Over the past 12-18 months there has been a buzz, made all the more loud by a recent episode of Oprah, regarding American couples going abroad, mostly to India, to pursue family building at what is being billed as a cost savings. At both the American Fertility Association conference and yesterday’s American Academy of Adoption Attorneys meeting, the issue of surrogacy and/or egg donation in places like India were explored.

Several months ago, Prospective Families was contacted by a service that brings American egg donors to Bangalore and Hydrebad India along with American Intended Parents to work with Indian surrogates for family building. Having no idea as to the level of interest of any of the donors registered with Prospective Families, I polled our donor pool and was shocked to find an overwhelming and enthusiastic interest in travelling to India to do a cycle….okay, I had my charge: research, research, research and find out what Fertility Tourism in places like India is all about!

 At the AAAA meeting, not surprisingly, there was a good degree of cynicism and, I might opine, some rumbling hostility towards that gentleman who was speaking about his agency (travel agency, tourist agency???) that coordinates all of the logistics for American Intended Parents. It was a tough audience, 200 or so practicing attorneys licensed and doing business in the United States with American clients…what/who is this new player in our marketplace??

 Well, I am sorry to report…not much information to share. Questions were asked about success rates, questions were asked about the quality of care at the Indian clinics, questions were asked about pre-natal testing, questions were asked about choice of law issues and legal counsel regarding contracts…we were offered very broad, general statements that left the audience all the more skeptical.

One of the most significant questions is the issue of cost and cost savings. I have been involved, professionally, with infertility, for many years, starting with my early days at RESOLVE: National where the main focus was and is still today, solid legislation acknowledging infertility as a disease and mandating insurance coverage for treatment. I am also a parent of ART conceived kids; through both my personal and professional experiences I  have come to develop a deep empathy and sensitivity towards the financial burdens of assisted family building.

So, is fertility tourism really cost effective? If I take a narrow view of this question and look only at the fees related to doing a domestic cycle as compared to an international cycle…I do not see much that is compelling. Yes, in the States, the fees to the surrogate may be greater, but the costs related to int’l travel and the additional legal counsel needed to oversee that parentage is managed properly seemingly bring the comparative costs to a similar bottom-line. If a couple is working with an egg donor as well as an Indian surrogate, the costs of either doing the IVF here and then shipping the frozen embryos to India or bringing the donor to India add significantly to that scenario’s bottom-line.

If we take a broader look at cost comparison and consider risks associated with fertility tourism, I have come to the conclusion that, at least in the foreseeable future, family building outside of the United States, whether in India or elsewhere is, in fact, cost prohibitive. How do the success rates compare to that in the US? What is the pre-natal testing protocol? What are the legal loopholes of parentage? How are the surrogates screened? Any of these issues and so many more each have a real price-tag attached to them.

I believe the sessions on this issue at various professional meetings are important, critical, in fact. I expect we will see this matter discussed at ASRM. I have no doubt the Oprah show and others like it will continue to sensationalize and make sexy the option of fertility tourism but, as is the case with all matters we counsel clients on, let’s be sure we understand how a cycle abroad can play out both short-term, in terms of success with the cycle and long-term with respect to parentage issues before we allow this to become anywhere near a trend.