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McLean L, Ros ST, Hollond C, Stofan J, Quinn GP. Patient and clinician experiences with cross-border reproductive care: A systematic review. PATIENT EDUCATION AND COUNSELING 2022; 105:1943-1952. [PMID: 35339328 DOI: 10.1016/j.pec.2022.03.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 03/15/2022] [Accepted: 03/16/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES This review analyzes the experiences of patients and clinicians with regards to international cross-border reproductive care (CBRC) for the purpose of conception. METHODS Electronic databases PubMed, Embase, Web of Science, and Scopus were searched using 'medical tourism' AND 'assisted reproductive technology' from 1978 to 2020. RESULTS Predominant patient motivators for CBRC were cost and legality of assisted reproduction technology (ART) in one's home country, followed by cultural factors like shared language, religion, and cultural familiarity. Clinicians suggested global laws for CBRC would reduce the potential for exploitation of vulnerable populations but believed the enactment of international regulations unlikely and, even if enacted, difficult to enforce. CONCLUSIONS While patient and clinician experiences with CBRC varied, patients frequently cited financial and legal reasons for pursuing CBRC, while many providers had concern for the patient's safety. CLINICAL PRACTICE IMPLICATIONS This review recommends clinicians involved in family planning counsel patients seeking treatment abroad by: (i) informing patients of the risks and benefits of treatment abroad, (ii) establishing guidelines and standards for clinicians on resuming patient care post-CBRC, and (iii) creating a directory of reputable CBRC clinicians and experts.
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Affiliation(s)
- Laura McLean
- Morsani College of Medicine, University of South Florida, Tampa, USA.
| | - Stephanie T Ros
- Morsani College of Medicine, University of South Florida, Tampa, USA
| | | | - Jordan Stofan
- Morsani College of Medicine, University of South Florida, Tampa, USA
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2
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Miner SA. Cultural health capital and the stratification of reproduction in Czech and Spanish egg donation markets. SOCIOLOGY OF HEALTH & ILLNESS 2021; 43:1887-1902. [PMID: 34453321 DOI: 10.1111/1467-9566.13363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 07/31/2021] [Accepted: 08/03/2021] [Indexed: 06/13/2023]
Abstract
This article explores the ways that fertility clinics in the Czech Republic and Spain attract international fertility clients for fertility treatment involving egg donation. I draw upon a content analysis of 18 fertility clinics' advertising materials and 31 in-depth interviews with fertility professionals in the Czech Republic and Spain, and Canadian fertility travellers to show how clinics use cultural health capital (CHC) to persist as popular destination sites for fertility travellers. I argue that the use of evidence-based medicine and patient-centred care combined with bioracial discourses are strategies by which clinics create a culture of fertility care that is legible to white, middle-class, hetero travellers. My interviews with fertility patients who travelled to these sites show the ways in which CHC is interactional-I document how fertility travellers desire these specific practices that are both created for and marketed to them. By expanding the definition of CHC to show how fertility clinics market and fertility travellers expect a particular culture of fertility medicine, I elucidate the interactions between clinics and professionals that reinforce ideals of white motherhood and the stratification of reproduction.
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Affiliation(s)
- Skye A Miner
- Department of Sociology, McGill University, Montreal, QC, Canada
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Degli Esposti S, Pavone V. Oocyte provision as a (quasi) social market: Insights from Spain. Soc Sci Med 2019; 234:112381. [PMID: 31252241 DOI: 10.1016/j.socscimed.2019.112381] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 06/15/2019] [Accepted: 06/20/2019] [Indexed: 10/26/2022]
Abstract
The provision of oocytes plays an important role in human fertility treatments. Spain alone performs half of oocyte provision cycles in the European Union whilst all other European countries face an oocyte shortage. How do Spanish fertility clinics manage to match the increasing domestic and foreign demand for female oocytes? Adopting a weak performativity approach and drawing insights from interviews carried out with 20 fertility clinic representatives, this study suggests that Spanish clinics are successful thanks to an egg provision system designed as a (quasi) social market. In the absence of traditional market mechanisms based on price fluctuations, the combination of fixed monetary compensation for providers and altruistic framing of oocyte provision as an act of donation, are used to mobilize relatively high numbers of women. Fertility clinics optimize this supply through a set of supplementary strategies to ensure oocyte supply always meets oocyte demand. Though successful, this market design reinforces gender stereotypes and relies on manipulative notions of altruism. A clear but unacknowledged appropriation of women's bodies and reproductive labour are also operated, which reinforces and reproduces racial and social stratifications. Therefore, we ask whether alternative mechanisms to promote female solidarity across different generations, to raise awareness of the risks of advanced maternal age, and to explore alternative market designs should be considered.
