IVF abroad, everything you need to know with Andrew Coutts

Andrew Coutts of the International Fertility Company tells us everything you need to know about having IVF abroad. For anyone considering IVF this is a must listen! 

We discuss: 

What are the benefits of having IVF abroad 
What are the standards of clinic like abroad
Do the clinics abroad offer ‘better’ more up to date treatment options than UK clinics Are there big cost differences
What are the pitfalls/potential downsides of IVF abroad
How do you start to look for a clinic 

Transcript

Unknown: 0:00

Hi, I'm Rachel Sherriff and welcome to the fertility suites podcast. Our aim is to educate and empower couples who are struggling with all aspects of fertility by giving you the information to make informed decisions along the way. We've had a little rebrand since series one, we were formerly the fertility method podcast. But in this second series, Mr. Short, we still have the same high standard of fertility experts coming to share their knowledge and support you. So if you are struggling with fertility, miscarriage or you just want to arm yourself with the facts, then this podcast is for you. Hi, everybody, and welcome back to another episode of the fertility suite podcast. This week, we have Andrew Coots joining us and Andrew is the founder of the International fertility company. This is a company that helps people to find IVF clinics abroad and support them through that process. So, Andrew, I'm going to hand over to you and you can elaborate on that and introduce yourself a little bit further. Okay, thank you very much, Rachel. Thank you for the invitation. So my name is Andrew Coots, and I founded the International fertility company. Six years ago, now, I am a former fertility patient myself, or be it in the dim and distant past. But my wife and I had struggles we were trying to conceive for eight years before we were finally successful. After that experience, I then started to do some work for the patients Association fertility network UK, and worked for them for five years. And working mostly with UK fertility clinics, visiting them, looking at them from a patient's perspective, and then reporting back to patients and giving feedback, sharing feedback. And then about two or three years into that work, I was invited to a clinic in Spain, and really was really shocked by the differences that I've experienced between that particular clinic and some of the clinics not all of them, but some of the clinics that visited in the UK. And then really had my eyes opened in the fact that people were at that point, we're travelling for treatments, to various different countries for different treatments. And I really didn't have a great deal of knowledge of that particular time. So I'd spent another two years I suppose you just looking at sort of Central Europe. And then five or six years ago realised that the demand seemed to be increasing, we was certainly getting more and more contacts from individuals and couples who were asking questions about travelling for treatments. So I then decided to invest more time in terms of visiting different countries. And the last six or seven years or so I've spent sort of visiting probably about 300 clinics now, I would say, and decided then that it was a good opportunity, perhaps to develop a specific platform that would enable people to get more information and access clinics in in different countries, but not only Europe, but further afield. So clinics in the US in the Middle East, in India, for instance. And the the international fertility company basically exists therefore to provide information and advice to anyone who may be considering travelling for treatment. We don't necessarily say it's the best option for everyone. And it's not, but it's certainly another option to consider. So you are the person that knows probably the most about fertility clinics that I've ever spoken to them. By the sounds of it, you've been through a lot. You've been through a lot, my eyes widened when you when you said you've seen 300 clinics. So if I was part of a couple then who was considering IVF. And I'm looking at my options, like what would you say are the benefits to going abroad for IVF? If you had to pick like the key benefits, what would they be? Yeah, I think we'd sort of take a little step back and then and just sort of have a look at the people who are looking for treatment abroad. So it's we have, I would say the vast majority of people that come to us from the UK are looking for donation treatment. And that with that sort of treatment, the vast majority are looking at places like Spain, Greece, Cyprus, we get another group of people who are perhaps younger who are looking for IVF treatment using their own eggs and sperm. And then we've got another group of people who are looking to access surrogacy programmes. So we've got three defined groups, I suppose, of people who are looking for specific treatments. And based on their treatment requirements, there's sort of the reasons why they they travel lot are different. I would say for the majority of people cost is a major consideration. And that's been increasingly so over the over, certainly since it just came out of the COVID pandemic. So, so cost yes is definitely a major concern. The other one is access, and that that may be access to a particular treatment, which isn't available in the country of residence for someone, it may be that they're excluded from treatment in their own country because of their age, because of their PMI, just basically, because of the low numbers of donors within that country. So so access is another issue. And also, I suppose, particularly again, in the UK, one of the major considerations is the speed at which the person can access treatment. So for the vast majority of clinics that are in the private sector, outside of the UK, there are no waiting lists, or if you're going for donor treatment, the way to the waiting period is a lot shorter than it would be in the UK, for instance. There are there big cost cost differences, then like what can you quote numbers like what sort of money would you be looking to save? On? I know, that's a really difficult question to answer when you've got