SHOULD YOU TRAVEL ABROAD FOR IVF?

Other countries offer more affordable care in appealing destinations, but couples should proceed with caution. Tens of thousands of U.S. residents are projected to have traveled overseas for reproductive health care this year.

For three years, Danielle Camarena's Internet search history looked like this: Why can't I get pregnant? Who can help me get pregnant? How can I change my diet to boost fertility? Is my laundry detergent preventing pregnancy?

She never got to the questions about parenting.

"We thought [pregnancy] would happen right away, but it sure did not," says Camarena, a 32-year-old technical writer in Covina, California.

So she and her husband got help. First, they tried intrauterine insemination – a fertility treatment that involves inserting the man's sperm directly into the woman's uterus. No luck. Then they tried it again. And again. And again. They moved on.

 

Next, they tried in vitro fertilization, a procedure that involves combining eggs and sperm in a lab dish before transferring the resulting embryo (or embryos) to the woman's uterus. But before the couple could complete the process, the facility closed temporarily without warning. "We felt like it was a red flag," Camarena says.

Then, they looked into adoption. But while Camarena was researching options overseas, she stumbled on a blog post that stopped her in her tracks. In the post, a woman detailed her positive experience traveling to Barbados for IVF. "Do we want to do international medicine?" the couple wondered. "Is that safe?"

By the end of this year, 1.2 million U.S. residents will have decided it's safe enough, traveling abroad for treatments ranging from knee replacements ​to dental implants to chemotherapy, according to projections by Patients Beyond Borders​ , an organization that produces books and medical travel resources. About 5 to 7 percent travel for reproductive health care like fertility treatments, estimates Josef Woodman, the organization's founder and CEO.

Still, the prospect is "intimidating"​ and "scary" at first, particularly if you're going to be put under anesthesia ​abroad, Camarena says. But when she asked her primary care doctor whether she was crazy for considering it, he told her no. "There are so many people who do it, [but] it's kind of like a secret," she remembers him saying. "They just don't talk about it because they're afraid of what people will say."

Not Camarena, who settled on the blogger-endorsed Barbados Fertility Centre this fall for IVF and is now 14 weeks pregnant. "I want to shout it from the rooftops," she says. "I want everyone to know."

Why travel for care?

​The trend of traveling away from the U.S. for medical care is a 21st century phenomenon due in part to the global spread of Western medicine, says Marcia Inhorn, a professor of anthropology and international affairs at Yale University, pointing out that well-to-do foreigners used to come to the states for modern care. "Medical care in the U.S. is so expensive that people feel like, to access it, they have to go to what we used to call 'developing countries," says Inhorn, author of "Cosmopolitan Conceptions: IVF Sojourns in Global Dubai," a book that tracks 220 reproductive health travelers from 50 countries. For example, an IVF cycle in the United States – which isn't usually covered by insurance – costs an average of $15,000, but only $3,300 in India, ​$6,500 in Thailand and $7,800 in Mexico, according to Patients Beyond Borders.​

Americans may also find equal, if not superior, care abroad, according to Woodman's book, "Patients Beyond Borders: Everybody's Guide to Affordable, World-Class Medical Travel." Barbados Fertility Centre, for example, reports an 80 percent IVF success rate for women under 35. Compare that to the United States,​ where only about 46 percent of IVF cycles result in a clinical pregnancy on average, according to the Society for Assisted Reproductive Technology. 
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"We pride ourselves on using the latest advances in reproductive medicine to ensure our patients have their best chance of success," says Anna Hosford, the facility's clinic director. 

Americans might also prefer how they're treated in other countries, Woodman says. "As IVF and [assisted reproductive technology] continue to deploy new technologies and innovation, it's hard for U.S. practitioners to treat people in the manner they're desperate to be treated," he says.  

That was the case for Camarena and her husband, who sometimes didn't even get a "hello" at California clinics. "It's like they're too busy for you or something," she says. By contrast, the staff in Barbados knew their names, hugged them and answered every question patiently. "They make everything so stress-free," Camarena says. 

The couple's trip was also a steal: While Camarena says one round of IVF at a California clinic would have cost between $18,000 and $20,000,​ they paid $13,000 for everything, including the treatment, medications, travel, food, tourist excursions and a three-week stay in a home (with air conditioning and a pool) rented through Airbnb. "No one thinks they're going to need IVF – no one," Camarena says. "So then we were here, we were like, 'Let's make the best of it,' and we had a fantastic vacation."

