Infertility, or the inability to conceive children after 12 months of sexual intercourse without birth control or the inability to carry a pregnancy to full term, affects around 10 percent of women aged 15 to 44  in the United States and around 8 to 10 percent worldwide. This infertility combined with the social pressure to have children and spread of western medicine across the globe have given rise to an entirely new industry where people travel to different parts of the world to conceive via artificial reproduction. Called fertility tourism, it is defined as ‘… the practice of moving or traveling to some other country for the treatment of fertility disorder.’

This phenomenon is attributable to two major causes- lower costs, and prohibition by legislation. According to an article by Medical Tourism Magazine, a surrogate in the United States would approximately cost anything around $100,000, but the same in Mexico would be less than half the price at roughly $45,000. While there are other hotspots like India for cheaper surrogacy, US citizens prefer Mexico according to the article because of short flights, no time difference, and no visa hassles. The legal impediments access to artificial reproduction come on multiple fronts. Certain jurisdictions ban PGD or PGS; the others do not grant reproductive rights to same-sex or transgenders. Yet others ban donor conception or surrogacy.

While these fertility treatments may seem to be cheap or even help in circumventing the possible regressive laws of countries, fertility treatment is not free from dangers. The UK watchdog, the Human Fertilisation and Embryology Agency (HFEA), has warned probable patients to look into the ethical and moral standing of their doctors, claiming that some treatments which these doctors provide are considered to be dangerous in the UK. The HFEA also cautioned that patients not be caught unaware by extras such as assisted hatching (a procedure in which the zona pellucida (outer covering) of the embryo is partially opened, usually by application of an acid or laser, to facilitate embryo implantation and pregnancy), which has no evidence whether these treatments are safe. There are also warnings with regard to multiple embryos being implanted, which poses its own set of risks and dangers. Another set of risks, that doctors and ethicists foresee is a risk where parents cross borders to select the genetic build-up of their children. According to an article by BioEdge, Australian parents are ‘spending A$20,000 to select the sex and eye color of yet-to-be-born babies via with IVF at American fertility clinics’.While the current ‘modest specs’ are limited to eye color, a lack of regulation in the US-based states like California, clinics their help the patients to flout the local Australian law, and there are agencies which help parents choose the color of their eyes and the gender by sending them to their associated clinics in places where gender and eye color selection are permitted according to the same article.

There is, however, also a different perspective, and probably the slightly optimistic view of fertility tourism. It reduces the social injustice that comes with low-income parents not being able to access the treatments because the insurance companies seldom cover the costs. While the politicians, doctors, and ethicists rack their brains trying to figure out the manner in which they can curtail these practices, the answer is simple. Reduce the restrictive legislation while simultaneously ensuring that these technologies are not misused and minimize, if not eliminate exploitation but this is seldom considered seriously. It is not only the infertility treatment seekers who are at risks. More often than not, the gamete donors or surrogates are also at the risk of exploitation. In India, which has become a frontrunner in providing surrogacy, most surrogates are believed to have come from the socially and economically disempowered class. The risks may also extend to them being ostracised from their local communities or being deserted by their husbands. Similarly, egg donors who have to undergo hormone treatments and take fertility drugs which expose them to cancer, enlarged ovaries and blood clots which may require hospitalization.

Often as it is with avant-garde technology, the industry of cross border fertilization is young, and so are the measures that seek to regulate it and the types and the extent of studies that seek to comprehend its tentacular nature. But there is no denying that with time, this industry will grow, throw complex problems at the legislatures and policymakers to resolve the presently nebulous ethical, moral and legal issues that surround it. However, even after the implementation of conducive legislation and policies in place, it can only be the doctors who will need to act as drivers of change and improve the standards of care in this future of medical consumerism.

A link to a video about fertility tourism can be found here.

Article by Rohin Bhatt