Surrogacy in Greece

Surrogacy in Greece has become extremely popular with single women and heterosexual couples. Reasons for this are multiple but two stand out. Firstly, it is a result of disruption caused by the war in Ukraine which was a popular destination. Secondly, the recent change in Georgian law means that international intended parents will no longer be able to access surrogacy programmes.

Why is Greece such a popular fertility destination?

According to the 2020 Fertility Tourism Survey by the International Fertility Company Greece is a a major player in fertility tourism. Well established treatment providers are staffed by experienced professionals providing high quality and competitively priced treatments. Treatments are offered to single women, heterosexual couples and female couples with a maximum ceiling age of 54 for women patients.

Combing traditional tourism with fertility tourism

Greece is known for its amazing climate, history, great food and hospitality. Over 35 million tourists visit the country each year, three times its own population. Greece is one of the most popular holiday destinations in the world. Tourists travel there from all over the globe.

This has enabled treatment providers to promote the country as a destination for fertility tourism.  There are 65 fertility clinics in the country which are very attractive propositions for international patients. The 2020 survey suggests the numbers of patients visiting Greece for treatment is increasing. We know patients from as far away as Australia and the U.S. are regular travellers to the country.

The reasons behind the rise of fertility tourism

Fertility tourism in Greece relies on good quality treatments and affordable prices. This is provided by clinics based throughout the country and its islands. The majority of providers are based in Athens, Thessaloniki and Crete. They offer state-of-the-art facilities and technologies as well as experienced medics, scientists and nurses. This means that success rates offered by clinics are as good as anywhere in the world. The good ones are certified by internationally acclaimed organisations. This  provides assurances to innovation, safety and quality.

Domestically, all clinics in Greece have to be licensed by the Greek National Authority of Assisted Reproduction. This regulatory body audits clinics and records details of all treatments carried out. This regulatory framework, similar to other European countries gives confidence and reassurance to patients.

Another reason for Greece being a top fertility tourism destination is cost. Treatment costs are very competitive and a lot cheaper than in countries such as the U.K. and the U.S. Some clinics offer guarantee and refund packages which makes fertility treatment in Greece more accessible.

Fertility Legislation

Greece offers very liberal fertility legislation. Women patients can be aged up to 54. All procedures are available to both married and unmarried heterosexual couples, single women and women in lesbian relationships. There is however no provision for single or men in a same sex relationship.

The country allows anonymous egg and sperm donation. This means it is very popular with international patients. It is home to a number of substantial egg and sperm banks and there are large pools of available donors. This in turn means that there are no waiting lists, unlike so many countries.

Surrogacy in Greece

Recent events have contributed to surrogacy in Greece becoming very popular. Ukraine was historically one of the most popular destinations for intended parents. Understandably, this has been disrupted by the war. In Georgia, recent changes to fertility legislation mean that surrogacy programmes will not be available to international couples from 2024.

Options for intended parents considering commercial surrogacy programmes in Europe are now limited. At present, Greece is helping  those intended parents who would have previously travelled to Ukraine or Georgia.

The Greek surrogacy law provides reassurance to all parties involved in the process. Before any programme can start intended parents, the surrogate and treatment provider have to present their case in court. This ensures that all consent to the surrogacy arrangement being proposed. It allows the treatment provider to offer a medical assessment of the surrogate. It also ensures that she is fully aware of what participation entails. Once this process is completed the surrogacy treatment can proceed.

After a baby is born a court decision is then required to establish parentage. The clinic will register the baby using the intended parents’ names and a birth certificate would be issued in their name. Any order made also concludes that the surrogate mother has no legal rights to the intended parents’ baby.

The costs of surrogacy in Greece are substantially lower than in other countries. All costs must be transparent. The surrogate is reasonably compensated and receives support and counselling prior to, and throughout her journey.

More Information about surrogacy in Greece

IFC works with a number of treatment providers in Greece who offer surrogacy packages. These individuals or couples are welcomed from all over the world. Information and advice regarding legal and logistical questions is provided at no cost. IFC can also introduce treatment providers that have been assessed from a patients perspective. These providers demonstrate high levels of patient centred care. They also have the infrastructure in place to offer a safe and successful surrogacy programme.