variables like donation of eggs or sperm involved. But like for a basic IVF cycle, like what would you be looking to save going forward, what would be like the minimum saving you might make, of course, so I mean, the latest research they've seen, in terms of average costs for an IVF cycle in the UK, and this take into consideration IVF eggs and sperm and donation treatment comes out around about 14,000 pounds pouring in for an individual or couple who want to access it. If you're looking at Central Europe, for donation treatment that could cost anywhere between six and 10,000 pounds for IVF own eggs and sperm that can anywhere between 3006 1000 pounds. So potentially you you're saving, potentially, you're saving up to 50% on the actual cycle costs. The other consideration is things like medication. So in Europe, again, we're accessing medication costs, which are 25% of the cost of medications in the UK. So aside from saving on the actual treatment cycle itself, and there's quite big savings that can be made on medication costs. Yeah, medication costs can be huge, right? If you're a highly medicated cycle, in terms of lots of add ons, sorts of, you know, clexane, they leave your injections, all those sorts of things, they're not cheap, right? So actually, that's actually blowing my mind a little bit that you could potentially be saving up to like 70 75% on a full treatment, if not more, maybe on a full treatment cycle. That is a lot of money, especially at the moment, then, you know, everything's super expensive already. And then couples who are struggling and then having to find money for private IVF, because of those access issues that you've talked about. What would be like you talked about the benefits of having IVF abroad in relation to different scenarios. So just wanted to go back and talk a little bit about about a donor scenario. What would why would someone who was considering donor eggs or sperm be benefited, would benefit from having IVF aboard what really is there to gain there? And that is a little bit of a naive question, because it's not an area that I actually know a lot about. But it would be good to help listeners because maybe they're in the same position. Yeah, of course. So I think probably one of the main reasons again for UK patients who who are considering travelling for treatment, particularly in countries like Greece and Spain, who are having to have donation treatment, that the big difference between those countries in the UK is in the UK, you have a non anonymous donors. So the couples of the subsequent child born from donation treatment can find out details about donors when they reach an appropriate age. For a lot of people who have to go down the donor route. They want to have anonymous donors. So they go to places like Spain, for instance, Greece and Cyprus that have a pools of donors who whose details are remain anonymous. So they access that those for for those reasons. And that's the last event benefit, right? That's a big that's a big factor when you're considering donation was probably the main factor. I'm sure it is certainly the main factor for we've we for UK pay Since the other one is at games go back to accessibility. We, historically in the UK, we've had quite low numbers of both male and female donors. You go to somewhere somewhere like Spain, I keep mentioning Spain, because for for Central Europe, at least, Spain is sort of the hub for international patients. So more patients travel to Spain, and more donor. Donor treatments are carried out in Spain and in any other European country. But in Spain, for instance, you have large pools of male and female donors, and other countries similarly have got larger numbers of donors. So it's far easier to access treatment if you're having to rely on a donor if you go to those countries, whereas in the UK, you could be waiting months to even get the access to the to the edge of the spam. And then you've got the anonymous issue as well, that you discussed. Okay. So there's huge benefits. And there are benefits. I mean, I mean, what is the the sort of the negatives I suppose for for people, I mean, the not the anonymity issue, works well for some people. So if people want to have anonymous donors, they can go to those European countries, for instance. But equally, they are then restricted in terms of the information that's given to them about the donors themselves. So the clinics will go through the appropriate tests. So they will make sure that any donors are physically healthy, genetically healthy, psychologically healthy, and you will get as a patient will get sort of minimum. Minimum descriptions of the donors themselves might be the hair colour or eye colour. But you won't get sort of the sort of huge amount of information or any identifiable information about the donor. So that's a sort of a negative in in that sense. And that's why patients, for instance, travel all the way to the US where, where those sorts of information about donors are readily available. So it is a bit of a sort of a mixed bag, there's the NEMA T question, really. So one hand, if you're looking for a number of stoners, you've got you've got your up on your doorstep. But if you do want some additional information, you know, that's restricted in that sense. Okay. So if we take the donor side of things out of the equation, so if couples are looking to travel abroad, using their own excellent their own sperm, what would be the potential pitfalls or downfalls of then having IPF aboard? Obviously, like that cost saving? is big. Right. So there's going to have to be something like to change you on that. Is there anything? Yeah, I mean, if we take out the sort of the, the distance between home, home and abroad, essentially, the clinic should find outside of the UK, are no different in many respects to the clinics, you'd find in the UK, you know, they're good ones, bad ones, and indifferent ones. And obviously, there are sort of associated problems with with with each of those. But the main differences, obviously, a few are in the UK, for instance, is when you make that initial contact with with a clinic, it's not sometimes it's not possible to physically go into a clinic, for instance, and have a good