success rates better. It may only make them worse. So I wouldn’t go for very cheap clinics – I would start with that. Then, there are, for example, internet forums and websites where you can find reviews of the clinics. You can see the website of the clinic and its doctors. What we are trying to do is to connect patients with clinics and give them a chance to have free consultations with doctors, in order to discuss their medical situation. And in the end of the day, it is a doctor that is important – and not the clinic itself. This is a real person you are speaking to and he or she will be responsible for your treatment. So you can look through the clinics’ profiles on our website – we have about 40 clinics on eggdonationfriends.com and maybe 50 on fertilityclinicsabroad.com . And we have visited almost 90% of all these clinics and most of them are good. I can tell you that they all put patients first – and not the money. They really care about their patients and try to do their best to make the treatment as successful as possible. So what are the differences? Well, there are differences in the customer service, the treatment experience or the patients’ experience – because every clinic is different. So honestly I cannot tell you how to choose the best one. I can only give you hints on what to ask clinics about and what to check at the beginning. 3 months ago, before we published our Guide, I made a test and sent emails to 5 clinics in one of the countries. They were all quite good clinics and I expected professional customer service. I asked just 5 questions, marking them with bullets. I got the answers from 2 clinics the next day – but the rest emailed me back after a week. And none of them answered my questions. My first thought was: I wouldn’t go to any of those clinics. They didn’t answer my questions and they were trying to sell me something I didn’t ask for. And my questions were very simple. So that may be a good starting point. If you have narrowed your choice to, let’s say, 5 clinics, prepare a list of your questions, ask the clinics to answer them and see what will happen after 1-2 days. If a clinic answers after 7 days – I wouldn’t go back to them. If it takes them 7 days to attract and help a patient, I do not know how long it will take them to answer after, e.g., an embryo transfer. Two weeks? So I think that the responsiveness, professionalism and the approach towards patients is very important. You can check it by asking questions by an email and see if they really answer them – in the first place. I cannot say anything more than I told you in my presentation. You are probably a patient with some medical history – you can put all of it in one email and sent it to the clinics you shortlisted, asking about their offer in your particular case. Some of the clinics will probably offer a consultation with a doctor – and while some of them will offer it for free, others would like to get money for that. You can always turn to our consultants: Elisabeth and Caroline at: [email protected] They will connect you with a proper clinic and offer a free consultation, basing on the information you provide us with. This is just another possibility. And that’s it.
I can tell you there is nothing to worry about in Ukraine now. There are of course some political issues, etc., but most clinics are located in two big cities: Kiev and Lviv where the situation is completely ok. Regarding Cyprus: I do not know if you are referring to Cyprus or North Cyprus. If it is Cyprus, it is completely ok. When it is North Cyprus – it is also ok as long as you choose the clinic that has a proper certification. You may not know but in North Cyprus there are some problems with the certification of the IVF clinics. In overall, there are 16 fertility centres in North Cyprus. At the time when we were in North Cyprus, only 4 centres had a proper certificate from the government – nowadays there are maybe 5 of them. This is the certification issued after 2016 as the law changed in that year. So we’ve been there with my colleague Jacob and we have visited almost all the clinics. Most of them look good. There are few that are very good – in terms of service, the treatment quality and the doctors’ experience. However, they still have a problem with the law and the certification.
A few months ago we did a survey about Brexit and we had only about 50 votes or so. However, today Brexit is more a reality than a dream (or nightmare) for people in the UK. At the time when we were at the Fertility Show and some other meetings in the UK last year, we asked the Fertility Network, the HFEA and other people what they thought about the impact of Brexit on the IVF treatment abroad. And to be honest, I cannot see anything that may interfere with it in any way – except for maybe the increase in the prices of flight tickets. Today we cannot see anything that could get worse because of Brexit. Of course, there are issues with visas, etc. but I don’t think that the UK will be really treated in a different way than it used to be. So I cannot see any bad impact of Brexit on IVF abroad.
Yes and no. No, when you’re going there, undergoing your treatment, getting back and everything is fine. Yes – in case you go there, undergo the treatment and… there’s something wrong. Weird things can always happen. If you have to take your case to court or fight with some organisation or even sue the clinic – then nobody knows how to do that. As North Cyprus is not in the EU and they’re not under the EU law, all court cases would probably happen there. And it would be much more difficult from the patient’s point of view. However, I haven’t heard about a single situation in the North Cyprus that led to such kind of solution. But it’s medicine and there are always people behind each clinic. And people are making mistakes. So it is something that always should be taken into consideration. However, I wouldn’t say it is something that should discourage patients from going there. You know, there are patients who go to the United States for IVF – and it’s outside the EU as well. Of course it’s a different case but there is one thing in common – when a country is outside the EU, no one knows how things look like over there.
