[Editor’s note; In 2009, shortly after marrying her (first and only) husband, Paolo, Elizabeth Heath was diagnosed with premature menopause and resulting infertility. Paolo and Liz are now parents to a baby girl, Naomi. In this series, Liz recounts the couple’s struggle with infertility, and how they finally achieved a successful pregnancy and parenthood.]
Once we had decided—or almost decided, in my case—that we would look into donor eggs as a means of getting pregnant, I set about my new project: researching the process and selecting a clinic. Little did I know there was a whole world of information, and a veritable industry built around egg donation. Couples literally have to comparison-shop for a clinic, and the process feels a little too much like shopping for a new car.
Italy is not the only country in Europe where egg donation is illegal or highly restricted. As a result, couples travel to countries where it is legal, such as Spain, the Czech Republic, Russia, Greece, Cyprus, among a handful of others, to undergo the egg donation and embryo transfer process. The industry—and yes, it is an industry—is called “fertility tourism.”
That alone was off-putting—the idea of an industry that profited from the desperation of infertile couples. It didn’t help that we had to contend with skepticism from Paolo’s family and from clinicians in Italy. The pretty doctor at the clinic in Chianchiano didn’t look so pretty when I asked her opinion of us traveling to Spain for donor eggs. “They just steal your money,” she said, her lip curled in a sneer, “and then they don’t transfer any embryos.” (How could a whole industry be built upon such deception? I wondered to myself.)
Read Related: Facing My Infertility Part 7: The Hail Mary Egg
She recommended that instead of going to Spain, we try a clinic in Belgium where she knew the director. So I called that clinic, only to learn that we had to bring our own donor and that there was a waiting list of 2-3 years. The only way to jump ahead in line and reduce the cost (and that still meant finding our own donor) was for Paolo to donate sperm 25 times. “Twenty-five times?” I repeated on the phone, suppressing my urge to burst out laughing. So Belgium was out.
MEANWHILE, BACK IN SPAIN
A simple internet search for “egg donors Spain” turned up results for dozens and dozens of clinics throughout the country, in every major metropolis, at beach resorts (there’s even one on Ibiza—now that sounds nice) and in smaller cities. Each clinic’s website offered content in English, and some also had pages in German and Italian, in addition to Spanish, of course. Each clinic boasted about the same success rate for IVF with donor eggs—roughly 60-70% on the first try. A 60-70% chance that we’d get pregnant on the first try? It seemed too good to be true. Yet those were either real statistics or every clinic was lying.
After the Italian RE scoffed, “How can they get a 70% success rate when we can only get 25% here?” I did more reading and research, and learned why those statistics might have been the real deal. With almost no exceptions, fertility clinics in Spain and elsewhere where donor eggs are used transfer blastocysts into the client’s uterus. A blastocyst is an embryo that has been cultivated in vitro for five days. On day 5 or 6, the embryo is ready to burst—or blast, as the case may be—out of the protective “shell” of the egg and burrow into the uterine lining. So by transferring blastocysts, a woman receives embryos that are in some cases just hours away from settling into the placenta and camping out for 9 months.
As with many things related to fertility, blastocysts, too, are a numbers game. If a clinic collects, for example, 12 eggs from a donor, perhaps 10 of those will fertilize. As the days tick by, most of those fertilized eggs—even some that started out looking strong and healthy—will stop developing and “die” in vitro. In fact, only a few—maybe 3 or 4—will survive to blastocyst stage. But those that reach Day 5 are far and away the strongest of the pack, and have a very good chance of implanting in the uterus and developing into a healthy fetus and in turn, a viable pregnancy.
So yes, these clinics could have the success rates they claimed, despite the doubts of our Italian RE. Blastocyst cultivation, like so many things related to creating life in vitro, is illegal in Italy, because the process of selection and survival of the fittest embryos just doesn’t fly with the Catholic Church.
I started contacting clinics via their websites and requesting information, which usually arrived the same day. I’d get a welcome email from each clinic’s international coordinator, with documents attached that included more explanation of the process, travel information for each city—Madrid, Barcelona, Valencia, and more—and a price list. Now, here’s where it got interesting.
The 2010 prices for a cycle of IVF with donor eggs varied from 7,000 euro (about $10,000 US) to 11,000 euro (about $15,000 US). In all cases, the price included our initial consultation, sperm collection, medication and monitoring of the donor, her egg retrieval surgery, embryo cultivation and transfer of blastocysts into my uterus.
So why the price differences? For us, and most people, I suspect, 3,000 euro ($5,000) was not pocket change. As near as I could tell, all the clinics essentially used the same technology, all boasted similar success rates, and the path from initial consultation to blastocyst transfer was exactly the same. But did we really want to choose the cheapest clinic? Wasn’t that like choosing a bargain basement baby?
During my research, I started frequenting an internet discussion forum for English-speaking women seeking fertility treatment abroad. The site, Fertility Friends, is comprised mostly of British women and has separate boards for each country where fertility treatment is offered and within each country board, separate discussion threads for each clinic. So I started jumping from thread to thread, and reading of these women’s experiences. Reading their firsthand experiences helped me immensely in narrowing our choices down to three or four clinics.
ROLLING THE DICE
I continued email dialog with this handful of clinics, and reported back to Paolo everything I learned: prices, waiting lists, success rates, how friendly each clinic seemed, and impressions I’d gleaned from Fertility Friends. In the end, we made our decision. We chose Vistahermosa clinic in Alicante, Spain. They were the second lowest cost of all the clinics we’d considered. (I was reminded of that Simpsons episode, where Homer, ordering dinner in a fancy restaurant says, “I’d like your second-least-expensive bottle of wine.”)
The clinic could see us right away, had donors readily available (meaning no waiting list), and had been timely and cordial in its responses to my numerous emails. More importantly, especially for Paolo, the clinic offered a refund program. If we paid in advance, at a discount, for three rounds of IVF with donor eggs, and did not have a viable pregnancy after the third try, they would refund a third of our fees. Paolo reasoned that if they were willing to offer the partial refund, they probably didn’t have to return anyone’s money very often. So that was it. We had an appointment for our initial consultation in September of 2010.