"I've Waited Long Enough": Why Cross-Border Fertility Care Deserves a Serious Conversation

Fertility treatment is time-sensitive in a way that almost nothing else in medicine is. A patient with a knee problem can (theoretically) wait a year and have the same operation. A patient who is 36 and waiting for IVF is not in the same situation twelve months later that she was when she first came to see me. Biology doesn't pause. And the emotional weight of that waiting - of watching months turn into years while you are told to be patient - is something I don't think we reckon with honestly enough in how we structure care. The WHO recently reported that globally, one in six couples struggles with fertility. That's 17.5% of people worldwide. And what struck me about that figure is that it holds across income levels and geographies - this isn't a problem concentrated in any one place. But the ability to get help for it absolutely is. In the UK, NHS funding for IVF has been inconsistent for years. Criteria vary by region. Many couples are told they don't qualify, or that the waiting time is 18 months, or that they've exhausted their funded cycles. Private treatment in the UK can cost between £5,000 and £8,000 per cycle - and many couples need more than one. For a lot of people, that's simply not possible. What happens next is what worries me most clinically. They try less effective, less appropriate treatments because they are cheaper. They wait. They come back when they're older and the chances of success are materially lower. In a woman under 35, IVF success rates in the UK are around 40-45% per cycle. At 40, that figure is closer to 20%. At 43, it's about 5%. Those numbers are not a footnote. They're the whole conversation.

When I tell people I now work with a medical travel company alongside my clinical practice, the response is usually some version of: "But is it safe?" It's a fair question. And it used to have a murkier answer. There was a period when medical tourism - including fertility tourism - operated in a grey zone of uneven regulation, opaque pricing, and clinics that ranged from genuinely excellent to deeply problematic. Patients who went abroad sometimes returned with no records, no continuity, no one to call if something went wrong. That picture has changed in India, and I say that having looked at it carefully rather than taken someone's word for it. India introduced the Assisted Reproductive Technology (Regulation) Act 2021, which requires fertility clinics to be licensed, to maintain transparent outcome data, and to follow defined standards for treatment and consent. The regulatory scaffolding now exists. What also exists - and I verified this before attaching my name to anything - is genuine clinical expertise. India has trained reproductive medicine specialists, high quality embryology labs, and infrastructure that is comparable to what I've worked with in Birmingham and at Birmingham Women's Hospital. It is not a cheaper version of something worse. When it's done well, it's just different geography.

I want to talk specifically about something that doesn't get enough attention in the mainstream fertility conversation in the UK: the situation for South Asian and other ethnic minority patients seeking donor treatment. The donor pool in the UK for ethnically matched egg or sperm donors is small. For South Asian patients specifically, the wait for a matched donor can be years. Years. During which time - as I've already described - the window is narrowing. I have sat with patients in clinics who have been on donor waiting lists so long that their age now limits their options further than when they first came to me. In India, the donor pool is larger and more ethnically diverse for South Asian patients. The matching is more straightforward. This is not a minor detail for the patients it affects — it can be the difference between treatment that works and treatment that arrives too late.

Every patient begins with a consultation with me here in the UK. We go through their full history - investigations, previous treatment, any complicating factors - and build a plan that is specific to them before anyone books a flight. What happens when they arrive in India is where TMTC has built something I haven't seen anywhere else in cross-border care. Patients are not left to navigate a foreign healthcare system alone. The logistics, the appointments, the day-to-day - all of it is managed. They are brought to a dedicated aftercare centre that I can only describe as the opposite of clinical. A private chef. A nutritionist. An in-house nurse who administers injections. A doctor and physiotherapist on site. The kind of unhurried, attentive care that is woven into how India looks after its guests - and that most patients tell me they didn't expect, and won't forget. And when they come home, they come back to me. Same doctor, full continuity, someone who knows exactly where they've been and what comes next. That end-to-end ecosystem - from our first conversation in the UK to their return - is what makes this different. And it's why I said yes.

I spent a long time in my career thinking that the answer to unequal access to fertility care was better NHS funding, more consistent commissioning, systemic change. I still believe that. I will always believe that. But I also live in the real world. And in the real world, systemic change moves slowly and patients need support now. I joined TMTC because I believe the two things can coexist. You can advocate for better public provision and also make sure that the people sitting in front of you today have a real path to treatment that doesn't depend on waiting for a policy change that may take another decade. If I can use twenty-four years of experience in reproductive medicine to help make cross-border fertility care safer, more transparent, and better supported - particularly for the patients who have always had the fewest options - then that feels like exactly where I should put my energy. I'm not here to push anyone into anything. I'm here to make sure that if you are considering fertility treatment and you're facing obstacles - financial, logistical, time-related, donor-related - you have a real conversation with someone who will tell you the truth about your options. All of them. Dr. Madhurima Rajkhowa is a Consultant Gynaecologist and Subspecialist in Reproductive Medicine with over 24 years of experience in the NHS and private practice in the UK. She is TMTC's UK Fertility Expert and can be consulted at

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