Two circles appear on a computer screen as a doctor in scrubs sits with her head curled over a microscope. Beside her a woman peers over from an operating bed, her feet in stirrups. A thick tear rolls down her face. Those two dots are five-day-old embryos. We are at the IVI fertility clinic in Madrid, watching as the embryos are brought out of an incubator, checked under the microscope, sucked into a catheter and then placed inside the woman’s uterus.
For the one in seven couples who need fertility treatment, an embryo transfer is one of the most emotionally fraught moments of their lives. Having injected herself daily with hormones to prepare her body for a pregnancy, and spent nearly £5,000 including travel and accommodation, the woman on the operating bed can only wait. Over the next 10 days the embryos may or may not implant and become a pregnancy.
Fertility treatment is big business. IVI, which runs 17 fertility clinics across Spain and another seven in Latin America, turned over €142 million (£101 million) in 2013. In the clinic that I visited in a genteel suburb, the shiny surfaces, minimalist design and pretty staff in high heels made it feel more like a conglomerate than a medical facility. In reception there were two types of people: well-dressed couples evidently there for treatment, and lone women in skinny jeans, parkas and worn leather boots, evidently there to donate their eggs. Only the occasional person in scrubs indicated that this was in fact a hospital.
This is where I met Sophie, 48, a teacher from south London who was waiting for her own embryo transfer. As we spoke she began to cry. “I’m taking so many hormones, I feel like an adolescent,” she said. She is evangelical about the treatment she has received at IVI, especially in comparison with her experience in the UK with a private clinic. “At home nobody would get back to me – and they were constantly upselling. When I finally did get an appointment the cost of the IVF was going to be around £6,000, but every extra test and extra treatment I needed was another £95 or £150.”
Some 300 patients from the UK are treated annually in IVI’s Spanish clinics, up 60 per cent in the past decade. Why? For Sophie it was simple. Given her age, she has a less than two per cent chance of having a baby using her own eggs. With donated eggs her chances are roughly one in four, but as there is a shortage of donors in the UK she faced a six-month wait. Sophie also wanted to use an anonymous donor. “It was an emotional decision but Tom [Sophie’s husband] and I wanted this to be our baby only,” she said. IVI confirms this is a key reason many British couples travel there for treatment. On 1 April it will be 10 years since a UK law was passed allowing children to discover the identity of their sperm and egg donors once they turn 18, and since then the numbers volunteering to donate have fallen. In Spain donors can remain anonymous and there is no shortage. “IVI was able to find a donor with my own blond hair and blue eyes, something never offered to us in the UK,” Sophie said.
In the UK the odds of having a live birth from IVF average about 25 per cent, depending on age and other factors, and in 2013 nearly 50,000 British women had fertility treatment in both private and NHS clinics, the resulting children accounting for two per cent of all births. The National Institute of Clinical Excellence (Nice)recommends that couples in which the woman is under 40 should get three free cycles of IVF. But a postcode lottery for fertility treatment on the NHS forces many UK couples down the private route. Susan Seenan, the chief executive of the charity Infertility Network (IN), said, “If you live in one area you might get one cycle of IVF only, and if you picked yourself up and moved postcode by only 10 miles, you might get three full cycles on the NHS.” The price of private fertility treatment in the UK is high, she explained, so UK couples are often forced to go abroad, where it can be more affordable.
Indeed, an online survey by the IN found that the reasons couples travel abroad for fertility treatment are many and varied, but for 70 per cent money was a key factor. Although there are no official figures for the average costs in the UK, IVI claims its treatments are 20-25 per cent cheaper than in the UK, charging roughly €5,000 (£3,600) for IVF and €6,795 (£4,850) for a cycle using donated eggs (excluding the cost of a week’s travel and accommodation). “The number of couples going abroad is increasing rapidly, and whereas once that was to access donor treatment, it’s now because it’s often cheaper,” Seenan said.
In 2012 the fertility pioneer Prof Robert Winston, a Labour peer and the former head of the NHS IVF clinic at London’s Hammersmith Hospital, launched an attack on the fertility industry in the UK, claiming a reasonable-sized clinic could offer a cycle of IVF for only £1,300. Last June he claimed the fertility industry has become“more and more private and more and more commercial”, despite success rates not having really improved by that much, leaving vulnerable couples open to exploitation. According to Dr Gillian Lockwood, the medical director of Midland Fertility Services, some clinics inflate their prices simply because of their location. “Our clinic is more down the Lidl end, and a full package of treatment including the usual drugs package would be about £4,000. But Harley Street clinics could charge up to £8,000. A lot of the things we include in our price, such as freezing, storing of embryos and culturing a blastocyst [a slightly more mature embryo], they charge as add-ons.”
Higher success rates were also a major draw, the IN study found. But whereas in the UK you can access data for any fertility clinic in the country via the website of the national fertility watchdog, the Human Fertilisation and Embryology Authority (HFEA), across Europe the only easily accessible data are those cited by the clinics themselves.