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Affiliation(s)
- Sara Degli Esposti
- Instituto de Políticas y Bienes Públicos (IPP), Consejo Superior de Investigaciones Científicas (CSIC), C\ Albasanz 26-28, 28037 Madrid, Spain; Centre for Business in Society (CBiS), Coventry University, Jaguar Building, Coventry CV1 5DL, UK.
| | - Vincenzo Pavone
- Instituto de Políticas y Bienes Públicos (IPP), Consejo Superior de Investigaciones Científicas (CSIC), C\ Albasanz 26-28, 28037 Madrid, Spain.
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Whittaker A, Inhorn MC, Shenfield F. Globalised quests for assisted conception: Reproductive travel for infertility and involuntary childlessness. Glob Public Health 2019; 14:1669-1688. [PMID: 31204900 DOI: 10.1080/17441692.2019.1627479] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The global movement of people across international borders to undergo assisted reproductive treatment is common, although there is little accurate data. In this article, we synthesise findings from our own empirical research on reproductive travel in addition to a review of clinical, ethical, legal, and regulatory complexities from studies on reproductive travel since 2010. Motivations for travel include legal and religious prohibitions; resource considerations; lack of access to gametes and reproductive assistors; quality and safety concerns; and personal preferences. Higher risks to mothers and children are associated with multiple embryo transfer and subsequent multiple and higher order pregnancies and the average older age of women undertaking reproductive travel. The potential exploitation of other women as providers of oocytes or surrogacy services, the lack of equity in access to assisted reproduction and the ambiguous legal status of children conceived from international reproductive travel are important ethical considerations. A range of significant legal issues remain given variable and limited international regulation. Scholarship on this trade necessarily engages with issues of power and gender, social inequities, global capitalism and the private decision-making of individuals seeking to form families. Research gaps remain given recent changes in the organisation, demands and destinations of the trade.
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Affiliation(s)
- Andrea Whittaker
- School of Social Sciences, Faculty of Arts, Monash University , Melbourne , Australia
| | - Marcia C Inhorn
- Anthropology and International Affairs, Council on Middle East Studies, The MacMillan Center, Yale University , New Haven , CT , USA
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6
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Investigating knowledge and perceptions of egg sharing among healthcare professionals in the United Kingdom. Eur J Obstet Gynecol Reprod Biol 2019; 236:98-104. [DOI: 10.1016/j.ejogrb.2019.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 03/01/2019] [Accepted: 03/03/2019] [Indexed: 11/19/2022]
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Platts S, Bracewell-Milnes T, Saso S, Jones B, Parikh R, Thum MY. Investigating attitudes towards oocyte donation amongst potential donors and the general population: a systematic review. HUM FERTIL 2019; 24:169-181. [DOI: 10.1080/14647273.2019.1602736] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Sophie Platts
- Imperial College Healthcare Trust, Hammersmith Hospital Campus, London, UK
| | - Timothy Bracewell-Milnes
- Division of Surgery and Cancer, Institute of Developmental Reproductive & Developmental Biology, Imperial College London, London, UK
| | - Srdjan Saso
- Division of Surgery and Cancer, Institute of Developmental Reproductive & Developmental Biology, Imperial College London, London, UK
| | - Benjamin Jones
- Division of Surgery and Cancer, Institute of Developmental Reproductive & Developmental Biology, Imperial College London, London, UK
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Couture V, Drouin R, Moutquin JM, Monnier P, Bouffard C. Reproductive outsourcing: an empirical ethics account of cross-border reproductive care in Canada. JOURNAL OF MEDICAL ETHICS 2019; 45:41-47. [PMID: 30301813 DOI: 10.1136/medethics-2017-104515] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 07/03/2018] [Accepted: 09/03/2018] [Indexed: 06/08/2023]
Abstract
Cross-border reproductive care (CBRC) can be defined as the movement from one jurisdiction to another for medically assisted reproduction (MAR). CBRC raises many ethical concerns that have been addressed extensively. However, the conclusions are still based on scarce evidence even considering the global scale of CBRC. Empirical ethics appears as a way to foster this ethical reflection on CBRC while attuning it with the experiences of its main actors. To better understand the 'in and out' situation of CBRC in Canada, we conducted an ethnographic study taking a 'critically applied ethics' approach. This article presents a part of the findings of this research, obtained by data triangulation from qualitative analysis of pertinent literature, participant observation in two Canadian fertility clinics and 40 semidirected interviews. Based on participants' perceptions, four themes emerged: (1) inconsistencies of the Canadian legal framework; (2) autonomy and the necessity to resort to CBRC; (3) safety and the management of CBRC individual risks; and (4) justice and solidarity. The interaction between these four themes highlights the problematic of 'reproductive outsourcing' that characterised the Canadian situation, a system where the controversial aspects of MAR are knowingly pushed outside the borders.
