According to infertility prevalence estimates from the World Health Organization (WHO), one in six people globally experience infertility at some point in their lives. The need for increased access to affordable, high-quality fertility care is clear, yet barriers in the form of cost, long waiting times and, in low-income and developing countries, limited reproductive technologies, persist. Indeed, cost represents a significant hurdle, with WHO reporting that the direct medical costs paid by patients for a single round of in vitro fertilisation (IVF) are often higher than the average annual income.

For many, fertility tourism offers a beacon of hope or is simply  a preferred option, with people opting to embark on an IVF  journey abroad. “There are many reasons why patients travel,
but motivators include lower costs, access to treatments that  are not available in host countries, waiting lists (particularly in  the UK) and donor availability,” stated Andrew Coutts, CEO of  the International Fertility Company. Coutts shared a recent quote  from Inge Kormelink, CEO of Clinica Tambre, an international fertility clinic in Spain: “Historically, patients chose to travel as  a last resort when treatments at home were unsuccessful.

In the last year, we had enquiries from patients living in 146 countries

Increasingly, we are seeing patients who choose to travel as a first choice; they are attracted by costs, success rates and, in  the case of Spain, by the availability of anonymous sperm and egg donors.”

The International Fertility Company has been helping individuals identify appropriate treatment centres for nearly 10 years and, during this time, Coutts has observed the expansion of fertility tourism. “Initially, we had a small number of enquiries from the UK from patients interested in countries like Spain,” he noted. “In the last year, we had enquiries from patients living in 146 countries, and many are prepared to travel extensively for the right treatment. For example, we have helped patients travelling from Australia and the US to countries like Greece, Cyprus and Spain.”

Whether as a first choice or a last resort, though, IVF abroad doesn’t come without its complexities, with important considerations including: choosing the right destination and clinic; understanding the legalities and ethics of IVF treatment in a different country; and making the appropriate travel arrangements, including – crucially – insurance.

Hospital wants and needs for international patients

For hospitals looking to attract patients, medical excellence, transparency and legal and ethical compliance are just a few must-haves. “Hospitals looking to attract international patients for IVF treatment must focus on both high standards of medical care and strong risk management practices,” said Carly Matson, CEO of Altea. “Clear communication about costs, success rates and potential risks is also essential in building confidence among patients – whether at home or abroad. Hospitals could further enhance their appeal by offering multilingual staff and support services, which cater to a diverse patient base, and providing virtual consultations before and after treatment, simplifying the process for patients managing their care from abroad.”

First and foremost, providers have to offer multilingual teams, including first points of contact, nursing and medical teams

Coutts agreed: “First and foremost, providers have to offer multilingual teams, including first points of contact, nursing and medical teams. Ideally they also want to provide an ‘at-home’ service, helping patients who want to undergo necessary tests and scans in their home country, reducing the time away from home. Hospitals should offer additional support services like counsellors, coaches and alternative therapists, and also a post-treatment service – even if this is merely signposting support services for the patient when they return home. Providers should also establish patient peer groups where prospective patients can speak to others who have undergone treatment. Finally, providers need to be transparent with costs and success rates, and share these in a clear and understandable format.”

Demonstrating quality in medical care

The primary indicator of medical excellence is accreditation. “Hospitals need to demonstrate their commitment to quality through recognised accreditations, which assure patients of their safety and adherence to global standards,” Matson asserted. This also assures would-be patients that the healthcare facility in question is up to legal and ethical standards, which is crucial to establishing a reputation as trustworthy and effective.

“In some countries, accreditation is either mandatory or strongly encouraged by regulatory bodies,” said Dr Claudia Mika, CEO of Temos International Healthcare Accreditation. “Governments and health authorities often require clinics to be accredited to ensure that they operate within legal and ethical frameworks. Examples are surrogacy, genetic testing or gender selection, which are either not allowed in many countries and/or ethically discussed.”

For people travelling abroad for IVF treatment, thorough research on laws and safety is paramount. Clare Ettinghausen, Director of Strategy and Corporate Affairs at the Human Fertilisation & Embryology Authority (HFEA), explained: “The HFEA oversees safe and effective fertility treatment in UK licensed clinics where patients can find transparent information about success rates. Some people go abroad for fertility treatment for a variety of reasons, but it is important for patients to do their research as the HFEA has no regulatory power outside of the UK. People should consider what laws are in place to protect them, how clinics present their success rate data and the policies in place to ensure treatment is safe. People considering treatment abroad can find out more on the HFEA website.”

Patients are more likely to choose a clinic that has been accredited, knowing that it meets rigorous standards

Dr Mika spoke with ITIJ about the increase in the number of IVF clinics seeking accreditation. “Reproductive care clinics seek accreditation to demonstrate competence, safety and quality, and attract more patients in the global, competitive market,” she said. Feedback from clients has highlighted a number of factors that underline the importance of accreditation, she said: “First is quality assurance and patient safety. Accreditation provides an external validation of a clinic’s adherence to best practices, which is crucial for patient safety and successful outcomes in the sensitive field of reproductive medicine.”

The next factor is enhanced reputation and trust. “Patients
are more likely to choose a clinic that has been accredited, knowing that it meets rigorous standards. This can lead to increased business and a stronger reputation in the community,” explained Dr Mika. Additional factors include globalisation, technological advancements, regulatory requirements and ethical considerations, increased awareness and education, continuous improvement and accountability, and insurance and funding requirements.

“Accreditation helps clinics align with global benchmarks, making them more attractive to international patients,” Dr Mika highlighted. “It also ensures that clinics are equipped to handle advancements in IVF technology safely and effectively.”

