Traveling Abroad for IVF
"Buckle your seatbelts and brace for severe weather conditions." A jolt of turbulence launched me backwards, and I clawed both armrests for support. I was alone on an economy Turkish Airlines flight to Tbilisi, Georgia. The purpose of my trip was to try one last-ditch fertility treatment before I was officially too old to have kids. Considering how this flight was going, I might not make it to either destination.
My husband and I had been trying and failing for five years in a fertility journey best described as Sisyphean. We married late in life, and we both craved parenthood. When natural methods of conception didn't work, we paid for In Vitro Fertilization (IVF). After two rounds of treatment and only one lonely embryo to show for it, we could no more fly to the moon than afford another $30,000 medical bill.
My case was no different than that of millions of American women who struggle with infertility but can't afford treatment. According to the CDC, infertility plagues one in five women of childbearing age who have no prior births. IVF is the most popular infertility treatment, but unlike other places in the world, access to IVF in the U.S. is considered a luxury--not a right. At least 71% of American women who receive IVF lack insurance for their care.
Moreover, skyrocketing costs and high demand at clinics are creating nearly insurmountable barriers to reproductive medical care for the majority of middle and working-class Americans.
According to Dr. Amy Speier, a medical anthropologist and scholar of tourism at the University of Texas-Arlington, rising inflation is not helping matters. "People can always pool together resources or refinance their house, but the cost is still prohibitive, particularly when it gets to egg donations…The technology is not getting any cheaper. Nothing is getting cheaper these days."
As a result of this deficit in the American medical system, infertile U.S. patients are taking matters into their own hands and becoming global healthcare consumers. With a few clicks, one can shop online for affordable deals at foreign clinics and then book an international flight for IVF treatment. "Right now, fertility clinics around the globe have begun to develop marketing schemes that cater to this North American desire for care," says Dr. Speier. Her research shows a growing trend of Americans venturing to popular fertility hotspots like Greece, Spain, Georgia, and Czechia after getting priced out of the expensive, privatized U.S. baby business.
My husband and I started our global IVF journey by joining a Facebook group for people travelling abroad for realistically affordable fertility treatment. (The average cost per cycle in the United States is a whopping $23,474.)
Online, I met Carrie Jones of San Francisco, who spent only $6000 for IVF in Thessaloniki, and Abby Krom, a 37-year-old therapist in Los Angeles who paid only $2500 in Prague. Even with the added food and lodging costs, Abby kept her total price tag under $7000.
I also met Sarah and Mark Joseph, a couple discouraged by the astronomical treatment costs in St. Louis. After trying and failing with IVF for two years, they were astonished to discover an entire round of treatment in Barcelona was only $5000. By capitalizing on their clinic's package discounts for hotels, transportation, and tours, the Josephs were able to finance two rounds of IVF and "experience a new culture and country simultaneously."
Aside from the financial and cultural advantages of cross-border reproductive travel, there is a noticeable trend among IVF travellers who report the benefit of more personalized care abroad. Carrie spent over three years trying to conceive. When her egg donor didn't produce any viable embryos, "the clinic didn't even have the decency to pick up the phone" to tell her the news. "They told me in an email…it was jarring. After we had spent so much money…I felt so unimportant."
Similarly, when Abby received treatment in Los Angeles, "people were so busy they could barely look you in the eye…our fertility clinic felt like a mill. One time, they received my husband's semen analysis, and when I called for the results, I was rerouted to a call center in Kansas. It was like, how will we ever get in touch with anyone?"
In contrast, the first thing Abby noticed in Prague was the medical team's supportive bedside manner and attentive disposition. Upon arrival, she was assigned a designated personal nurse who explained the IVF process in detail, advised where to eat and sightsee, and made herself available 24/7 to help. "Everyone was very concerned and genuine," said Abby. "Being in a new country and having a new treatment, I appreciated the personal touch, which is harder to get in the States." Carrie was pleasantly surprised that her clinic in Northern Greece "treated everyone like family; they were so excited and invested in the process."
This brings us back to me vomiting into a bag from turbulence on that Turkish Airlines flight to Georgia, a former Soviet republic bordering the Black Sea that is home to a burgeoning reproductive medicine industry. Today, the Republic of Georgia is to infertile couples what the Barney's Warehouse Sale is to discount designer bargain hunters.
My plane finally touched down on an icy runway at 4 AM on Orthodox Christmas morning to giddy applause and relief by everyone on board. The streets were dusted with snow like powdered sugar on holiday cookies. The air was so cold my teeth ached. I huddled in a taxi cab through a snowstorm on the ride to the hotel and then to the hospital, where I exchanged scarves and jackets for a paper gown. I was seated in a gynecologist's chair as the physician, Doctor Kate, performed an ultrasound of my uterus to hunt for eggs. She grimaced and brought me next door to meet in her office.