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Affiliation(s)
- Vincent Couture
- Laboratory of Transdisciplinary Research in Genetics, Systems of Medicine and Social Sciences, Division of Genetics, Department of Pediatrics, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada
- Bioethics Institute Ghent, Department of Philosophy and moral sciences, Faculty of Letters and Philosophy, Ghent University, Ghent, Belgium
| | - Régen Drouin
- Division of Medical Genetics, Department of Pediatrics, Faculty of Medicine, Université Laval, Quebec, Quebec, Canada
| | - Jean-Marie Moutquin
- Department of Obstetrics-Gynecology, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Patricia Monnier
- MUHC Reproductive Centre, Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec, Canada
- The Research Institute of Montreal University Health Center (RI MUHC), Montreal, Quebec, Canada
| | - Chantal Bouffard
- Laboratory of Transdisciplinary Research in Genetics, Systems of Medicine and Social Sciences, Division of Genetics, Department of Pediatrics, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada
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Salama M, Isachenko V, Isachenko E, Rahimi G, Mallmann P, Westphal LM, Inhorn MC, Patrizio P. Cross border reproductive care (CBRC): a growing global phenomenon with multidimensional implications (a systematic and critical review). J Assist Reprod Genet 2018; 35:1277-1288. [PMID: 29808382 PMCID: PMC6063838 DOI: 10.1007/s10815-018-1181-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Accepted: 04/05/2018] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Many people travel abroad to access fertility treatments. This growing phenomenon is known as cross border reproductive care (CBRC) or fertility tourism. Due to its complex nature and implications worldwide, CBRC has become an emerging dilemma deserving more attention on the global healthcare agenda. METHODS According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic review of the literature was performed for all relevant full-text articles published in PubMed in English during the past 18 years to explore CBRC phenomenon in the new millennium. RESULTS Little is known about the accurate magnitude and scope of CBRC around the globe. In this systematic and critical review, we identify three major dimensions of CBRC: legal, economic, and ethical. We analyze each of these dimensions from clinical and practical perspectives. CONCLUSION CBRC is a growing reality worldwide with potential benefits and risks. Therefore, it is very crucial to regulate the global market of CBRC on legal, economic, and ethical bases in order to increase harmonization and reduce any forms of exploitation. Establishment of accurate international statistics and a global registry will help diminish the current information gap surrounding the CBRC phenomenon.
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Affiliation(s)
- Mahmoud Salama
- Department of Obstetrics and Gynecology, Medical Faculty, University of Cologne, Kerpener St. 34, 50931, Cologne, Germany.
- Department of Reproductive Medicine, National Research Center, Cairo, Egypt.
| | - Vladimir Isachenko
- Department of Obstetrics and Gynecology, Medical Faculty, University of Cologne, Kerpener St. 34, 50931, Cologne, Germany
| | - Evgenia Isachenko
- Department of Obstetrics and Gynecology, Medical Faculty, University of Cologne, Kerpener St. 34, 50931, Cologne, Germany
| | - Gohar Rahimi
- Department of Obstetrics and Gynecology, Medical Faculty, University of Cologne, Kerpener St. 34, 50931, Cologne, Germany
| | - Peter Mallmann
- Department of Obstetrics and Gynecology, Medical Faculty, University of Cologne, Kerpener St. 34, 50931, Cologne, Germany
| | - Lynn M Westphal
- Department of Reproductive Endocrinology and Infertility, Stanford University, Stanford, CA, USA
| | - Marcia C Inhorn
- Department of Anthropology, Yale University, New Haven, CT, USA
| | - Pasquale Patrizio
- Department of Reproductive Endocrinology and Infertility, Yale University, New Haven, CT, USA
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Madero S, Gameiro S, García D, Cirera D, Vassena R, Rodríguez A. Quality of life, anxiety and depression of German, Italian and French couples undergoing cross-border oocyte donation in Spain. Hum Reprod 2018; 32:1862-1870. [PMID: 28854722 DOI: 10.1093/humrep/dex247] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 06/30/2017] [Indexed: 11/14/2022] Open
Abstract
