With as many as 1 in 4 pregnancies ending in miscarriage and approximately 3.5 million people in the UK finding it difficult to conceive, it is not surprising that fertility support specialists are frequented daily by couples seeking alternative treatment to get their babies. Unfortunately, with the NHS threatening to cut fertility funding and with many Clinical Commissioning Groups (CCGs) reducing the number of cycles they offer people – or even cutting them completely – couples face difficulties in the UK, pushing them to seek fertility treatment abroad, despite NICE’s 2013 recommendations that all women aged 40 or under who have not conceived after two years, should have access to a minimum of three cycles.

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Dr. Caroline Phillips, a former senior embryologist and now founder of a free information portal, Fertility Clinics Abroad, has teamed up with Fertility Network UK, a registered charity that provides essential fertility support services, to research the driving factors behind people seeking fertility treatment abroad instead of the UK.

The online research project was conducted between August 2016 and February 2017 and took findings from 241 people who had either undergone fertility treatment or were considering it. The survey respondents shared their views on the current state of fertility treatment in the UK and the factors that motivated them to travel abroad for treatment. Fertility Clinics Abroad and Fertility Network UK hope that their findings will highlight some of the key issues that the fertility industry in the UK face today and inform the Government, CCGs in England and Wales, Scottish NHS Boards, private and NHS funded fertility clinics and health professionals of how the public perceive UK fertility treatment.

The survey hopes to act as a catalyst to improve fertility care, treatment standards, and best practices. Below is a breakdown of the research’s key findings and how people have been affected with difficult fertility treatment provisions that the UK impose.

Cost is the driving factor for pushing people out of the UK

The media has painted a negative picture of the core issues surrounding the fertility treatment provisions in the UK, namely highlighting long waiting lists, inconsistent access to NHS funded treatment, low supply of donor eggs and the heavy cost of private fertility treatment.

However, it was without doubt that lack of NHS funding for fertility treatment and the spiralling cost of private treatment were the main drivers behind people seeking fertility treatment abroad. 76% of respondents felt that private fertility treatment was very expensive, with nearly 80% stating that it was twice as expensive as they were willing or able to pay.

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The survey found that most respondents sought IVF using their own eggs and that they were willing to pay between £1,000 and £5,000 for treatment. However, in the UK, IVF can often exceed £10,000, including additional expenses. This issue of ‘hidden costs’ has yet to be challenged and, because of the high fees, 62% resorted to using their life savings, which affected their ability to fund pensions, pay for educational fees or support other family members.

Some even had to re-mortgage their houses or sell personal belongings to fund their fertility treatments. Some respondents sought help from family and friends, secured bank loans, used credit cards, or started a crowdfunding campaign to find the funds available to pay for their treatments. With the lack of funding available, some people who experienced secondary infertility thought that these high fees were unacceptable. It is unsurprising then that 58% would go abroad because the treatments on offer are generally cheaper.

Why people are being driven to seek fertility treatment outside of the UK

60% of the respondents in the survey had already had treatment in the UK, and the majority of those felt it was either passable or substandard, with 44% believing the standard of care was average. Only 3% of the respondents said that the treatment they received was excellent.

The survey found that people were worried about the lack of person-centred care in the NHS, which uses a ‘one size fits all’ approach. 36% said that the service and aftercare were poor and 35% said that the long waiting lists and a lack of egg donors were some of the major reasons to find fertility treatment aboard. 65% also pointed out that access to free NHS treatment depends on where you live.

While there are many positive factors for staying in the UK, i.e. the convenience of not having to travel (33%) and being near friends and family (17%), people felt more like a statistic rather than an individual, with only 7% saying that the standard of treatment in the UK is high and that there are good service and aftercare available (3%).

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As a result, 93% of the respondents said they would consider travelling abroad for fertility treatment and those that have already received treatment abroad, would consider it again. 50% believe that foreign clinics can offer higher success rates and 46% would consider travelling abroad upon positive recommendations from other people. It is said that there are also shorter waiting lists and more access to egg donors, which seems to be the opposite of what is happening in the UK.

There are also fewer restrictions placed on people, for example not basing access to treatments on Body Mass Index. People felt that the NHS is paralysed by bureaucracy, which directly impacts waiting times, as well as offering no special consideration for older women who have a limited time window to conceive. Women in their 40s felt there were more opportunities for them abroad with more clinics catering to their age group.

Where are people going for treatment?

Over 60% of respondents had an interest in having their treatment in Spain, with 43% wanting to travel to Greece, 41% to the Czech Republic, and 29% to Cyprus. Over twenty other countries were mentioned in the survey across the world, with some surprising countries including Tunisia, Nigeria, and South Africa.

The barriers to seeking fertility treatment abroad

There were several barriers found in seeking fertility treatment abroad, with 45% saying that travel was the most inconvenient option. 30% were worried about the lack of regulations compared to the UK and 33% were concerned about the language barrier. Some respondents included factors like being away from friends and family and the lack of performance figures related to fertility success, with the perception that cheaper may not necessarily mean better results.

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How to encourage fertility treatment access in the UK

73% of respondents felt that having a centralised database of performance figures by country would help them to decide which destination would be better suited for their fertility journey. 62% felt that there should be more organisations dedicated to providing advice and resources for people considering treatment abroad. Respondents also wanted GPs and health professionals to provide more information and funding support from the Government, with more detail required on success rates abroad.

The current cost of fertility treatment in the UK, as well as the lack of free or reduced cost of treatment by the NHS, are no doubt the main factors for driving people away from the UK. The excessive cost of private treatment is attracting people to countries like Spain or Greece where the cost is up to 50% cheaper.

The fact that people are re-mortgaging their houses or using their life savings, shows how far people will go to pay for treatment. To keep people in the UK, there needs to be shorter waiting lists, more access to funding and NHS care, a higher number of anonymous egg donors and a better standard of personalised care because the ‘one size fits all’ approach offers very little aftercare and support to those who have forked out a large amount of money to receive the treatment.

Even with the key factors of not travelling abroad boiling down to the inconvenience of travel and being away from support networks, 93% of people would still consider going abroad, which shows us how much needs to be changed regarding the standard of fertility treatments in the UK.

To find out the full results of the survey, please visit Dr Caroline Phillips’ report here: Understanding the drivers behind fertility tourism in the UK – May 2017

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