When IVF abroad might be the answer (& where we’re looking to book in, right now)

Where is the best place to have IVF abroad?

The answer will, of course, depend on where you’re based, and your top concerns.

Worried about IVF waiting lists? Looking for a more specialist approach, or cost-effective options? 

We sat down with Vladimiro Silva, Scientific Director of Procriar Fertility Clinic to chat through all things IVF abroad, and to find out why more and more of us are choosing Portugal as a top destination in Europe for treatment, in 2024.

Watch as we cover

• What the best fertility clinics in Portugal are offering in 2024
• A deep dive into Portugal’s patient-friendly fertility laws
• How international patients can get the ball rolling on IVF in Portugal
• And much more

Transcript

Eloise Edington

Hello, welcome. I am joined by Vlad, who is here to discuss treatment in Portugal, why IVF abroad might be the answer, and where we’re looking for people to help book in for 2024. It’s so accessible. For example, being able to get flights that are affordable and with lots of options, and not long to travel, makes Portugal a really desirable location. It would be interesting to know the benefits that Portugal offers, as we know, over and above some other countries in Europe.

Vladimiro Silva

The first benefit that Portugal offers is, I think, the most important, which is great quality of care in terms of the quality of the treatment and the availability of procedures, techniques, and so on. In terms of technology availability, we have all it counts, so in terms of quality of care, we are absolutely, I would say, in the top front. Then we have two other advantages. One of them is the price, which is cheaper than most other IVF destinations. In terms of value for money, definitely, it’s a competitive advantage on our side.

Then we have the law, which is also very favorable. If you need treatment with donation in Portugal, donors are open ID, and this means that at the age of 18, any child conceived by donation—either sperm donation, egg donation, or embryo donation—can have access to the identity of their donors. We can share detailed profiles of our donors. For example, a lot of patients are concerned about the ethics of egg donation. In Portugal, an egg donor can donate four times in her lifetime. She receives €1,019. This is regulated by law. We can only pay by bank transfer, the donor needs to sign a receipt, and it’s the same value for all public and private clinics.

If a donor comes here to donate and she has already donated four times elsewhere, I will not be allowed to get a donation code, so it’s not authorized to do the treatment. That being said, in Portugal, we have this legal framework of huge transparency towards the rights of the children, the rights of the donors, and the rights of the patients. Everything is very crystal clear. I think patients, especially from Northern countries, Central Europe, and so on, typically from their culture, value this. One of the reasons they come to us is because, first of all, they can get information on the donors, they have access to our detailed profiles, and they like the transparency and the overall ethics of the system.

Eloise Edington

I think it’s really interesting also what you said about having more choice when it comes to donors. As a mother of sperm donor-conceived children, that was one of the biggest things for us, and we selected someone who was an open donor. Of course, there are other countries in Europe where you don’t have that kind of advantage of being able to go down the open donor route. You must do that in the UK, however, we know there’s a shortage of donors in the UK, so being able to have a larger pool to select from is a positive thing.

Vladimiro Silva

Yeah, it is. Here we really have problems. For example, even this week, one of our clinics was complaining because they were having too many donor candidates, and it was being difficult to schedule all of them because obviously the agendas were full, and the donors also wanted to donate. After the summer break, everyone wanted to donate at the same time. Sometimes I talk to patients, and, for example, the other day a patient of ours was telling me, “Can I…” and I said, “Well, I actually think that we have the perfect donor for you,” because I was thinking about a very specific donor that really looked like the patient. We were discussing an egg donor at the time, and I said, “I know that we’re going to have this donor that really looks like you, and I’ll send you her profile, and you can have a look,” and so on. Then the patient said, “Well, but please send me two profiles,” and I was like, “Okay, but typically we send one by one. If you don’t like it, we send you another one,” and so on. Every time we send a profile, that donor is blocked for you and no one else because we have several doctors asking for donors. The patient said, “Yeah, but I need to feel that I was able to choose.”

Eloise Edington

Exactly, I get that. 

Vladimiro Silva

The patient ended up selecting the donor that we were suggesting in the first place. It was important for her to see the contrast, and we did our best to have two options. But it’s the emotional part associated because obviously someone else is choosing a very important thing—making a very important decision on your behalf, and you don’t control all the parameters.

Eloise Edington

What about the treatment abroad? What about the process?

