By Kathryn Kaycoff-Manos & Lauri de Brito
Co-founders, Global IVF, Inc.
Recently, Global IVF, Inc.’s co-founders Kathryn Kaycoff-Manos and Lauri de Brito, returned from an amazing and informative trip to Spain. Here’s their personal feedback on what you can expect if you try ‘expecting’ via a fertility trip to Spain.
Beyond the beautiful countryside and cities, friendly people and amazing food (we’re going through tapas withdrawal!), the clinics we toured and the staff/physicians we met were extremely impressive. Like in the United States, each clinic had a distinct personality and feel, and just like anywhere else in the world, what might be a perfect fit for one Intended Parent, is not necessarily right for another.
Our trip’s intention was very clear — we focused exclusively on researching the egg donation services that are currently offered throughout parts of Spain. We spent nearly ten days there and traveled to Madrid, Murcia, Valencia, Alicante and Barcelona. We met with top clinics and professionals every day (sometimes 3 in a day) and still, we didn’t get to visit all of the IVF clinics that exist. While there are many similarities to the services and care offered in the United States (the main being exceptional medical care), there were some noticeable differences. Below you will find an outline of the top 8 major differences between pursuing egg donation in the United States vs. Spain. Now, remember, this is NOT a Pros/Cons list… it is merely an educational tool to help you further decide what is the best option for you.
1. THE COST
On average, egg donation in the United States will cost between $30,000-$40,000 all-inclusive. This means your medications, your donor’s medications, the donor fee, donor travel, donor monitoring costs (if she is not local to your clinic), egg donor agency fee, legal fees, psych fees, IVF for the egg donor, ICSI and embryo transfer to you. In Spain, the all-inclusive fee is significantly lower… with savings of up to $30,000! Here’s how we came up with that:
In general, most cycles in Spain will cost $7500 – $10,000EU ($9300 -
$12,300US depending upon the exchange rate when you are cycling)
Airfare (which will also vary depending upon where you’re coming from and the time of year) should probably cost between $400 – $800 US round trip.
Hotels can range between $100 – $200/night (of course you can always spend more or less, but these are for 3-4 star hotels in good areas.) The average stay in Spain for an egg donor cycle is 7 – 10 days,
You will also need to factor meals into your total cost – and that also depends upon your appetite for expensive meals and your level of frugality – add in meals for 7-10 days.
Medications for yourself and the Donor are significantly lower if purchased in Spain (average is around $500-600/cycle),
Monitoring costs, initial tests and screenings will in most cases be done at your home clinic – a few ultrasounds and blood tests and should run approx. $800 – $1000.
Overall, one can expect to spend about $10,000 – $15,000 for a cycle in Spain, which is a significant savings over a comparable U.S. egg donor cycle.
2. NO WAIT
If you were to use an egg donor agency in the United States, you are pretty much guaranteed to find at least one if not more egg donors you like available at any given time — unless you choose someone who is experienced or highly desirable (due to ethnicity, academic standing, etc.), then you may find yourself at the bottom of a waiting list that could be up to 6 months. In Spain, there really are no waiting lists.
In the United States, you can circumvent working with an egg donor agency and find reputable clinics that have lower fees with in-house egg donor programs. This can cut costs to roughly $25,000 all-inclusive. The problem is these clinics often have long waiting lists — sometimes upwards of a year. Typically with an in-house U.S. egg donor program, the egg donors are anonymous.
The main difference between U.S. in-house egg donor programs and Spanish egg donor programs is that there is no waiting in Spain. If you call today, you can pretty much be cycling within 2 months – at any number of clinics. They all have donors available and ready and cycles are individually planned, not grouped together.
3. ANONYMOUS DONORS
If you do pursue egg donation in the United States, you open up the option to read detailed profiles, health histories and view plenty of pictures of potential donors. You can opt for an anonymous donation, a semi-anonymous donation, or even talk with or meet your donor. If you choose to work with an egg donor agency, the possibilities for donors and choosing the ‘right’ donor are endless. But the recipient pays (literally) for this privilege. Everything adds up – if a donor is experienced or has higher SAT scores, she can ask for and often get a higher fee. Add in agency fees, legal fees, medical costs, travel, etc and you start to see how the costs quickly add up.
One of the biggest differences between American egg donation (using an egg donor with an agency) and Spanish egg donation is that ALL egg donation cycles are totally anonymous in Spain. What that means is that you, as the recipient usually a nurse/coordinator who will do their best to find someone who is similar to you in looks, ethnicity and blood type. They will often request a photo of you to help with the match. You will not receive any photos of your donor and you will never know anything more about your egg donor than her hair color, eye color, blood type, ht/wt, skin color and maybe her education level and occupation… very basic information. This level of anonymity is not an individual clinic’s decision — it is the law.
Sometimes this anonymity is a comfort for Intended Parents pursuing egg donation – this way they will never have a ‘mental image’ of the donor forever burned in their minds. However some people feel that they MUST have much more information about their donor and for them Spain probably won’t feel like a comfortable option.
4. HOW MANY EGGS/EMBRYOS TO EXPECT
In the United States, the doctors rely a great deal on their statistics to attract new clients. Because of this, they stimulate their donors more aggressively. Their equation is more drugs = more eggs. Many European doctors feel that more eggs don’t mean more embryos and they do think that embryo/egg quality might suffer. In Spain, the optimal goal for an egg retrieval is 8-10 mature eggs. In the United States, it is more like 12 – 18 eggs, and we often hear stories of 20 or 40 eggs retrieved. In Spain, the embryologists do NOT want these kinds of numbers. They are looking to get 5 – 6 viable embryos on day 3. Of course you may get more than that, but it is unlikely. The aim is for two cycles – one fresh, one frozen…but only one cycle is guaranteed, nothing more.