STUDY QUESTION What is the quality of life (QoL) and mental health of infertile heterosexual couples from different nations (Italy, Germany and France) undergoing cross-border oocyte donation (OD) in Spain? SUMMARY ANSWER Women have lower QoL and more anxiety than their male partners; overall French couples have lower QoL than their Italian and German counterparts. WHAT IS KNOWN ALREADY In Europe, thousands of couples move across national borders annually to seek ARTs, primarily OD, driven mainly by legal restrictions in their countries of origin. Most research shows that infertility and ARTs affect patients' mental health and QoL. The decision to undergo reproductive care abroad might add further emotional and practical complexity. Reliable information on how this experience affects the mental health and QoL of cross-border reproductive care (CBRC) patients is lacking. Moreover, most research has focused on women, and further research on male partners and intercultural differences is needed. STUDY DESIGN, SIZE, DURATION Cross-sectional study including 548 heterosexual individuals (347 women, 201 men) from Italy, Germany and France seeking IVF with donated oocytes in Barcelona, Spain between March and November 2013. PARTICIPANTS/MATERIALS, SETTING, METHODS A total of 432 couples were invited to participate and handed a questionnaire set. Questionnaires were answered separately and anonymously by each member of the couple on the day of embryo transfer. The questionnaire set included the Fertility Quality of Life (FertiQoL) instrument, the generic Hospital Anxiety and Depression Scale (HADS) instrument and three close-ended questions assessing perceived usefulness, desire, and use of psychological support. The overall response rate was 63.4%. MAIN RESULTS AND THE ROLE OF CHANCE Men reported significantly higher scores than women in the emotional (+13.74; P < 0.001), mind-body (+13.39; P < 0.001) and social (+4.11; P < 0.01) FertiQoL domains, at multilevel analysis controlled for confounder factors. Intercultural differences in QoL of couples were seen. French individuals had significantly lower emotional (-6.44; P < 0.01), mind-body (-7.41; P < 0.001) and relational scores (-6.41; P < 0.001) compared to Italians. Germans showed higher social scores (+6.41; P < 0.001) but lower relational scores (-8.94; P < 0.002) than Italians. Men reported significantly lower anxiety scores for the HADS than their partners (-1.38; P < 0.001), and German couples reported lower anxiety (-1.70; P = 0.003) and depression than their Italian counterparts (-1.56; P < 0.001). French patients were more likely to have required support by a mental health professional due to fertility problems in the past (+0.19; P < 0.001). LIMITATIONS, REASONS FOR CAUTION The scope of this study is limited to heterosexual couples undergoing cross-border OD. Caution on the interpretation of the results in men is advised, mainly because only three men for every five women completed the questionnaire. WIDER IMPLICATIONS OF THE FINDINGS These findings call for further work to identify the true nature of the differences in QoL and mental health observed. STUDY FUNDING/COMPETING INTEREST(S) None.
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Affiliation(s)
- S Madero
- Clínica EUGIN, Travessera de les Corts 322, Barcelona 08029, Spain
| | - S Gameiro
- Cardiff Fertility Studies Research Group, School of Psychology, Cardiff University, Park Place Cardiff, CF10 3AT, UK
| | - D García
- Fundació Privada EUGIN, Travessera de les Corts 318, Barcelona 08029, Spain
| | - D Cirera
- Clínica EUGIN, Travessera de les Corts 322, Barcelona 08029, Spain
| | - R Vassena
- Clínica EUGIN, Travessera de les Corts 322, Barcelona 08029, Spain
| | - A Rodríguez
- Clínica EUGIN, Travessera de les Corts 322, Barcelona 08029, Spain
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Bracewell-Milnes T, Saso S, Abdalla H, Thum MY. A systematic review investigating psychosocial aspects of egg sharing in the United Kingdom and their potential effects on egg donation numbers. HUM FERTIL 2017; 21:163-173. [PMID: 28549399 DOI: 10.1080/14647273.2017.1329554] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This review aims to provide an up-to-date knowledge of the psychosocial aspects of egg donation from the perspectives of the egg share donor and their recipient. It explores the motives, experiences and attitudes of egg sharers and their views towards donor anonymity and disclosure. Conclusions are made on how these findings can guide clinical practice and improve egg sharing numbers. A systematic search of peer-reviewed journals of four computerized databases was undertaken. Eleven studies were included in the review. Psychosocial aspects towards donation were positive from the egg share donor and recipient. Concerns raised were whether participating in the egg sharing scheme would impact on their success rates, as well as frustration expressed by a minority regarding the lack of knowledge of egg sharing outside of fertility clinics. The 2005 legislative changes in the UK have not caused the anticipated dramatic decrease in egg donation; however, oocyte donation still falls short of demand. Egg sharing provides a practical option for more patients to access IVF, whilst also providing more donor oocytes. Improved information provision will result in greater awareness of egg sharing, with the potential to recruit more donors and meet the needs of recipients currently on long waiting lists.
