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Tackling issues in cross-border reproductive care

18 May 2009
By Professor Eric Blyth
Professor of Social Work, University of Huddersfield and Visiting Professor of Social Work, Hong Kong Polytechnic University
Appeared in BioNews 508
What we currently know about cross-border reproductive services derives primarily from anecdotal patient accounts shared on the Internet and reports provided by journalists - often working 'undercover' and posing as patients. The nefarious character of some services under investigation, alleging illegal activities (1,2) and exploitation of young women as egg donors (3,4), mean that these are among the least likely to be amendable to systematic empirical research and verification.

More recently, in the UK at least, research has been undertaken to identify the cost to home country health services of providing care to mothers and babies when treatment provided elsewhere involves the transfer of more embryos than are permitted in the home country (5). Recent surveys of the experiences of patients who have undertaken cross-border reproductive care have also indicated that at least some consider they were exploited by unscrupulous service providers; although the majority of patient reports in these surveys indicate positive rather than negative experiences - especially when compared with previous encounters with services provided in their home country (6, 7). Two key and inter-related findings from patient accounts are that the Internet is a significant source of information about reproductive services in other countries and that in most instances patients make their own arrangements with service providers in destination countries. As is always the case, the quality of information on which decisions are made is all-important and, in the case of cross-border reproductive services, the sheer volume of information available on the Internet, the pace at which this information changes, and the difficulty in verifying it, may service to disempower rather than empower patients. For example, a 'Yahoo' search undertaken on 18 April 2009 for this piece identified 11,100,000 websites for 'sperm donation', 5,400,000 for 'IVF clinics', 4,090,000 for 'surrogacy', and 3,600,000 for 'egg donors'.

A further key group of individuals whose interests are also affected by cross-border reproductive care are the children conceived as a result of services provided. Currently nothing is known at all about these children, and so any concerns about their welfare must remain speculative, although we are aware anecdotally of concerns expressed by some parents who sought donor services in another country who are seeing in their growing children unanticipated physical characteristics suggesting, at the very least, that the ethnic origins of their child's donor might not be what they originally thought. As these children grow up, whatever their parents' initial intentions, it will be impossible to avoid talking to their children about their origins. And, as concerns are articulated about the possible exploitation of donors, donor-conceived people are quite likely to be troubled if they have reason to think their conception was potentially founded both on donor exploitation and donor misinformation.

Three key characteristics of many countries that have become popular destinations for cross border reproductive services are: first, the lack of regulation affording adequate protection for the parties most directly affected, i.e. donors, surrogates, patients and children; second, the operation of a commercial market in human gametes - especially eggs - and women's gestational services; and third a level of secrecy that helps to conceal unprofessional, unethical and illegal practices.

However, some efforts are now underway to develop trans-national responses to address a problem that cannot be resolved by jurisdictions or professional organisations working alone. In 2005, the European Parliament adopted a resolution banning trade in human cells and embryos (8). In 2008, the International Consumer Support for Infertility (iCSi) produced an information leaflet available online for anyone considering travel to another country for reproductive care (9). Also in 2008, ESHRE (European Society of Human Reproduction and Embryology)'s Task Force on Ethics and Law produced a statement on cross-border reproductive care (10), while ESHRE also began work to investigate and collate members' experiences of cross-border reproductive care. In 2008 the International Federation of Social Workers (IFSW) became the first world professional body to issue a global policy which, among several recommendations, calls for national regulation in all jurisdictions to safeguard the interests of patients, donors, surrogates and children conceived as a result of cross-border reproductive services (11). In January 2009 the first International Forum on Cross-Border Reproductive Care, hosted by the Canadian government, brought together, for the first time, national regulators, representatives of national and international professional bodies and consumer groups, the European Union and the World Health Organisation.

Tackling the 'unacceptable face' of cross border reproduction is no easy task. However, it is to be hoped that these initial steps will mark a distinct beginning to rise to the challenge.