IFC offers a bespoke, concierge service for intended parents seeking surrogacy programmes which includes support throughout the journey and accompanied clinic visits if required.

For more information, contact andrew@internationalfertilitycompany.com

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Caroline and Ed from South Wales are the latest couple to begin their fertility journey with one of IFC’s partner clinics, the Embio Medical Center in Athens.

The couple, both 39, were chosen by the clinic to receive a complimentary treatment earlier this year and are now in the process of planning their visit to Athens in September.

We caught up with them recently to find out how things were going, and their mood was summed up perfectly by Ed who said, “it’s a little bewildering, it’s a mixture of anxiety and excitement, but the support we have had from the International Fertility Company and Embio has been excellent, and we feel completely prepared for what is to come”.

Like many other couples, Caroline and Ed’s journey was interrupted by the Covid Pandemic which caused some delay in identifying the potential issues which were affecting their ability to conceive. Caroline spoke about their experience,

“Our initial communication with our G.P. was via email and telephone which was not ideal, but it was necessary because of Covid. We were initially told, ‘not to worry about it’ but as time went on and nothing was happening we took the decision to move things along ourselves”.

The couple had started preliminary investigations when they saw the offer of free treatment provided by Embio and IFC. “We registered an interest and put it to one side”, Ed said, “But were then gobsmacked to get a call to say that we had been chosen – within days we were contacted by Konstantina at the clinic who outlined the process, the timetable and explained what we needed to do in terms of tests”.

One of the challenging aspects of travelling for treatment is sometimes identifying providers and booking in scans and tests. Fortunately, for Caroline and Ed this didn’t prove to be too difficult, “Finding someone to do the necessary scans and blood tests was relatively easy but we experienced a number of delays whist we waited for results which was frustrating”, said Caroline.

All the necessary preparations, however, have now been undertaken and Caroline and Ed are looking forward to visiting Athens and the Embio Medical Center for their treatment in September, “whilst we are a little apprehensive we are confident that we will be given this possible opportunity for this to work” said Ed, “The clinic’s success rates are really good and patient feedback suggests that they receive a first class service from Dr Paraschos and his team. Whatever happens we cannot thank IFC and Embio enough for the support they have shown us to date, and we look forward to September and meeting the team at Embio”.

Look out for an update on Caroline and Ed’s visit to Athens in September where we will share their experience of treatment at the Embio Medical Center.

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WHAT’S NEXT FOR FENOMATCH?

Finding an egg donor is not an easy task. Long donor waiting lists exist in many countries. . This is where Fenomatch comes in. Launched in 2019 Fenomatch is an innovative facial matching tool. It allows medical teams to compare patients with agg donors. Comparisons are based on their facial characteristics including hair colour, eye colour and ethnicity. Four years on and how has Fenomatch evolved? This article explores how the company has developed its product.

FENOMATCH SCORE – FACIAL MATCHING

When a egg donor or sperm donor is required,  the challenge is to find a suitable one. Fenomatch tools address this by focussing on a number of specific questions:

How can we measure scientifically the compatibility of people by their physical characteristics?

How can we automate this process?

How can we avoid human error so the  medical staff and patients remain confident that the right donor is chosen?

Today, most IVF centres offer patients an egg donor who shares basic phenotypic traits. But, how do you know if an egg donor really resembles the patient? So, Fenomatch developed an artificial intelligence-based tool that produces objective facial similarity results for each potential donor. This result is the Fenomatch Score. In this way, centres see which donors from the bank are the best match to the patient offering more options for them.

The algorithm on which Fenomatch has been developed has been evaluated and validated by all the centres who actively use it.

BANK CONNECTION AND REQUEST MANAGEMENT

One of the big challenges in assisted reproduction treatments is the shortage of gametes for donation. This means that some patients have to travel for treatment.

Fenomatch has been focused on this shortage since its beginning. As a consequence, it has developed a way to connect all types of IVF centres. This allows for the possibility of sharing gametes.