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Affiliation(s)
- Timothy Bracewell-Milnes
- a Division of Surgery and Cancer, Institute of Developmental Reproductive & Developmental Biology , Imperial College London , London , UK
| | - Srdjan Saso
- a Division of Surgery and Cancer, Institute of Developmental Reproductive & Developmental Biology , Imperial College London , London , UK
| | - Hossam Abdalla
- b Fertility Specialist , The Lister Hospital , London , UK
| | - Meen-Yau Thum
- b Fertility Specialist , The Lister Hospital , London , UK
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Hudson N, Culley L, Blyth E, Norton W, Pacey A, Rapport F. Cross-border-assisted reproduction: a qualitative account of UK travellers' experiences. HUM FERTIL 2016; 19:102-10. [PMID: 27144511 DOI: 10.3109/14647273.2016.1168530] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Surveys on patients' experiences of cross-border fertility treatment have reported a range of positive and challenging features. However, the number of such studies is limited, and there is no detailed qualitative account of the experiences of UK patients who travel overseas for fertility treatment. The present study used a cross-sectional, qualitative design and in-depth interviews. Fifty-one participants (41 women and 10 men, representing 41 treatment 'cases') participated in semi-structured interviews. The experiences reported were broadly positive with a large proportion of participants (39 cases, 95%) citing a favourable overall experience with only two cases (5%) reporting a more negative experience. Thematic analysis revealed 6 major categories and 20 sub-categories, which described the positive and challenging aspects of cross-border fertility travel. The positive aspects were represented by the categories: 'access', 'control' and 'care and respect'. The more challenging aspects were categorized as 'logistics and coordination of care', 'uncertainty' and 'cultural dissonance'. The study confirms findings from others that despite some challenges, there is a relatively high level of patient satisfaction with cross-border treatment with participants able to extend the boundaries of their fertility-seeking trajectories and in some cases, regain a sense of control over their treatment.
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Affiliation(s)
- Nicky Hudson
- a Applied Social Sciences , De Montfort University , Leicester , UK
| | - Lorraine Culley
- a Applied Social Sciences , De Montfort University , Leicester , UK
| | - Eric Blyth
- b School of Human and Health Sciences, University of Huddersfield , Huddersfield , UK
| | - Wendy Norton
- c School of Nursing & Midwifery, De Montfort University , Leicester , UK
| | - Allan Pacey
- d Reproductive & Developmental Medicine , University of Sheffield , Sheffield , UK
| | - Frances Rapport
- e Centre for Healthcare Resilience and Implementation Science (CHRIS) , Australian Institute of Healthcare Innovation, Macquarie University , Sydney , NSW , Australia
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Machin R. Anonimato e segredo na reprodução humana com participação de doador: mudanças em perspectivas. SAUDE E SOCIEDADE 2016. [DOI: 10.1590/s0104-12902016149132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo As tecnologias reprodutivas, ao separar a sexuali dade da reprodução, interferiram não somente nas relações entre os sexos, mas também nas relações de filiação, possibilitando o surgimento de configu rações familiares decorrentes do acesso a material genético de terceiros (doadores de óvulos, sêmen ou embrião). O segredo e o anonimato que sempre envolveram os doadores de gametas têm sido desa fiados. Nos últimos vinte anos, diversos países alte raram sua legislação adotando a identidade aberta do doador de material genético. A possibilidade de conhecer e ter acesso a esta identidade (chegando à maioridade) ou mesmo a busca por meios irmãos pode ser uma realidade em muitos países para crianças nascidas por meio do acesso à tecnologia reprodutiva. O artigo enfatiza a questão do segredo e do anonimato envolvendo o uso de material ge nético de terceiros em tecnologias reprodutivas. A discussão é explorada por meio do debate ocorrido no Reino Unido relativo à abolição do anonimato e suas implicações sob a perspectiva dos doadores, dos casais demandantes e da criança concebida. O estudo reflete ainda sobre as concepções de família envolvidas nessa discussão.