01) Foggo, D. and Newell, C. (206) Doctors offer illegal baby sexing: Couples pay £12,000 to get child of choice [accessed 23 April 2009].
The Sunday Times |  5 November 2010
02) McBeth, C. (2008) Parents queue to select baby gender [accessed 23 April 2009]
BBC News Online |  29 October 2008
03) Abrams, F. (2006) The misery behind the baby trade [accessed 23 April 2009].
Daily Mail |  17 July 2006
04) Barnett, A. and Smith, H. (2006) Cruel cost of the human egg trade. The Observer. 20 April.  [accessed 23 April 2009]
The Observer |  20 April 2006
05) McKelvey A., David, A., Shenfield, F. and Jauniaux, E. (under review) The impact of cross-border reproductive care or 'fertility tourism' on NHS maternity services. Fertility and Sterility
|  23 January 2022
06) Infertility Network UK (INUK) (2008) The Infertility Network UK Fertility Tourism Survey Results. 2008. Infertility Network: Bexhill-on-Sea.
|  23 January 2022
07) Blyth, E. (2008) Fertility Patient's Experiences of Cross-Border Reproductive Health Care. Report to Assisted Human Reproduction Canada.
|  23 January 2022
08) European Parliament (2005)
|  23 January 2022
09) International Consumer Support for Infertility (iCSi) Travelling abroad for assisted reproductive technology (ART) treatment. 2008
|  23 January 2022
10) Pennings, G., de Wert, G., Shenfield, F., Cohen, J., Tarlatzis, B. and Devroey, P [ESHRE Task Force on Ethics and Law] (2008) Cross-border reproductive care. Human Reproduction. 23:2182-2184.
|  23 January 2022
11) Blyth, E. and Auffrey, M. (2008) International policy on cross border reproductive services. International Federation of Social Workers policy statement in Geneva
|  23 January 2022
29 November 2010 - by Dr Vivienne Raper 
Are European airlines bursting with 'fertility tourists' risking their health by travelling abroad? Do most people seeking fertility treatment overseas fit the media stereotype - white, middle-class career women over 50? Does cross-border reproductive care (CBRC) include eggs imported from abroad? Dr Françoise Shenfield and Professor Lorraine Culley tried to answer these questions during the first session of last Wednesday's Progress Educational Trust (PET) annual conference...
15 March 2010 - by Ailsa Stevens 
A donated human egg will be raffled on Wednesday to mark the launch of a new IVF service which helps UK women to access egg donation services in America. The new service, offered by the Bridge Centre in London, will allow patients to select egg donors on the basis of characteristics such as racial background, health, education and appearance....
4 November 2009 - by Ben Jones 
US company 'The World Egg Bank' has signed a deal with IVI fertility clinics in Spain to provide US consumers with 'IVF vacations' to Spain. The company, which provides the world largest online registry of egg donors, specialises in services involving the extraction, storage and sale of cryopreserved eggs. The company touts the tours as costing the same or less than the price of IVF in the US but with the added benefit of a vacation in Alic...
21 September 2009 - by Ailsa Stevens 
British couples travelling abroad to take advantage of commercial surrogate arrangements are engaging in a form of 'exploitation', Professor Naomi Pfeffer, an expert in the ethics and regulation of controversial developments in medicine, said at a fertility meeting this week....
1 September 2009 - by Dr Francoise Shenfield 
As a clinician based in the UK, one cannot fail to be aware that some patients seek fertility treatments abroad. Until now we only had newspaper headlines or anecdotal evidence, but having presented the results of the first European study in Amsterdam at the annual ESHRE conference (1), we may now base our reflections on some facts, even if selected by the voluntary nature of participating colleagues and centres abroad....
22 September 2008 - by Sarah Pritchard 
A report has indicated for the first time the cost faced by the UK's National Health Service (NHS) as it copes with multiple births resulting from IVF patients treated abroad. New research undertaken by the Fetal Medicine Unit at University College London Hospital (UCLH) makes a link...
26 August 2008 - by Professor Guido Pennings 
The European Society for Human Reproduction and Embryology (ESHRE) has been concerned about the development of cross-border infertility treatment for some time. There are three reasons for this: the frequently negative publicity for infertility treatment presented as 'reproductive tourism', the increasing numbers and the risks for patients. ESHRE has taken...
21 July 2008 - by MacKenna Roberts 
An overwhelming majority of infertility patients in the UK said they would contemplate travelling abroad for fertility treatment, according to the first comprehensive study on the strength and motivations behind the fertility tourism industry. Among the 339 infertile patients who responded to an online poll conducted by...
5 February 2007 - by MacKenna Roberts 
An AP/Washington Times report has revealed that the market for fertility treatment tourism is booming as a solution to egg donor shortages, high private clinic costs and restrictive donor anonymity laws. More permissive nations are taking a cottage industry approach to promote fertility services that are...
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