Brittany Hawkins and Catherine Hendy, founders of ELANZA Wellness and co-authors of Everything: Egg Freezing guide, generously answered questions from our community about egg freezing. In this post, we focus on 3 questions around clinic selection and special considerations when freezing eggs abroad.
Brittany and Catherine both decided to freeze their eggs in Cape Town, South Africa, when they were in their early 30s. This experience led them to write a comprehensive guide to egg freezing, sharing with other women the extensive research and in-depth thinking they went through on the journey. As founders of ELANZA Wellness, the two women are now working to improve how women experience fertility care.
Let’s dive right in.
Why did you choose South Africa for egg freezing?
For us, because those things were already checked off, it boiled down to two main reasons: firstly, South Africa is known as a medical tourism destination and has a very high standard of clinical care. Secondly, the cost of freezing and storage is far lower for egg freezing in the US and in the UK - which was a big factor. And finally, for Catherine, frozen egg storage laws came into it. The UK (unlike the US and most other countries) has an arbitrary 10 year storage limit for frozen eggs - which we’re joining campaigners in trying to overturn. In South Africa you can store frozen eggs indefinitely.
People often ask us what we would do if we wanted to use our frozen eggs to try to conceive in the future. While we would have the option of filing paperwork and shipping them to use at a clinic in our own countries, we both feel like we’d want to go back to Cape Town and undergo IVF there. Not only is it an excuse to go back to amazing Cape Town (which we both love) but that would also be cheaper and we’d avoid the small risk of damaging the eggs in transit.
What do I need to watch out for if I go abroad for egg freezing?
It’s never an easy decision to undergo fertility treatment outside of your home country. While the cost savings of going overseas can be great, there’s a lot of different inputs that go into weighing up if it’s the right option.
1. The laws of the country itself: Not all countries’ medical, legal and political systems are robust and reliable. Of the estimated 103 countries around the globe with fertility centers, 42 operate with what’s deemed “legislative oversight” (i.e. a regulatory system), 26 with voluntary guidelines, and 35 operate with neither. Interestingly, the US falls into the “voluntary” category, which basically means fertility doctors self-regulate and most European countries practicing non-medical freezing don’t have a specific law governing it. It’s a good idea to check around and see which laws, regulations and guidelines around assisted reproductive technologies are in place for the country you’re traveling to, as that might form part of your decision making process.
2. The clinic: Using a clinic overseas obviously makes it harder to swing by to check it out. In our opinion it makes sense to gather as many reviews as possible. Now we’re in the age of Zoom, it should be possible to easily arrange for a video consultation with your doctor. If the country does have a fertility industry regulator or reporting mechanism, check the reputation/reviews and “live birth rate” statistics for the clinic - you’ll want to see it’s on or above the national average, and then maybe compare that to your home country’s average too. Don’t worry about getting too in the weeds with the data - it’s hard to compare apples with apples, but a top level check can be indicative of a good clinic. The same important questions apply as in the US - staff qualifications, clinic and lab standards and things like storage security and power backups. You could also ask if they regularly have overseas patients and if there is a system to manage them, as this would likely streamline your experience.
3. The price: Although treatment costs may be substantially lower, remember to calculate added costs like flights, visas, transportation, accommodation, insurance and other travel costs.
4. Insurance: Regular travel insurance will not cover problems arising from egg freezing overseas. In some cases, even claims that have nothing to do with the procedure will not be covered if the trip is taken for medical tourism purposes. However, you can find specialist medical travel insurance (coverage for people traveling specifically for surgery) usually at a pretty reasonable cost.
5. If something goes wrong: In the very small chance that anything goes medically wrong (maybe you have a reaction to the sedative, for instance) it’s worth considering if you would be comfortable being far from home and potentially alone? Of course, your medical travel insurance should cover any additional hospital stay and treatment, but it’s a good idea to think through every scenario.
6. Using your eggs in the future: By default, your eggs will be frozen and stored in the country in which you have the procedure. For some women, like us, this makes sense because if you end up choosing to use your frozen eggs, you might want to return for the IVF procedure as you are likely to reap the same cost benefits. Depending on your situation, other realities might come into play - like the availability of donor sperm if you are considering that route.
