Sun and oocyte tourism: Spain becomes a mecca for oocyte vitrification

More and more women travel to Spain to undergo the treatment due to the high cost of egg freezing in their countries of origin

Some people receive gifts for their wedding. Kaia Nathalie Klaumann decided to get one for her divorce. At 38 years old and with her life falling apart, she thought it was time to freeze her eggs and her life project. But buying time costs money. To do it in Texas, where she lives, costs exactly $20,000 (about 18,600 euros). So after a Google search and a call to a friend, she decided to make her gift a double one: egg freezing and a vacation in Spain, where the same process costs about 4,000 euros.

Kaia asked for two weeks off work and took a plane. “It’s a pretty common thing,” she explains in a phone conversation. “A lot of American women travel to Spain to freeze their eggs.” And there are more and more of them. According to the market research company Grand View Search, the global fertility tourism market is expected to grow at a rate of 30% over the next seven years, to move 5.8 billion euros by 2030. And on the world map of this buoyant business, Spain is marked in red.

“First of all, it’s because of the price,” says Klaumann, who has spent the last few years working in dozens of forums. “It’s also true that I’m an eight-hour drive from Mexico. But of course, Spain has a good reputation, it’s one of the countries with the most research on the subject,” he acknowledges. In addition, Klaumann had lived in Alicante for several years, so he knew the country. She didn’t need to rely on the many intermediary companies that organize these trips for American women.

One such company is Milvia. “Spain is a wonderful tourist destination,” its director, Abhi Ghavalkar, explains by email. “The warm weather, the option of being by the beach and the possibility of exploring a new destination (sometimes while on vacation) are attractive to Americans,” she stresses, while emphasizing that the country “has some of the best fertility providers in the world” and that “treatments are offered at a very competitive price.” Spending a couple of weeks gorging on hormones seems less unpleasant if the plan is garnished with a stroll along Las Ramblas, a visit to the Prado Museum or a day languishing in the sun on a Mediterranean beach.

According to the latest data from the Ministry of Health, of the 127,420 cycles performed in Spain during 2020, 12,171 were by foreign patients. This is confirmed by Erin Moore, who worked as a translator for seven years in a clinic in Alicante. “Many women came from England, Holland, Italy and the United States,” she explains on the phone. The treatments last several weeks, so the patients have to stay in the city for a while. “And that’s where I was,” Moore interjects. “I would help them find good hotels or restaurants to enhance their vacation.” The average health tourism traveler spends €1,082 a week, according to a 2022 INE analysis. In the case of vitrification, spending can be even higher, as it is a relatively simple and not particularly painful procedure. It is easier to integrate into a vacation.

The warm weather, the option of being by the beach and the chance to explore a new destination are attractive to Americans. In addition, treatments are offered at a very competitive price.

Oocyte vitrification is “an ultra-fast freezing of eggs in their earliest stage,” explains Sara López, gynecologist and author of Quiero quedarme embarazada. Keys to understanding assisted reproduction. The process begins when the patient is injected with hormones that give the order to the ovaries to release as many eggs as possible. “Thus, instead of one egg growing, all 13 or 15 in the menstrual cycle grow,” she points out. Next, there is a small surgical intervention to extract the eggs and place them in liquid nitrogen to preserve them for future use. The process went from experimental to everyday in 2012. Since then, it has continued to grow, not so much for medical reasons as for environmental ones.

In the last decade, the number of women freezing their eggs has increased by 142% in Spain, from an anecdotal 129 cases in 2010 to 5,480 in 2020, according to the most recent data from the Spanish Fertility Society (SEF). The number is now believed to be much higher, but there is some lag in data collection. “Having such a large volume of treatments allows you to carry out more studies and make progress,” López points out. “That is why in Spain we are leaders in Europe, and I would dare say also worldwide, in assisted fertilization issues.”

Spain was placed on the international map thanks to egg donation. “It is still the most important sector within this market,” explains Anna Molas, a postdoctoral researcher in Health Anthropology at the Autonomous University of Barcelona. Many women go to the clinic when it is too late to freeze their own eggs and this is the only alternative. The expert points out that there is an age and class bias in this practice, which she sees as problematic.

She also highlights another factor that has helped put Spain on the map: its legislation, which is more lax and permissive than that of surrounding countries. “Here in the private sector there are no age restrictions as there are in other countries. Nor do they put obstacles for being a single woman, or a woman married to another woman. And because of anonymity [in the case of ovonodonation], which is no longer the case in most countries”.