'Buyer Beware'

Of course, international reproductive care ​comes with weighty risks, says Dr. Robert Stillman, medical director emeritus at Shady Grove Fertility, a fertility center with offices in Maryland, Pennsylvania, Virginia and the District of Columbia. "You're not talking about defective footwear that you can get less expensive elsewhere or online," he says. "You're talking about your health and perhaps, in this case, your child's health."

Depending on the country's laws and medical practice guidelines, Americans may not have access to accurate information about foreign clinics' quality of care or outcomes, adds Judith Daar, a professor at Whittier Law School and at the University of California-Irvine School of Medicine who chairs the American Society for Reproductive Medicine’s ethics committee. They also may not be told about procedures' risks and benefits and may not have as much legal protection abroad should something go wrong, she says. It's also possible to face language barriers, unsafe medical practices such as needle reuse or counterfeit medications, and health complications due to travel, the CDC points out.

 

Such issues contribute to why "it's a small percentage of overall fertility patients who travel abroad to access care," Daar says. And those who do usually consider it a last resort, Stillman says. "Anyone who thinks these couples are doing this without great anxiety, great concerns, without great thought, are doing those couples a disservice," he says. "But there really is a buyer beware."

Here's what to know before you go:

1. Do your research.

Scour the Internet, search for reviews and pick apart stats. Look for facilities accredited by the Joint Commission International or listed in the Patients Beyond Borders directory, which includes top fertility centers​ worldwide. If a hospital doesn't have an international patient services center visible on its website – which can help international patients with visas, passports, hotel accommodations and more – move on, Woodman suggests. Old-fashioned word-of-mouth is powerful too, says Dr. Pankaj Shrivastav, ​director of Conceive: The Gynaecology & Fertility Hospital in the United Arab Emirates that gets ​many international clients that way. 

Once you find a facility, check the doctor's certifications, education and make sure his or her credentials are up to date, Woodman advises. You can look for a physician who's U.S.-educated, if that's important to you. "You really have to trust the place where you are going," Inhorn says. 

2. Talk to former patients. ​

In her years of Internet research on fertility clinics, Camarena read her share of "terrible" reviews from couples who didn't like how they were treated, the outcome or hidden fees. That's why the Barbados Fertility Centre stood out. "Even the [previous patients​] who were unsuccessful had nothing but good things to say about them," she says. Daar recommends also talking to couples that ultimately decided against the facility you're considering.

3. Communicate.

For weeks before their departure, Camarena and her husband talked to the clinic staff – including the doctor – about everything from what medications Camarena would take and when to how they would get from the airport to their temporary Caribbean home. Camarena recommends preparing a list of questions and making sure to talk to the doctor who will deliver your care. Whether via Skype, email, phone calls or even a translator,​ Woodman says "you have to be comfortable" communicating with your provider.

4. Involve your U.S. doctor.

Communication with your U.S. doctor is important too. He or she can help prepare your medical records and might give you some tests and medications you need before departure. Plus, Woodman says, "if you inform your specialist prior to going … that doctor is going to be much more comfortable treating [you] once you get home."

Worried your American providers will take offense when you tell them you're taking your business elsewhere? Don't, Stillman says. So long as they're not aware of any clinical concerns at the other practice, fertility doctors' "goal is to help facilitate individuals or couples having a family," he says. "If a couple can avail themselves of care elsewhere, it's the ethical responsibility of the​ [U.S. providers] to support that or participate in that or not block it – to say the very least."

5. Consider paying for logistical help. 

While Camarena and her husband preferred to make the travel arrangements themselves, you don't have to. Barbados Fertility Centre, for example, offers packages that include flights, lodging and taxi services. If you haven't settled on a clinic yet, some medical travel agencies can link you with vetted hospitals and do the leg work to get you there.

6. Collect your records. 

The more information about your medical history, medications and test results you can bring abroad, the better. The same goes for the records you bring home, which should ideally be digitized, Woodman says. "If [patients] return home with all of their medical records, then the doctor's got a road map," he says, noting it's not much different from moving from, say, San Francisco to Boston and transferring your care.

7. ​Listen to your gut.

No matter how much you do your due diligence, you don't always get what you expect abroad. For example, Stillman heard about a couple that traveled to Mexico for donor eggs, only to be told the eggs they agreed on weren't available anymore. "Cross-border reproductive care can be a blessing," he says, "or it can lead very, very far down a tragic rabbit hole."

To boost your chances of a blessing, trust your instincts, Woodman says. Any red flag is worth heeding. "You can always say no – even when you get there," he points out. "You can always call it off."

 

Source : http://health.usnews.com/health-news/patient-advice/articles/2015-12-15/should-you-travel-abroad-for-ivf