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Schick M, Rösner S, Toth B, Strowitzki T, Jank A, Kentenich H, Thöne C, Wischmann T. Effects of medical causes, role concepts and treatment stages on quality of life in involuntary childless men. Andrologia 2016; 48:849-854. [DOI: 10.1111/and.12519] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2015] [Indexed: 11/29/2022] Open
Affiliation(s)
- M. Schick
- Institute of Medical Psychology; Centre for Psychosocial Medicine; Heidelberg University Hospital; Heidelberg Germany
| | - S. Rösner
- Department of Gynaecological Endocrinology and Reproductive Medicine; Women's Hospital; University of Heidelberg; Heidelberg Germany
| | - B. Toth
- Department of Gynaecological Endocrinology and Reproductive Medicine; Women's Hospital; University of Heidelberg; Heidelberg Germany
| | - T. Strowitzki
- Department of Gynaecological Endocrinology and Reproductive Medicine; Women's Hospital; University of Heidelberg; Heidelberg Germany
| | - A. Jank
- Fertility Center Berlin; Berlin Germany
| | | | - C. Thöne
- Heidelberg Fertility Clinic; Heidelberg Germany
| | - T. Wischmann
- Institute of Medical Psychology; Centre for Psychosocial Medicine; Heidelberg University Hospital; Heidelberg Germany
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Inhorn MC. Medical Cosmopolitanism in Global Dubai: A Twenty-first-century Transnational Intracytoplasmic Sperm Injection (ICSI) Depot. Med Anthropol Q 2016; 31:5-22. [PMID: 26756447 DOI: 10.1111/maq.12275] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Dubai-one of the seven United Arab Emirates and the Middle East's only "global city"-is gaining a reputation as a transnational medical tourism hub. Characterized by its "medical cosmopolitanism," Dubai is now attracting medical travelers from around the world, some of whom are seeking assisted conception. Dubai is fast becoming known as a new transnational "reprohub" for intracytoplasmic sperm injection (ICSI), the variant of in vitro fertilization designed to overcome male infertility. Based on ethnographic research conducted in one of the country's most cosmopolitan clinics, this article explores the ICSI treatment quests of infertile men coming to Dubai from scores of other nations. The case of an infertile British-Moroccan man is highlighted to demonstrate why ICSI is a particularly compelling "masculine hope technology" for infertile Muslim men. Thus, Muslim men who face barriers to ICSI access in their home countries may become "reprotravelers" to Dubai, an emergent ICSI depot.
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Hammarberg K, Stafford-Bell M, Everingham S. Intended parents' motivations and information and support needs when seeking extraterritorial compensated surrogacy. Reprod Biomed Online 2015; 31:689-96. [PMID: 26371710 DOI: 10.1016/j.rbmo.2015.08.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 08/09/2015] [Accepted: 08/11/2015] [Indexed: 11/24/2022]
Abstract
Cross-border reproductive care (CBRC) is becoming increasingly common. Little is known about the motivations and information and support needs of people who cross borders to access surrogacy. This study aimed to explore: how those considering or undertaking extraterritorial surrogacy reach their decision; what other avenues they have considered and tried to have children; their sources of information and support; and perceptions of how others view their decision. Members of two Australian parenting support forums completed an anonymous online survey. Of the 249 respondents, 51% were gay men, 43% heterosexual women and 7% heterosexual men. Most heterosexual respondents had tried to conceive spontaneously and with assisted reproductive technology before considering surrogacy. Most respondents felt supported in their decision to try extraterritorial surrogacy by close family and friends. Surrogacy-related information was mostly sourced online and from other parents through surrogacy. Few sought information from a local general practitioner or IVF clinic and those who did reported IVF clinic staff were significantly (P < 0.001) more likely than other groups to communicate negative reactions to their decision to seek surrogacy. The apparent negative attitudes to cross-border surrogacy among health professionals warrants further research into health professionals' knowledge, beliefs and attitudes relating to surrogacy.
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Affiliation(s)
- Karin Hammarberg
- Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, Victoria, Australia; Victorian Assisted Reproductive Treatment Authority, Victoria, Australia.
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Inhorn MC, Patrizio P. Infertility around the globe: new thinking on gender, reproductive technologies and global movements in the 21st century. Hum Reprod Update 2015; 21:411-26. [PMID: 25801630 DOI: 10.1093/humupd/dmv016] [Citation(s) in RCA: 880] [Impact Index Per Article: 97.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 02/28/2015] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Infertility is estimated to affect as many as 186 million people worldwide. Although male infertility contributes to more than half of all cases of global childlessness, infertility remains a woman's social burden. Unfortunately, areas of the world with the highest rates of infertility are often those with poor access to assisted reproductive techniques (ARTs). In such settings, women may be abandoned to their childless destinies. However, emerging data suggest that making ART accessible and affordable is an important gender intervention. To that end, this article presents an overview of what we know about global infertility, ART and changing gender relations, posing five key questions: (i) why is infertility an ongoing global reproductive health problem? (ii) What are the gender effects of infertility, and are they changing over time? (iii) What do we know about the globalization of ART to resource-poor settings? (iv) How are new global initiatives attempting to improve access to IVF? (v) Finally, what can be done to overcome infertility, help the infertile and enhance low-cost IVF (LCIVF) activism? METHODS An exhaustive literature review using MEDLINE, Google Scholar and the keyword search function provided through the Yale University Library (i.e. which scans multiple databases simultaneously) identified 103 peer-reviewed journal articles and 37 monographs, chapters and reports from the years 2000-2014 in the areas of: (i) infertility demography, (ii) ART in low-resource settings, (iii) gender and infertility in low-resource settings and (iv) the rise of LCIVF initiatives. International Federation of Fertility Societies Surveillance reports were particularly helpful in identifying important global trends in IVF clinic distribution between 2002 and 2010. Additionally, a series of articles published by scholars who are tracking global cross-border reproductive care (CBRC) trends, as well as others who are involved in the growing LCIVF movement, were invaluable. RESULTS Recent global demographic surveys indicate that infertility remains an ongoing reproductive problem, with six key demographic features. Despite the massive global expansion of ART services over the past decade (2005-2015), ART remains inaccessible in many parts of the world, particularly in sub-Saharan Africa, where IVF clinics are still absent in most countries. For women living in such ART-poor settings, the gender effects of infertility may be devastating. In contrast, in ART-rich regions such as the Middle East, the negative gender effects of infertility are diminishing over time, especially with state subsidization of ART. Furthermore, men are increasingly acknowledging their male infertility and seeking ICSI. Thus, access to ART may ameliorate gender discrimination, especially in the Global South. To that end, a number of clinician-led, LCIVF initiatives are in development to provide affordable ART, particularly in Africa. Without access to LCIVF, many infertile couples must incur catastrophic expenditures to fund their IVF, or engage in CBRC to seek lower-cost IVF elsewhere. CONCLUSIONS Given the present realities, three future directions for research and intervention are suggested: (i) address the preventable causes of infertility, (ii) provide support and alternatives for the infertile and (iii) encourage new LCIVF initiatives to improve availability, affordability and acceptability of ART around the globe.
