Examining the migratory pathways of a global reproductive industry.
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American reproductive travelers
I met Valerie at a Czech clinic the summer of 2010. She pushed her long, dark hair behind her ears as she leaned in and gave her name to the receptionist. She carried a stack of papers that I assumed included her medical history, as her husband Dan shrunk into a corner holding tightly onto a tour book of Vienna. The two were from San Diego, and had met when she was in her late 30s. During our interview the next day outside of the penzion, she remembered how they were both surprised when she accidentally became pregnant early in their relationship. They decided to get married, only to suffer successive miscarriages. She had a friend who had traveled abroad for less expensive in-vitro fertilization. Valerie did a lot of research online, comparing costs and potential egg donors in places like Greece and Spain. She ultimately chose the Czech Republic because she wanted a child that would resemble her, since she was not telling anyone she was using a donor.
Valerie and Dan were one of 30 American couples I met undergoing assisted reproductive technologies far from home. In fact, millions of people are crossing borders seeking health care treatments abroad. When health care services are cost prohibitive or unavailable in a patient’s home country, people will turn to the Internet to find options elsewhere. Migratory pathways of patients seeking treatment beyond their national borders are increasingly varied. Despite debates regarding its terminology, medical tourism is enabled by globalization and the commercialization of reproductive medicine that creates consumers out of patients.
Cross-border reproductive travel is one growing field of medical tourism. Reproductive medical services in the United States are cost prohibitive for most Americans—estimated at roughly $10,000 to $40,000 (IVF and IVF with an egg donor) to $100,000 for those who need a surrogate. Lower-middle-class Americans simply cannot afford the multiple cycles of IVF that are typically required to have just one child. Their experiences going through treatment in the US leaves them feeling jaded, broke, and angry. Doctors often lack a bedside manner and are perceived as profit-oriented by patients who visit fancy clinics with ostentatious designs that symbolize wealth garnered by the “baby business.”
Reproductive travelers are men, women, and couples who seek to create a family with the help of reproductive technologies abroad. Given its global scope, methodological complexities abound in trying to trace these travel routes. My recent ethnography Fertility Holidays: IVF Tourism and the Reproduction of Whiteness (2016) lays bare one particular pathway for Americans like Valerie and Dan who travel to the Czech Republic for IVF using an egg donor. Couples, or rather women, who travel abroad are buoyed by a desire for white babies, a European vacation, better health care, and technological success.
Once couples reach the end of treatment options in the US because of high costs, women turn to various forms of social media to learn about possible routes toward parenthood. It is online that they become diligent consumers of a global marketplace for healthcare. Virtual communities of those who suffer from infertility are highly gendered, and it is via these communities that women learn about the possibility of traveling abroad for more affordable fertility treatment.
The 30 heterosexual couples that I met in Czech fertility clinics in 2010 and 2011 wanted a white egg donor who could ensure that their child’s skin color would resemble their own. Valerie imagined that IVF in Spain would produce brown babies. The desire for white babies reflects a larger appeal of European ancestry, revealing a possible reverse migration of Americans traveling to Europe to create their families. Even more, as Americans spend at least ten days in Moravia, they form social bonds with others aiming to build similar families. As they return home, hopefully with the best “souvenir” possible, they maintain these relationships with one another.
IVF brokers brand these migratory travels as “vacation,” and intimate that couples who treat their trip as a vacation are more likely to be successful. Ultimately, I frame these “fertility holidays” as fraught with contradiction for women who are trying to relax on a European getaway, yet still suffer the strain and stress of trying to conceive a child using assisted reproductive technologies. Their European vacations are ultimately disrupted by awkward encounters in foreign clinics. I argue that despite the “vacation” branding, women work hard at managing their stress while in a foreign country and often feeling highly vulnerable and isolated.
While Americans are seeking fertility treatments abroad, many international markets, particularly those for surrogacy, are withdrawing access for foreign patients under media cries about the exploitation of poorer women. However, fertility clinics that offer IVF using an egg donor have avoided popular media scorn thus far. The Czech Republic’s burgeoning fertility business is a direct result of clinics treating a number of patients from abroad, including Europeans and Americans. The explosive success of its reproductive travel industry has led to new ways of attracting young Czech egg donors.
Egg donor mobility
The geographic and economic mobility of reproductive travelers to the Czech Republic in turn stimulates the mobility of Czech egg donors. During the summers of 2014 and 2015, I conducted 30 interviews with egg donors to understand their motivations and experiences as the supply side of the Czech Republic’s reproductive medical industry. In fact, a recent story claims that Czech women donated their eggs to 20,000 foreign couples between 2010 and 2014. As I spoke with Czech egg donors, I noticed parallels in the experiences of foreign intended parents and Czech egg donors on various levels: First, Czech egg donors have become part of a growing Facebook page dedicated to information sharing, support, and self-training. Most donors donate multiple times, and there are no regulations that strictly limit how many times a woman may donate. Hence, egg donation must be considered a new type of flexible, part-time employment. Second, donors are a geographically mobile population as they travel long distances throughout the country to donate in reputable clinics. And finally, they are compelled by a combination of altruism and financial motivation to donate. Czech women earn roughly 1,000 euros for a donation, and this money offers young unmarried women the financial means to travel, or provides single mothers with some financial stability.
There are various inequalities inherent in this global marketplace for reproductive medicine. While Czech women earn 1,000 euros, American women often earn $8,000 on average, though they could make up to $30,000. Egg donation or surrogacy should also be considered avenues of economic mobility for young American women. American egg donors and surrogates may also travel to different states in order to cycle for their intended parents.
Migratory pathways to the United States
Despite the high costs of treatment in the US, flocks of upper-middle-class intended parents from nearly 80 countries visit the US to seek help in building their families. Those traveling may be barred from accessing reproductive technologies at home because of their sexuality or marital status. Some countries such as Australia ban the use of third party assisted reproductive technologies, prompting intended parents who need or choose an egg donor and/or surrogate to travel abroad for treatment. The US reproductive medical field is vastly complex, and includes over 100 egg donor and surrogacy agencies and over 500 fertility clinics. Intended parents must visit law offices, mental health agencies, and medical clinics to consult the various professionals who coordinate their cycles, all of which may include extensive travel. During the summer of 2017, I intend to trace some of these complex migratory routes.
It is evident the global reproductive medical industry is a vast marketplace with various options for intended parents who cannot afford, or who cannot access, treatment at home. Intended parents make choices about where to travel based on wanting a child that will resemble them, regulations regarding third party assisted reproductive technologies, or liberal legislation that will grant them access to care. Migratory pathways of reproductive travelers also incite migratory pathways of egg donors within their countries. Over the past decade, anthropologists have joined others in critically examining this growing industry of medical travel that encompasses the globalization of technologies, ideas, money, and reproductive migrants.
Amy Speier is an assistant professor at the University of Texas at Arlington. She is a medical anthropologist interested in how the analysis of tourism can be refined through ethnographically based research in medical anthropology.