|Year : 2013 | Volume
| Issue : 2 | Page : 99-104
Capabilities of infertility tourism in Isfahan: A qualitative study 1
Alireza Jabbari1, Zahra Agharahimi2, Sheida Hosseini3, Farnoosh Safari3
1 Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
2 Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
3 Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran
|Date of Web Publication||4-Mar-2014|
Children's Medical Center, Tehran University of Medical Sciences, Tehran
Source of Support: None, Conflict of Interest: None
Introduction: Several constraining rules on infertility treatment in many countries lead to providing market in infertility treatments as one of the developing medical tourism markets. Further, many patients travel abroad to receive the services with lower costs. The present study attempts to identify Isfahan capabilities of infertility tourism. Materials and Methods: The present study is a qualitative research. The subjects participated were a group of 11 gynecologists working in the centers providing infertility treatment in Isfahan, who were chosen purposefully. To gather the data, they were given a semi-structured questionnaire and to analyze them, content analysis was performed. Findings: Total of 3 themes and 13 sub-themes were identified: Two sub-themes were stated as "the nature of foreign patients' demand" namely "Iranian citizens abroad" and "patients in neighboring countries". "Factors underlying therapeutic journey" includes "skilled gynecologists", "human resources professionals in fertility treatment" (16 persons), "cost advantage", "environmental features" and "ethnic and cultural advantage in Persian Gulf countries" which, in participants' point of view, all show Isfahan capabilities to succeed in infertility tourism. The third theme, "factors underlying medical tourism development", includes "basic tourism infrastructure enhancement", "infertility hospitals and clinics development", "inter-sectoral collaboration at the macro level", "inter-sectoral collaboration at the operational level", "marketing and information" and "census and registry system". Conclusion: Noting the capabilities of medical sector and low costs of infertility services in Isfahan, we can conclude that policy-making and comprehensive planning to remove the challenges at macro and operational level can make Iran more actively successful in the field.
Keywords: Capability, health tourism, healthcare tourism, Iran, infertility tourism, medical tourism, reproductive tourism
|How to cite this article:|
Jabbari A, Agharahimi Z, Hosseini S, Safari F. Capabilities of infertility tourism in Isfahan: A qualitative study 1. Int J Health Syst Disaster Manage 2013;1:99-104
|How to cite this URL:|
Jabbari A, Agharahimi Z, Hosseini S, Safari F. Capabilities of infertility tourism in Isfahan: A qualitative study 1. Int J Health Syst Disaster Manage [serial online] 2013 [cited 2022 Aug 12];1:99-104. Available from: https://www.ijhsdm.org/text.asp?2013/1/2/99/128123
1This paper is derived from a research project No. 289122 affiliated by Health Management and Economic Research Center.
| Introduction|| |
The classic medical tourism market is subcategorized into non-surgical interventions, cosmetic and non-cosmetic surgery, dental interventions (essential and cosmetic treatments) and reproduction-interventions (infertility treatment, delivery, and sex change). , Infertility tourism is a particular kind of medical tourism having changed to a principal medical field since four decades ago. Infertility tourism is defined as "one's journey abroad to receive infertility treatment through assisted reproductive technology". Several reasons for infertility tourism including various rules are available on infertility treatment in different countries, more successes in foreign centers than in home centers, unavailability of infertility professionals and limited availability to treatment because of long-waiting list or high expenses.  The expense of treatment is approximately €2400 in Hungary and Slovenia, but €3000-6000 in England. On the other hand, a law is passed in Italy which has strongly limited the availability to infertility treatment. As a consequence, the Italian doctors have currently established some clinics in neighboring countries to treat their patients with low cost.  Moreover, instead of waiting for long time to receive the infertility treatment in England, the patients prefer to go abroad. 
