Heterologous fertilization: how does it work abroad?

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Until seven years ago in Del Paese it was not possible to carry out heterologous fertilization and therefore couples who wanted to undergo this medically assisted procreation (MAP) treatment necessarily had to go abroad. Still today, however, seven years after the abolition of the ban on heterologous fertilization and after about 10 thousand children born thanks to this practice, in our country there are still thousands of couples who every year decide to go abroad in search of a pregnancy. So much so that we talk about a real "procreative tourism". The reasons? First of all the long waiting lists to be respected in order to access the procedures that force many would-be parents to wait months or even years.

In this article

  • what is heterologous fertilization
  • to whom it is recommended
  • la lie Del Paesena
  • heterologous fertilization abroad
  • the countries chosen by the Del Paesene couples
  • risks and contraindications

What is heterologous fertilization

Heterologous fertilization is a technique, or rather a set of techniques, of medically assisted procreation which can be used in case of infertility (even absolute) and which provide the use of gametes (the female ovum and / or the male semen) from a donor external to the couple. Like homologous fertilization, heterologous fertilization provides first and second level techniques depending on the couple's problem.

1st level - Intrauterine insemination

Heterologous intrauterine insemination is recommended when there is a male infertility problem and when the woman is under 35 and her eggs are still qualitatively good. It's about a very simple procedure which consists in the introduction of the seminal fluid of a donor into the uterine cavity, thus facilitating the encounter between the woman's oocyte and the spermatozoa. If intrauterine insemination does not give the desired results, it will be necessary to switch to in vitro fertilization.

Read also: First level medically assisted procreation techniques

2nd level - in vitro fertilization with embryo transfer (IVF)

Second level MAP techniques are characterized by a greater degree of complexity. In fact, they provide for the in vitro fertilization of the oocyte and the subsequent transfer of the embryo into the uterus. In the case of heterologous fertilization, the oocytes from a donor, while as regards the seminal fluid, it can come from the partner or from a donor outside the couple.

Read also: All medically assisted procreation techniques

Heterologous fertilization: when it should be considered

Infertility is a condition that only in Del Paese, according to estimates by the World Health Organization, affects about 15% of couples of childbearing age. A real drama for all those who would like to become parents.

If, after having carried out all the necessary investigations, it appears that and gametes of one or both members of the couple cannot offer a reasonable chance of success, then it is necessary to resort to heterologous fertilization.

To be more precise, the sperm from a donor when it is not possible to find spermatozoa in the ejaculate, even after testicular sampling.

The oocytes from a donor when the woman:

  • has an advanced age, over 44 years, so the quality of the oocytes does not allow a reasonable probability of success;
  • has an early menopause.

In certain situations, heterologous fertilization can also be proposed when the gametes (male and / or female) are carriers of a genetic mutation.

Read also: Heterologous fertilization: what it is, who can access it and how it works in Del Paese

What to foresee the Del Paesena law regarding heterologous fertilization

With Law 40 of 2004, which regulates MAP in Del Paese, heterologous fertilization was prohibited, but seven years ago the sentence 162/2022 of the Constitutional Court sanctioned the full legitimacy of this medical practice. From 2022 to today, therefore, it is estimated that they are about 10 thousand children were born in our country thanks to the heterologous, and the data, according to the projections of the Del Paesena Society of Fertility and Sterility-Reproductive Medicine (Sifes-Mr), is increasing.

Law 40 provides that the use of ART techniques, including heterologous techniques, is "permitted if there are no other effective therapeutic methods to remove the causes of sterility or infertility". It also provides that these techniques can only be accessed by "adult couples of different sexes, married or cohabiting, of childbearing age, both living".

In Del Paese therefore remain in force some limitations as:

  • fertilization if a member of the couple has died;
  • the use of surrogacy;
  • the use of heterologous fertilization for same-sex couples or singles.

Women who cannot access medically assisted procreation treatments in our country must therefore turn to foreign clinics like the Spanish ones, where the procedures are open to everyone, regardless of sexual orientation and marital status.


Read also: Assisted fertilization, what the Del Paesena law provides

Heterologous fertilization: why many couples go abroad

The reasons that push many couples to choose to go abroad for heterologous fertilization are many, first of all is the time.

Waiting lists are too long in Del Paese

In our country to access MAP techniques through the National Health System, and therefore in public form, waiting times vary from 3 months to 2 years depending on the region where you want to perform the treatment.

With the pandemic, then, the treatments of MAP have been slowed down, if not blocked, for months and this has led to the exclusion of some couples due to the age limit. 

The age limits for heterologous fertilization in Del Paese

In Del Paese, the age limit for accessing heterologous fertilization varies from 42 to 50 years depending on the region in which the treatment is carried out.

  • Umbria: 42 years;
  • Bolzano, Basilicata, Lazio, Liguria, Marche, Friuli-Venzia Giulia, of the city, Calabria, Puglia, Molise, Val D'Aosta: 43 years;
  • Piedmont, Lombardy, Campania, Sardinia, Emilia of the city, Tuscany, Abruzzo: 46 years;
  • Veneto: 50 years.

