More and more British couples, frustrated by what is available in this country, are choosing to have fertility treatment abroad. Kate Graham talks to some of them about their experiences
Sitting in her toy-filled living room, cradling seven-week-old twins Rosie and Thomas, Juliette Stamper looks like millions of other new mums - extremely proud and utterly exhausted. But the story of the Stamper family is far from ordinary. It stretches over three years and features an anonymous egg, a financial transaction and a trip to Spain. Like an increasing number of UK couples, Juliette, a 37-year-old teacher, and husband Stan, 39, are fertility tourists, travelling abroad to pursue their dream of starting a family. It's a dream they are convinced would not have come true in Britain.
In 2002, this Norwich couple had never even considered treatment abroad. But when two failed IVF cycles in the UK revealed just a 5% chance of conceiving using their own eggs, they felt they had little choice. "We were devastated at the news," Juliette says. "At first we looked into the possibility of using an egg donor here in the UK. But when we discovered there were 200 couples on the waiting list [at our hospital] already, we knew our chances were slim."
It has become a familiar story to couples battling with infertility. Figures from the Human Fertilisation and Embryology Authority (HFEA) show that egg donations increased from 247 in 1990/1 to 1,125 in 2001/2. But as more and more women put off starting a family, demand is increasing, and with just £15 compensation and anonymity no longer guaranteed for donors, there are just not enough eggs to go round.
So when a nurse mentioned to Juliette that donor eggs were available in Spain, the couple gave it serious consideration. "I discovered that because they offered €1,000 compensation and donors retained their anonymity, there wasn't an egg shortage. But we shopped around and explored other countries. Our main priority wasn't the treatment cost, it was how the clinic worked within their country's legislation."
Finally choosing Spain's Ceram clinic in Marbella at a cost of £1,800, they arranged their first bank transfer. "At that point I panicked. What if these people are charlatans? We had never even spoken on the phone."
As the first UK couple to visit the clinic, there were teething problems. They had difficulties getting drugs, having them injected and having the necessary scans here in the UK, which became increasingly stressful. "It was just like knocking our heads against brick walls," says Juliette.
Since then the Spanish clinic has developed links with fertility centres in the UK to build shared-care programmes for patients travelling for treatment. Ruth Pellow, head nurse of IVF programmes at Ceram, has treated 20 UK couples this year, and expects to see an increase in the months to come. "It is pure frustration that drives couples abroad; frustration with multiple cycles without success, frustration with not being allowed to have a third embryo put back, frustration with waiting years for a donor. Couples don't want to wait three years before they can even start treatment."
Alison Jackson, 28, and David Ellis, 31, of Lewisham, south London, completely agree. After treatment for ovarian cysts and endometriosis left Alison with little chance of conceiving naturally, they tried one private IVF cycle in London. "It felt as if I was going to buy a car rather than have a medical procedure. I was told the devastating news that my cycle was to be abandoned by a doctor I had never met before. He just came in and said it as if he was telling me the bus was running late."
With a second operation booked to treat her endometriosis, they had to move quickly. "We had a three-month window following the operation to get pregnant using a donor egg, so the NHS was out. I spent a lot of time on internet message boards, saw the number of women travelling abroad, and so decided to go for it.
"We looked at South Africa, but discovered that the coordinator I was emailing was actually a broker. I felt uneasy and decided not to go ahead." With time running out, her doctor suggested Moscow. "I knew nothing about the country," Alison admits, "but I trusted my doctor, and the donor women in Russia are pale like me, which was important."
Costing £2,700, the price at the Altra Vita clinic was competitive, but with limited time they compromised on important preliminary tests. "Normally patients have an initial appointment, but because we were short of time we skipped that part." Paying a 50% deposit despite never having seen the clinic, they bought their drugs here in the UK, and got on the plane. Despite a Moscow-wide power cut that left them walking six miles home in 30C, they were delighted with their treatment.
"The minute we walked through the door, the difference between the clinic in Moscow and the UK was stark - you were not even allowed to walk into the reception there without putting covers on your shoes first."
Now six weeks pregnant, Alison has no regrets. "It had been three years of hell and I was just desperate to get started. We were thinking that if it didn't work we would have some frozen eggs and could nip back to try again. It is only a plane journey away."