look. And that's something that we would always recommend, if at all possible that a patient does, that they actually go in and physically see the environment in which they're going to be treated. So that's, that's potentially negative in the first instance. And that's why we always recommend that people we can talk about this later, but a patient spends a lot of time in terms of sort of considering an appropriate clinic to go to, but I suppose that's one of the main main issues is the the inability sometimes to actually physically go into to a clinic. In terms of other negative points, some of the best clinics now have been working for 20 years plus in terms of bringing in international clinic, international patients, and they're so well set up equally as well as some of the UK clinics. So in terms of communication, there's not usually any problems in terms of sort of finding English speaking stuff. usually find a lot of the International clinics because they they have to work quite hard in terms of marketing and making sure that they provide a good level of service and patient centred care to to their customers. They so they do invest heavily in terms of the environment that they offer to patients. And this is one of the things that really struck me when I first went to the clinic in Spain. A lot of them look very different to the clinics. We find in the UK, particularly the clinics, unfortunately, in the NHS, you know that not had the investment made in them. But they look differently, they have to work that much harder to recruit patients, they're really relying on good feedback. So they're really well set up in terms of sort of promoting themselves and ensuring that the patients get the best possible care. And the best possible experience was, it's almost a bit more competitive, like they have to up their game, right. So they're on the ball with things like that. Okay. So it's interesting, like, obviously, I've had people go through the clinic, having therapy with me that have had IVF aboard. And I think what I've noticed is that actually, talking about the logistics travel side of things and going into clinic, it often depends on what people do for a living, like the patients that have found having IVF abroad are relatively seamless and stress free. Time for them, within reason, have been the ones that are maybe self employed, or have a bit more flexibility with their hours, they're able to work from anywhere, you know, they'll go and rent an Airbnb close by to the clinic make a bit of a holiday or it. But other people, that's just not an issue, or, you know, it involves taking two weeks off work that has to be timed very carefully. So I think it's a very individual choice, right. And we can talk about pros and cons. But actually, it comes back to what's right for that patient, which I know is part of what you do is like matching people up with clinics will come and talk about that. But I think, yes, there's so many variables, right. So definitely, definitely. And as I said at the beginning, release it you know, it's not suitable for for everyone. It's just a different option. Yeah. And what would be like the main countries? So you've mentioned Spain, like, where else? Is there that is top of the list? Or in terms of like, Are there countries that are better for certain things? You mentioned Spain in relation to egg and sperm donation? Are there other countries that specialise in different areas? And it might sound like a bit of a silly question, but it's kind of just something has popped into my head. Yeah, of course. So Spain, as I mentioned, has got probably the longest track record in terms of donor treatments, it receives more doughnut patients. You've got countries like the Czech Republic, Cyprus, both north and south, and Greece, who are very competitive in terms of price. So those countries, if you're looking for sort of cheaper cycles, those are countries to look at, with the with the with the word warning in terms of the sort of the legalities in different countries. So the Czech Republic, for instance, is great in terms of price, but it will only accept married heterosexual couples, for instance. So there's that you said, there are lots of variables between countries as well. But essentially, somewhere like the Czech Republic is good in terms of price. You get other countries like North Cyprus, for instance, which has more liberal legislation, and its provides a more flexible service for older patients. So for instance, in Northern Cyprus, there's a, there's not really a ceiling on an upper age for female patients. So most clinics work on a clinic by clinic basis. So if you if you're an older woman looking for treatment, North Cyprus might be a better option. Say for instance, something somewhere like Spain, which has a fixed ceiling on age, you then you've got countries like Norway, and a lot of UK, couples actually go to Norway. Because Oh, for IVF with own eggs and own sperm, that's a that's a really popular destination for UK couples, or is becoming one because of cost. And because of success rates. Their success rates are very good. Well, why is I my head, I kind of think Scandinavia equals expensive, you know, like, the standard idea about something, but also Yeah, why their success rates higher, you don't mind paying if you're going to have success, right? So again, whereas Spain, for instance, heavily concentrated on donor treatments, you know, that's become their, their niche, and historically, they've worked with patients who've got quite challenging histories. So they they've sort of developed a niche, they're in someone like Norway. They don't offer donation treatments. So they've developed this sort of Nisshin IVF of own egg and sperm. And they've got a there's a couple of really good clinics in Norway, for instance, we've got long track records, you were very good success rates. And they've always consistently brought in patients from places like Germany and Eastern Europe, but it certainly over the last two or three years more and more UK patients are sort of looking at no way in particular in other Scandinavian countries, some Scandinavian countries are expensive. But Norway seems to stand out as offering some some competitive