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18TURKIYE'S GLOBAL COMPETITIVENESS IN IVF TOURISM: A QUALITATIVE STUDY ON PATIENTS FROM TURKIC
REPUBLICS
Dr. Ahmet ALKAN
International Islamic University Malaysia, Faculty of Islamic Revealed Knowledge and Human
Science, Kuala Lumpur, Malaysia ORCID: https://orcid.org/0009-0001-6378-3706 https://doi.org/10.5281/zenodo.13896597
Abstract. This article explores the current challenges and opportunities in the IVF tourism sector, focusing on patients from Turkic states traveling to Turkiye. Turkiye has emerged as a prominent IVF destination for individuals from Central Asian countries such as Azerbaijan, Kazakhstan, Kyrgyzstan, Uzbekistan, and Turkmenistan, thanks to its high success rates, advanced medical infrastructure, competitive costs, and cultural similarities. Nevertheless, legal constraints, economic issues, and bureaucratic hurdles hinder Turkiye's advancement in this sector.
The study employs a qualitative research approach and a case study design, utilizing semi-structured interviews with 10 patients from Turkic states. Data sources include literature reviews and patient interviews, with data analyzedfor patient satisfaction through thematic analysis. The results indicate that while Turkiye holds a strong position in IVF tourism, legal and economic barriers impede its growth.
The aim of this article is to provide a meaningful contribution to the field of health tourism by assessing Turkiye's potential in IVF tourism and offering strategic recommendations for optimizing this potential.
Keywords: ivf tourism, Medical Competitiveness, Reproductive Tourism Strategies, Patient Satisfaction, Health Flow in the Turkic World.
Аннотация. В данной статье рассматриваются текущие проблемы и возможности в секторе ЭКО-туризма с акцентом на пациентов из тюркских государств, путешествующих в Турцию. Турция стала заметным направлением для ЭКО среди людей из стран Центральной Азии, таких как Азербайджан, Казахстан, Кыргызстан, Узбекистан и Туркменистан, благодаря высоким показателям успеха, развитой медицинской инфраструктуре, конкурентоспособным ценам и культурным сходствам. Тем не менее, юридические ограничения, экономические проблемы и бюрократические препятствия мешают дальнейшему развитию Турции в этом секторе.
Исследование использует качественный подход и дизайн кейс-исследования, применяя полуструктурированные интервью с 10 пациентами из тюркских государств. Источники данных включают обзоры литературы и интервью с пациентами, с анализом данных для оценки удовлетворенности пациентов через тематический анализ. Результаты показывают, что, несмотря на сильную позицию Турции в области ЭКО-туризма, юридические и экономические барьеры препятствуют ее росту.
Цель данной статьи — внести значительный вклад в область медицинского туризма путем оценки потенциала Турции в ЭКО-туризме и предоставления стратегических рекомендаций по его оптимизации.
Ключевые слова: эко-туризм, Медицинская конкурентоспособность, Стратегии репродуктивного туризма, Удовлетворенность пациентов, Потоки здоровья в тюркском мире.
Annotatsiya. Ushbu maqolada turkiy davlatlardan Turkiyaga sayohat qilayotgan bemorlar bilan bog 'liq IVF turizmi sohasidagi dolzarb muammolar va imkoniyatlar o 'rganiladi. Turkiya Ozarbayjon, Qozog'iston, Qirg'iziston, O'zbekiston va Turkmaniston kabi Markaziy Osiyo davlatlaridan kelayotgan shaxslar uchun IVF bo 'yicha muvaffaqiyatli ko 'rsatkichlari, rivojlangan tibbiyot infratuzilmasi, raqobatbardosh narxlari va madaniy o 'xshashliklari tufayli yetakchi IVFyo 'nalishiga aylandi. Shunga qaramay, huquqiy cheklovlar, iqtisodiy muammolar va byurokratik to 'siqlar Turkiyaning ushbu sohada rivojlanishiga to 'sqinlik qilmoqda.
Tadqiqot sifatli tadqiqot usuli va holat o 'rganish dizaynidan foydalanadi, bunda turkiy davlatlardan kelgan 10 bemor bilan yarim tuzilgan intervyular o 'tkazilgan. Ma'lumot manbalari adabiyot sharhlari va bemorlar bilan suhbatlarni o 'z ichiga oladi, va bemorlar qoniqishini tematik tahlil orqali baholash uchun ma'lumotlar tahlil qilinadi. Natijalar shuni ko 'rsatadiki, Turkiya IVF turizmida kuchli mavqega ega bo 'lsa-da, huquqiy va iqtisodiy to 'siqlar uning o 'sishiga to 'sqinlik qilmoqda.
