Your growth comes from abroad. Almost no one knows why.

Picture this: a 41-year-old woman in London writes to three clinics, in Barcelona, Valencia and Alicante, at 10:40 on a Tuesday night. She has had two treatments at home that did not work. She asks about egg donation, about timing and about how many times she will have to travel. One of the three replies that same night, in fluent English. The other two reply the next day, with a standard template.

If she chooses your clinic, she will start treatment a few weeks later. And it is very likely that no one will record anywhere why she chose Spain. That is not a guess: in the 2023 national registry, for 90.4% of the cycles of patients living in another country, no reason is recorded.

The growth does not come from more cycles.

According to the DBK sector observatory, private centres specialising in assisted reproduction earned €685 million in 2025, 5.1% more than the year before, within a total market of around €1 billion. In March 2026 there were 265 centres, around 65% of them in Catalonia, Andalusia, Madrid and the Valencia region, and the ten largest operators held 69% of the market in 2024.

The important part is the explanation. Revenue is rising because the average cost per treatment is rising, while the number of cycles is levelling off. DBK describes cycles for Spanish patients as stagnating, with possible saturation of the domestic market, and demand from foreign patients as dynamic. Put simply, the volume missing at home is arriving from abroad.

Who comes from abroad.

The Spanish Fertility Society’s registry records 168,372 in vitro fertilisation cycles and 30,464 inseminations for 2023. Of these, 34,849 were for patients resident in other countries, close to one in six by my calculation. More than half of those cycles, 53.4%, involved egg donation. By origin, France accounted for 38.3%, Italy for 19.2%, the United Kingdom for 8.1% and Germany for 7.3%. The society itself estimates that around 20% of the births achieved with these techniques took place outside Spain.

What no one writes down.

This is the blind spot. Of those 34,849 cycles, only around 3,350 record why the patient came to Spain. For the other 31,499, the field is empty. With so few cases, no firm conclusion is possible, but what is there contradicts a widely held idea. The most frequent reason is to improve the quality of treatment after failed attempts, with 1,062 cycles. Then come waiting lists or proximity, with 533, and a technique that is illegal in the patient’s own country, with 509. Price appears in 300.

If patients from abroad came mainly for price, a promotion would be the best advertisement. The little data that exists points elsewhere: they come for a second chance, to avoid waiting or to do what their own country does not allow. That is won with trust, clear information and a fast reply in their language, not with a discount.

A clinic that does not know why it is chosen will not know why it stops being chosen.

Where I stand.

I would not lower the price to attract the patient from London. I would ask her why she is coming, in her language, from the first message, and keep the answer with the care that health data requires. After a year of answers, a clinic knows what to say on its website, which languages to serve first and what it has to settle before the patient travels. The market is no longer growing in the number of patients. It is growing in what each patient decides to trust you with.

What I would check.

• The first reply. In which language, and at what time, your clinic answers someone writing from Paris, Milan or London.
• The missing question. Why Spain, and why now, asked tactfully in the first conversation rather than in a twenty-field form.
• The whole journey. How many trips are needed, what can be done remotely and who answers once the patient is back home.
• The total cost, explained. What the price includes, what it does not and when each part is paid, so that nothing comes as a surprise.
• Your own records. What you report to the national registry, and what you could learn by filling in the reason field.

Where to start.

1. This week

   Count

   How many enquiries last quarter came from outside Spain, and from which countries.

2. This month

   Ask

   Add the question of why to the first conversation and record the answer.

3. This quarter

   Walk the journey

   Follow, message by message, what a patient from abroad experiences from the first enquiry to follow-up at home.

4. Every year

   Compare

   Set what your patients tell you against the national registry, and adjust the website and the languages.

Before you close this page, try answering from memory. From how many countries did patients write to you last year? How many of them made it to the first consultation? And why did the others drop away?

If all three answers are numbers, you have something few clinics have. If they are impressions, the question of this note stays open in your own clinic: your growth comes from abroad, but do you know why?

If you would like me to review how your clinic receives the patient who writes from another country today, start with the Strategic Diagnostic. What may be asked and stored about a patient’s health is for your data protection officer to decide, not a designer.