"You have one bigger follicle than the rest," she said. "This is bad news because it may hog all of the nutrients and the other follicles will arrest in their development. The choice is up to you. Do you want to call the whole thing off or move forward, even if you may not succeed?" I stared mournfully at the tulips and ivy on the wallpaper.
All eyes in the room were on me. It wasn't the first time I had heard bad fertility news. My previous doctor had told me not to even bother with another round of IVF due to my advanced age of 43. "I understand the odds, but I've come all of this way, and I'm not giving up now."
My circumstances were far from unique. Research shows that women over 40 have less than a ten percent chance of conceiving through IVF. According to Dr. Speier, fertility treatment does not come with guaranteed results. Due to these variable success rates, "clinics call it 'fertility tourism' to give people a sense that even if it doesn't work out, you still have an adventurous cultural experience to show for it."
With that in mind, I left the doctor's office and took the day to explore Tbilisi with my Mother-in-Law, who had flown in from New York to lend moral support. My husband wasn't able to arrive for another two weeks. We went sightseeing, wandered through a Christmas fair, and scoured old Soviet paraphernalia, chessboards, and tea sets. Then, we indulged in a famous Georgian culinary tradition: delicious Khinkali soup dumplings with savoury meat and spices. These exploits were a necessary distraction for what came next.
A far cry from the lazy beach days and mango margaritas of a typical vacation, IVF is a process that requires enormous physical and emotional exertion in unfamiliar surroundings. (Also, it's harder to enjoy a holiday when one is banned from exercise, alcohol, sex, hot tubs, or spicy food!) The next three weeks were a doleful montage of hormone injections into my abdomen, which bloomed into a rainbow of yellow, blue, and purple bruises.
Luckily, I found a major advantage to fertility treatment in Georgia. During my previous IVF treatment in San Diego, I had to give myself all the dreaded shots every morning and panicked about miscalculating the amounts. In Tbilisi, I was paired with a personal nurse, Irina, who came to my hotel every day to give me the shots, double-check the dosages, and literally hold my hand through the whole process. I couldn't have been more grateful.
For the final egg retrieval surgery three weeks later, Brian flew in from San Diego and hugged me before I was wheeled into the operating room. I tried my best to look confident and optimistic. Inside, I was trying not to panic. White rubber gloves removed my glasses. Physicians spoke hurriedly in Georgian, and I understood nothing. Someone poked a needle into my left arm, and everything faded to oblivion. I woke up with no pain, in a comfortable bed and a feather-down comforter. A nurse conjured some sweet ginger tea and home-made biscuits. It felt like a VIP room compared to my prior surgeries in San Diego, where I woke up with stabbing cramps in a freezing metal cot, and then got ushered into a wheelchair to free up space for the next patient.
Dr. Kate came in and pronounced the procedure successful. They extracted seven eggs and would keep us updated. Victory! Brian took a selfie of us to send to our families. We were back home recovering from jetlag and snuggling with our dogs on the couch when the final verdict came in a WhatsApp message from Hannah, our fertility agency coordinator. "Michelle, I am so sorry. There are no embryos left on day five. Your doctor said this is an egg quality issue due to your age. Take some time, as I know that this is extremely devastating for you and all of us." There was a single broken red heart emoji. I stared at the letters in disbelief.
All I could do was ugly cry for days. I'd believed that with the lunacy of this grand gesture of flying across the world for fertility treatment, the universe would cooperate and answer our prayers. I had thought that by throwing all of our chips into the pot, we would get some karmic reward for these herculean efforts. That was wrong. The reality? We never had control over any of this. All that was left to do now was surrender.
When enough time had passed to process our profound disappointment, we moved ahead with our backup plan. We still had one healthy embryo in cryo-storage from our previous IVF treatment in the States. This was our last chance to have a child of our own. After everything we had been through in Georgia, we knew we had the creativity and determination to start a family, no matter how much the final results varied from our original vision.
At the end of our collective journeys, everyone's mileage varied. Abby caught COVID-19 in Prague, and her first embryo transfer was unsuccessful. However, she did create a second healthy embryo and is now planning the next steps of her parenting journey. Sarah and Mark returned from Spain to give birth to two healthy babies. They later launched a website to help other families cope with infertility. For Carrie, the conclusion was bittersweet. Upon returning to California from Greece, her husband was diagnosed with colorectal cancer. He is currently undergoing chemotherapy, and she is 18 weeks pregnant. "This baby was such a miracle for us. I feel like they gave us the gift of our lives."
As for Brian and I, by some miracle, we celebrated the birth of our baby girl on March 26th, 2024. The money that we saved on IVF in Georgia will go into her college (and diaper) fund. For that, we don't regret a thing.