Ushbu maqolaning maqsadi Turkiyaning IVF turizm sohasidagi potensialini baholash va ushbu potensialni optimallashtirish uchun strategik tavsiyalar berish orqali mazmunli hissa qo 'shishdir.
Kalit so'zlar: ivf turizmi, Tibbiy raqobatbardoshlik, Reproduktiv turizm strategiyalari, Bemorlarning qoniqishi, Turkiy dunyoda sog 'liqni saqlash oqimi.
Introduction:
Recent advancements in medical technology and the globalization of healthcare services have significantly accelerated the growth of health tourism. This sector involves individuals seeking treatment outside their home countries, with reproductive health and in vitro fertilization (IVF) treatments being particularly popular. The rising rates of infertility worldwide are prompting couples to explore alternative methods to fulfill their desire for children. According to the World Health Organization (WHO), one in six couples globally experiences infertility at some stage in their lives [18]. This growing issue has led to increased demand for IVF treatment on a global scale.
In this context, Turkiye has emerged as a prominent destination for health tourism in recent years, owing to its high success rates, modern medical facilities, and cost-effective health services. Turkiye, particularly appealing to patients from the Turkic world, excels in IVF tourism due to its geographical and cultural proximity to countries like Azerbaijan, Kazakhstan, Uzbekistan, Kyrgyzstan, and Turkmenistan [8]. Couples from these nations seek to enhance their chances of conceiving by opting for Turkiye's advanced healthcare services [9].
Several key factors contribute to the growth of IVF tourism. Firstly, Turkiye's IVF centers are renowned for their high success rates and adherence to international standards, making them a reliable choice for patients. The success rates of these centers are recognized globally, attributed to advanced technologies and skilled healthcare professionals [14]. Secondly, treatment costs in Turkiye are notably lower compared to Western Europe and North America, which is a significant draw for patients, especially those from the Turkic world [5]. However, Turkiye faces challenges in the IVF tourism sector, including legal restrictions and cultural differences related to IVF treatments. For instance, the prohibition on the use of donor eggs and sperm in Turkiye can limit
treatment options for some international patients [12]. Additionally, although relatively minor, language barriers and the economic difficulties faced by some patients can complicate the treatment process [15]. Despite these challenges, the increasing demand for IVF services from the Turkic world to Turkiye has the potential to boost the country's economic growth and enhance its position in the global health tourism market. To maintain its strong standing in IVF tourism, Turkiye needs to implement strategic measures.
Since this study aims to investigate the factors driving, challenges, and opportunities of IVF tourism from the Turkic world to Turkiye, the primary research questions are:
1. What factors influence patients from Turkic countries in choosing IVF treatment in Turkiye?
2. What legal, economic, and cultural challenges does Turkiye face in the IVF tourism
sector?
3. What strategic measures should Turkiye take to achieve sustained success and maintain its leadership in IVF tourism?
The study seeks to evaluate how Turkiye can more effectively leverage its potential in IVF tourism and address the current challenges. Additionally, it will assess the quality of medical services in Turkiye, its economic benefits, cultural compatibility, and the impact of legal regulations. This analysis will provide strategic recommendations to enhance Turkiye's competitiveness in health tourism [2].
Method:
This research will employ qualitative research methods, using a case study design. Qualitative research aims to explore the social worlds and life experiences of individuals, focusing on detailed insights into their feelings, thoughts, and behaviors rather than numerical data. This approach seeks to understand how people act and what they think within their social and cultural contexts through techniques such as observation, interviews, and document analysis. A key feature of qualitative research is its iterative and flexible nature, allowing for a deeper exploration of the subjects under study [1]. Additionally, qualitative research endeavors to explain social phenomena and individual experiences [13]. In this context, our research investigates the experiences and satisfaction levels of patients from the Turkic world who travel to Turkiye for IVF treatment. The case study design, commonly used in social sciences, offers detailed insights into a specific phenomenon or unit. It aims to derive general conclusions by thoroughly examining a single unit (event, individual, community, or group) [7]. Case studies facilitate a more comprehensive understanding by analyzing complex events in real-life settings [6]. Therefore, this research will utilize the case study design to thoroughly examine the experiences of IVF patients traveling to Turkiye.
