Travelling abroad for fertility treatment: an exploratory study of UK residents seeking cross-border care

Introduction: Cross border reproductive treatment has provoked extensive commentary, ethical debate and media speculation. There is however, little published empirical data on the extent of this phenomenon, the reasons why people undertake cross border treatment and their experience of it. A survey of clinics in Belgium reported that the desire to evade legal restrictions in their home country was the main motivation for patients accessing treatment in Belgium. However, few UK patients were included in this sample. An unpublished study of 6 European countries by an ESHRE taskforce also suggested that most patients cross borders because of 'legal' restrictions in their home countries. However, given the differing legal and regulatory contexts and availability of publically funded IVF, the driving forces for cross-border care will vary from country to country. This paper reports preliminary data from an ESRC funded qualitative study (http://www.transrep.co.uk/), which aimed to explore the motivations, understandings and experiences of UK based individuals who travel abroad for assisted reproductive treatment (RES-000-22-3390). Methods and Materials: The study includes in-depth, audio-recorded interviews with a purposive sample of people travelling abroad from the UK for fertility treatment, and interviews with key informants (clinicians, counsellors and support group representatives). Participants were recruited via online support forums, British and overseas clinics, support group mailings, snowballing, and through media coverage of the project. The participants were asked about their experiences of treatment in the UK, their motivations for travelling abroad, their decisions about which clinics to use, the treatments undertaken overseas, the level of information, care and support received both in the UK and abroad, their concerns about undertaking treatment abroad, disclosure of treatment, media representations, regulation of treatment in the UK and overseas, donor anonymity and payment and attitudes to adoption. Results: This paper is based on data from interviews with 48 participants (n = 38 women, n = 10 men) who had travelled (n = 41) or planned to travel (n = 7) outside the UK for fertility treatment. We present the findings relating to demographic characteristics of these participants, including age, ethnicity, marital status, sexual orientation and occupational level. The presentation discusses the experience and length of fertility treatment in the UK before going abroad; the complex and dominant reasons for seeking treatment abroad; specific routes of accessing overseas clinics; countries visited and forms of treatment received. We also comment on the level of satisfaction of patients who accessed cross border treatment. Conclusions: Given the highly variable national differences in the social and legal context of fertility treatment, the extent of cross-border travel and the motivations of those undertaking it are likely to vary considerably according to country of origin. In contrast to the survey of Belgian clinics, our UK data suggest that legal restrictions on forms of treatment or restrictions on categories of people who may access treatment are not major motivating forces for patients seeking treatment overseas. The UK has a strong regulatory framework for fertility treatment, coupled with a relatively liberal access policy to self-funded treatment, but limited availability of NHS care. A shortage of egg donors, the consequent perceived waiting times for treatment and issues of cost were more significant drivers. Contrary to media reports of 'fertility tourists', many of our participants had decided to travel abroad following a long infertility journey in the UK and this was reported to be a 'last chance' to have a child, although some had delayed motherhood for a variety of reasons. Despite some initial concerns about quality and safety, many interviewees reported a high degree of satisfaction with their experience of cross border care.