Who is abroad for fertility treatment, and why?

Amsterdam, The Netherlands: A significant number of patients in Europe, in other countries for fertility treatment because they believe that improving the quality and supply abroad, subject to procedures to be prohibited in their country of origin, said a study on the theme of the 25th annual conference of the European Society of Human Reproduction and Embryology today (Monday 29 June). Coordinator of the study Dr Francoise Shenfield of University College Hospital, London, UK, said that this is the first evidence of a hard drive, high fertility patients of migration in Europe. "So far we have only anecdotal evidence of this phenomenon," she says. "We believe that our results are very useful for patients, physicians and policy makers." During one month, the ESHRE Task Force analysis of clinical data of participants in six European countries: Belgium, Czech Republic, Denmark, Slovenia, Spain and Switzerland. Clinics were asked questionnaires for patients abroad for treatment. The questionnaires seek information on their age, country of residence, reasons for moving to another country for treatment, which had received the treatment, if the information in their own language, as for the Center, they were and if they get a refund of their country of origin of the health system. 1230 has been completed and is returned.

"It may not seem, for a very large number," said Dr Shenfield, "but it shows only a month of events in a limited number of centers in six countries. The number of treatment cycles per year can be estimated by extrapolation, in our monthly data over a year and the assumption that the centers are more than half in each country studied. This leads to an estimate of at least 20 000 to 25 000 cycles of treatment by border year in these countries. It is difficult in a number of patients from these figures as patients, more than one cycle, for a pregnancy, the average number depending on the type of treatment. "

Almost two thirds of patients from four countries with the largest number of Italy (31.8%), followed by Germany (14.4%), the Netherlands (12.1%) and France (8.7%). Overall, people from 49 countries beyond the borders for fertility treatment.

The main reason for going abroad for fertility to legal restrictions at home. 80.6% of Germans surveyed patients their main reason, 71.6% of Norwegians, Italians, 70.6% and 64.5% of French. Difficulties of access to treatment was cited more than patients in the United Kingdom (34.0%) than other countries.

Age plays an important role in the decision of the mission for treatment. The average age in all countries to more than 37.5, German and British patients, but rather a much higher age with 51.1% of Germans aged over 40 and 63.5% of the British. Civil status between different countries, with a total of 69.9% of women were married and only 6.1% only. But 82% of Italian women to marriage, while 50% of French women live (often in same-sex couples), and 43.4% of women were single.

The majority of respondents, the assisted reproductive treatment (ART) alone (73%) compared to 22.2% in the intra-uterine insemination (IUI), and 4.9% and IUI art. These numbers are between one country and others, it was a majority of IUI treatments for french (53.3%) and Sweden (62.3%) patients, with a majority of ART for most other countries.

Fertility treatment abroad is not repaid, "says Shenfield. "Only 13.4% of patients interviewed by the partial refund, and only 3.8% were fully reimbursed for their treatment."

The generous country, the Netherlands, with a total or partial reimbursement of 44.4% and 22.1% of patients. In France, patients can be reimbursed for treatment abroad, where there is a delay at home, and treatment, illicit trafficking at home, for example for single women or homosexual couples, are non-refundable.

"This was a pilot study in a small number of countries, and thus has its limits," said Dr Shenfield. "It confirms the information gathered by support groups for patients and in the media. For example, Spain and the Czech Republic are destinations of oocyte donation, in Sweden, Denmark for the collection center and french in Belgium.

"It also helped us concrete evidence for the large number of Italians, boundaries for treatment, illegal under the 2004 legislation, or because they get them, making it a better quality of treatment. This may mean, for example the possibility of freezing embryos, "she says.

In another study, Professor Guido Pennings of Ghent University, Ghent, Belgium, in detail on the situation in his country. Belgian, 16 of the 18 centers of reproductive medicine, the license to use the ova and embryos questioned the nationality of the patient for treatment between 2000 and 2007, and the nature of treatment, for which they came.

The researchers found that since 2006, flows of foreign patients in Belgium has about 2,100 patients per year, and most of them were couples of lesbians in France, the donation of sperm.

It seemed a clear correlation between the legal prohibitions in patients from countries of origin and the numbers abroad, he said. "Changes in the number of patients from a country for special treatment and changes in the legislation in this country are not by chance.

"In France, for heterosexual couples in stable relationships and reproduction, the age for access to assisted reproduction. Besides the legal reasons, because of the proximity of the two countries and the fact that the difficulties language are limited, it was not surprising, patients in french most of the trip to Belgium (38%). These were patients from the Netherlands (29%), Italy (12%) and Germany (10%), "he says.

Professor Pennings was of the opinion that the figures underestimate may be. Not only that 2 of the 18 centers not qualified answer, but centers on the condition, treatment, less demanding techniques, such as hormonal stimulation or artificial, are not taken into account. In addition, it has no data from the countries least five patients per year per center.

"Although the collection of data on the number of patients from one country to another is an important first step for future research should the patient experience, the difficulties that live, the impact of these movements on national health systems and the effects of, eg, portability of insurance on the number, "he said. "We are only able to properly assess the phenomenon, if we can see the whole picture."