Clinics and gamete banks can now be connected to find the right donor. Clinics can now request donors from diiferent banks if they do not have access to one. All information is encrypted: banks cannot see data about patients from different clinics, and clinics can’t see the database of banks. This makes it possible to expand the search. IVF centres all over the world can now interconnect and bring better results to their patients: the more donors, the better the selection.

GENETIC MATCHING & VALIDATION

Genetic carrier testing and genetic matching is also popular. More centres are starting to test both their donors and their patients to achieve what is called “Genetic matching”.  As a result,  Fenomatch has developed its own automated genetic matching process. The matching is then reviewed and validated by a geneticist.

This technology has been incorporated into the tool and it provides more options for IVF professionals. However, this genetic matching and validation is not mandatory.

NEXT STEPS

Fenomatch will continue to work to ensure the product continues to deliver results for  patients and clinics. A new version of the tool is planned for the end of 2023. Our moto remains –  if we can find a way of helping patients find the best egg donor or sperm donor, we will do it.

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The use of technologies such as Fenomatch in IVF donor treatments have revolutionized the IVF industry by helping professionals save time and improve efficiencies. This in turn has helped improve patient experience. The use of technology in health care can be overwhelming for some and its use needs to be explained and understood to create confidence.

IFC is pleased to partner with Fenomatch, specialists in the use of facial biometrics in fertility treatment. To understand how the product works in action we spoke to Reproducción Bilbao, an IVF clinic based in Bilbao, one of the best known cities in the Basque country and north of Spain.

Why did you decide at was the reason to start using Fenomatch?

One of the main concerns of our patients who need a donor to carry out their treatment is always around physical resemblance. When a donor is chosen, a physical similarity between her and her recipient is sought. Carrying out this search only by phenotype (ethnicity, hair colour, eyes) does not give the patient sufficient security and peace of mind regarding resemblance. We wanted to use a technology which inspired more confidence about our choice of donors.

Do you use Fenomatch with all patients who require donors?

At Reproducción Bilbao, we carry out an exhaustive study of donor candidates that involves everything from the simplest tests, physical and psychological examinations or genetic tests to study recessive mutations on a mandatory basis. The use of Fenomatch has become an integral part of our internal protocol to choose a suitable donor in a systematic way.

This allows us to find the right donor through phenotypic, genetic and biometric comparison.

If there is only one donor available for the patient, Do you still use facial matching to see if thereis a reasonable facial resemblance?

Yes, we use Fenomatch in all cases in which we need to assign a donor.

What do you like the most about Fenomatch?

It is a very easy-to-use tool and results are obtained immediately, so its use does not delay the choice of the donor.

What is the response from patients when you tell them about Fenomatch?

It is reassuring for our patients, because they attach great importance to the similarity between the donor and the recipient. They are overwhelmingly pleased that we offer an additional level of confidence to the donor selection process.

Do patients ask you to provide confirmation that Fenomatch technology has been used?

Patients have at their disposal the certificates confirming the use of Fenomatch which are automatically generated by the application and included in their medical records.

Do people know about Fenomatch when they arrive at the clinic? If not, is it hard for you to explain what it is?

There are still many patients who have not heard of this tool but are pleasantly surprised when we describe how we use it and the results we achieve each time.

Has the patient experience in your clinic improved since you have Fenomatch?

We believe that yes, that is what our patients tell us. It promotes confidence and addresses the natural anxieties that patients have about the use of anonymous donors.

Has the number of patients increased since you have Fenomatch available at the clinic?

Yes, it has definitely strengthened the service we offer to patients. It has proved to be very efficient and successful.

Have you had any funny anecdotes when using Fenomatch?

Sometimes we receive too many photos from the same recipient and it becomes too difficult to choose! All we ask from our patients is to choose a nature photo which displays their everyday appearance – you don’t have to dress up for Fenomatch!

Have you had any problems getting the photo of the patient or the donor?

We have not had any problems with either party. We explain to the donors why we need the photo and they understand it. In the case of the recipients, the predisposition is very good.

Do you always choose the donor with the highest Fenomatch matching score?