According to World Health Organization (WHO), there are 510 million infertile couples all over the world. However, infertility treatment has recently developed appropriately in Iran. Iran has employed the latest technology in treating infertility and is successfully competing with the other counties.  Therefore, the government has considered this kind of healthcare service as one of the medical tourism markets that was previously planned for. As a consequence the present study is to identify Isfahan capabilities in infertility tourism as one of the medical tourism market.
| Materials and Methods|| |
The present study is a qualitative research conducted in 2011. The subjects participated were a group of gynecologists in Isfahan chosen purposefully. These were the doctors treating at least an infertility tourist during the last year.
Because of saturation, the data were gathered through an interview with a group of just 11 samples. Saturation occurs when no new data will emerge from the process. At this time, the researcher can stop the process of sampling.  A semi-structured questionnaire was used to gather the data based on the interview with gynecologists. The participants were first asked whether they like to be interviewed or not; if "yes", an appointment was arranged. The questions in the interview might change based upon what the participants said in answer to the previous questions. The interview got over when the participants revealed and described all their beliefs, views and experiences, and they had nothing else to declare. Given complete information on researchers' personal characteristics, the subject of the research, its aims and also the researchers' letter of introduction, the interviewees agreed to participate in the process themselves. For a better communication, the participants were interviewed face-to-face in their working place. Each interview took 20-25 minutes that was recorded and then transcribed, noticing the main ideas and research questions, shortly after the process.
To analyze the data, content analysis was performed: This phenomenon was described first; the descriptions were gathered and analyzed, i.e., the sentences were summarized and categorized according to themes and sub-themes. Moreover, to maintain confidentiality, some reference codes were used. To ensure the validity of descriptions, all interviewees got involved, but just some participants were to control the acceptability (objectivity) of the data and confirm its validity.
Total of 3 themes and 13 sub-themes were identified when determining the medical tourism capabilities in infertility treatment. [Table 1]
The nature of foreign patients' demand
The two sub-themes identified here are Iranian citizens abroad and the patients in neighboring countries.
Iranian citizens abroad
As most participants claim, these patients are mostly offered the required medical services when they come to visit their relatives in Isfahan. Visiting their relatives in Isfahan, the Iranian citizens abroad demand the infertility services there as well since the services are of high quality but cost not very much. The participant, for instance, said:
Interview #2: "Iranian citizens in America or in other countries come to Isfahan if they have any alternatives there."
Patients in neighboring countries
The participants believe the patients in neighboring countries travel Iran for several reasons including high cost of fertility services in other countries and the low quality of services in their own country. In addition, that Iran is an Islamic country affects their decision deeply.
Interview #1: "Our foreign patients are mostly from Persian Gulf countries, or from Iraq but rarely from Afghanistan".
Factors underlying therapeutic journey
Five sub-themes are identified here including "skilled gynecologists", "human resources professionals in fertility treatment", "cost advantage", "environmental features", and "ethnic and cultural advantage in Persian Gulf countries".
Overall, one reason the patients in the neighboring countries come to Iran is that there are many experienced specialists in Iran. In addition, they choose Isfahan because they have some relatives there as declared by the participants.
Interview #3: "The foreign patients come here since they are aware of the successes the centers have had. The centers are all competing with each other, but the statistics revealed our doctors' skill and capabilities. We can offer all kind of infertility services; however, the most provided ones are micro injections and IVF".
Human resources professionals in fertility treatment
As the statistics of deputy of medical treatment in 2009 revealed that there are 164 gynecologists from among which 16 are infertility fellowships. Most of these gynecologists have foreign patients who are mostly Iranian citizens abroad or patients from Persian Gulf countries.
The findings imply that treatments cost really cheap in Iran. Infertility is treated cheaply in Isfahan, too. The participants said:
Interview #10 : "Expenses are much less in Isfahan than in Tehran. Moreover, the services in Isfahan are either better or cheaper than in Yazd; therefore, while Yazd is nearer to the southern parts of Iran like Bandar Abbas, Izeh and Ahvaz, Isfahan attracts more patients there".
