Increasing numbers of people are travelling abroad for PGD, according to the first study of the provision and regulation of PGD to encompass the whole of the European Union. The study was led by James Lawford Davies, a solicitor who also lectures in law and medicine at Newcastle University. He presented his findings in Lyon, France at the annual meeting of the European Society of Human Reproduction and Embryology (ESHRE).
The study was launched by the European Commission, in the wake of an earlier initiative organised jointly by ESHRE, the European Society of Human Genetics, and the Institute for Prospective Technological Studies of the European Commission's Joint Research Centre. This earlier initiative found that little was known about the extent to which people travel seeking PGD, or about the regulatory context and consequences of such travel. Davies and his colleagues set out to clarify the situation.
PGD involves the genetic testing of an IVF embryo at the 3-5 day stage, to identify those free from a particular genetic disorder. The team found that the principal reason why couples travel to receive PGD is because it is prohibited in their home country and permitted in their destination country, although factors such as the cost, quality and availability of PGD - which vary widely between EU countries - also play a part. The country that received the greatest number of PGD patients from abroad was Spain, followed by Belgium, the Czech Republic and Cyprus.
It emerged that doctors are sometimes reluctant to provide information about PGD clinics in other countries. One reason for this is that in countries where PGD is legally prohibited (Germany, Ireland and Switzerland), it is unclear whether referral to PGD clinics abroad is prohibited as well - some doctors assume that it is, whereas others assume the opposite. There may even be an 'inverted referral' process, whereby patients contact PGD clinics abroad and these clinics then approach the clinics in the patient's home country in order to obtain relevant information. Further confusion arises from the apparent inconsistency of prenatal testing and termination of pregnancy being permitted in countries where PGD is prohibited.
It may fall to patients to identify suitable PGD clinics by themselves, in which case they may lack the advice, support, monitoring and follow-up that are widely considered to be essential complements to PGD. Also of concern is the fact that quality assurance for PGD testing is insufficient in any case, with only a minority of clinics participating in external quality assessment schemes, and few clinics meeting the requirements of the EU Human Tissue and Cells Directive. But Davies and his colleagues remain hopeful that once this directive is fully implemented, it will go some way towards addressing the problems and challenges identified in their study.