Vladimiro Silva

It depends on the type of treatment. Most people go abroad because they need some type of donation. Whether it is sperm or egg donation, the procedure is different. If you’re a single lady, a lesbian couple, or a heterosexual couple with a severe male factor and you just need sperm donation, for example, you can—if you have the support of your local doctor in your country of origin, say in the UK—even start the stimulation in your own country. You can do all the necessary bloods, scans, and smear tests before you start. We will validate the results, define the dosage, and then do the process together with the local physician. We have patient care assistants that are always in touch with the patient. They are the bridge, the point of contact with the clinic, and they create the bridge between the patient and the doctor. It’s a system that works. You can start in the UK, for instance. You will obviously select the donor before you start. We have our own sperm bank, but we can also work with external sperm banks. Typically, we work with sperm banks in Denmark, such as the European Sperm Bank or Cryos, or Fairfax Sperm Bank.

They can start the treatment in their country of origin, then send us the results. Whenever we think it’s the right moment for that person to travel, she can travel to Portugal. In cases where we feel more comfortable with good support from a local doctor, patients could even arrive in Portugal the day before the aspiration. If we need to do some control before that, we will advise them to come around day nine or day ten of the stimulation so we can do a check. The most likely day for the egg pickup is on day 12 or day 13. We collect the eggs, we have the donor here, we fertilize the eggs, and then we culture the embryos.

There are two options. If we are doing pre-implantation genetic testing, you can travel home after the aspiration because we will need five days to grow the embryos until the blastocyst stage. Then we do the embryo biopsy, collect the cells, freeze the embryos, and wait for the genetics test results, which takes approximately three weeks. If one or more embryos are available, we can then start the preparation, and you will only come to Portugal the day before the embryo transfer. We don’t know how the ovaries are going to react and how long the endometrium will take to reach eight millimetres of thickness, so there are a lot of parameters to control, but typically two trips to Portugal in these treatments is the most common.

If you’re doing egg donation, it’s a little bit the same. Normally we ask the male partner to come first to freeze his sperm. The sperm is secured in our tank, we wait for the aspiration of the egg donor, fertilize her eggs, create the embryos, freeze them on day five, and then the recipient—the female patient—starts the preparation. There are variants to all of this depending on the protocol. Sometimes we use longer protocols, shorter protocols, or natural cycles, modified natural cycles, so there are lots of things that can change. Some men, their sperm doesn’t have enough quality to be frozen. In those cases, we use fresh sperm. We can also use frozen eggs from the donor, so there is a world of possibilities for us to optimize.

Eloise Edington

Got a question coming in, which I’d love to ask you: What is the upper age limit for egg donation?

Vladimiro Silva

For the person who is receiving the embryo, it’s the age of 50, so 49 years and 364 days. For an egg donor, it’s 34. Egg donors must be between 18 and 34, and egg recipients can be up to the age of 50. We always disclose the age of the egg donor before the treatment. If you’re not comfortable with the age of our suggested donor, we can find you another one. You won’t move forward with treatment unless you are completely comfortable.

Eloise Edington

Fantastic. Do your clinics have access to egg donors from a Black Caribbean background?

Vladimiro Silva

We have to remind ourselves that Portugal was the first country of globalization, so we have a mixed population from 500 years ago. Our last African colonies left the Portuguese state in 1975, so we have a huge community of people from Angola, Cape Verde, São Tomé and Príncipe, Guinea, and they speak Portuguese. The relationship is very close. 

Eloise Edington

Why is Portugal becoming such a popular destination? 

Vladimiro Silva

More and more people are looking for Portugal as an ideal destination. There are a lot of other international groups opening clinics in Portugal exactly for that reason. It’s the attractiveness of the Portuguese law, the fact that prices are more affordable in terms of value for money, and obviously, word of mouth. We’re having more and more patients getting pregnant and telling their friends about it, so this is how this generates.

Eloise Edington

Wonderful. Could you tell us a little bit about each of the clinics, please?

Vladimiro Silva

Of course. Starting from south to north, our Lisbon clinic was founded in 1999. It was one of the first private IVF clinics in Portugal and joined our group last year, in 2023. It is located in the center of Lisbon. It’s a very nice clinic with an experienced staff—most of the people have been there since its foundation. We also have some new doctors and embryologists who have joined the team in the meantime. It will be our biggest project of growth because it is a clinic that nowadays is essentially focused on national patients or ex-pats living in Portugal, and it’s based in the center of Lisbon.