Isfahan environmental features
Isfahan is one of tourist-attractive cities in Iran. There are many historical and cultural attractions in Isfahan like Naghsh-e Jahan Square, Monarjonban, Chehelsotoon, AliQapu which make the city really attractive. There is also a river in Isfahan which increases the number of attractions there.
It is also worth mentioning that all four seasons are beautiful in Isfahan, and the weather is always very pleasant there. All these environmental features make Isfahan a distinguished part in medical tourism. In this regard, the participants claimed:
Interview #7: "Patients do not travel to some cities because they are far or hard to access. These are really important for patients. I think Isfahan enjoys all attractions: It has tourist attractions, it has some holy shrines, and it has historical places. The Shia having strong beliefs knows Isfahan very well and knows the well-known people are there. Then, they "kill some birds with one stone." I think the tourist-attractions in one hand, and its availability, on the other hand,….".
Ethnic and cultural advantage in Persian Gulf countries
Isfahan has such cultural features that attract many patients there to treat their infertility. The interviewee asserted:
Interview #6:"Nowadays, tourism industry is regarded as one special kind of industry. If we could do anything regarding our historical places and cultural heritage, if we could have more and more advertisements and if we could spend as much money we spend for our oil, there would be provided as much job opportunities as is provided by oil industry. Our cultural heritage is a long-lasting heritage throughout the history of Iran…. If the ministry of foreign affairs attempts its best to take advantage of Iran-Iraq relationship, we can boost the income because Iran is fortunately playing important roles in Iraq and they both trust each other".
Factors underlying medical tourism development
Basic tourism infrastructure, the number and quality of infertility hospitals and clinics, inter-sectoral collaboration at the macro level, inter-sectoral collaboration at the operational level, marketing and information and census and registry system are all the sub-themes identified regarding the third theme.
Basic tourism infrastructure
The findings reveal that basic infrastructure in Isfahan, especially hotels and airlines, need to be improved and developed. Regarding the basic infrastructures, the interviewees criticized:
Interview #8 : "There are not hotels equipped enough in Isfahan. The best hotels we have are not more equipped or luxurious than 3 - or 4 - star hotels in Europe. Such things seem really important for the medical tourists".
Interview #10: "Another problem is housing. The kind of service mostly offered was micro injection therapy, but since it takes a long time to treat infertility through it and the patients have many problem staying in Isfahan, this service is limitedly provided now. In turn, implantation and laparoscopy, for those suffering from cyst, has been substituted. Moreover, all patients need a translator".
Infertility clinics and hospitals
There are two infertility clinics and one infertility hospital in Isfahan. The participants deem them hardly suitable for foreign tourists, and believe a very infertility clinic is needed to enhance the medical tourism industry. Generally, the interviewees asserted:
Interview#1: "All services and facilities we have provided either in our center or the center in Yazd or in Royan Institute are global academic facilities. Techniques, facilities, medical apparatus and medical information are all playing important roles in achieving success. We have provided all these here in our center, but these are not sufficient and more investment is needed…."
