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  The Wall Street Journal, Feb. 19, 2008  
 

Infertile Couples Head Overseas for Treatments

Clinics in Thailand, Canada, Israel Tout Cheaper In-Vitro; Checking Up on Success Rates
By HEATHER WON TESORIERO

As fertility-treatment costs soar - and more women seek treatment at an older age - a growing number of Americans are heading abroad to try to get pregnant.

The Internet has made it easier for women to connect with fertility clinics in diverse locales such as the Czech Republic, Israel, Canada and Thailand. And specialized travel services have sprung up to help people arrange accommodations, set up medical appointments and even plan sightseeing tours.

The cost of in-vitro fertilization in many foreign countries is a fraction of that in the U.S., even after factoring in expenses for travel and accommodations. And some women say they have been able to get treatment abroad after having been turned away by a U.S. clinic because of their age.

There are some downsides. Treatments can take four or five weeks -- too long for many couples to take a break from their regular lives. It might not be possible to find medical practitioners who speak fluent English, though some of the travel firms also provide translation services. And while medical standards are high in many countries, regulations can vary, including rules for screening egg donors, leaving it to patients to do due diligence. In the U.S., the Food and Drug Administration regulates egg-donor screening, though some states set stricter standards.

"Money was a factor" for Robyn Bova, 47 years old, in deciding with her husband to travel to the Clinic of Reproductive Medicine and Gynecology in Zlin, a college town in the Czech Republic, for IVF treatment in May and again in November after their first attempt failed. Though initially concerned about everything from the health of the egg donors to the medical standards, Ms. Bova researched the clinic and contacted other American women who'd gone there. "I thought, if we get there and it's horrible, we don't have to go through with it," she says.

Ms. Bova says she was pleased with the treatment she received and is now 17 weeks pregnant. And during their time in Eastern Europe, "we had the most incredible trips you could imagine." Ms. Bova says the total price tag for both trips, including travel, hotels, food and treatments, was $22,000, or roughly the cost of one round of in-vitro fertilization in the U.S.

The Bovas booked their overseas treatment through IVFVacation.com, which was started by Craig and Marcela Fite. The Ohio couple had traveled to Marcela's native Czech Republic for their own IVF treatments and decided to serve as middlemen for Americans wishing to do the same. The couple charge between $1,500 and $2,500 for their services, which include arranging appointments at the clinic and providing on-site assistance for driving and translations.

Other such service providers include IVFThailand.com, a Web site that helps arrange treatments at a fertility clinic in Thailand. And the CHEN Patient Fertility Association (www.amotatchen.org/english/homepage/homepage.htm1), an Israeli fertility group that promotes fertility treatments along with sightseeing tours around the Holy Land.

"We're just now starting to see foreign clinics market themselves to U.S. patients," says Barbara Collura, executive director of Resolve: The National Infertility Association.

U.S. fertility doctors say that while IVF isn't a high-risk medical procedure, patients going abroad should consider several things, including the reputation and number of procedures performed, and the success and complication rates of a clinic -- information the clinic should be able to provide. Also worth considering: liability and patients' rights to take legal action if something goes wrong. "There are great and good hospitals in many countries," says Zev Rosenwaks, director of the Center for Reproductive Medicine and Infertility at New York Weill Cornell Center. "One has to look at the overall medical standards and I think it's much harder to judge from far away."

While Americans have increasingly gone abroad in recent years for medical procedures ranging from hip replacements to face lifts, fertility treatments have largely remained an outlier. Concerns about medical standards and the strong emotions that often surround infertility have persuaded many people seeking IVF treatment to stick close to home.

But outsize costs and relatively sparse insurance coverage at home are driving more Americans to seek treatments abroad. The cost of fertility treatments in the U.S. varies by region and depends on the procedures needed. A single round of IVF with a woman's own eggs, including medications, costs on average about $12,000, according to Resolve, but can run much higher. For IVF using donor eggs, the cost can add as much as $5,000 to $15,000. Prices have risen steadily in recent years as more-advanced technology and additional options have emerged.

The in-vitro fertilization process involves stimulating a woman's ovaries with hormone treatments, extracting eggs for fertilization, and then implanting embryos in her uterus. Alternatively, a donor's eggs are used to create an embryo. Insurance plans sometimes cover aspects of the process, such as the drug treatments, or they might cover a single round. Only a handful of states, including Massachusetts, require some form of IVF coverage.

It can be difficult to compare success rates of women getting pregnant from IVF treatments because of the different ways statistics are collected. In the U.S., the rate of live single births from IVF transfer was 40.5% in women under 35, according to the Centers for Disease Control and Prevention 2005 Assisted Reproductive Technology Report. That fell to 13.1% in women ages 41 to 42. In Europe, 18.6% of IVF transfers resulted in pregnancies, according to 2003 statistics from the European Society of Human Reproduction and Embryology, which doesn't break out data by age.

Age restrictions for fertility treatments vary in the U.S. by clinic and by the individual health of the patients. For women using their own eggs, the age cutoff is usually early 40s; if using donor eggs, it's usually late 40s to 50.

Kathy Jackson, a 43-year-old Minneapolis resident, says she was turned away by local fertility clinics because they require a woman to be no older than 43 at the time of a birth. Instead, she has gone twice to the Markham Fertility Centre near Toronto for IVF. The cost, at about $6,000 for a single treatment using her own eggs, was half what it is in her area, not including medications, she says.

Ms. Jackson says her Canadian doctor "was brutally honest with me about my chances, to the point where I cried after." She says she was told that with her age and medical history, her chances of getting pregnant were 3% to 5%. Ms. Jackson returned to the Canadian clinic for her final attempt last month, and just learned that she is not pregnant.

Ofra Balaban of Holon, Israel, founded the Chen Patient Fertility Association seven years ago following her own experience with assisted reproductive therapy. She promotes tour packages: A one-week trip is $7,000, including the $2,500 cost of one round of IVF. But women need to do some initial preparation, including hormone treatment, in their own country.

Fertility treatments are cheaper in many foreign countries, partly because of nationalized health plans. In the Czech Republic, for instance, citizens up to the age of 39 can get three IVF treatments for roughly $750 each. Visiting Americans must pay for the service, but it is still cheaper than in the U.S.

When Jennifer Rosendale, 33, and her husband decided to start a family, she says they were told that IVF near their home in Shelton, Wash., would cost them roughly $25,000. The hormone-boosting drugs would cost $3,000 to $5,000 alone, and none of the costs would be covered by insurance.

Ms. Rosendale at first began looking online to see if she could purchase the medications more cheaply overseas. But then she came upon IVFVacation. A year ago, she and her husband traveled to the Czech Republic. They stayed for five weeks, mixing their fertility treatments with trips to Prague and Vienna. The price tag for their entire stay: $12,000. And at the end of October, Ms. Rosendale gave birth to twin girls.

Write to Heather Won Tesoriero at heather.tesoriero@wsj.com2

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