When a woman considers her life project, just as she thinks about where she is going to live and what she is going to do for a living, she should also consider her reproductive project. This is not a guarantee, it is an opportunity.

Egg freezing means winding down the biological clock, putting the decision to have children on hold until there is sufficient financial, employment or emotional stability. That’s what happened to Klaumann, who couldn’t find a stable partner or a job she liked. “Also, my desire to be a mother didn’t awaken until I was at least 35 years old. I was too busy living and enjoying my freedom,” she admits. Hers was an individual decision, but it is, like all of them, conditioned by a social context.

A woman’s eggs begin to lose quality at the age of 35, explains Antonio Urries, a biologist dedicated to assisted reproduction and president of the ASEBIR association. At first, the eggs were frozen in patients before undergoing radiotherapy, chemotherapy or uterine removal. “But its use has changed, it has advanced. In recent years there has been a very important increase due to age”. In this sense, the expert stresses the importance of education. “When a woman considers her life plan, just as she thinks about where she is going to live and what she is going to do for a living, she should also consider her reproductive plan,” he points out. She does so by reminding that this technique “is not a guarantee, it is an opportunity”, since it is not 100% effective. “It is very variable and we cannot talk about a specific percentage. In 2020 there was one pregnancy every 12 or 13 vitrified eggs, but it depends a lot on each case.” Klaumann’s, for example, does not fit into this statistic.

A medical response to a social problem

In 2014, major Silicon Valley companies began offering their female employees the possibility of financing egg freezing for their female employees. Some voices criticized then that this work incentive hid a clear message to women: prioritize your career, postpone motherhood. However, the model gradually spread, and today 20% of large US companies offer it as a benefit to their female employees. In Spain it is less common, but some companies have agreements to co-finance the treatment. This direct relationship between the productive and the reproductive is not casual.

Sun and oocyte tourism: Spain becomes a mecca for oocyte vitrification

“Delaying motherhood hides a productivist impulse,” says Sara Lafuente Funes, an anthropologist specializing in oocyte vitrification. “It is the result of a society that puts capitalist productivity at the center of social issues and leaves care and reproduction on the margins. In this context, denounces the anthropologist, egg freezing comes to be a medical patch to a social problem, an individual solution to a collective situation. “Moreover, it does so by constructing yet another consumer product, turning reproduction into a market,” she denounces.

Lafuente is currently researching the social impact of this practice in the Cryosociety project at the University of Frankfurt. He defends the existence of these techniques, but with nuances. “It’s not a question of going against these treatments. They are an advance, I know. But we should question the fact that they are not solving the problem, and that they are also generating inequalities, since not everyone can access them”.

The delay of motherhood hides a productivist impulse. It is the result of a society that places capitalist productivity at the center of social issues and leaves care and reproduction on the margins.

In Spain, the Social Security offers the treatment to women who have lost their fertile capacity due to illness. In addition, it requires the fulfillment of a series of requirements (being under 40 years of age, not having other children…) which means that many women end up going to a private clinic. They are the ones who can afford it. Many other reproductive projects end up on the waiting list of public clinics or when they find that they cannot afford the cost of private clinics. Others do not even make it to term in the private sector.

In 2020, Kaia Nathalie Klaumann remarried and decided to start a family. It was time to thaw her eggs. Limitations on international travel due to the covid crisis caused her to scrap the idea of coming to Spain for insemination, so she asked to have them sent to Texas. It was not a good idea.

The shipment was paralyzed for a year due to bureaucratic and legal obstacles, and when she got her eggs shipped, the logistics company to which they were subcontracted lost them. “I was checking with a code where the package was, I could see it until I stopped seeing it. Suddenly it was gone,” Klaumann recalls with anguish. “I called and they didn’t know how to tell me, they even hung up on me.” After several days of searching, the package turned up, but when thawed, none of the 10 eggs it contained were viable. “No one can tell me for sure why, it’s something I can only suspect,” she laments.

Despite this unpleasant episode, Klaumann’s story has a happy ending. His name is Calvin and he is two years old. At the same time, she had initiated an in vitro fertilization process at a clinic in Texas, and it did come to fruition. Despite the incidents, she is a staunch advocate of egg freezing. She is also an advocate of doing it abroad. She only regrets that covid, incompetence and a series of misfortunes thwarted her plan. And she repeats in a somber tone what the experts say: this is not a guarantee, it is an opportunity.