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Affiliation(s)
- Marcia C Inhorn
- Department of Anthropology, Yale University, 10 Sachem Street, New Haven, CT 06520-8277, USA
| | - Pasquale Patrizio
- Department of Obstetrics and Gynecology, Yale Fertility Center, Yale School of Medicine, 150 Sargent Drive, 2nd Floor, New Haven, CT 06511-6110, USA
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Blake VK, McGowan ML, Levine AD. Conflicts of Interest and Effective Oversight of Assisted Reproduction Using Donated Oocytes. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2015; 43:410-424. [PMID: 26242963 DOI: 10.1111/jlme.12257] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Oocyte donation raises conflicts of interest and commitment for physicians but little attention has been paid to how to reduce these conflicts in practice. Yet the growing popularity of assisted reproduction has increased the stakes of maintaining an adequate oocyte supply and (where appropriate) minimizing conflicts. A growing body of professional guidelines, legal challenges to professional self-regulation, and empirical research on the practice of oocyte donation all call for renewed attention to the issue. As empirical findings better inform existing conflicts and their potential harms, we can better attempt to reduce these conflicts. To that end, the article first describes the nature of conflicts in oocyte donation and relevant regulations and professional guidelines. We then describe studies on conflicts at four phases of oocyte donation: recruitment, screening, stimulation, and post-stimulation monitoring. Next we consider three models for conflict reduction in medicine generally: improved professional self-regulation, outright restriction like Stark anti-referral laws, or the use of conflict mediators, like in living organ donation. We ultimately conclude that improved professional self-regulation is a reasonable starting place for oocyte donation.
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Affiliation(s)
- Valarie K Blake
- Associate Professor of Law at the West Virginia University College of Law
| | - Michelle L McGowan
- Associate Professor of Women's Studies and Bioethics at Penn State University
| | - Aaron D Levine
- Associate Professor in the School of Public Policy at Georgia Tech
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Rodino IS, Goedeke S, Nowoweiski S. Motivations and experiences of patients seeking cross-border reproductive care: the Australian and New Zealand context. Fertil Steril 2014; 102:1422-31. [PMID: 25241371 DOI: 10.1016/j.fertnstert.2014.07.1252] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Revised: 07/29/2014] [Accepted: 07/29/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To explore the motivations, clinical care, counseling, and support experiences of Australian and New Zealand participants considering or having participated in cross-border reproductive care (CBRC). DESIGN Questionnaire-based study. SETTING Not applicable. PATIENT(S) One hundred thirty-seven Australian and New Zealand participants aged 23-53 years. INTERVENTION(S) None. MAIN OUTCOME MEASURES(S) Quantitative and qualitative responses to an anonymously completed online questionnaire. RESULT(S) Quantitative responses from participants indicated that motivations for engaging in CBRC included limited availability of gamete donors in their home state, difficulty in meeting treatment eligibility criteria, and treatment being legally prohibited. Experiences of CBRC were generally rated positively in terms of medical needs (91.2%), safety (89.4%), and costs (85.7%), although rated more conservatively to emotional needs being met (57.9%). Less than half the sample (47.5%) had accessed some form of CBRC-related counseling. Themes identified in qualitative analysis reflected gamete supply and demand issues, the importance of donor information and disclosure, the personal impact of legislation, and ongoing support needs after CBRC treatment. CONCLUSION(S) A greater percentage of participants agreed that their CBRC clinic satisfied their overall medical needs and treatment expectations in comparison with overall emotional needs. Participants indicated access to post-treatment support counseling particularly with regard to their emotional well-being and disclosure issues to donor-conceived children would be useful. The implications of our findings for the provision of best-practice psychosocial counseling support and development of counseling guidelines are highlighted.