Then we have Ferticentro. Ferticentro is the biggest clinic in our group. It’s one hour away from Porto Airport and two hours away from Lisbon Airport. It is the most international of our clinics—80% of our activity is with international patients. We have almost 60 staff members who speak seven different languages. It’s a big clinic, where everything is very optimized. It was founded in 2002, and it’s maybe the clinic with the most experience handling international patients.

Then we have Procriar, our Porto clinic. Porto is in the north of Portugal. It’s the second-biggest city in the country after Lisbon. There are plenty of direct flights to many destinations in Europe. Procrea is a really boutique clinic. It was founded in 2019, so it’s the newest of our clinics. Nowadays, we have a staff of around 30 people. The clinic is 1,000 square meters—we’ve doubled the area. It’s a clinic that is growing a lot. It’s probably the clinic where we have more donors nowadays. More or less 80% of the patients are Portuguese, 20% are international, but we are growing in both national and international patients. It’s a very well-equipped clinic because it’s more recent and new.

But the three of them share that characteristic. So, I would say in terms of size, Ferticentro is the biggest, then we have Procriar, and then Lisbon. We hope in two or three years to be at the same size at the three locations, but the quality of care is, I would say, the same. I couldn’t say anything else, but it really is the same.

Eloise Edington

Someone has just asked if you could give an example of egg donation IVF cycle costs and whether you do embryo guarantee programs.

Vladimiro Silva

Okay, so egg donation IVF cycle costs and embryo guarantee programs are linked because we offer different types of guarantees, and they come at different prices, I would say. Our standard program is an egg donation cycle where we guarantee at least two blastocysts. According to Portuguese legislation, all of the embryos belong to the patients, even if it is a double donation. So, for example, if I have just one embryo, we transfer that embryo, and then the patient is entitled to as many cycles as necessary to achieve the agreed number of blastocysts. For example, if while trying to get the second blastocyst, I get another five, those six embryos belong to the patient.

The cost of this is €7,500 to €7,800 depending on the clinic. Then we have guarantees of two blastocysts or three blastocysts, which is €1,000 more expensive, and five blastocysts, which—I don’t know the exact costs off the top of my head—but it’s around €11,500 or €11,800. It’s always cheaper to have the five blastocyst guarantee than to try twice. Typically, what I tell patients is that it will depend on your personal plan. If you want to just have a kid and then decide what to do next, I would say the two blastocyst or three blastocyst guarantees are good options.

Then we have the baby-at-home guarantees.

Eloise Edington

How does that work?

Vladimiro Silva

Patients need to qualify for that. We’re not too demanding on their characteristics, but they are entitled to three attempts with three different egg donors and all the frozen cycles associated. If, after all of that, the patient doesn’t have a baby—it’s not just a pregnancy, it’s a baby-at-home guarantee—if they don’t have a baby, they can get all their money back. They receive 100% of their investment back, and they can try again, either with us or elsewhere. The money goes back to their account. This one costs—I’m not 100% sure—but it’s €17,500 or €18,000. It’s around those lines.

This is only possible because we have a very good cumulative pregnancy rate across the clinics. So, it’s all related to personal wishes, the type of risk, your previous experience, and obviously economic resources. But we always try to assess each patient’s particular situation and counsel them accordingly.

Eloise Edington

Great advice. Thank you so much for all of your insights and expertise. I encourage people to take the next step by calling, emailing, or getting in touch with any of the three clinics in Portugal to find out more. Thank you so much to those who have joined live today, and for those watching back. Any questions, please don’t hesitate to ask the team—they are all delighted to help you. We did have questions sent in advance, and we’ve covered a lot of them. So, for anything additional, please do get in touch with the team, and they will happily answer you.

Vladimiro Silva

Thank you very much for your time today, and I wish all the luck in the world to the people watching us. Like Eloise said, if you have other questions, I’m very happy to talk to you directly. It’s a genuine pleasure for me to share and discuss, even informally, your particular situations, so I’m very happy. I think Eloise will share our contact details.

Eloise Edington

Okay, thank you so much, and thank you, Vlad.

Vladimiro Silva

Thank you, bye!

Eloise Edington

Bye!