Why do patients choose clinics abroad?

Cost is high very frankly and I say this as I am working in a London based clinic. Having treatment here is very expensive especially when you are doing it privately and the NHS is not funding too many cycles or withdrawing funding for IVF for couples which is making it difficult for these couples. Going abroad for treatment, the cost is practically half of what they have to pay here so I think going abroad is because of the costs.

It’s really challenging and I think it extends across a whole range of specialist areas now where there are many conditions that you are not allowed to even refer to secondary and they’re classed as procedures of limited clinical benefit and even mainstream things like referring for hip replacement, knee replacement and things like that, you have very very rigid pathways now that have to be followed again before you’re even allowed to refer into secondary care and that referral doesn’t reach the clinician in secondary care, it’s chopped if the criteria aren’t hit.

So, I think infertility has always been a little bit like that. In the whole of my working career, there have been very strict NHS IVF guidelines which vary with postcode which is the most challenging thing because nobody can understand that and it’s impossible to explain to people why if they lived five miles down the road they might be eligible for two or three cycles of IVF but where they live, they’re only eligible for one, I mean that’s lunacy in anybody’s book but that’s been part of the repro-med world in the UK for all of my working life.

Increasingly, however, those kind of restrictions have become more and more widespread into what I would consider mainstream clinical areas. Referring children for tonsillectomy, referring children for grommets – all kinds, of varicose vein surgery – nearly impossible to get now, unless someone has such bad varicose veins they’re bleeding out with them and things like that. So you spend half your time as a GP, trying to work out whether patients hit the criteria for referral and that takes a lot of time and one of the things in infertility I’ve always said to groups that I’m sort of lecturing or whatever, don’t tell people about criteria unless what they are, tell them there are criteria and then find out about them and let them know because people get very annoyed and very upset and very angry if they’re told one thing in terms of eligibility and then that’s contradicted when they go through to the hospital setting and having been told they were eligible, they’re then told they’re not eligible and that causes a huge amount of angst, much better off for them to find out right at the outset that they’re not going to be eligible then, at least they have an opportunity to head around that but it’s very challenging it’s very frustrating and increasingly we’re aware of people going for all kinds of procedures: bariatric surgery, going off for package surgical trips to Istanbul and places like that, some of them go well, some of them don’t go so, well and then the trouble is the NHS ends up picking up the pieces because they come back.

Special care baby units around the country are in the IVF context and I remember having a conversation in Sheffield with one of the pediatric senior registrars who was moaning about the multiple births in the Scaboo at that time. I said well, we don’t generate very many now and he said no they’re not from you, these are people who’ve gone for IVF abroad and had double embryo transfers or even triple embryo transfers with egg donors – egg donation IVF – which in the UK you’d get shot down in flames for that.

So, it affects both ways, it affects the assessment referral pathways and the day-to-day work of GPs but also specialists who are not allowed to see or operate on people that would have done a decade or two ago but also those people going abroad many of them for the plastic surgical procedures, maybe things like varicose veins or breast augmentation or whatever and again when they go wrong they tend to then come often the NHS is expected to pick up the consequences and that’s, that’s frustrating as well because you wonder in the first place, if they’d had it done by an appropriately trained surgeon within the NHS whether that would have been the case so, it’s added another layer of complexity to the job frustration to the job I think and again, the part of the frustration is it’s very difficult to know how you affect that, how you do anything about it, how you change that because those decisions are made way up the food chain from where GPs and their surgery or specialists in their clinics are sitting, they’re made at not even trust level, they’re often made much higher than that and you’re not part of that decision-making process, you just expected to deal with the consequences at the coal face as it were really.

So, yeah it does, it made it very much more frustrating I think. The huge change in used to be able to refer as a GP 25 -30 years ago if you felt a patient needed a referral, you referred them now, okay, many of those referrals probably need to be a better quality but there are many areas now where that just is not the case, you cannot refer that person off and you have to explain to them, sometimes print off the reasons why they’re not going to be eligible and they’ll well what am I supposed to do and they then start looking, as you say, they look at options within the private sector in the UK, they then compare them with eastern Europe or the Mediterranean or whatever and off they go and I must admit, you can understand why they do that, it’s but it’s very frustrating, absolutely very frustrating.

One of the main reasons why UK patients are looking to go abroad is the waiting time for the egg donor or sperm donor and the cost of the treatment. Also they say that it is far less cost wise when they access it abroad so, these are the two main reasons: the quicker access to the treatment at lesser cost is taking patients over the seas to access treatment.

Well, I think some of the fertility claims abroad are extremely good as well, so I think they’re going for very good treatment. I also think they get a very nice experience in some of these clinics when you talk to people who’ve been abroad, they’ve had a very very good experience being away. Sometimes if they’re going abroad to a sunny place, they can fit in a holiday around their treatment which makes it much less stressful and sometimes it’s cheaper. I think those are all reasons why people do it and of course many people would go on recommendations, so if they know someone who’s had a good experience, then they will do the same thing.