Inter-sectoral collaboration at the macro level
Participants believed inter-sectoral collaboration and coordination are necessary to enhance medical tourism, but such collaboration has been very weak recently. In addition, the supporting organizations like ministry of health and medical education, the organization of cultural heritage and tourism, ministry of culture and Islamic guidance and foreign ministry of foreign affairs have not fulfilled their roles there. The basic causes of enhancing this industry are marketing and advertisement which are provided by these organizations. The cultural heritage, handy craft, and tourism organization can support the medical tourism by enhancing infrastructure, the advertisements on tourist-attractions and hotels in Isfahan, and thereby improving quality. The ministry of foreign affairs can play its role by signing an agreement with other countries, informing healthcare programs in Iran, and developing protocols with neighboring countries. The participants believe:
Interview #5: "Although no organization is playing a role, there should be coordination in between. It is not just the private sectors which have a role there, but are radio and television important, too. Besides, representatives of the target countries have crucial roles. This means the so-called Charge d'affaires, ambassadors, and Iran representatives in other countries can involve a lot. The ministry of foreign affairs, the minister himself, deputies, doctors and doctor representatives should all collaborate. Ministry of foreign affairs can hold a meeting to talk especially with well-known doctors and all those playing important roles in medical treatment services like health deputy, ministry of health and medical education and representative of broadcasting. In other words, it should hold a meeting and invite experienced doctors in any field and some representatives from the media, radio and television, ministry of foreign affairs, health department and from different universities. It should even invite some from inside the city like the officials in hospitality and the cultural heritage. There should be 50, 100 or 200 persons invited. They should form some committees in the meeting. Each committee's responsibilities should become clear so that I, as a doctor, know I am to work for this committee, and the ministry of foreign affairs, of health and medical education, the universities and the organization of cultural heritage are supporting me. Then we can consult regularly with the committee and they offer some solutions".
Inter-sectoral collaboration at the operational level
As participants asserted there are no comprehensive and coordinate system of medical tourism in our country. They believe enjoying inter-sectoral collaboration but taking a unit decision are important factors to enhance medical tourism. The interviewee said:
Interview #1: " The organizations in Iran should coordinate so that the ministry of foreign affairs has the embassies cooperate since every foreigner entering our countries, anyhow, knows there is a specific organization or region existed in Iran which is a branch of assembly. All related organizations should be involved, too. That I myself perform well is not sufficient; all related organization should do as well. There should also be more advertisements on radio, television and on national media".
Interview #3 : "I think a meeting should be held at the macro level where some representatives from Isfahan university, from Isfahan broadcasting center, the organization of cultural heritage in Isfahan sand all those playing important roles take part. They should be justified by the minister and be given a specific instruction of what to do and how to do".
Interview #8: "To educate people in this regard, there needs an organization to present the laws in congress or different conferences. Then, the ministry of health and medical education, insurance companies like social welfare organization, tourism organizations, airlines, governor and municipality should also be involved".
Marketing and information
Participants claimed that the number of foreign patients traveling to Iran has reduced as some organizations like cultural heritage, handy craft and tourism organization, ministry of culture and Islamic guidance, health ministry (in introducing infertility services), doctors' offices, and basic infrastructures like hotels have made feeble attempts in this regard.
Interview #8: "The biggest obstacles to the growth of infertility medical tourism are the foreigners' lack of knowledge about the centers in Iran and the lack of facilities. For instance, in India, a successful country in tourism, there are a lot of advertisements placed in magazines, newspapers, press and several websites. These are to feature all the facilities provided by the centers, their expenses and results".
Census and registry system
The findings suggested the lack of any current mechanism to gather foreign patients' information. As the participants declared the census of patients are not recorded since there is no instruction specifically provided to present the results. It is not reported may be because the number of the patients are very low.
Interview #11: The census is not recorded although it plays an important role in enhancing medical tourism. Recording census, we know where we are know: We can plan for the future, we can compare it with the census in the last year, we can highlight the improvements and we can announce them.
| Discussion|| |
In the present study, a framework is provided for the factors related to medical tourism in infertility treatment. The findings revealed that large number of participants are Iranian patients living abroad although they are not regarded as medical tourists. Medical tourism is defined as "voluntary traveling, as a tourist, across international borders to obtain medical healthcare provided that the tourist travels for a reason rather than the lack of the service in his/her hometown". This means Iranian patients abroad are not considered foreign tourists because they can enjoy the services only if they travel to Iran but they visit primarily to see their relatives in Iran and also enjoy the healthcare services. However, it is really rewarding for Iran as there are three millions Iranian citizens abroad who demand cheap but good services.