It is very difficult to answer. According to the practice in IVF clinics today, being 40 years old is an indication to use donor eggs and go one step forward in your treatment. The point is, this is the easier solution from the clinics’ point of view. I think that finding a clinic, which is really happy to support you as a patient for IVF with own eggs, may be really difficult. I mean the clinic that would not be pushing you into egg donation because of your age. The clinic is of course always obligated to show you all the risks and lower prospects which are related to your age. I think there are still such clinics on the market. However, I cannot give you advice that would help you straightaway. The only advice I can give you is to contact our consultants at: [email protected] . Elisabeth and Caroline are in touch with clinics and they know them very well because they’re organising consultations with doctors, etc. They may find a solution for you, the solution that you may want to try. I don’t mean going there but – as a starting point – you may, for example, have an online consultation and get the information which clinic would be happy to take care of you. I fully understand what you are saying about these standard protocols and so on. This is true that many clinics are using them because it is easier, cheaper and more profitable. In the end of the day, most patients who are 40 years old or more, will have indications to go for donor eggs anyway. However, medicine is far more advanced today than it was 20 years ago and I think that every patient should get a chance to continue the treatment with their own eggs. It’s a pity that many clinics do not want to think differently. I’m not saying they are bad clinics as mostly they’re very good at what they are doing. But you are – let me say that – a complicated and difficult type of a patient for them because you are looking for different solutions. So I would recommend you to contact Elisabeth or Caroline. Of course, they won’t send you the list of clinics the next day as they need to have a chat with you to really understand your situation, your medical history and what countries you’re looking for. Then they can think about the clinics and the doctors who are working with this kind of patients. So this is the advice I would give you. I know it doesn’t solve your problem but maybe it could be a good starting point at least. Of course, contacting Elisabeth or Caroline doesn’t cost you any money, the consultations they’re organising are also free of charge. So do not worry about that.
Well, we do not have the information what they should have. They can show you what they have and that may be enough for you to make your decision. However, we do not know what they need to have to be certified. In such a case, you should ask the Ministry of Health. You can read about the requirements for IVF units in Ukraine in our Guide. We contacted the Ukrainian Association of Reproductive Medicine (UARM) – the national body in Ukraine. They provided us with contact information for fertility patients. In our Guide, there are email addresses and phone numbers of people working for UARM. They are happy to help English-, Ukrainian- and Russian-speaking patients asking about guidelines and recommendations for clinics in Ukraine.
It’s ESHRE – European Society of Human Reproduction and Embryology (https://www.eshre.eu/). It’s the association that brings the data from all the clinics in Europe together. This is the most important organisation in Europe.
I think it is a very good idea to talk to the doctor before you go. Especially if you’re about to travel, let’s say, 2000 km or so. In your place, I would really like to check if this is the person I want to have my treatment with. It is the same for all the doctors you choose, either a gynaecologist or GP. The doctor-patient relationship is very important and sometimes it is just not working well. I think that online consultation will help you to sort this issue out already at the beginning. You can check if this person really fits you. And it’s not about the knowledge or professional experience of the doctor – I’m talking about the relationship between both of you. Remember that this is not the dentist and we’re not talking about a 45-minute surgery on the dentist chair. This is someone who will be running your treatment for several weeks or months. So I think it is a very good idea to have the consultation beforehand. Should you be worried if a clinic is not offering this kind of a solution? Well, as far as you have money to fly a few thousand kilometres just to see that the doctor does not suit you – then no. However, I think that most clinics will be happy to arrange this kind of consultation for you. And in most cases they will charge you money for that – probably from 80 to 200 Euro. But I think that spending this amount of money for a 45-minute online consultation is still better than spending a few thousand Euros for just flying there and back. Apart from that, while having this online consultation, you can discuss all your medical history. It is always good to look at it from a fresh perspective – and maybe the doctor will say something that you have not heard before. We witness such situations in our work on every day basis. It often happens that patients decide to go to this or that particular clinic because they saw one of our #IVFWebinars. During the webinar, a doctor said something they never heard about. For example, they had already 3 failed IVF cycles in their own country and no one told them there was a possibility of doing something in a different way. It may happen that during your online consultation something similar will happen to you. Maybe the doctor will find something in your history that can help you in the future. Looking from that perspective, I think it is the best what the new technology (internet, webinars, online chats, etc.) can do for patients nowadays. You can save time, money and learn new things during your online consultation with a doctor.
The slides in my presentation are taken from our Guide. It’s the IVF Abroad Guide that we published a few months ago. It was launched during the Fertility Show in London in November 2019. You can download it from here: www.whereivf.com . It is important to mention that there are no advertisements there – the Guide is completely impartial and independent of IVF clinics. We did it as patients would do it from their point of view.