Participant Group
The participant group for this study comprises 10 individuals who received in vitro fertilization (IVF) treatment in Turkiye between 2017 and 2023 and are from Turkic Republics, including Turkmenistan, Kazakhstan, Uzbekistan, Kyrgyzstan, and Azerbaijan. The study aims to explore IVF treatment experiences from a broad perspective, capturing the diversity among patients from these five distinct countries.
Participants were selected based on their residence in one of the five specified countries and their receipt of IVF treatment in Turkiye. To maintain confidentiality, each participant was assigned a code (P1, P2, P3, ... P10), and personal information was kept private. This coding system ensured the protection of participants' identities while facilitating the analysis and reporting
of the collected data. Consequently, the treatment processes and satisfaction levels of the participants were analyzed anonymously.
Table 1: Participant Demographics and IVF Treatment Details
Participant Age Country Treatment Success Status
P1 35 Uzbekistan successful
P2 22 Azerbaijan successful
P3 41 Uzbekistan unsuccessful
P4 27 Kyrgyzstan successful
P5 32 Kazakhstan unsuccessful
P6 26 Kyrgyzstan successful
P7 33 Azerbaijan successful
P8 28 Turkmenistan successful
P9 24 Uzbekistan successful
P10 29 Kazakhstan successful
Data Collection
In the data collection phase, the initial step involved reviewing academic research on IVF tourism, medical tourism, patient satisfaction, and in vitro fertilization clinics in Turkiye. This review encompassed both international and local academic articles, reports, and regulatory documents related to health tourism. Subsequently, detailed and semi-structured interviews were conducted with patients who chose Turkiye for IVF treatment. Semi-structured interviews, which incorporate both predefined and flexible questions, facilitate a comprehensive data collection process. This method enables the researcher to ask questions within a structured framework while also posing open-ended questions to gather in-depth responses.
This approach is particularly effective for exploring complex issues, as it allows researchers to delve deeper into topics and clarify participants' responses [17]. Semi-structured interviews are commonly used to gain a thorough understanding of participants' experiences, thoughts, and emotions [10]. During the interviews, discussions centered on patients' reasons for selecting Turkiye, challenges faced during the treatment process, and their levels of satisfaction or dissatisfaction following treatment.
Interview Questions
1. What factors influenced your decision to choose Turkiye for IVF treatment? This question seeks to identify the key factors that led patients to select Turkiye, including aspects such as cost, success rates, cultural compatibility, and language.
2. What were the major legal, economic, linguistic, or administrative challenges you faced in Turkiye during your treatment? This question aims to gain a detailed understanding of the obstacles patients encountered and the elements that complicated their treatment process.
3. Were you generally satisfied with your IVF treatment in Turkiye? Did the treatment meet your expectations? This question is intended to assess the overall satisfaction of patients with their treatment experience and whether their expectations were fulfilled.
4. How did cultural and linguistic adaptation impact your treatment process? In what ways did language or cultural differences affect your treatment? This question seeks to explore the influence of cultural and linguistic adaptation between Turkiye and the patients' home countries on their treatment experience.
5. How would you assess the health services provided by IVF clinics in Turkiye in terms of professionalism, treatment environment, and use of technology? This question is designed to gather patients' opinions on the quality of the clinics' services and technological resources.
6. How do you perceive the follow-up and support services you received after your treatment? Did these services meet your expectations? This question aims to evaluate the effectiveness of the support services provided post-treatment and whether they aligned with patients' expectations.
Data Analysis
Qualitative data typically comprises text or verbal information and may occasionally include visual elements [16]. In this study, the data was analyzed using thematic analysis. This technique involves identifying, examining, and interpreting themes or patterns of meaning within qualitative data, offering substantial flexibility in the analysis process [11]. Thematic analysis allows for the detection of recurring patterns (themes) in the data and is particularly useful for uncovering significant themes in complex datasets. It is notable for its ability to analyze data without relying on a specific theoretical framework, facilitating in-depth meaning extraction through data categorization, and is adaptable to various research approaches and disciplines [3, 4].
In this context, the data from patient interviews were coded to identify key themes emerging from each interview. These themes encompass reasons for choosing Turkiye, legal, cultural, and economic challenges encountered, and levels of satisfaction with the treatment process. Patient satisfaction data were analyzed to assess discrepancies between patients' expectations and their actual experiences. The analysis focused on factors influencing patient satisfaction during and after IVF treatment, including cost, success rates, service quality, and cultural adaptation. The findings will inform the development of strategic recommendations to better leverage Turkiye's potential in IVF tourism.
