Patient pressure: is the tide of cross-border reproductive care beginning to turn?

Abstract

Two important explanations exist for cross-border reproductive care: restrictive legislation at home and limited access to affordable treatment. Both have recently been subject to patient pressure, favouring domestic and not cross-border services. The oppressive effect of regulation has been best illustrated in Italy, where legislation introduced as Law 40 in 2004 imposed restrictions on embryo freezing and embryo selection. After a decade of legal challenges by patients, the components of Law 40 have now been deemed unconstitutional in Italy. Similarly, a paucity of donor gametes in the UK has left many patients with few options but to seek donors and treatments overseas. Yet new techniques of donor recruitment and a revised allowance of compensation now means that some UK clinics can meet all requirements for donor gametes and patient matching from their own resources.

Societal pressures and procreative preferences for gay fathers successfully pursuing parenthood through IVF and gestational carriers

“…CBRC is a rapidly growing practice where individuals seek ART treatment outside their home country (Carone et al, 2017;Igareda Gonzalez, 2019;Pinto et al, 2018). CBRC poses considerably more ethical and legal challenges than American treatment, particularly in countries such as Italy and Germany which have banned surrogacy completely (Shenfield et al, 2010), while the USA (Hughes et al, 2016), India (Inhorn and Patrizio, 2012), and Ukraine (Ahuja, 2015) place few restrictions on commercial surrogacy but fully enforce gestational surrogacy contracts in most states or territories. When patients seek treatment abroad, it is difficult to ensure their medical safety, prevent undue coercion for gestational carriers, and establish children's parentage and citizenship status (Pinto et al, 2018;Tendais and Figueiredo, 2016).…”

Vitrification and the demise of fresh treatment cycles in ART

“…It was significant that the legal challenges to Italy's Law 40 came not from doctors but from patients, and significant too that Court rulings were made in the interests of patients and not of the Italian lawmakers. Such patient pressure was similarly evident in the UK when the regulatory authority sought to resolve anomalies in gamete donation first by public consultation (in 2011) and later by a change in regulation (Ahuja, 2015). Until then, the UK had been critically unable to meet its own patient demands for donor spermatozoa or donor eggs, with the result that donor spermatozoa were almost exclusively imported and donor eggs only plentifully available in Spain, Cyprus, Ukraine and Czech Republic.…”

Cross border reproductive care (CBRC): a growing global phenomenon with multidimensional implications (a systematic and critical review)

“…In addition, traveling abroad to receive aggressive fertility treatmentsinashortperiodoftimemayresultinahigherriskofmedical side effects and complications. Traveling patients are often unable to receive standard medical care and second opinions due to time pressures, making them at risk for potential harm [92,93].…”