Treatments for infertility range from artificial insemination to In Vitro Fertilisation (IVF) with either donated eggs or sperm or the patients’ own. Breakthroughs in new technologies and medical procedures mean that many couples and single women who previously would have faced childlessness are now able to conceive and deliver healthy babies. Around one in six couples worldwide are affected by fertility issues, and treatments offered or accepted may differ depending on the legislation and culture of each country. IVI has treatment centres in thirteen countries across the globe, as well as 27 clinics in our home country of Spain. Working with advances in research and within the parameters of each host country, IVI aims to help treat infertility on an international level. Wherever there is a person struggling with signs of infertility, IVI wants to be able to offer a helping hand. IVI also offers overseas programmes to make patients as comfortable as possible with the procedures.

Infertility and anonymity

A hindrance to infertility treatments in different places may be the legislation surrounding the issue. Sometimes this is informed by cultural traditions or attitudes to anonymity. These may lead to shortages in egg or sperm donors. In the UK egg donors receive no more than £250, to cover loss of earnings, resulting in fewer eggs being donated overall. In Spain donors receive a higher amount, though again, this is only to address loss of earnings. This means there are more donors in Spain overall. While UK lawmakers are addressing concerns about the sale of genetic material, the limitations on recompense do mean that couples opting for infertility treatments that require egg donation are forced to travel abroad. This adds to the financial cost and emotional toll taken by each attempt.

Anonymity for sperm donors ended in the UK in 2005, which has resulted in a steep drop in this sort of donation as well. Some couples travel abroad to acquire anonymous sperm. While lawmakers in some countries feel that any children born of donated sperm or eggs should be entitled to trace their biological family, many patients undergoing treatment for infertility would prefer to keep the process as straightforward as possible. While they may want to have information about genetic pre-dispositions to disease, any further information is unimportant or potentially harmful. Infertility is an emotionally draining issue as it is, and anything that can help the couple or single woman to feel more comfortable is a big positive.

Surrogacy for love or money

In some countries, such as India, surrogate mothers are entitled to a large cash sum in exchange for carrying the baby. A surrogate mother-to-be may carry a fertilised embryo made with her own egg, with the egg of another donor, or with the egg of the mother-to-be if infertility is the result of being unable to carry a baby to term. It can have been fertilised by the biological father or through artificial insemination. The parents are likely to form a relationship with their surrogate as they work through nine months of pregnancy hoping for the safe delivery of their child. As may be expected, there are some thorny legal and ethical issues associated with this way of addressing infertility.

In the USA some states have outlawed the use of surrogates, or “gestational mothers”, while in others surrogacy is permissible by law but somewhat complicated. If the surrogate mother is also the biological mother, with her own egg having been used, she may have to sign the child over to the new parents. Likewise the non-biological mother may have to legally adopt the child, and there may be rules governing the names that are allowed to appear on the birth certificate. The couple or single woman who has opted to use a surrogate may not want this third person to be a part of their life post-birth, but she may have rights over the child depending on state legislation. It is important that both the couple and the prospective gestational mother go through each potential sticking point in advance, and know where all parties stand before going ahead with the surrogacy.

Another issue to consider is compensation. The couple is expected to pay the medical bills, as well as other expenses resulting from the pregnancy. These include maternity clothes, travel to and from prenatal appointments and other incidentals. In some countries, the surrogate will also be paid a fee for carrying the child. This has led some critics to decry the practice of surrogacy as a luxury that only the wealthy can afford. Others view surrogacy as an exploitative “rent-a-womb” arrangement. It is up to the prospective parents to do only what they are comfortable with in terms of paying a surrogate, as long as they are acting within the law. In Australia and the UK only altruistic surrogacy is legal, while gainful (paid) surrogacy is not. In Russia both forms of surrogacy are allowed, while in Iceland and France, neither is. In some countries, surrogacy – either procuring or providing the service – will result in a jail sentence. It is illegal for Hong Kong nationals even to opt for surrogacy in another country.

Keeping a positive attitude

Signs of infertility need not dash any hope of having a biological child. There are differences in terms of what treatments are available in each country. However, fertility treatments are becoming more and more widely available worldwide. For the average prospective parent(s) facing infertility issues or challenging circumstances, there is more hope now than ever before. Celebrities opting to conceive via IVF, or to have their children carried by a surrogate, are helping to lift any stigma that may have surrounded these procedures in some quarters. That said, procedures to assist with reproduction including artificial insemination and egg donation are far from being available only to the wealthy and/ or famous. They are becoming more commonplace, and therefore more affordable, every day. For many infertility sufferers, this brings the prospect of having a healthy baby sometime in the future within reach.