Regarding the gynecologists' skill and the number of professionals involved in infertility treatment, all participants believe the gynecologists are extremely skilled and they have considerable clinical experience which leads to more traveling to Iran. Salimpour (2007) believes the following two factors attract medical tourists:
- Trusting and liking Iranian doctors
- Iran's high global rank in such fields as heart surgery, graft (transplantation), eye surgery, cosmetic and plastic surgery and infertility treatment. 
The studies also suggest that trained and skilled doctors play important roles in enhancing the industry of medical tourism. ,,
It is also noted that most doctors deem the treating expense is really low in Iran; the tourists are, then, attracted to come. They believe most European patients prefer to travel abroad because the expense of healthcare service is high in their own country. Jones (2006) and Unti (2009) also claim that the medical tourist travel to other countries since the cost of traveling is low while the quality of healthcare services is high and their low costs; in addition, there is no long waiting list at all to receive treatment. , The findings of this study also demonstrate that ethnic and cultural advantages make the medical tourists travel. Bristown (2011) regards the culture and its similarity to the patient's culture, besides the cost and popularity of facilities, clinics and hospitals, as crucial factors influencing his/her behavior. 
The participants also emphasize the importance of basic health and tourism infrastructure, and inter-sectoral collaboration in operational level in enhancing the industry of infertility tourism. Nagarajan (2004) claims this industry has hardly developed in India since the government has limited creativity and the involved organizations do not coordinate. He believes that all main sectors in the country like the government, the private sector and all the related organizations should coordinate to develop this industry as much as possible.  Furthermore, in his studies on the industry of medical tourism in the fields of cosmetic surgery  and dentistry  in Isfahan, Jabbari (2012, 2013) focuses on the importance of inter-sectoral collaboration in operational and macro levels to develop medical tourism. Jabbari (2013) also suggests, in another study, that to develop medical tourism in Isfahan, it is helpful to form a network of stakeholders between the organizations involved in medical tourism development and set all their duties in planning, policy-making, decision-making and performing.  Heng Leng (2007) reveals three ways through which the government has continuously supported the modification of healthcare in Malaysia and makes it a successful country in this field. These three ways are: 1) offering tax incentives to support developing the organizations which provide healthcare services; 2) establishing an organization to provide and develop the standards and quality of services; 3) directly involving in marketing of the international medical tourism.  The findings of the present study also suggest that these should be taken into consideration when we are to develop the capabilities of infertility tourism because there are less equipped hospitals in Isfahan. There is also another study titled "Challenges and Opportunities in the Philippine Medical Tourism Industry" which shows the government should improve the infrastructure and business environment to enhance medical industry. In addition, it should make the healthcare industry and tourism sector coordinate and it should support some organizations like marketing, communication, and information.  Moreover, the participants in the present study claim that the inter-sectoral collaboration is necessary to enhance medical tourism. Heng Leng (2007) believes that the government has continuously supported the modification of healthcare in Malaysia and makes it a successful country in the field by establishing an organization to provide and develop the standards and quality of services, and directly involving in marketing of the international medical tourism.
| Conclusion|| |
Infertility tourism has considerably influenced Iran's economy and its development. However, it cannot take enough advantage of this industry unless it benefited from its position especially in Isfahan which has some potential capabilities like cultural, historical and art-related heritage, climate change, experienced plastic surgeons, and cost advantage. To accelerate infertility tourism development, some marketing and advertising strategies should be used to introduce the available services in Isfahan. It is also recommended to form an inter-sectoral network to enhance coordination and relationships and to persuade stakeholders to invest in developing basic infrastructures in tourism and healthcare services. Furthermore, housing is another important issue that needs focusing because, as the participants claimed, the patients should stay a long time in Isfahan to receive infertility treatments. Finally, infertility tourism may developed more and more if the infrastructure is paid more attention by the officials, a specific portal is formed in Isfahan for medical tourism, a census and registry system is provided for recording the number of patients, and if the officials and policy-makers in medical tourism inform the gynecologists of their performance to be praised and persuaded to offer even better services.
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