7. Transporting your eggs: If you’d rather have your eggs stored in your home country, you can arrange to have them sent via specialist airmail courier to the storage facility of your choice. This can cost from several hundred dollars to more than $1,000 and involve some administration. Transporting eggs is known to be safe (many US clinics transport eggs to off-site storage facilities), but of course, any additional movement increases risks. Most doctors would advise leaving them in place. Although this is broadly possible, it can also be difficult to arrange the paperwork between some countries - so it’s worth checking out the specific transit rules between your intended clinic country and home country.
8. Timing: While you can take the contraceptive pill to time your cycle and plan your travel, the ovarian stimulation cycle isn’t a fixed length. For most of us, the stimulation cycle lasts for 8-12 days but it can reach up to 14, not including recovery time. Some people start their stimulation meds in their home country, then travel only for the procedure itself. This involves your overseas clinic doctor working in unison with a doctor in your home country. Personally, bloated and a little anxious about doing anything to disrupt the outcome, we’re not sure we would have wanted to fly during the stimulation cycle itself - especially after around day 5. So if you feel the same that would mean a couple of weeks away. After the retrieval, it is possible to fly 24 hours after your procedure, but without knowing how you might feel or in the rare event that there are any complications, you might consider adding on a few days post-procedure to allow time for a full recovery.
All in all, it’s something to think through carefully. We are glad we chose to freeze in South Africa, but there are real upsides and downsides to doing it away from home, and only you can know where the balance lies for you personally.
I’m not finding a clinic that I click with. I spoke to 3 local clinics and they seemed too sales-y or not that into egg freezing. How did you find yours? How many clinics did you talk to?
We feel your pain. It can be so hard to get an honest feel for the doctor and their approach. We went to a few egg freezing seminars at clinics and then each ended up meeting with 2 doctors at different clinics (neither or which were doctors at the clinics that hosted the seminars).
Brittany: it was a case of choosing between one doctor that was more established and had been in the industry for a while vs. the other who was a bit younger but really spent some quality time with me in what felt more like a fertility counseling session. I ended up going with the one that I felt understood my needs and where I was in life. That ended up being SO important to me during the process.
Catherine: For me, deciding between the top two was also a case of having a consultation with each and doing a gut check of which person and clinic processes made me most comfortable. One clinic felt very sad and sterile - even the waiting room was a medicinal pale green and beige. It felt like being there to fix something that was wrong. At the other, with a more energetic doctor and thoughtful surroundings, it felt like we were crafting a smart plan of action for the future. They both had similar success rates, so in the end it really came down to how they made me feel. I will say that in Cape Town there was less choice which probably made things clearer. I also knew I was moving to another country within two months, so I wanted to get it booked in. As someone who overthinks things, narrowing down a way smaller list of choices and also having a set window to aim to get it done really helped me grab the bull by the horns and finalize my clinic choice. You never want to rush the decision about whether or not you want to do it (check out our workshop Is Egg Freezing Right For Me?) But once you’ve got that clear in your mind, I think aiming for “excellent” rather than “perfect” in a clinic can make it easier to choose - and certainly when it comes to age, “done” can be better than “perfect” for securing your eggs. Part of me wonders if I would still be weighing up clinics years on without that external time frame, as it is a tough thing to make a decision about without help!
This is certainly something that we’ve found has been an issue for the dozens of other women we interviewed when writing our book. We’re currently in the process of developing a clinic/doctor discovery platform to make choosing a clinic easier. We hope it will help patients easily learn a lot more about specific clinics’ and doctors’ approaches to patient care, and streamline what can be a very long and intimidating process. It will be launching soon so feel free to join the waitlist so we can ping you when it’s live - and also please let us know if you have feedback and ideas on how to make it better!
Check out the community over at ELANZA Wellness, if you have other questions about egg freezing or other kinds of fertility treatment, where you can ask questions and receive feedback from peers and experts. And please do reach out to us with questions as well. We are with you.
Thank you so much, Brittany and Catherine, for sharing your real experience of freezing eggs and helping others on the journey.