Childless couples warned of risks as 'reproductive tourism' booms in Spain

Valencia, Spain's third largest city, has traditionally been known for the quality of its oranges and the wild Las Fallas, or fire, festival.

Valencia, Spain's third largest city, has traditionally been known for the quality of its oranges and the wild Las Fallas, or fire, festival.

But the city is now the main attraction in a growth industry known as "reproductive tourism", bringing childless couples to Spain from Britain, Germany and elsewhere in Europe. Dozens of Britons travel to Valencia, Barcelona and Madrid each year hoping to take advantage of Spain's high success rate and more relaxed regulations about what methods of treatment can be used.

Most head for Valencia, where 20 per cent of the patients treated at the specialist Infertility Institute of Valencia last year came from outside Spain. Of the 400 couples, half were from Germany, which has the tightest embryo protection laws, but about 30 came from Britain, where regulations are relatively liberal.

The majority of the foreigners have a form of fertility treatment using donated eggs, which are then genetically screened for abnormalities in a controversial procedure at the heart of the debate about so-called designer babies.

The use of aneuploidy screening worries experts in Britain, where it is licensed only under restriction. They believe it is an untested procedure that should be used as a research tool rather than an option for treatment.

Spain also has a record of multiple births because it implants more embryos than is allowed in Britain, and there are fears that the NHS will be left to pick up the bill for women who suffer complications when carrying twins or triplets.

The concerns have not stopped the flood of reproductive tourists from countries that do not permit the donation of eggs, such as Germany, Norway, Austria and Denmark. Egg donations are allowed in Britain, but donors are not paid, unlike in Spain, where they receive about £375.

Spain's "fertility tourism" has grown steadily since it began five years ago, to the point where the Valencia institute provides interpreters, helps patients find a hotel and offers a website (www.ivi.es) in English and German.

Couples make two visits, the first to give hormone treatment to the potential mother and take a semen sample from the father. They return home until a donated egg becomes available, when they will be called back to Spain for a stay of less than a week.

Amparo Ruiz, an embryologist and spokeswoman for the institute, said: "We receive patients referred by gynaecologists, and those who find out about us from our website or by word of mouth. The average length of stay is three to six days, for the implantation. We try to make the stay as painless as possible. Any treatment is stressful, especially if it is not your own country."

Spain claims a 60 per cent success rate for egg donation treatment, the highest in Europe, although the figure, which was achieved at the cost of a high rate of multiple births, is disputed by the British Fertility Society. A spokeswoman for Madrid's In-Vitro Fertilisation Clinic said the success rate had fallen slightly because most clinics now transferred only two embryos, so the risk of multiple births was "minimal".

But Richard Kennedy, the secretary of the British Fertility Society, and other fertility experts have grave concerns about reproductive tourism and the treatments on offer in Valencia. In Britain, aneuploidy screening is allowed only for couples who have had a child with a genetic abnormality.

Mr Kennedy said it was entering uncharted waters to extend it to couples with no such history purely to increase the chances of successful conception. It was not 100 per cent reliable and could possibly harm embryos. "It is very complex, extremely expensive and it's probably not necessary," he said. "It may be that this is something new we will do in the future, but this is part of the slippery slope.

"At what point do you stop testing the embryo? Do you not implant embryos that have a tendency towards Down's syndrome or towards diabetes, that have breast cancer genes, that have brown rather than blue eyes, that are homosexual or not homosexual? Where do you stop?"

There were also implications for the NHS, which would have to take responsibility for the pregnancies once the couples returned to Britain, Mr Kennedy said. "The NHS foots the bill for complications from the treatments and the main problem is multiple pregnancies.

"In the UK, legislation makes a strong recommendation that only two embryos should be implanted in all cases, but in an unlicensed environment three or four can be implanted. It can be a huge cost and we have to ask if it is appropriate."

Other leading fertility experts raise concerns that inadequate support is given for treatment that consists of two quick trips abroad.

Alison Murdoch, a consultant gynaecologist in reproductive medicine at the International Centre for Life in Newcastle upon Tyne, said a "significant minority" of the approximately 20,000 couples who had IVF each year chose to go abroad, and extra risks were involved.

"Patients do need support before the treatment and complications can occur some weeks after the treatment," she said. "If they are going outside the UK, they will not have access to the guidance and support available here."

The Human Embryo and Fertility Association said couples who travelled abroad for pregnancy services could be putting their health at risk.

The venture into fertility tourism does not always live up to the dream. Caroline Kemball, 36, has had unsuccessful treatment in London and Paris and visited a clinic in Madrid before deciding against it because of the length of time she would have to take hormone drugs.

Mrs Kemball, who suffers from early menopause syndrome, and her husband Andrew, 64, have been trying for a baby for 10 years. She said the experience of shopping around for treatment had left her disillusioned and considering adoption. "It is exhausting and you end up not trusting anybody because it is all private treatment and there is always an interest in money behind it," she said.