16. 3. 2015
Around 30,800 IVF (in vitro fertilization) procedures – monitored cycles of fertilization outside of the body – are performed each year in the Czech Republic. A certain percentage of these procedures at the country’s assisted reproduction clinics is carried out on foreigners. These clinics have the advantage of employing experienced Czech doctors as well as benefitting from legislation which is quite liberal when compared to some nearby countries. RNDr. Tomáš Mařík has been involved in fertility marketing for a number of years.
Above-average success attracts overseas couples to the Czech Republic's assisted reproduction centres
The history of artificial fertilization in the Czech Republic goes back to the 1980s. How did it all begin?
From today’s point of view it was all quite amateur – no possibility of working with experts from other countries or exchanging knowledge, no access to equipment or medicines. But despite all this, and thanks to a large dose of enthusiasm, the first Czechoslovak IVF baby was born just four years after Louise Brown, the first test tube baby in the world, born in England in 1978. Members of that first team who worked on the problem under the leadership of Professor Ladislav Pilka at the gynaecological clinic in Brno, were actively working in reproductive medicine until quite recently, and were passing on their knowledge to their successors who we now encounter in most Czech assisted reproduction centres today.
Today the Czech Republic is one of the top countries in Europe. Which are the procedures foreign patients undergo most often here?
I don’t think there is a method, piece of equipment, medicine or diagnostic aid to which Czech fertility experts don’t have access these days. They also take part in, and are invited to the top conferences and workshops in the field. But perhaps even more important is this country’s legislation which was formulated with the work of IVF specialists in mind, and which allows them to employ every effective procedure possible. The most common procedure for which couples travel to the Czech Republic is our egg donation programme, an aspect of fertility treatment which has encountered problems in many countries around Europe, from complete bans to various limitations. Without this many mainly older women could never have got pregnant.
How does the legislation in the Czech Republic differ from other countries? In what ways is it more liberal?
Strangely enough the differences in legislation around Europe are quite marked and it would seem that even membership of the EU doesn’t mean there’s a trend towards any sort of harmonization. There’s a complete ban on egg donation in neighbouring Germany and Austria; in other places there are differences in the relationship between the donor and the receiver of the eggs, in whether the donor is compensated for costs incurred during the two-week cycle of ovarian stimulation etc. But even Czech legislation has its limits and insurmountable obstacles: assisted reproduction is only available to heterosexual couples (though the character of the relationship between the man and woman who request fertility treatment is never examined) and to women up to the age of 50.
How many clients from other countries pass through assisted reproduction centres each year? What share of the total number of patients do they represent?
Here I can only hazard a guess using the data from the national assisted reproduction register, where all IVF centres must record all fertilization treatments they carry out. Foreign couples travel to this country for our egg donation programme and last year they made up around one sixth of all IVF cycles. To that we must add cycles using frozen embryos, either as the first attempt wasn’t successful or because the clients wished to have another baby from their frozen embryos. Of course a small proportion of so-called classic fertilization treatment (using the woman’s own eggs) is also made up by foreign clients. So we are talking about thousands of patients from other countries coming to this country to seek fertility treatment.
"Strangely enough the differences in legislation
around Europe are quite marked and it would
seem that even membership of the EU doesn’t
mean there’s a trend towards any sort of
From which countries do they come?
The national assisted reproduction register doesn’t record the nationality of those couples we treat, so exact details just aren’t available. One clue might be the languages in which the centres‘ websites appear, or those belonging to the parent companies. The above mentioned legislation and other issues – such as long waiting times in certain countries – certainly play their role in this. It’s believed that the greatest number of foreign patients come from the German-speaking countries. But no distance is too great when we are dealing with such specialist treatment as artificial insemination, and centres in this country welcome patients from other continents, mainly North America and Australasia. This isn’t just down to economic factors on these continents but also the fact that the Czech Republic offers eggs and sperm donated by white-skinned donors. This country is a very homogenous place as far as nationality of the locals is concerned.
How long does the whole artificial insemination process take?
How successful are Czech doctors in this area? When we can count on cooperation from gynaecologists in the countries from where the infertile couples originate, then the patient can prepare pre-departure according to instructions which we send through. All centres have diligent coordinators who speak many world languages and who are responsible for communication with the couple. Here the hormone treatment for the donor takes up to two weeks on average. The day when the eggs are taken from the donor and sperm is supplied by the patient’s partner the most important part of the whole process begins, the actual fertilization of the egg “in a test tube“ and the embryos this produces are cultivated in specific conditions for two to five days. Here I would emphasise that Czech doctors always strive to cultivate the highest, but at the same time a safe number of eggs. The partner’s spermiogram should be in harmony with the basic norms set out by the WHO (World Health Organization).
So what do the couple do immediately afterwards?
During the embryo cultivation stage the couple normally remain in the Czech Republic and do a bit of sightseeing perhaps, if thoughts about the treatment, weather and other factors allow. They are in regular contact with the centre and are subsequently asked to come for the embryo transfer (or perhaps the woman comes on her own). After a short period of rest on a bed she can leave but we usually recommend she spends one more night in the hotel. Next day they can go home, whether that be by plane or car. Couples whose home isn’t that far from the borders of the Czech Republic can come for each stage directly from where they live.
How much does artificial insemination cost in the Czech Republic?
Every assisted reproduction centre includes an exact price list on its website, often in different languages. The classic IVF treatment using the woman’s own eggs costs around 2,000 EUR, not including drugs and ovarian stimulation. The egg donor programme, including stimulation drugs for the donor, costs around 4,500 EUR when all the donor’s eggs are given to one patient. The costs can vary according to what level of success is guaranteed and so it’s important to study any price list carefully. Many centres also offer a range of packages including premium laboratory techniques which raise the chances of success, plus other services such as accommodation, airport transfers and the like.
"New features offered by centres in this country
are essentially the same as those around
the world meaning foreign clients are often
well informed about them and actively seek
Why do you think the Czech Republic has become one of the most popular countries? What do foreign couples appreciate here most?
I think there are several reasons for our success in the field of reproductive medicine on the international scene. Without doubt a key factor is our high success rate which is well above the average set by the ESHRE (European Society of Human Reproduction and Embryology) for its member states. This has given our centres an excellent reputation on dedicated internet forums in other countries. Foreign couples also appreciate our individual approach when it comes to carefully selecting a donor, taking the characteristics of the patient into consideration. Height, weight, hair, eye and skin colour, blood group etc are all compared, while maintaining complete anonymity. The abovementioned liberal legislation plays an important role, as does a large choice of centres which drives prices as well as waiting times down – this can be a vital factor when it comes to older couples. Another significant positive aspect is the country’s location in the middle of the continent, excellent transport links, a good number of flights, a growing motorway network and our superb railways. This country is also attractive due to its places of interest and cultural heritage, a trip to treat infertility often acting as an impulse to return; sometimes couples bring their child to show him or her the people who made their conception possible. Judging by what people post on the internet it would seem foreign clients feel good here and appreciate the high quality of the services both medical and others such as accommodation, transport and dining as well as the friendliness of medical staff and local people.
Source: Czech Travelogue, 01/2015 (cotmedia.cz/ecasopisy/travelogue/2015/01/ ).