Findings
This study analyzed data from interviews with participants undergoing IVF treatment in Turkiye using thematic analysis. The table below highlights the primary themes and subthemes identified from the participants' responses.
Table 2: Themes and Subthemes of Participant Experiences with IVF Treatment in Turkiye
Theme Subtheme Participants (Codes) Sample Explanations
Factors Leading to Preference for Turkiye Excellent Success Rates and Advanced Medical Facilities P1, P2, P7, P9 "The IVF centers in Turkiye boast very high success rates and their technological infrastructure meets international standards."
Economic Benefits P4, P6, P8 "Treatment costs are affordable, and Turkiye offers more accessible options compared to other countries."
Cultural and Linguistic Alignment P2, P7, P9 "There were no language barriers, and I felt culturally at ease."
Challenges Faced During Treatment Legal Barriers P3, P5 "The use of donor eggs is prohibited in Turkiye, so I had to seek alternative options."
Economic Challenges P4, P6 "Expenses for accommodation and transportation exceeded my expectations."
Administrative Hurdles P7, P5 "The paperwork was time-consuming, which prolonged the overall process."
Patient Satisfaction Levels Satisfaction with Clinical Services P1, P6, P8 "The doctors and medical staff demonstrated high professionalism and expertise throughout the process."
Post-Treatment Follow-Up and Support P1, P2, P8 "The post-treatment support was excellent, with continuous monitoring even after the procedure."
Satisfaction with Treatment Results P1, P2, P4, P6, P7, P9 "The treatment was successful and the outcomes fully met my expectations."
Challenges Associated with Treatment Failures and Outcomes P3, P5 "I faced significant financial and emotional difficulties when the treatment did not succeed."
Factors Leading to Preference for Turkiye
Most participants cited high success rates and advanced medical facilities as primary reasons for selecting Turkiye for IVF treatment. Participants such as P1 and P9 highlighted that IVF centers in Turkiye offer world-class services and exceptional success rates, reflecting Turkiye's strong international standing in this field. Additionally, economic benefits were also a significant factor in choosing Turkiye. Participants like P4 and P8 noted that the cost of IVF treatment in Turkiye is more affordable compared to many other countries. This indicates that Turkiye's cost advantage in health tourism is a major draw for patients from Central Asia and the Turkic Republics. Furthermore, cultural and linguistic compatibility played a crucial role in the decision to choose Turkiye for IVF treatment. Participants such as P2 and P7 mentioned that the cultural and linguistic similarities in Turkiye made them feel more at ease during the treatment process, showcasing the unique benefit Turkiye offers to patients from culturally similar regions.
Challenges Faced During Treatment
Despite the advantages offered by Turkiye for IVF treatment, some participants reported encountering legal and economic challenges. Individuals like P3 and P5 noted that the prohibition on the use of donor eggs and sperm in Turkiye limited their treatment options, creating a barrier to meeting their expectations. Economic difficulties also emerged as a significant issue. Participants P4 and P6 pointed out that additional costs, such as those for accommodation and transportation, were higher than anticipated, adding a financial burden to the treatment process. This suggests that expenses beyond the cost of treatment can significantly impact IVF tourism. Moreover, administrative challenges also complicated the process for some participants. P7 and
P5, in particular, mentioned that lengthy insurance procedures contributed to delays and negatively affected patient satisfaction.
Patient Satisfaction Levels
Overall, participants expressed satisfaction with the IVF clinics in Turkiye. Participants P1, P6, and P8 praised the professionalism of the clinic staff and the quality of support services provided during the treatment. The availability of language support was particularly beneficial for patients facing language barriers. Satisfaction with post-treatment services was also high. Participants P1, P2, and P8 noted that the follow-up and support services provided after treatment contributed significantly to their overall satisfaction, reflecting the attentive care given by IVF clinics in Turkiye. However, participants P3 and P5 reported facing economic and emotional challenges in cases where the treatment was unsuccessful. This highlights the substantial impact of unsuccessful treatments on patients, emphasizing the need to consider the psychological and financial effects of such outcomes.
Discussion
This study explored the experiences of patients from Central Asian Turkic republics who traveled to Turkiye for IVF treatment, examining the challenges they faced and the benefits they gained. The findings highlight Turkiye's strengths and weaknesses in the IVF tourism sector and offer strategic recommendations for maintaining a leading position in this field.