We always try to choose the most similar candidate and we take the score into account. Our priority however is the Genetic Compatibility Test that we carry out in all our treatments with donors.

We would recommend Fenomatch to all treatment centres who are required to choose donors on behalf of patients. It makes our job easier and inspires confidence amongst patients.

We thank the team at Reproducción Bilbao for participating in this interview.

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It is a question we get asked daily. So why do so many people choose to get IVF treaments in Spain?

Well, lets start with the facts.

• Spain is the most visited European country by those looking for IVF abroad
• 40% of all the international fertility patients who travel within Europe opt for Spain
• Spain performs the highest number of fertility procedures in Europe, some 120,000 per year
• Just under 50% of these procedures involve egg donation
• There are around 300 registered fertility clinics in Spain – popular locations include Alicante, Barcelona, Madrid and Malaga
• Spain offers a diverse range of treatments for single women, gay (women) couples, and heterosexual couples
• Spanish fertility success rates are amongst the highest in the world
• Although no longer the cheapest in Europe, IVF treatments in Spain remain competitive
• Since 2003 it is estimated that the number of international patients accessing IVF treatments in Spain has risen over 30 times

Cost

The cost of IVF treatments in Spain varies between clinics and will depend on the procedure you undergo, however costs tend, on average, to be anywhere between 5,000 to 10,000 euros. Quoted fees are usually accurate but you will need to build in costs associated with preparatory tests and scans, medication, travel and accommodation. Some Spanish fertility clinics will offer in-house finance packages or refund and guarantee programmes which may involve higher, upfront payments.

Donor Treatments

IVF treatments in Spain with an egg donor is the most popular treatment undertaken by international patients in Spain. Spanish clinics purchase donor eggs and sperm from gamete banks but many clinics have their own banks therefore donor availability is generally very good compared to other countries. Donors are aged between 18 and 30, each will undergo a medical and psychological evaluation before being chosen. All donors are anonymous, and most clinics do not have overly long waiting lists, if at all.

Access to Treatments

Gay couples In Spain have the same rights as heterosexual couples in terms of marriage and adoption. Although male couples can’t access IVF treatments women can, as a single patient or via the procedure known as ROPA (Reception of Oocytes from Partner) or shared motherhood. The procedure involves one of the partners undergoing a standard IVF protocol to obtain mature eggs. Using sperm from a donor the retrieved ages will be fertilised and then transferred to the other partner. This procedure is one of the few instances where it is legally acceptable for the recipient to know the identity of her egg donor.

Regulation and Agreed Practices

Fertility regulation covers certain activities such as the transportation of eggs, sperm and embryos as well as fertility preservation techniques and commercial surrogacy. The latter is prohibited under Spanish law. Additional practices are not expressly covered by statute but have been collectively agreed by providers. Such examples include generally only treating women under the age of 50 or those with a BMI of under 35. In comparison to many countries Spanish fertility legislation is generally considered very liberal and as such, is another reason for the higher numbers of inbound fertility patients.

In terms of clinic regulation, Spain offers a comprehensive system which promotes a high level of confidence in treatment providers. The National Health Ministry Registry was established in 2001 and is now managed by the Spanish Fertility Society (S.E.F.). It shows information on treatments undertaken, success rates and how individual clinics operate. All new clinics in Spain have to obtain a licence to operate.

Patient Centred care

Patient Centred Care is often cited as one of the unique selling points of the Spanish fertility market. Traditionally, providers often treated international patients who travelled to Spain as a last option. Patients had often run out of options in their host country and those that did arrive for treatment often presented with very challenging health issues. As a consequence, Spanish clinics have developed excellent protocols based on four decades of helping patients with complex issues.

Spanish fertility clinics have also worked hard to welcome patients. Those clinics that treat international patients have created multilingual teams to provide dedicated information and support. International patients often receive a personalised service, available 24/7 together with additional support around the logistics of travel and accommodation.

Spanish fertility clinics offer a patient centred care approach which is envied and duplicated far and wide.     