prices. What's really interesting, I'm sure a lot of people listening well, you know, when I'll be Googling Norway for IVF? Yeah, sure. What about further afield? Like you talked about the states anywhere else, like what would be the benefits because obviously, then you're looking at more travel costs. You are. So on one side, you get places like the Middle East, and one or two clinics now in Northern Cyprus who offer gender selection. So So if so, you know, a couple were specifically looking to have treatment and a child of a particular gender, they would look to someone like the Middle East, for instance. And they would go in that direction. There's one or two clinics in North Cyprus now that offer donor treatment with known donors, and they give more information. So as I mentioned, that you're restricted in some European countries, North Cyprus, there's a pocket of clinics now the author, like the American model, where patients can find out a lot more details about a particular donor, then you've got the US. That seems to be that's not very popular for UK patients who are looking for donor treatment, or IVF, with omega and sperm. Because it's so much more expensive than the UK, you're probably looking at at least double the price of a UK cycle in the US. So but the US is very popular for couples who are looking to access surrogacy programmes. Again, they've developed a long track record, there's a number of surrogacy agencies in the US who have got established track records. So people do travel to the US, and increasingly places like South America as well for surrogacy. Okay, so again, it's that that individual scenario, but it's good to know there's options further afield. And, again, you never know what someone's situation is, if you've got family in the states that might make the travel and the whole experience cheaper and less stress free. So it really is, like unique to the individuals, isn't it? And you talked a little bit about, like how clinics have to be a bit more competitive, and they've marketed themselves and you know, the experience of walking in the clinic door probably aesthetically is better. And you may begin to feel you're not on that hamster wheel that you might get in certain UK based clinics. But in terms of like clinical outcomes, statistics, like the actual care level, what sort of feedback are you getting? And are there any stats around that? And what can people expect clinically? Like? Can you expect to get access to more up to date meds or more up to date protocols in terms of the actual cycle itself? Yeah, again, I think with this, this is specifically for for UK patients. But if you're doing some comparative work between UK clinics and ours, I wouldn't say all of the non UK clinics, but the best non UK clinics who've got good international departments, there's not a huge difference in terms of success rates. For instance, there is a difference between success rates when you look at donor treatments. And that's again, because of the larger numbers of cycles that are undertaken by non UK clinics, the younger age of donors, and that has an effect on the actual success rate. So there is a difference between success rates in terms of donor treatments. There isn't a huge difference in terms of success rates for Onega, unknown sperm. So success rates. There's minimal differences, I would say. So it's more of an access more of a cost. difference, I think between the two in terms of the clinical standards, again, most of the better. Non UK clinics have got ever sort of achieved quality standards accreditation, so they've gone through that whole process of making sure that their labs are working to a sufficient standard. They provide high levels of patient centred care. They're externally and independently audited, like UK clinics would be. So again, in places like Greece and Spain, their ministry of health, maintain independent statistics about different clinic performance and success rates that are monitored like our UK clinics are as well. So in terms of sort of Patient Care that that sense in clinical standards, there's not a huge amount of difference. I would say we have had negative feedback from some patients who go to certain countries and certain clinics. And that mean, it's mainly to do with communication. So it hasn't been to do with complaints about the clinical standards or protocols. The main complaint is if they go to a clinic, or a country based purely on cost, for instance, and they've come away, and they've had unsuccessful treatment. And there's been communication issues between the patient and the clinics, and that and I think that's why, you know, when you choose a clinic, you've really got to look at the whole picture. You don't necessarily just go for a cost. But communication in Yes, key. Yeah. Yeah, there's a service called fertility Bappa, you've probably seen it, it's like a fertility clinic review service, and I was having a good look through. And what I found was really interesting is that people are reviewing clinics, not necessarily based on the pregnancy outcome based on their experience and the process throughout. So you've got people who had had a negative pregnancy outcome, and we're reviewing the clinic and stowing them a really good review, because they felt like they were so well cared for, and well looked after and communicated to. And then you've got people who had a positive pregnancy outcome, what we're still giving clinics, or reviews because of their experience throughout, which just goes to show like how important communication and care is when you're with a fertility clinic. Like I think for a lot of people, obviously, the outcome is important, but it's not until you're in it that you understand, you know, and like yourself, I had IVF. So you really understand that, like how important that care is when you're in the cycle. So yeah, it's really and I think what you pointed out about the clinical standards, and safety is also really important, because a lot of people listening, maybe considering IVF, maybe they are thinking, Oh, I'm not quite sure about the standards abroad, you know, are they as safe and, you know, we're lucky enough to have the hfpa in the UK governing everything. But