Have womb, will travel: the ethical implications of fertility tourism
by Elizabeth Yuko, Institute of Ethics, Dublin City University
While some people travel for business, or in order to experience new cuisine, scenery and culture, others travel with another activity on the agenda: obtaining fertility treatments.
Fertility tourism – or reproductive tourism – involves people travelling to another country in order to receive fertility treatments, typically if they are unaffordable or unavailable in their home country, or if they believe they will be receiving better care abroad.
In a 2009 study on fertility tourism in Europe, the European Society of Human Reproduction and Embryology (ESHRE) estimated that at least 20,000 to 25,000 cross-border fertility treatments are carried out each year in the six countries included in the study: Belgium, the Czech Republic, Denmark, Slovenia, Spain and Switzerland.[1]
Nearly two-thirds of the participants surveyed for the study came from four countries: Italy (31.8%), Germany (14.4%), the Netherlands (12.1%) and France (8.7%).[2] People travelled from a total of 49 countries to the six destination countries in the survey in order to receive fertility treatments. [3] The main reason for seeking the treatments abroad was to avoid legal restrictions in home countries, and the average age across all countries surveyed was over 37.5.[4]
There is significant movement across Europe itself, particularly amongst people seeking treatments banned in their home countries. For example, Italians are travelling to receive treatments banned under 2004 legislation, including embryo freezing. [5] Another study carried out at the University of Ghent in Belgium found that there was a significant influx of lesbian couples from France who sought sperm donation in Belgium.[6]
Although the United Kingdom (UK) has some of the most liberal fertility laws in Europe, many people are still travelling abroad for treatments because of National Health Service restrictions on age and waiting lists, and because private treatments are highly costly.[7] British citizens also travel to the United States in order to undergo pre-implantation genetic diagnosis (PGD), which can reveal the sex of an embryo, and is banned in the UK, with the exception of when it is used to screen for genetic diseases. [8]
The UK is also facing sperm and egg shortages, following a change in the law protecting anonymous sperm donors and allowing children of donors to learn the identity of their biological parents, which resulted in fewer people willing to donate. [9] As a consequence of the shortage, people are sourcing gametes from abroad. [10]
The goal of fertility tourism – having a child – can be viewed as valuable, and fertility tourism can be seen as expanding the autonomy of an individual by increasing his or her chances to reproduce. [11] There are, however, ethical issues that arise in relation to fertility tourism.
Firstly, a woman may have multiple embryos implanted in a clinic abroad, as opposed to transferring a single embryo – a practice that countries such as the UK favour. [12] With the implantation of multiple embryos may come multiple births, which are riskier – particularly for babies born premature and in need of intensive care. [13] This practice could jeopardise the health of the mother and children.
Secondly, varying amounts of compensation given for donated eggs may make women more willing to donate. For example, in the UK, egg donors can only be compensated up to £250, while in Spain the limit on compensation is £900 and £500 in the Czech Republic. [14] Egg donors – particularly those who are young – may not be fully aware of the implications of egg donation, and may not be properly counselled about the issues surrounding their donation.
Thirdly, there may be the potential for the unauthorised transfer and/or sale of gametes or embryos. For example, one case in Spain saw hundreds of spare embryos leftover from the IVF treatment of British couples donated to other couples without the biological parents’ knowledge or consent. [15] While there are some overlapping concerns between the unauthorised transfer and/or sale of organs and tissue, and gametes and embryos, the distinct difference is the potential of the gametes and embryos to create a new human life. This could result in a person or couple having a biological child of which they are unaware.
Additionally, fertility tourism may result in situations similar to that of the 66-year-old Spanish woman who travelled to California for IVF treatment and lied about her age, telling doctors that she was 55. She died at the age of 69 from cancer, leaving two-year-old twins.[16] There are several ethical issues that arise from that scenario surrounding the age of mothers seeking IVF treatment, and background checks on fertility patients from abroad.
Several questions still remain. Is fertility tourism ethically desirable? Is it simply a harmless form of travel that permits the infertile to obtain more affordable or available forms of treatments outside of their home countries, or a troubling trend further commodifying the reproductive process? Should there be transnational regulations setting minimum standards regarding infertility treatments?
Regardless of any potential ethical problems with fertility tourism, it is unlikely to stop any time in the near future. As long as people have the desire to have their own genetic children and the willingness and funds to travel, fertility tourism will continue to grow as an industry.
References
7 http://www.guardian.co.uk/society/2009/jun/29/women-over-40-fertility-tourism
8 http://www.timesonline.co.uk/tol/life_and_style/health/article6805880.ece
9 http://www.sheffield.ac.uk/mediacentre/2010/1480.html;
http://www.telegraph.co.uk/health/healthnews/7869822/Desperate-hunt-for-donor-eggs-forces-couples-to-seek-IVF-abroad.html
10 http://www.sheffield.ac.uk/mediacentre/2010/1480.html;
http://www.telegraph.co.uk/health/healthnews/7869822/Desperate-hunt-for-donor-eggs-forces-couples-to-seek-IVF-abroad.html
11- 14 http://www.guardian.co.uk/society/2009/jun/29/women-over-40-fertility-tourism
16 http://news.bbc.co.uk/2/hi/health/8152002.stm
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