Fertility patient migration within Europe – some facts

Many European patients are travelling to other countries for fertility treatment, revealed by researchers at the 25th annual conference of the European Society of Human Reproduction and Embryology.

Patients with infertility think that they will receive better quality care abroad, and in order to undergo procedures that are banned in their home country.

The ESHRE Task Force analysed data from participating clinics in six European countries: Belgium, the Czech Republic, Denmark, Slovenia, Spain and Switzerland.

Clinics were asked to provide questionnaires to patients coming from abroad for treatment. The questionnaires asked about their age, country of residence, reasons for travelling to another country for treatment, which treatment they had received, whether they had received information in their own language, how they had chosen the centre they were attending, and whether they had received reimbursement from their home country’s health system.

1230 forms were completed and returned. Findings from the study:

Country —

1. Almost two-thirds of the patients surveyed came from four countries, with the largest number coming from Italy (31.8%), followed by Germany (14.4%), the Netherlands (12.1%) and France (8.7%). In total, people from 49 countries crossed borders for fertility treatment.

Main reason — legal restrictions —

2. The main reason for going abroad for fertility was to avoid legal restrictions at home. 80.6% of the German patients surveyed have this as their primary reason, 71.6% of Norwegians, 70.6% of Italians, and 64.5% of French. Difficulties of access to treatment were cited more by patients from the UK (34.0%) than those from other countries.

Age —

3. Age also played an important part in the decision to travel for treatment. The average age across all countries was over 37.5, but German and UK patients tended to have a much higher age profile with 51.1% of Germans being aged over 40 and 63.5% of British.

Status —

4. Civil status also varied between countries; overall 69.9% of all women were married and only 6.1% single. But 82% of Italian women were married, while 50% of French women were cohabiting (often in same sex couples), and 43.4% of Swedish women were single.

Kind of therapy —

5. The majority of respondents were seeking assisted reproduction treatment (ART) only (73%) as opposed to 22.2% intrauterine insemination (IUI), and 4.9% both ART and IUI. These figures also varied between one country and other; there was a majority of IUI treatments for French (53.3%) and Swedish (62.3%) patients, with a majority of ART for most other countries.

Reimbursement —

6. Fertility treatment abroad is poorly reimbursed. Only 13.4% of the patients received partial reimbursement, and as few as 3.8% were reimbursed totally for their treatment. The most generous country was The Netherlands, with a partial or total reimbursement of 44.4% and 22.1% of patients. In France, patients could only be reimbursed for overseas treatment where there was a delay at home, and treatment that was illegal at home, for example for single women or homosexual couples, was not reimbursed at all.

Study co-ordinator Dr. Fran?oise Shenfield, from University College Hospital, London, UK, said that this was the first hard evidence of considerable fertility patient migration within Europe. This was a pilot study carried out in a small number of countries, and hence has limitations. It has also enabled us to have concrete proof of the large numbers of Italians who cross borders to obtain treatments which were made illegal under the 2004 legislation, or because by doing so they will receive what they perceive to be better quality treatment. This may mean, for instance, the possibility of embryo freezing.

Source: European Society for Human Reproduction and Embryology, Belgium

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