Fertility Tourism. Dr Karen Buckingham. National Women s Annual Clinical Report Day August 2013

Transcription

1 Fertility Tourism Dr Karen Buckingham National Women s Annual Clinical Report Day August 2013

2 Cross Border Reproductive Care refers to the activity surrounding patients who travel outside of their country of domicile to seek assisted reproductive services and treatments

3 Cross Border Reproductive Care Growing international phenomenon Global hubs of CBRC Belgium initially ICSI, now wide range of ART services Israel IVF Spain oocyte donation Denmark sperm donation India commercial gestational surrogacy USA PGD + sex selection Emergence of CBRC Brokers

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8 Reasons for CBRC To circumvent legal restrictions on treatment in the home country Restrictions on patient age, marital status and sexual orientation Desire for anonymous gamete donors Prohibitions on embryo freezing/gamete donation/surrogacy Prohibitions on PGD/sex selection Resource considerations Availability of treatment/gametes/cost issues Desire for privacy or cultural comfort in a destination country

9 Incidence of CBRC Relatively little is known about the scope of CBRC; lack of an international reporting system Estimated that at least 20,000 25,000 couples receive fertility treatment abroad each year Kovacs 2010

10 Incidence of CBRC in NZ Estimated 1 2 couples/week travel outside of NZ for ART treatment Main reason for travel seems to be the shortage of donor gametes in NZ Increasing use of/demand for CBRC could lead to future dilemmas for providers and patients

11 Implications of CBRC Patients Generally high levels of satisfaction with CBRC Concerns: Added practicalities of travel/costs to the difficulties and stress of undertaking ART treatment Lack of counselling offered by crossborder clinics Differing levels of safety and quality of care between clinics outside; fragmented care May result in patient s making dumb decisions

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15 Implications of CBRC Donors and Surrogates Paucity of data Payments for egg donation/surrogacy may temporarily raise their economic status Concerns: Potential exploitation/stigmatisation Possibility of permanent physical, social or psychological harms Lack of regulation on donor and surrogate recruitment Little counselling offered

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19 Implications of CBRC Resulting Children No empirical evidence yet on experiences of individuals born as a consequence of CBRC Concerns: Increased morbidity/mortality associated with multiple pregnancies Offspring who are the result of gamete donation abroad may have less access to information about their genetic origins than donor conceived children produced by domestic arrangements

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23 Implications of CBRC Destination Country Health Care Systems Increase tourism numbers/help destination country s economy Concerns: Possibility of fertility services being stretched and diverted away from home patients. May drive up the price of ART to the detriment of local citizens. Lack of adequate patient follow up; those who provide the care usually do not see the patient subsequently

24 Implications of CBRC Home Country Health Care Systems Greatest concern is the increased risk of multiple pregnancy due to the lack of restrictions on number of embryos transferred in some countries; and the resulting increased health risks and costs Lack of documentation +/ communication with the treating clinic makes diagnosis of complications more difficult Who manages and pays for any complications of treatment?

25 The NZ Situation What we can and can t do

26 HART Act 2004 Key law that regulates assisted reproductive technology and human reproductive research in NZ

27 Currently permissible in NZ. Egg, sperm, embryo, ovarian tissue freezing Egg, sperm, embryo donation Surrogacy But known donors, altruistic/non commercial, family number limits

28 Summary CBRC is a widespread growing phenomenon NZ ers undertaking CBRC need to consider the full implications We can be proud of our current legislation and guidelines in NZ but are aware it is an evolving field

29 Thank you