Laws and regulations between different countries
Regulations and assisted conception treatment
Laws and regulations governing Assisted Conception Treatments vary between different countries.
With different ethical, political and religious viewpoints it not surprising that each country would develop separate laws regarding reproductive technologies. In some countries such as USA and Australia, each state has its own legislation. Reproductive tourism is a result of these localised restrictions giving couples freedom to choose appropriate treatment and avoid moral conflict.
The laws governing new technology tend to lag so far behind the technology itself , that they are often in danger of being obsolete by the time the legislation is enacted. There is also the problem that laws may be unsuited to responding to the complex individual circumstances that often characterize this field of science.
Forms of Assisted Conceptions Treatment
Some countries forbid all forms of assisted conception treatments using donor sperm, donor eggs, donor embryos and surrogacy donor such as Egypt, Saudi Arabia and Italy, while others allow donor sperm but no egg or embryo donation and no surrogacy as in Norway and Japan.
The number of embryos to be transferred
Some countries have legislation with limit to the maximum number of embryos to be transferred such as United Kingdom, France, Australia, Germany and Greece
Some countries have guidelines specify limit but no enforcement mechanism such as Egypt, USA and Japan. Whereas, some countries have neither legislation nor guidelines.
New Belgium legislation imposes on women less than 36 years a restriction to single embryo transfer (SET) in their first treatment cycle.
Freezing spare embryos
Human embryo freezing is allowed in some countries such as UK and not allowed in others as in Italy.The storage period also varies from a limited period of 2 years as in Denmark to 10 years as in UK and unlimited period for infertile couples as in Finland.
Anonymity of gamete donors
Countries such as UK, Sweden, Denmark and Norway have passed new legislation abolishing the anonymity of gamete donors (egg, sperm and embryo donors).
Treating single women
Treating single women is allowed in some countries but not in others such as Sweden and Denmark. Even in the same countries such as Australia, some estate will allow single women to be treated while others do not.
Fertility Tourism (or more correctly Cross-border Fertility Treatment)
BRITISH couples desperate for a child are becoming “fertility tourists” to take advantage of the low prices and high success rates of eastern European IVF clinics.
Treatment in countries such as Slovenia and Hungary generally costs half as much as in Britain, yet is often more likely to result in a pregnancy. This has made it attractive to British patients, three quarters of whom pay for therapy.
While there are no official figures for the numbers travelling abroad for treatment, they are believed to run into hundreds every year. At least two British clinics organise treatment in Spain, Greece and Romania, and doctors predict that more people are likely to follow this route following the enlargement of the EU.
Slovenia and Hungary are the most attractive likely destinations for fertility tourists as both countries have higher IVF success rates than Britain and significantly lower prices. A cycle of treatment in either country costs about £1,600, compared with up to £4,000 in Britain.
The latest European survey of IVF, places Slovenia third with a success rate of 36.2 per cent, Greece in joint 7th place with 32.3% and Hungary ninth on 31.9 per cent.
Britain comes 14th, with a success rate of 28.4 per cent, the European Society of Human Reproduction and Embryology conference in Berlin was told.
Most existing fertility tourism takes place because of the shortage of donated eggs in Britain, which means many women who have no viable eggs of their own choose to travel to countries such as Spain and Greece where donors can be paid. Two London centres — the Bridge Clinic and the Bupa Roding Hospital — already organise such trips. This has increased since new British laws stripping egg and sperm donors of the right to anonymity become active in 2006 year.
Italian IVF law is said to be the most restrictive in Europe-The law restricts the provision of fertility treatments to 'stable heterosexual couples' who live together and are of childbearing age, and who are shown to be clinically infertile.
Research using human embryos is prohibited, as well as embryo freezing, gamete donation, surrogacy and the provision of any fertility treatments for single women or same-sex couples.
The law also says that no more than three eggs can be fertilised at any one time, and that any eggs fertilised must all be transferred to the uterus simultaneously.
Pre-implantation genetic diagnosis / screening for genetic disorders have also been banned.
Fertility clinics across Europe have seen an increase in the numbers of Italian patients seeking treatment since the legislation came into force.
Pros
Reproductive tourism is on the increase in Europe, but rather than condemning it, we should regard it as a “safety valve”
Reproductive tourism helps to avoid moral conflict.
Thousands of people travelled between European countries each year, seeking to take advantage of fertility laws that were more liberal in countries other than their own or because treatment was cheaper.
Rather than seeking harmonisation of laws on reproductive medicine across Europe to prevent such tourism, we should accept the existing diversity and recognise that it enables people of different ethical and religious views to live peacefully together.
The number of movements is increasing because people are more used to travelling, are much better informed about policies in other countries and clinics by means of the internet, and because some clinics facilitate access by foreign patients by offering packages including visas, hotels and interpreters.
“The main causes of reproductive tourism are that a type of treatment is forbidden by law for moral reasons, certain categories of patients are not eligible for assisted reproduction, and the waiting lists are too long.”
People seeking fertility treatment were travelling between most European countries now. “There is a general move to former East European centres because of the lower financial costs and towards Spain for oocyte donation (they have more donors because compensation of donors is allowed). In reality there is movement from almost every country to other countries and vice versa.”
Italy was an example of a country where people were voting with their feet following the new law that banned embryo and gamete donation and the freezing of embryos and that allowed only three eggs to be fertilised, all of which had to be implanted in the woman in one go, regardless of their quality or the age of the woman.
Patients and practitioners vote with their feet with hundreds of non-sterile couples at high genetic risk of a particular condition going abroad for treatment.
“Reproductive tourism illustrates the conflict between ethics and politics. Although the majority has the political right to express its moral views in the law, a number of important ethical values such as autonomy, tolerance and respect for other people’s opinion urge the majority to take the minorities’ position into account.
Cons
Think twice about taking an “IVF holiday”
Human Fertilisation and Embryology Authority (HFEA) - the UK's regulator for fertility treatment is urging people to think twice about taking an “ivf holiday” and undergoing fertility treatment abroad .
The HFEA's role is to ensure that care and treatment in UK licensed clinics is of the highest standard - UK patients can be confident clinic inspections and monitoring ensure standards remain high. However, the HFEA do not have the powers to regulate treatment carried out abroad - even when UK clinics are able to refer patients to clinics abroad - and so cannot assure patients that they will receive safe and high quality care.
We would urge patients to consider the risks and implications of going abroad for treatment and have provided key information on the most important issues that patients should be aware of on our website.
As the UK is unique in its standards of fertility treatments we advise that patients who are considering going abroad must check the standards and regulation of clinics in that country. For example, key issues to consider include:
* What happens if treatment abroad goes wrong?
* Is patient information kept safe and confidential?
* The legal position for donors in that country - are they anonymous?
* Do donors have legal responsibility for the child?
* How are ethical considerations made regarding how donors are recruited, compensated and screened?
If a patient is not satisfied with the treatment they have received at a UK licensed clinic then they can follow the clinic's complaints procedure - which is monitored by the HFEA. However, if they are unsatisfied with treatment they have received abroad , they do not have the same opportunity as their clinic will not be regulated by the HFEA.
.HFEA spokesman says "We have heard of some clinics which offer treatment to patients that is so dangerous that it has been banned in the UK - for example implanting five embryos which significantly raises the chance of multiple pregnancy - the biggest risk of ivf for both mothers and babies.
We would urge patients to think twice and consider the risks and implications before going abroad for treatment ."