it's really reassuring, I think, for people to understand that there is similar in other countries, and that they are regulated and everything is safe. And obviously the lab is a big part of IVF. You know, as we're recording this, there has been something in the news actually about a big IVF clinic in the UK, where there's been some errors in the lab, which have led to, you know, loss of embryos and loss of eggs for people. Now, that is obviously a concern, right, you put your trust in clinics, and I think it I know if I was considering IVF aboard, that would be something that would pop into my head. So that is really, really reassuring, I think for listeners to hear that that's not the case. Yeah, I think. And this is why, one of the reasons why I set up IFC. But there are another a number of other agencies that provide sort of independent advice as well. And that's why it's important for anyone, before they make that final decision about clinic. Or even in the early stages, they come to someone like us that have experience, particularly in the on the legal side as well. So we can we can provide legal advice, I should say, but before becoming patient. I qualified as a solicitor in the UK. So we again, it's important for me to be able to provide that sort of legal framework, advice about different countries, and equally other independent organisations have that service as well. So it's vitally important for prospective patients to to seek that information out before they even sort of sign up for any sort of treatment. Yeah, that's not that's not something that perhaps would have entered my head. So yeah, it's good. Good to know, I think. Yeah, so let's talk a little bit more about your company then and how you, like if I was looking for an IVF clinic or board, where would I start? And how do you help people? What do you guys do? Yep. So so that, again, a step back from us. There's lots of sort of different platforms that people can can access. Now. Obviously, the you know, the standard Google search, sometimes is a good place to start. I've spoken to patients who've said, it's not a great place to start, because there's so much choice. And it's so difficult to different differentiate between clinics. And that just causes too much anxiety even more frustration, because, you know, who do you trust when you do when you do a search like that, but certainly, you know, have a look at different clinics go to their websites. There's lots of different forums which exist, but with a proviso when you are joining a forum. Think about the people that are also in the forum because you get people that may also be in the same situation that occurred looking for advice about a specific country or clinic, but you also get people who have been to clinics and countries and had unsuccessful treatment, who may be shy Earning quite negative feedback and only negative feedback about a particular clinic. So potentially you may not be getting that independent information within those, those forums. So and then equally there are some not for profit organisations here in the UK that provides some great advice. You've got fertility network UK, fertility first, not for profit organisations that provide that independent advice. And then you've got the international fertility company. So as I said, we provide a range of services for clinics, Render, we're independent in the sense that we do not recommend specific countries, we've got a portfolio of clinics that we think are good in different countries. And they are aimed to be a balanced portfolio for people looking for different types of treatment. We provide a free service for people who just want signposting. So if they come to us, and they say, We want this type of treatment, and this age, we can then point them in the direction of a particular country or a number of clinics. And then we provide a more bespoke service to people who want a little bit more than that, that is a paid service. But essentially, that is a consultation with ourselves, to find out exactly the type of treatment that they're looking for. We then go away and map that against opportunities. So we will come back then, with a shortlist of countries and clinics, will arrange an online consultation with each of those clinics then speak to the patient or patients about their own feedback. And then work with them on a sort of a step by step process, right the way through to them accessing treatment, even travelling to clinics with patients who want that reassurance. It's really not holding someone's hand through the process, right, which is sometimes what you need. Yeah, you've got both options, you know, yeah, yeah. As you said, you know, some people will be confident about travelling, some, you know, will need that extra support. So that's why that service is there. So how do people find you then? Where are you? How do we get in touch with you? So we've got a website is our main platform. So that's the IFC dots world. We're obviously active. Under the the IFC dot world on Instagram, and Facebook. We also have some closed Facebook and messenger groups for different countries. So for instance, we've got a closed Facebook group for people specifically interested in Spain, one for the Czech Republic, one for Greece, one for the US. So we've got sort of bespoke closed groups for patients who want to share information about specific countries as well. Brilliant. Okay, so what I'm going to do for anyone listening is in the Episode Notes, I'll put all those details if you want to find Andrew and the International fertility company, you know, if you're thinking about having IVF board, you want some more support, or you just want to get started, then you can contact Andrew using the details that I put in the Episode Notes. Thank you, Andrew. That's been brilliant, really informative. And hopefully for anyone listening who's considering IVF or board, we've answered sort of some of the key questions. So the questions I've asked you were things that would come into my mind. But equally, if anyone's got any questions, I'm sure they can pop you an email via the website and get in touch. Right. Thank you very much. Thanks. Thanks so much for coming on. Andrew. Nice to see you.