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Analysis & Opinion
21.06.10 A Fertile Land
By Svetlana Kononova

Despite Lacking Infrastructure for Tourism, Russia Is an Attractive Destination for Childless Couples Seeking IVF Treatment at Affordable Rates

The story of Susan Tollefsen, the British teacher who became a mother at 57 after receiving in vitro fertilization (IVF) treatment in Russia, has inspired many childless women from the West, and generated a new breed of tourism in the CIS – “fertility tourism.” Medical experts warn that multiple IVF procedures could have an impact on women’s health, but the number of patients coming to Russia has been on the up in the last few years, clinics report.

In vitro fertilization (IVF), a reproductive technology by which eggs are fertilized outside the womb, began in the late 1970s when the first “test tube babies” were born. Since then, more than three million babies have been born by this method, helping childless couples worldwide become parents. IVF has allowed women even in their 50s and 60s to become pregnant by using donor eggs. In some instances, surrogate mothers are used.

But the law on IVF in countries across the world differs. In some states, the technology is banned for religious reasons. In others there are restrictions according to the age of the patient, meaning that women older than 40 cannot become mothers. In some West European countries the donors of eggs and sperm cannot remain legally anonymous, which leads to a lack of donors. Moreover, in many countries there is a limit on the number of IVF attempts allowed per couple in order to reduce health risks.

CIS countries, including Russia, have the most liberal law regulating IVF treatment. Women are not restricted by age all, a huge number of donor eggs is available because donors have the right to remain anonymous and the number of attempts is not limited, which increases the chance of pregnancy.
All these factors attract make Russian clinics an attractive destination for foreign patients to Russian clinics, and even more so because the cost of IVF treatment is much lower in Russia than in EU countries, the United States and Canada.

There are no official statistics regarding “fertility tourism” in Russia. But experts claim that about 1,000 foreign women visit the country annually to get IVF treatment. The majority of them go to Moscow and St. Petersburg, where they are placed in the largest and most reputable reproductive clinics. “Between 10 and 15 percent of patients in our clinic are foreigners. Women from the United States, Great Britain, Germany, France, Italy and Spain travel here each year,” said Sergei Shulga, the assistant director general at Altra Vita, one of the largest Russian clinics that specialize in reproductive technologies. “Most of them are older than 40. Many of our foreign patients have already undergone several unsuccessful IVF attempts in their home countries, and are not eligible for medical reproductive programs at home because of their age. But they become pregnant after our treatment. The oldest patient who became a mother with our help is 64. She is from Germany.”

Nina Rusanova, a scientist at the Moscow-based Institute of Social and Economic Studies of the Population who researches “fertility tourism,” believes that Russian reproductive clinics are competitive on the global market for economic reasons. “Russian clinics use the same technologies, medical equipment and high-skilled personnel as the clinics in Western Europe and the United States,” she said. “The successful pregnancy rates are the same – 30 to 35 percent, but the treatment in Russia might be several times cheaper.”

Shulga said that the pregnancy rates in his clinic are much higher than average. “Between 55 to 60 percent of our patients become pregnant. The average cost of our program is 150,000 to 200,000 rubles ($5,000 to $6,600), while in Western Europe it might cost up to $9,900 to $14,800.” In some less well-known regional clinics, the price for IVF programs is even smaller.

Most foreigners who visit Russia as “fertility tourists” have a much deeper knowledge of IVF than childless women in Russia. They are informed of all the nuances of the procedure, monitor scientific news in this field and ask doctors to explain each step of the treatment. They are prepared to undergo some inconveniences in service and accommodation in order to achieve the main goal – the long-awaited baby. “Fertility tourism in Russia experiences the same problems as does tourism in general,” Rusanova said. “Unfortunately, there is a shortage of high-quality hotels and secured premises for foreign guests. In many cases clinics cannot offer foreign patients the same level of comfort and safety as in the EU countries and the United States. However, women from these countries choose Russian clinics because of the affordable prices.”

“The second obstacle that hinders the development of “fertility tourism” is Russian law. For example, in cases of surrogacy, a surrogate mother has the right to break a contract and keep the newborn. In contrast, in Ukraine the corresponding law was changed in 2004 and nowadays, only biological parents have the rights to babies born from surrogate mothers. “It drew many childless couples to the country,” Rusanova said. Last year 66-year-old Elizabeth Adeney from the United Kingdom gave birth to her son after IVF treatment in Ukraine, and has become one of the oldest mothers in the world.

Big clinics try to help their patients to solve these problems. “We have a special department that manages accommodation and legal issues,” Shulga said. “Our foreign patients are offered several options of accommodation and receive visa assistance. For example, if a woman wants to get a refund from her medical insurance program in her home country, she will receive all the necessary documentation from us. If she prefers to remain anonymous, we can help her to obtain a general tourist visa. We are also planning to build a hotel for foreign patients.”

The language problem can also be solved in various ways. In some cases travelers hire interpreters, but it is not a must because the clinic staff usually speaks foreign languages.

Yet some critics say that clinics in the CIS have too much of a commercial approach toward IVF and “fertility tourism.” Some medics from Western Europe believe that women who travel abroad for reproductive programs could be putting their health at risk, especially in old age or in cases of multiple IVF attempts. Older women need to be warned more about the dangers they could face, including strokes, paralysis and diabetes.

Potential patients sometimes notice the same trend. “I have visited seven clinics in Moscow, and I wasn’t told anywhere that IVF might potentially influence my health. Nobody told me about there being a limit on the number of recommended attempts. It seems they are only interested in profits, trying to persuade me that fertility treatment is like being on holiday,” wrote a blogger who goes by the nickname of Behealth.

But despite the skeptical voices, “fertility tourism” will probably continue to develop in Russia and other East European countries. Moscow clinics report an annual ten percent growth in the number of foreign patients. “It is difficult to make any prognoses. The development of ‘fertility tourism’ in Russia depends on many factors. However, undoubtedly the demand for IVF will grow in the nearest future because more couples will need this procedure,” Rusanova said.

Shulga pointed out the recent trend of cooperation between Russian clinics and doctors from West European countries. “We keep in touch with foreign doctors who watch the women going to our clinic. It makes treatment more effective and reduces stress for the patient,” he said.
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