Using an agency for IVF abroad: what an intermediary should do, and who pays them

IVF abroad involves choosing a clinic, preparing paperwork in another language, dealing with changing dates, flights, accommodation, medication, and organising the return journey. Many patients do this on their own, and manage it very well. Others prefer to have support. In between, there is a vast and confusing array of options: agencies, platforms, ‘facilitators’, coordinators and associations. Here’s how to make sense of it all.

Four roles under one term

• Platforms and comparison sites. Directories of clinics, with contact forms. They are generally paid by the clinics, either per referral or via a subscription. Useful for drawing up an initial shortlist, but rarely for making a final decision.
• Medical tourism agencies. They sell a package: clinic, accommodation and transfers. Their remuneration often comes from a margin on the package price or from commercial agreements with the clinics.
• Independent coordinators, sometimes called patient advocates. They are paid by the patient to organise and provide support, without selling the treatment itself.
• Patient organisations. They do not sell anything. They provide information, listen and put people who have been through the same journey in touch with one another. Fertility Europe brings together national organisations from many European countries.

None of these options is inherently good or bad. What matters is knowing exactly what you’re dealing with.

What a good intermediary actually does

• They review your medical records before discussing prices, and tell you what is missing. See the fertility assessment.
• They help you compare written quotes, line by line, and spot what isn’t included. See the real cost of IVF in Greece.
• They prepare you for the consultation with the doctor, translate, and explain the proposed protocol to you.
• They organise the logistics: dates, flexible flights, accommodation near the clinic, medication.
• They are on site, or available by contact, on the key days: egg retrieval, embryo transfer, and the evening of the trigger injection.
• They act as a liaison after your return: results, reports, and any queries to the clinic.

What they cannot do

They do not make any medical decisions: the treatment protocol, the number of embryos to be transferred and any additional tests are the doctor’s responsibility. They do not guarantee a result. They do not ‘find’ you a donor in return for payment: in Greece, donors are recruited and monitored by licensed clinics; their compensation is set by the National Authority; and acting as an intermediary in the sale of gametes is a criminal offence (see the legal framework for egg donation). Nor can they open up a path for you where the law has closed one off, such as surrogacy for people who do not reside in Greece (see the article on surrogacy).

The only question that matters: who pays whom?

In Greece, the Code of Medical Ethics prohibits doctors from using intermediaries paid on a percentage basis to attract patients, and from paying a share of their fees to those who refer patients to them. However, a service presented as ‘free for the patient’ is in fact paid for by someone. If it is paid for by the clinic, in one form or another, the intermediary has an interest in directing you to that particular clinic, whether or not it is the best option for you.

In my view, it is this conflict of interest that poses a problem, rather than the support itself: support paid for by the patient, with no financial link to the clinics, does not have this flaw. The European Society of Human Reproduction and Embryology (ESHRE) goes further on one specific point: for egg donation, its guidelines on cross-border care recommend avoiding intermediary agencies, in order to protect donors and prevent any risk of trafficking.

Ask the question directly, and request a written reply:

• How much does your service cost, and what exactly does it include?
• Do you receive any payment, benefit or contract from a clinic that you recommend to me?
• Who do I pay for the treatment: you, or the clinic directly?

A reputable intermediary will answer without hesitation. An intermediary who is uncomfortable with the second question has already replied to you.

Warning signs to look out for

• A guaranteed success rate, or a ‘money-back guarantee if unsuccessful’ without specific written conditions.
• A request to pay for the treatment into the agency’s account rather than the clinic’s.
• Only one clinic offered, by someone claiming to be independent.
• No written quote, or a quote that changes after your arrival.
• Promises that contravene Greek law: sex selection without medical grounds, transfer of a number of embryos exceeding the set limits, or a ‘donor’ recruited and paid for on your behalf.
• Pressure to book quickly: ‘there’s only one donor left’, ‘the price is going up next month’.
• Success rates highlighted as a selling point: in Greece, the clinics themselves are not permitted to publish their success rates or compare themselves with one another.
• A clinic that cannot be found in the official register. Checking the clinic’s accreditation takes two minutes.

Also bear your data in mind: an intermediary handles your medical records, which means they must comply with the European General Data Protection Regulation. Ask how your documents are stored and to whom they are passed on.

How I work, as this issue concerns me personally

I spent twenty-four years coordinating the care pathways for patients from abroad at a clinic in Thessaloniki. Now working independently, I operate under a simple rule: the initial consultation is free; my fee is a fixed amount per case, paid by you and set out in writing; and treatment, travel and accommodation are paid directly to the providers. I am not paid by any clinic. If you’d like us to look at your situation together, please write to me; and if you’d prefer to organise things yourself, the articles on this website are designed to help with that.

Frequently asked questions

Source: https://fertilitegrece.com/en/blog/ivf-abroad-agency-facilitator/ — Triada Baloukoudis, IVF patient coordination in Greece. General information, not medical or legal advice. Printed on

Triada Baloukoudis
Independent IVF patient coordinator in Thessaloniki, with 24 years of experience supporting patients travelling from abroad. More · Contact · Facebook