Spanish clinic success rates tend to be slightly lower than their American counterparts. However, this doesn’t mean they are doing inferior work. The overall concept of statistics and what they mean just needs to be explored further…
The fact is that in order to keep their statistical ‘numbers’ up, the American REs tend to transfer more embryos at one time – this in turn results in more pregnancies overall but also in more high-order multiples (twins, triplets and more). The Spanish clinics are focused on minimizing the risk of a multiple pregnancy. While it might seem advantageous to get a bigger bang for your buck, there are a lot of risks associated with a multiples pregnancy for both the mother and the babies and the European reproductive clinics are very sensitive to this issue. Their goal is one healthy baby, and they limit transfers to 2 to 3 (day 2 or day 3) embryos. That said, with the media outrage over ‘Octomom,’ the American REs are now also trending towards being more conservative in the number of embryos that are transferred in a fresh donor egg cycle. In fact, many are beginning to advocate single embryo transfers in the U.S. and we may eventually see statistics reflect this change.
The bottom line is that in Spain you will not see the same statistics as you do in the United States. But on a global scale, the Spanish clinics are far above the average. Most clinics we met with reported between 45 – 65% success rates on a fresh cycle and between 45 – 60% on a frozen. Yes, there are definitely clinics with higher success rates in the United States, but overall not that much higher.
6. DONOR SCREENING
Your donor’s screening will be different than what is done in the United States (thanks to the FDA.) While some may consider the American version of donor & donor partner screening a bit excessive (and costly), the international clinics seem slightly less stringent. However, don’t get too nervous. In general, they all do screen for STDs, HIV, Hepatitis, etc. They also screen for alcohol, drugs, and nicotine (though you must remember that smoking and/or drinking is often better ‘tolerated’ in a foreign country). They do screen for family genetic illnesses and psychological factors but you will never get full details on what was ‘screened out’ or what might have passed. In the United States, you almost always get all of these details but you won’t when traveling abroad — so there is a much greater leap of faith involved.
7. FROZEN CYCLES
The newest method of freezing embryos, vitrification, is starting to catch on in a major way in the US, but in Spain and many places in Europe they are ahead of the game. For many European clinics, vitrification is the only way to go and has been for a while. This is a process that freezes and thaws the embryos at a much faster pace. Clinics are reporting success rates with vitrification that are as good or almost as good with fresh embryo cycles.
8. NO OR MINIMAL BEDREST
The Spanish clinics tend to have their local patients go home after the transfer and take it easy for a day or two before resuming normal activities (much like their U.S. counterparts). However, their Global IVF patients will often board a plane home within 24 hours of the transfer. The interesting thing is they have the same success rates. So, for those of you who have stayed on bed rest for 72 hours (ourselves included) after a transfer … don’t fret, you can actually get up and get moving, it’s very doubtful that it will affect the success rate.
ON THE HORIZON
During our visit to Spain, we were greatly impressed with the quality of care — not only from the medical perspective but from a psychological one as well. The Spanish clinics seem to take a proactive stance on psychological care throughout the egg donor process. Many had on-site therapists and required counseling sessions – which we found refreshing. Too many American clinics give lip service about how much they care for the ‘entire’ patient, when the truth is they seem to be uncomfortable with the psychological aspect. In Spain, the clinics really cater to the full process – they are ready and committed to give individual and thoughtful care from the first phone call or email until the patient was safely back in their own country.
Even more exciting was the development we saw with a particular Spanish clinic working in conjunction with an American egg bank/reproductive clinic. This Spanish clinic will be using American donors (although at this time they are still subject to Spanish laws regarding anonymity) and shipping the eggs to Spain. They will guarantee 8 eggs to be available for a given cycle. This is truly groundbreaking – It also means that cycles no longer have to be ‘synched up’ between egg donor and recipient. Basically, a recipient will be able to travel to Spain to do the transfer process whenever she wants (down to the exact day) and stay for a shorter amount of time. A recipient could even ship frozen sperm so that only the woman needs to travel. The idea of having an American egg donor available in Spain (where costs are lower per cycle) will no doubt be very appealing to many Intended Parents. So far, the success rates are comparable to fresh cycles – 55%. We’re anticipating that the cost for an ‘asynch’ cycle will be even lower than a fresh cycle, but the cost has not yet been determined. Stay tuned though – the minute Global IVF knows more, we’ll pass it on to you.
There’s one final thing we want to mention in regards to traveling to Spain for egg donation. Global IVF travelers are often concerned as to what would happen if they were to travel all the way to Spain only to have a donor who doesn’t produce enough eggs for a transfer. Since most Spanish clinics guarantee 8 mature eggs (we have yet to see an American clinic make such a promise!) almost all of the clinics have frozen vitrified eggs for such occasions. So, if it were to happen, they would go into their egg banks, find someone who fits your requirements and use those for your cycle. That way you will not have spent all of that money only to come home with a few pictures of Spain and no potential baby.
So that’s the lay of the land. If you can afford to do a cycle in the United States, it’s probably easier to do so. You will have more control over the selection of your donor, statistics are slightly better, and you won’t have the added stress (or excitement – depends how you view it!) of international travel. But if you’re getting on in age, really want to have a child, can’t foresee saving or borrowing $30-40,000 in the near future, then Spain is a great and viable option for creating your family. Not only does Spain offer state-of-the-art medical care, but there are lots of English speakers (or you can have fun brushing up on your high school Spanish), great food, museums, beaches, modern cities, etc. The best that happens is you return home pregnant. But even if you don’t, it will have cost you less to try and you will hopefully have had a bit of fun and travel in the process.