Widowed, single and / or homosexual women

Single women, widows and / or homosexuals are in fact forced to go to foreign assisted procreation centers to overcome the limits imposed by the Del Paesena law.

The costs of heterologous fertilization

In Del Paese, MAP treatments have been included within the Essential Levels of Assistance (LEA) and are therefore theoretically covered by the National Health System through the payment of a ticket. In fact, however, in some regions it is particularly difficult to access services and many couples are forced to go to private clinics. The costs, in this case, are between 5 and 8 thousand euros, a cost that not everyone can afford and that pushes some couples to turn to cheaper centers located mostly in Eastern Europe.

Let us now see which countries are affected by "procreative tourism" and what their laws provide for medically assisted procreation.

The countries chosen for "procreative tourism"


Spain is certainly one of the most "popular" destinations for medically assisted procreation. Prices are not lower than that of the country as regards heterologous fertilization, and indeed it is possible to exceed 10 thousand euros for a treatment of heterologous MAP with egg donation. However, the price can go down if you choose a shared donor with another couple.

La Spanish legislation in the matter of heterologous fertilization provides that:

  • women up to 50 years of age can access it;
  • single women can access it;
  • in the presence of particular hereditary diseases linked to the sex of the unborn child, the sex can be chosen;
  • the phenotypic characteristics are chosen by the medical team on the basis of the characteristics of the couple;
  • if there is a medical indication, a pre-implantation diagnosis can be made;
  • donors are anonymous.

On the other hand, surrogacy is not legal, as in Del Paese.

The advantage of choosing Spain as a destination for heterologous fertilization certainly lies in theno waiting lists. In the Iberian Peninsula, in fact, there is no shortage of donors because there is a real culture of donation, unlike what happens in Del Paese.


After Spain, Greece is another popular destination for medically assisted procreation treatments. The quality standards are very high and the costs are lower than in Spain.

In Greece, for heterologous fertilization, the law states that:

  • women up to the age of 50 (51 not yet completed) can access it, even if unmarried;
  • the pre-implantation diagnosis can be performed if there is the consent of the persons concerned;
  • sperm donation is allowed for men up to 40 and for women up to 35;
  • donors must be anonymous;
  • a kind of "maternity on commission", only in the event that the woman who wants a child cannot carry it in her womb for medical reasons. In this case, special permission from the judge is required.


Czech Republic

The Czech Republic has also built a good reputation for its specialized ART clinics in recent years. Unlike in Spain, there are waiting lists, but generally they do not exceed two months. In the Czech Republic, the law on heterologous fertilization provides that:

  • access is guaranteed only to infertile heterosexual couples up to 49 years of age (50 years old);
  • embryos can be frozen;
  • pre-implantation diagnosis can be performed;
  • sex can be chosen in the case of hereditary genetic diseases linked to sex;
  • couples who no longer intend to "use" them can donate gametes and embryos in a free and anonymous way.

I prices in the Czech Republic they are slightly lower to those of Del Paeseni, but if you choose embryo transfer with embryos donated by other couples, the cost is even lower.


In Belgium, all heterosexual or homosexual married couples or cohabiting heterosexuals, as well as single women with the limit of 47 years of age for egg donation. The law also provides that:

  • if the couple has frozen the embryos in view of a pregnancy and one of the two partners passes away, it is still possible to carry out the post-mortem embryo transfer within two years of death;
  • pre-implantation diagnosis can be performed.


Ukraine is not a member of the European Union, but it is still one of the "favorite" states of those who wish to become parents. Let's see what the law provides:

  • no age limit for heterologous in vitro fertilization;
  • treatments allowed for both married couples and single women;
  • heterologous MAP treatments are not allowed to couples of homosexual women;
  • for medical reasons it is possible to select the sex of the embryos;
  • Pre-implantation diagnosis is allowed.


Surrogacy has also been legal in Ukraine since 2002.

Read also: Preimplantation genetic diagnosis and preimplantation genetic screening: what they are, when to do them

Risks and contraindications of heterologous fertilization

Heterologous fertilization, as we have seen, is very successful both in our country and abroad because it allows overcome problems related to both male and female infertility. However, heterologous fertilization techniques, and in particular in vitro fertilization (IVF), are not without risks and contraindications. This is because often women who undergo a heterologous IVF cycle are already over 40 and can experience complications during pregnancy. The donne about 45, for example, they need to be well aware that, once pregnant, they are exposed to one greater risk of obstetric pathologies as:

  • gestational diabetes;
  • preterm birth;
  • premature rupture of membranes.

The most important advice, however, remains that of relying on European or non-European centers with proven experience and which provide for very high sanitary standards.

  • assisted fertilization
  • Heterologous assisted fertilization
  • medically assisted procreation techniques
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