When it comes to funding requirements, Dr Mika said that some insurance companies and funding agencies require clinics to be accredited before they will cover or reimburse costs associated with IVF treatments. “Accreditation can be essential for clinics that want to attract insured patients or receive public funding,” she underlined.

Specialist insurance for fertility tourists

When it comes to insurance options, the landscape has evolved, with specialist insurers filling a gap in the market. Vered Lobel, CEO of OneBefore, explained: “Individuals travelling abroad for medical treatment generally have a hard time finding appropriate cover. Most retail travel insurance policies or policies packaged with UK bank accounts exclude from cover anyone whose main purpose of travel is to receive medical treatment abroad –
even for standard issues like an unrelated accident or illness,
loss of personal belongings or trip delays. Specialist insurers have recognised this gap and are beginning to provide tailored cover specifically for these travellers. The Pulse Globetrotter product, developed in partnership with OneBefore, protects them for the standard travel risks, as well as against any issues arising from their planned procedure that result in an emergency, life-threatening situations. The product does not cover any claims related to other pre-existing medical conditions.”

ITIJ asked Wendy Sherry, CEO, Global Health Benefits, International Health, at Cigna Healthcare, about available insurance options for its members. “Robust fertility benefits
are no longer a perk, but a necessity. At Cigna Healthcare,
we recognise this as a key priority, not only aligning with market trends but also serving as a powerful employee engagement and retention tool. Our commitment to meeting the needs of diverse populations and fertility care is evident in our robust plans, which have long provided comprehensive coverage for IVF and other assisted reproductive technology access,” she explained.

“Looking ahead, we are deepening this commitment – in 2025, an infertility diagnosis will no longer be a prerequisite for access to IVF, making these family-building treatments more accessible than ever before.”

Cigna Healthcare is partnering with a leading fertility benefits platform called Carrot Fertility. “Our partnership with Carrot enables us to navigate the regulatory complexities of providing care globally, ensuring we remain compliant with country rules while offering equitable access to all employees,” stated Sherry. “With virtual access to medical fertility experts, including clinicians, pregnancy specialists and emotional support specialists in the languages of all the countries in which our customers reside, we are breaking down geographical barriers, making cross-border care a reality and significantly increasing the accessibility of IVF and other fertility and hormonal health treatments.”

Matson discussed insurance for healthcare facilities. She remarked that there are complex legal challenges associated with insuring hospitals providing cross-border IVF treatments, particularly regarding where claims for negligence can be made. “To mitigate these risks and ultimately to provide patient confidence and protection, hospitals and medical professionals must ensure that their medical indemnity and public liability insurances cover cross-border claims,” she stated. “Any contractual documentation between parties should clearly stipulate under which jurisdiction the treatment is governed.”

Matson said there are insurance options that provide specific coverage designed to address the risks associated with treating international patients. “These include cover for liabilities that arise specifically from treating patients who travel from abroad, including complications that occur after the patient has returned to their home country. International hospitals providing IVF (and other) treatment to UK patients can access various specialised insurance products that cater specifically to the complexities and risks of cross-border medical care,” she underlined. “It is always advisable for hospitals to work with experienced brokers with specialist expertise in the medical tourism and international healthcare fields to find the most suitable coverage options.”

Accreditation not misinformation

The risks associated with IVF abroad include medical and regulatory concerns, again highlighting the importance of accreditation as a marker of trust and expertise. Matson
pointed out that there is also the risk of misinformation.
“Some people are attracted to going abroad because they’ve found a clinic which claims to have very high success rates,”
she stated. “The HFEA advises people to be cautious in these cases, as there are many ways to present success data. For example, they may only present data for women under 35, or their data may relate to pregnancies rather than births. Success rates can also be affected by the types of patients a clinic treats.

“There are also inherent risks in cross-border treatments due to potential complications and the logistical difficulties
of managing patient care from a distance. Hospitals must be vigilant in navigating these considerations to treat international patients safely and effectively. Effective risk management and appropriate insurance coverage are crucial in mitigating these risks.”

Dr Mika agreed that increased awareness and education is required. “We have still got a long way to go to ensure that patients base their decisions on transparent, trustful and reliable information. However, if patients and couples become more informed about their healthcare options, they are more likely to seek out accredited clinics. This increased awareness
puts pressure on clinics to obtain accreditation to remain competitive,” she stated.

Growing demand

A 2021 study in the Lancet found that global fertility is declining and, in tandem, fertility tourism is rising. Where there is demand, there is supply, with a wealth of high-quality healthcare facilities and cutting-edge technology across the globe. In the UK, long waiting lists are prompting, sometimes forcing, people to look elsewhere for IVF treatment.

“Looking to the future, we anticipate continued growth in the international IVF market,” said Matson. “This will be largely driven by increasing demand, as more individuals and couples are willing to travel internationally for potentially better success rates, lower costs, or access to treatments not available in their home countries. The trend may also be a consequence of increased delay and difficulty in accessing IVF on the National Health Service (NHS). HFEA shows the proportion of IVF cycles funded by the NHS in the UK has fallen to the lowest level for 14 years (data from the Fertility Treatment 2022 report).”

Lobel agreed: “The growing number of people travelling abroad for IVF will likely follow the upward trend seen in demand for other medical treatments abroad. This demand is as a result of lengthening NHS waiting times, the relatively high cost of private healthcare in the UK and the growing reputation of specialists in some treatments abroad. While the NHS remains a cornerstone of UK healthcare, alternative treatment paths that involve travelling abroad are growing in popularity.”