Cross-border reproductive care is becoming more widespread, but is fraught with safety concerns. We at the European Society of Human Reproduction and Embryology (ESHRE) have no objection to patients seeking reproductive treatments outside their home country because it enhances their autonomy and allows free patient movement in Europe. But to protect patient safety, we believe there should be a Code of Practice (COP) to protect patients, donors and potential surrogates.
Why is a COP necessary? First, there is evidence that women who had fertility treatment abroad are less likely to have a selective reduction with triplets than women treated at home (1). Second, patients who seek treatment away from home and the donors and surrogates who make their treatment possible may fall prey to various pressures. For patients, these may include pressure to replace more than two embryos; use ICSI when a partner's sperm is normal; or change from a partner's to donor sperm without implications counselling for infertility. Sometimes this only becomes apparent when people finally return to the listening ear of their home practitioner.
This isn't to say most fertility treatment abroad is performed to dubious standards. Most cycles are conducted with the care enshrined in UK legislation (including the offer of counselling and taking into account the future child's welfare) and in the manner recommended by ESHRE's 'Good Practice Code'. But too many adverse reports sully the reputation of the profession as a whole and this must stop. ESHRE is not alone in this endeavour to improve patient safety - we are backed by the International Federation of Fertility Societies (IFFS) and International Federation of Gynecology and Obstetrics (FIGO).
Note that I am also very careful never to use the term 'fertility industry', which is sadly rather telling. If we fertility specialists are branded an 'industry' by some, it must mean the image we sometimes give is a money-making machine, not a professional medical group working to standards. This is yet another reason for a COP that colleagues can sign up to when it is published. Our COP will, hopefully, be approved in November and may well receive its first official airing at Progress Educational Trust's (PET) conference "Passport to Parenthood: The Evidence and Ethics Behind Cross-Border Reproductive Care" on the 24th November this year.
Although our ideal is fair access for fertility treatment in their home country, we hope the COP will provide guidance for fertility centres and physicians. We also hope it will encourage and help regulators and policymakers create a legal framework to enable centres to abide by these rules. Along with ensuring high-quality ART (assisted reproductive technology) treatment and the prevention of multiple pregnancies, the COP will cover important principles like the equity, efficiency, effectiveness, timeliness and patient-centredness of care. For instance, it discusses ensuring equity for travelling patients, perhaps by applying similar protocols, counselling and fees to those received by domestic patients.
Finally, I have some exciting news to report. In view of the lack of published evidence on the demographics, motivation and compensation of egg donors in Europe, the ESHRE Taskforce on Cross-Border Reproductive Care is planning another study in several European countries favoured by (mostly) European patients. The protocol is being finalised right now, and we hope to report within the next 12 months. Watch this space!
Sources and References
1) McKelvey A, David AL, Shenfield F and Jauniaux ER The impact of cross-border reproductive care or 'fertility tourism' on NHS maternity services