Challenges
Legal Restrictions: Some of the legal regulations surrounding IVF treatment in Turkiye can be restrictive for international patients. Specifically, the ban on using donor gametes (eggs and sperm) poses a significant obstacle for those who rely on these methods in their home countries. This restriction forces some patients to seek alternative destinations for treatment. Participants P3 and P5 noted that these legal constraints were major issues during their treatment and adversely impacted their success rates. Additionally, regulations such as marriage and age limits further complicate access to treatment for certain patients in Turkiye.
Economic Difficulties: Although Turkiye offers more competitive prices for IVF treatment compared to Western Europe and North America, some patients reported that additional expenses, such as for accommodation, transportation, and medications, create a financial burden. These supplementary costs can strain patients' budgets, particularly in long-term treatment scenarios. Participants P4 and P6 highlighted how these extra expenses pressure their finances. This suggests that such costs can negatively influence patient satisfaction.
Administrative and Bureaucratic Problems: The study also identified several administrative and bureaucratic hurdles faced by patients undergoing IVF treatment in Turkiye. Issues with paperwork, insurance processes, and obtaining necessary documents were noted as factors complicating access to treatment. Participants P7 and P5 observed that lengthy paperwork extended the treatment process, which can diminish patient satisfaction. These bureaucratic challenges are significant barriers that need addressing.
Opportunities
Growth Potential: Turkiye possesses considerable growth potential in the IVF tourism sector. To fully capitalize on this, it is essential to introduce more flexibility in legal regulations. Reviewing restrictions on donor eggs and sperm, streamlining documentation processes, and expanding health tourism packages can attract more international patients. Comprehensive packages should include accommodation, transportation, and consultancy services to enhance their appeal.
Cultural and Linguistic Adaptation: The cultural and linguistic similarities with the Turkish world offer a significant advantage in IVF tourism. Participants noted that they felt at ease and did not experience language barriers during their treatment. Participants P2, P7, and P9 highlighted this linguistic and cultural harmony as a key factor in their comfort during treatment. Leveraging this advantage can enhance Turkiye's attractiveness to patients from Central Asia and other Turkic countries.
Technological Advancements: Turkiye's IVF centers are distinguished by their modern technology and specialized medical professionals. The country's high success rates are bolstered by these technological investments. Participants P1 and P9 emphasized that Turkiye's advanced medical infrastructure positively influences treatment outcomes. Continuing to invest in and advance these technologies will further solidify Turkiye's position in the health tourism sector.
Future Perspectives
For Turkiye to secure a sustainable leadership role in IVF tourism, it must reassess its legal frameworks and enhance strategies for attracting international patients. Strengthening health cooperation with the Turkic world can increase patient numbers from these regions. Collaborative health projects and educational programs can fortify Turkiye's connections with Central Asia and facilitate patient flow. Additionally, streamlining bureaucratic processes and expediting paperwork will be crucial for boosting patient satisfaction.
While Turkiye has significant potential in IVF tourism, overcoming existing challenges is essential for fully realizing this potential. Improving legal and administrative regulations will reinforce Turkiye's leadership in the sector and enhance its competitiveness in global health tourism.
Conclusion
This study evaluates the strengths and weaknesses of Turkiye in the context of IVF tourism, focusing on the experiences of patients from Central Asian Turkic countries such as Azerbaijan, Kazakhstan, Kyrgyzstan, Uzbekistan, and Turkmenistan. The results highlight that Turkiye's high success rates, modern medical infrastructure, and competitive costs are key factors making it a desirable destination for these patients. Central Asian patients have noted that IVF clinics in Turkiye offer world-class services at accessible prices. Additionally, the cultural and linguistic similarities between Turkiye and these countries have contributed to a comfortable treatment experience for patients.
However, challenges such as legal restrictions, particularly the prohibition on using donor eggs and sperm, and inefficiencies in bureaucratic processes, present significant obstacles for some patients. These legal barriers have led some to seek treatment elsewhere. Furthermore, additional costs, including those for accommodation, transportation, and medications beyond the treatment itself, have been financially burdensome.
In summary, while patient satisfaction among those from Azerbaijan, Kazakhstan, Kyrgyzstan, Uzbekistan, and Turkmenistan remains high, Turkiye must address legal and bureaucratic issues, enhance the affordability of health packages, and streamline administrative procedures to sustain its leadership in IVF tourism. Expanding services that cater to cultural and linguistic needs will further support Turkiye's growth in this sector by attracting more patients from Central Asian countries.
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