Rebecca and Stephen Evans, from Northern Ireland, also conceived abroad, on their second IVF holiday, at the Fertility Centre in Chania in Crete. After the trauma of two failed IVF cycles in the UK, they were looking for a more caring approach, as well as an available egg. "We looked at more than 16 clinics worldwide but the compassion from the staff was the deciding factor. They spoke to us as human beings rather than medical procedures," says Rebecca, 33.
Crucially for the couple, in Crete the donor remains completely anonymous. "We did not want anonymity to be removed from an egg that I use. We want the control of the information, we'll just explain to our child that a nice lady helped mummy have a baby." They booked their trip, despite having never seen the clinic. "Because we were going to a different country and spending so much money, we knew it was a big leap of faith."
Their faith was rewarded when their second visit resulted in a pregnancy that Rebecca - now seven weeks pregnant - is adamant would not have been possible in the UK. "After our first cycle in Crete failed, the clinic discovered an immune problem. By solving that I got pregnant, but I am convinced it would not have been picked up at home."
Not every couple travels for an egg donor. After three IVF cycles in the UK failed for Roz and Greg Wisdom, at a cost of £3,500 each, the couple searched for a clinic that offered a more specialised service. "Our local clinic was professional and good value for money," Roz says, "but it turned out we were a very complicated case. They didn't have the level of sophistication we needed."
They found what they were looking for at the Sirm clinic in New York and arrived for an IVF cycle in February. "Suddenly we were confident that we were dealing with a 100% fertility expert, Dr Geoffrey Sher, who personally did the scans and the treatments. If we could have found a figure like that in the UK, we might have stayed."
Infertility Network UK's chief executive, Clare Brown, is sympathetic to couples in desperate need, but counsels caution. "We understand that couples feel this is their only chance, but clinics abroad are not as regulated as they are in the UK. The tests, the donors, the screening are not always as rigorous, and it is done like that here for a reason." Many do not offer counselling, which couples might require. "It's when IVF fails that couples really need it. When it is over and you fly home, you are on your own."
The HFEA is similarly cautious about fertility tourism. Angela McNab, HFEA chief executive, says: "The UK's approach has been achieved through consensus among patients, clinicians and the wider public and it continues to command confidence throughout the world. Beyond the UK, patients do not have the same guarantees and without independent regulation, real risks can be taken unknowingly by patients."
Dr Gillian Lockwood from Midland Fertility Services believes any patient going abroad should be supervised by clinics in the UK. "My clinic has established good links with clinics abroad so we are happy with the quality of care that they are getting. I would not want people to surf the internet and just turn up at a clinic in eastern Europe. It is not a good idea."
And however temptingly cheap that treatment might be, Allen Pacey, senior lecturer in andrology at Sheffield University and secretary of the British Fertility Society, warns against being seduced. "If somebody is advertising very cheap treatment online, is it because overheads are lower, or because they are cutting corners? Remember, anyone can throw up an impressive-looking website."
Tony Reid, from online support network Fertility Friends, knows that there are people online trying to exploit vulnerable couples. He recently discovered false claims posted about a Caribbean clinic on his message boards. "She claimed to have cycled, got pregnant and was back in Britain, but her address proved she was posting from the Caribbean." On contacting the clinic he was told that this woman had cycled the year before, and was asked to continue posting falsely. "My question about the clinic is not about their technical ability, it is about their ethics. Couples experiencing infertility are a vulnerable group of people, and this clinic was just exploiting their hopes."
For Greg and Roz, from Worcester, there has not yet been a happy ending. Tests revealed that because they are so closely genetically matched, without a medical breakthrough they will never be able to conceive. Although devastating, they feel that at least they have some answers. "We would never have known if we had carried on cycling in the UK," says Greg. "But it is incredibly disheartening to think of the cost that journey has taken, the time, the money, the trips, the stress and the arguments."
Whatever the cost, Pacey believes this trend is here to stay. "Fertility tourism has always happened and will continue to happen. The real tragedy is that those with money can always go overseas, but the people who haven't two brass farthings to rub together are always the people who lose out." Some names have been changed.
Kate Graham. The Guardian, Tuesday 21 June 2005