I’m afraid you put me in an uncomfortable position, asking to answer this question. There are a lot of very good clinics in Prague. If you are asking about IVF CUBE – we’ve been there, we know them, we heard very positive opinions about this clinic from patients. However, you need to remember that there is not such a thing as the best clinic. What is best for you may not be the best for me or someone else. This is about the relationship between you, the clinic’s doctors, the customer service, etc. It is always advisable to check it out before you make the final decision. But I cannot say anything wrong about IVF CUBE. It’s a good and well-established clinic.
I cannot tell you right now as I remember only two of them at the moment. I wouldn’t like the others to feel offended by the fact I have not mentioned them. So if you could just contact Elisabeth or Caroline, they would get back to you with this information. As I told you, we did not quote any clinic in the Guide or publish names or info on any of them – it also refers to the North Cyprus part. We did not give any such information as it is changing all the time. So in order to learn that, please send an email to Elisabeth and Caroline at: [email protected]
I wouldn’t use the word ‘typical’. There are many different types of clinics, working in a different kind of way. The clinic you’re mentioning is working in this particular way, putting a lot of communication through coordinators. They may not be offering an online consultation because they may not have it on offer. And I wouldn’t say it’s typical for North Cyprus. You can find clinics working like that in every country. I wouldn’t say it’s good or bad – it’s just the way they work. If you prefer a clinic that offers an online consultation, you can ask them if it’s an option. If not – you can find another one. But as I told you, it’s not typical of any location. There are clinics all over the world working that way. The small, boutique clinics have more time to support patients while the big clinics have less time to do it. It is just about the procedure they use.
This is how it works according to the Spanish law which treats the donor’s anonymity in a bit different way than in other destinations. They cannot share any information that would connect you with the donor in any way. This is why they cannot say how the person looks like, etc. However, you know that this person looks like you because, according to the Spanish law, the donor and the recipient are matched by phenotype. The phenotype matching means that the donor is as similar to you as possible. It’s surely the same race and she must be very close in height and weight – as well as in the colour of eyes and hair. This is how it works in Spain. There are strict rules regarding the donors’ qualification and connecting donors with recipients. If it’s a well-established clinic, I’m sure you can trust them that everything will be ok. I do not know what you mean by health – if they are doing some genetic testing of a donor, etc. But it is important as well. However, remember that what they say is not because of that one particular clinic. It’s because of the Spanish law. In most clinics in Spain, they do exactly the same.
We need to ask the particular clinic about that. But there are two things to consider – if there are fresh eggs or frozen oocytes. If there are frozen eggs from the bank, the clinic has different possibilities because they can do the egg retrieval and then they can test the donor again after 3-6 months. It depends on the way they’re doing the testing – if it’s via PCR methods or genetic testing. I used to work in one of the biggest IVF clinics in Poland where they used PCR methods to diagnose all of these things. That works in a bit different way because you do not have to repeat the tests. If the donor has HIV on the day of egg retrieval, they just know it because the test is very sensitive. However, it is very expensive for the clinic – as compared to the standard HIV testing. But there are clinics that are doing that. If the clinic you’re in contact with is doing that, then it is possible for them to make sure there is no HIV.
I’m not sure how to explain it to you as I’m not good at medical terminology. If I were you, I would ask the clinic how they make sure that a donor is HIV-free in case of a fresh cycle. And if it’s a well-established clinic, they will answer you straightaway. Besides, there are a lot of articles online on how to test HIV using PCR methods. I’m sure it’s possible – otherwise, it would not be possible to do any fresh cycles with donors. You also have to take a closer look at all the documents on the donors’ qualification process provided by the clinic. If the medical and social background of a donor is known, then the risk of HIV is very low. I imagine clinics would include such information in their documents.
Choosing between fresh and frozen eggs or sperm is always a dilemma for patients, doctors and embryologists. There are clinics saying that fresh donor eggs are better. With sperm, the issue is less important as it is relatively easier to freeze and thaw its genetic material. Oocytes, on the other hand, are a very delicate material. Although it is not impossible, it is much more difficult to freeze and thaw them. There are different opinions. Some doctors say fresh donor eggs are better, others say frozen donor eggs are exactly the same as the fresh ones. Probably, if you ask five different clinics about that, each one of them will answer differently. I would refer to the US organisations that I mentioned in my presentation – the Society for Assisted Reproductive Technology (SART) and American Society for Reproductive Medicine (ASRM). They are publishing statistics for all the treatment types done in US clinics every year. They’re very strict and they’re doing it very well. They have published these reports for approximately 10 years – the last one is from 2017. And basing on this very large data source (as there are plenty of IVF and egg donation cycles in the US), you can see that differences between fresh and frozen eggs in the United States are up to 10% on average. It means that frozen eggs’ success rates are 10% lower than fresh eggs’ success rates. I’m not saying this because I think it works like that – I’ve simply seen that in the report. And this is not the report that is based on one clinic’s results. It’s based on 200 clinics and probably 35.000-40.000 egg donation cycles a year. And the reports from the previous years show exactly the same difference. So summing up: I do not know what is better as I’m not a doctor. However, basing on the reports I’ve seen so far, there is a 10%-difference between fresh eggs and frozen eggs cycles.