This is why

It is easy to see why Spain is the leading European destination for those seeking to travel for fertility treatment. Spain offers an excellent transport network and the cities and regions where the majority of providers are based are easily accessible from all over the world.

With its rich history, excellent climate and cosmopolitan regions it is not surprising that Spain claims to be the second most visited tourist destination in the globe. This popularity extends to so-called fertility tourism and the International Fertility Company is proud to partner with some of the best examples of fertility clinics in Spain.

Contact andrew@internationalfertilitycompany.com if you would like more information about clinic options in Spain.

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‘There are three kinds of lies: lies, damned lies, and statistics’ is a term often used in discussions questioning the validity of any form of statistics. In the fertility world, the most used (and sometimes, abused) statistics are those that relate to the success rates of IVF treatment.

I am asked everyday without fail, ‘can I trust the success rates quoted by a fertility clinic’? The answer is important. Success rates are generally perceived as being the one of the most important drivers for patients when they choose the IVF clinic that will take responsibility for their fertility journey. Read the 2020 Fertility Travel Survey for more information about the reasons why patients choose particular clinics and countries to receive treatment.

I will get to my answer a little later but first let us look at some of the ways in which treatment outcomes are recorded,

A Pregnancy Rate refers to those women who record a positive pregnancy test after an IVF cycle.

A clinical pregnancy rate refers to those women who exhibit evidence of pregnancy when the foetus can be either seen or heard.

A live birth rate refers to the number of women who go on to have a live birth delivery.

Statistics which demonstrate these outcomes are calculated by dividing them by the number of IVF procedures performed which could mean the number of treatment cycles undertaken or embryo transfers. Some clinics report on cumulative pregnancy rates, that is, when the results refer to a number of recurrent cycles rather than a single one and you can begin to see how many variables are involved in calculating and reporting success!

In addition to the way that success rates are presented you will have to remember that their very basis is subject to a number of factors which can influence success. Let us consider three,

Firstly, we all know that fertility declines with age so when you consider the success rates of a particular clinic take a look at the age distribution of patients treated. Some clinics may not offer treatments to women of advanced maternal age, preferring to treat younger women with a greater chance of success. In this case, higher success rates will be reported. It is advisable therefore to consider success rates by age in order to get a more accurate measure of the clinic’s ability.

Another factor that can influence success rates is the number of embryos transferred in each cycle. Although it is now standard practice for the vast majority of IVF clinics to only offer single embryo transfers there are still those which offer patients multi-transfers which can determine success. Check with your potential provider to see what their transfer policies are and remember that although transferring multi-embryos might have higher success rates in terms of clinical pregnancy rates there are a number of negative outcomes associated with the procedure like miscarriages for instance.

If we take the example of a woman of advanced maternal age, the chances of conception increase when she has IVF treatment with donor eggs. It is important therefore to try to identify the type of treatment which quoted success rates refer to. If you are choosing a treatment using your own eggs you will want to know the success rate for this!

So, if we return to the initial question, ‘can I trust the success rates quoted by a fertility clinic’? what is my answer?

Well, with the exception of a very few unscrupulous clinics I have visited in my dozen or so years of visiting clinics across the world, I would say there is a basis of truth in the success rates that are quoted by the vast majority of externally regulated IVF clinics. I use the term, ‘basis of truth’ cautiously; we all know statistics can be created, interpreted and applied in different ways, and many clinics do this very effectively.

So, my short answer is that you can place a certain amount of trust in what you are being told. However, you should remember that the figures quoted are average ones and may not take into account your age, general and fertility health and the treatment you are seeking. To get a more bespoke figure of how successful your treatment might be in a clinic you need to seek an answer from staff which takes this specific information into account. And then, only then, can you be satisfied that the success rates you are being quoted are realistic for your particular case.

We are surrounded by IVF treatment providers that claim to provide personalised patient centred care and bespoke treatments Therefore, it is your right as patients who are in the centre of the treatment process to demand individual assessments regarding the chances of success and be given access to transparent, accurate and relevant success rates.

 If you would help in navigating your fertility journey, contact pamela@internationalfertilitycompany.com for details of the concierge support programme offered by the International Fertility Company.

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