Iranian ART providers perceptions of third party reproduction and fertility tourism
Ethical challenges in reproductive donation tourism: A qualitative study of clinicians’ perspectives in Iran. (Sarafraz, 2026)
Sarafraz, N., & Ghafoori, F. (2026). Ethical challenges in reproductive donation tourism: A qualitative study of clinicians’ perspectives in Iran. BMC Medical Ethics. Advance online publication. https://doi.org/10.1186/s12910-026-01547-8
Geographic Region: Tehran, Iran
Editor’s Note: Iran is both an origin and a destination country for reproductive tourism. Iranian citizens travel abroad specifically to circumvent Iran's own restrictions on who can access ART. Inbound individuals often choose Iran because it is comparatively low-cost in the region.
Research Question: What ethical challenges do clinicians in Iran perceive in cross-border, donor-assisted reproductive tourism?
Design: Qualitative descriptive study. Researchers conducted 22 semi-structured, in-depth, face-to-face interviews with clinicians and policymakers between January and October 2025. The interview guide moved from broad opening questions to more detailed probes about overlapping normative frameworks in gamete and embryo donation, including formal state regulations, religious interpretations (fiqh), and institutional practices within ART centers. It was not designed to systematically analyze formal legal texts or religious rulings, only to capture how clinicians perceive and interpret them.
Sample: 22 Iranian clinicians and health-system policymakers. Fifteen participants (68%) were women and seven (32%) were men. Most were mid-career: 36% were aged 30–40, 46% were aged 40–50, and 14% were aged 50–55. Represented disciplines included medical ethics, general medicine, reproductive biology (PhD), reproductive health (PhD), gynecology/infertility, embryology, urology, midwifery, and nursing. Sixteen participants (71%) worked as ART clinicians and six (27%) were policymakers, most of the latter recruited through the Ministry of Health. Recruitment ran through official university and Ministry channels rather than public advertisement or snowball sampling
Key Findings
Legal and Structural Heterogeneity Between Countries - Almost all participants described the gap between Iran’s own rules and those of other countries as a central force shaping reproductive tourism. For example, individuals might decide to leave or come to Iran for reproductive care based on differing rules about who counts as an eligible recipient or differing age restrictions for who can receive services. Beyond the decision to travel, participants pointed to legal differences that led to patient misunderstandings, legal objections, and complaints in the source country. Most participants highlighted that lack of coordination and shared standards between countries limited the reliability of collected data.
Clinical Uncertainty and Physical/Genetic Concerns - Most participants described an absence of standardized clinical protocols within Iran itself. Participants described disagreement between centers on basics such as how many gametes can be received from one donor and donor screening criteria, which they said complicate clinical decision-making and can undermine patient confidence in the treatment process. Participants also mentioned concerns about egg donor safety, repeated donor use, and sex-selection biases.
Synergistic Moral, Psychological, Identity, Social, and Cultural-Religious Implications and Secrecy - Most participants described a layered stigma, with infertility, third-party reproduction, and “tourism” each carrying separate social weight. That pressure showed up in specific anecdotes: a Ministry of Health manager described donor-conceived adults learning the truth only after a parent’s death or through family conflict, and a clinician described a family rejecting a mother and child after a surrogacy arrangement became known. Participants distinguished parents’ anxiety about disclosure from a separate, sometimes competing, concern about the child’s own right to know their origins. Religious ambiguity added a layer specific to the Iranian context, such as uncertainty about a donor-conceived child’s mahram status and tension when Iran’s emphasis on preserving lineage (nasab) runs up against the anonymity or non-anonymity rules of whichever country a family used.
Justice, Commodification, Exploitation, and Demand - Participants described Iran’s position in a global fertility market shaped by economic inequality running in both directions. Iranians with more money can bypass domestic restrictions in ways lower-income couples cannot. Cheaper treatment in Iran draws foreign patients, particularly from Arab countries, competing for the same limited clinical resources local patients rely on. Some participants raised concerns about the exploitation of economically disadvantaged women as donors or surrogates, including one account of a husband repeatedly bringing his wife in to donate against her own stated wishes so that he could collect payment.
Ultimately, most participants described fertility tourism in positive terms and did not call for restricting it further, framing it instead as an ethically fraught but practically necessary path to parenthood for people who would otherwise have none.
Limitations: The study does not provide a legal or jurisprudential analysis of Iranian reproductive law; it reflects clinicians’ interpretations of how state law, Islamic jurisprudence, and institutional practice interact in daily practice, which may not align with formal legal or religious authority.
Applications: The authors call for standardized clinical protocols, independent donor/recipient counseling, harmonized cross-border legal and data frameworks, and interdisciplinary collaboration among clinicians, legal scholars, bioethicists, and policymakers.
Funding Source: No funding was provided for this research.
Lead Author: Nasrin Sarafraz holds a PhD in Reproductive Health from Tehran University of Medical Sciences and is affiliated with the Faculty of Nursing and Midwifery at Islamic Azad University, Larestan, Iran. No personal connection to donor conception was disclosed.
Regulatory Context
The Ministry of Health and Medical Education oversees ART centers; the Act on Embryo Donation to Infertile Couples (2003) and its 2005 bylaw are the only dedicated statutes, supplemented by religious rulings (fatwas) that carry practical legal weight in the absence of codified law. This includes a ruling by Ayatollah Khamenei permitting third-party gamete donation.
Egg and embryo donation are accepted, primarily through religious ruling rather than statute; sperm donation is more religiously contested. Embryo donation is the only form with a dedicated statutory basis.
Non-commercial (altruistic) donation is required; payment for gametes beyond expense reimbursement is prohibited, though the extent of enforcement is not well documented.
Donor anonymity is legally mandated. Fertility centers must keep donor and recipient identities confidential, and there is no legal mechanism for donor-conceived individuals to access identifying donor information.
Access to donor-assisted ART is limited to legally married heterosexual couples. Single individuals and LGBTQ+ people are not legally entitled to donor-assisted reproduction in Iran.
Related Posts