I haven’t heard about any Premier Egg Donors’ bank. Actually, I do not know how to answer you. You are in a difficult situation because of your characteristics that make it difficult for you to find a donor. However, it depends a bit on the option you’d like to use. If you wanted to use the donor’s oocytes in one of the Ukrainian clinics, you could go there and do it in the first cycle. However, if you wanted to transfer these oocytes to another country, you could have problems as Ukraine is outside the European Union. It would be difficult to transfer them to any of the UE countries. And then, when you get frozen oocytes (which are not so expensive over there), you never know how many of them would survive the thawing process. So in such a case, you would have to ask the clinic if there are any guarantees on the number of oocytes, etc. It’s can be tricky. It’s different when you do it with the clinic directly as then, in most cases, the rules are clear. If you just buy the oocytes and transfer them, you never know e.g. the quality. So I do not really know what to advise you. Maybe – as the last slide of my presentation says – don’t be suspicious but be careful. And ask the right questions.
I don’t know. What we know today is that there are two countries that think of changing the legislation. One of them is Germany. We heard that they are thinking of changing the legislation to allow IVF and egg donation with non-anonymous donors only. There is also another destination where there are a lot of rumours about changing the IVF law. And this is Spain. When we were in Spain about two months ago and we visited the clinics, we learned that the law there would be probably changed to allow non-anonymous donation in this kind of treatment. So this is the change that I’m aware of and which may be important to patients. In Spain, it is confirmed that it’s happening and the changes are possible. Portugal, UK and Ireland have non-anonymous donation today. However, the last two have problems with the lack of donors. And I can tell you why: it’s because they’re non-anonymous. Although it is not that bad from a patient’s point of view, it looks very very different for a donor. Think of possible impact it could have on their future life. Someone could say that there is no such a problem in the US where there are a lot of donors – despite non-anonymity. Yes, but it is also the reason why so many American patients come to Europe for treatment. It’s because of a donor compensation that is between 8.000 and 16.000 dollars. Imagine what is the total cost of the treatment in such a case. So if most European countries go on with non-anonymous donation, the treatment will become much more expensive. Within a few years’, we’ll see what is going to happen.
Ukraine has anonymous egg donation. However, it does not mean that you can’t e.g. see a donor’s picture as a baby. There are the clinics that offer this kind of service.
This question consists of two parts. One refers to the political situation and what may happen in a year, two or five. I don’t know that, you don’t know that. If there is anybody who knows that, I would like to hear their voice. I know for sure that today it is ok, tomorrow is probably ok, too. But what’s going to happen in a few years? I don’t know. There are many things changing rapidly every day in the world today.
Referring to the second part of the question: this is your genetic material. If you have your embryos thawed and frozen in one of the clinics in Ukraine, I don’t think there will be any problems to transport these embryos to your country – unless you’re going to sell them. In other words: as this is your material and it’s not for sale, you will have no problems with transferring it to one of the clinics in your country. There are companies specialising in all of the legal stuff and transporting this kind of precious genetic material. I don’t think you should worry about that. You can also ask the clinic before making any decision. If they have some experience in sending genetic material to other countries, they would do it. Obviously I’m not talking about oocytes bought from the external bank but the situation when you are the owner of your genetic material. The only exception I can think of is USA or Canada with this FDA stuff, etc. But if it’s your material, I think it would be much easier.
It’s true that if the embryos are going to be transferred to a non-family member, you have to do special FDA testing. We had a similar situation at the clinic I used to work for. We were about to send oocytes to one of the patients the US. The problem was that the oocytes weren’t hers – so in that way they were to be transferred to a non-family member. But in your case, if the embryos have been created with yours and your partner’s genetic material, I do not think there might be any problem. If you send an email to Elisabeth or Caroline at: [email protected] , they will send you contact details of one or two companies that specialise in this kind of shipment. Ask your clinic as well as they must have some experience in sending this kind of material outside of the UK.
Unless you’re not asking me about Lotto winning numbers, please feel free to write to me and I’ll do my best to answer your questions ? . My email address is not a secret at all. It is very transparent and not as secret as the pricing lists of some of the clinics in Spain that do not publish them on their websites ? .