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Affiliation(s)
- Iolanda S Rodino
- School of Anatomy, Physiology & Human Biology, The University of Western Australia, Perth, Western Australia, Australia; Concept Fertility Centre, Subiaco, Western Australia, Australia.
| | - Sonja Goedeke
- Department of Psychology, School of Public Health & Psychosocial Studies, Faculty of Health and Environmental Sciences, AUT University, Auckland, New Zealand
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Lunt N, Smith RD, Mannion R, Green ST, Exworthy M, Hanefeld J, Horsfall D, Machin L, King H. Implications for the NHS of inward and outward medical tourism: a policy and economic analysis using literature review and mixed-methods approaches. HEALTH SERVICES AND DELIVERY RESEARCH 2014. [DOI: 10.3310/hsdr02020] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BackgroundThe study examined the implications of inward and outward flows of private patients for the NHS across a range of specialties and services.ObjectivesTo generate a comprehensive documentary review; to better understand information, marketing and advertising practices; examine the magnitude and economic and health-related consequences of travel; understand decision-making frames and assessments of risk; understand treatment experience; elicit the perspectives of key stakeholder groups; and map out medical tourism development within the UK.Design and participantsThe study integrated policy analysis, desk-based work, economic analysis to estimate preliminary costs, savings and NHS revenue, and treatment case studies. The case studies involved synthesising data sources around bariatric, fertility, cosmetic, dental and diaspora examples. Overall, we drew on a mixed-methods approach of qualitative and quantitative data collection. The study was underpinned by a systematic overview and a legal and policy review. In-depth interviews were carried out with those representing professional associations, those with clinical interests and representative bodies (n = 16); businesses and employees within medical tourism (n = 18); NHS managers (n = 23); and overseas providers. We spoke to outward medical travellers (46 people across four treatment case studies: bariatric, fertility, dental and cosmetic) and also 31 individuals from UK-resident Somali and Gujarati populations.ResultsThe study found that the past decade has seen an increase in both inward and outward medical travel. Europe is both a key source of travellers to the UK and a destination for UK residents who travel for medical treatment. Inward travel often involves either expatriates or people from nations with historic ties to the UK. The economic implications of medical tourism for the NHS are not uniform. The medical tourism industry is almost entirely unregulated and this has potential risks for those travelling out of the UK. Existing information regarding medical tourism is variable and there is no authoritative and trustworthy single source of information. Those who travel for treatment are a heterogeneous group, with people of all ages spread across a range of sociodemographic groups. Medical tourists do not appear to inform their decision-making with hard information and consequently often do not consider all risks. They make use of extensive informal networks such as treatment-based or cultural groups. Motivations to travel are in line with the findings of other studies. Notably, cost is never a sole motivator and often not the primary motivation for seeking treatment abroad.LimitationsOne major limitation of the study was the abandonment of a survey of medical tourists. We sought to avoid an extremely small survey, which offers no real insight. Instead we redirected our resources to a deeper analysis of qualitative interviews, which proved remarkably fruitful. In a similar vein, the economic analysis proved more difficult and time consuming than anticipated. Data were incomplete and this inhibited the modelling of some important elements.ConclusionsIn 2010 at least 63,000 residents of the UK travelled abroad for medical treatment and at least 52,000 residents of foreign countries travelled to the UK for treatment. Inward referral and flows of international patients are shaped by clinical networks and longstanding relationships that are fostered between clinicians within sender countries and their NHS counterparts. Our research demonstrated a range of different models that providers market and by which patients travel to receive treatment. There are clearly legal uncertainties at the interface of these and clinical provision. Patients are now travelling to further or ‘new’ markets in medical tourism. Future research should: seek to better understand the medium- and long-term health and social outcomes of treatment for those who travel from the UK for medical treatment; generate more robust data that better capture the size and flows of medical travel; seek to better understand inward flows of medical travellers; gather a greater level of information on patients, including their origins, procedures and outcomes, to allow for the development of better economic costing; explore further the issues of clinical relationships and networks; and consider the importance of the NHS brand.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Neil Lunt
- Department of Social Policy and Social Work, University of York, York, UK
| | | | - Russell Mannion
- Health Services Management Centre, University of Birmingham, Birmingham, UK
| | - Stephen T Green
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Mark Exworthy
- School of Management, Royal Holloway, University of London, London, UK
| | | | - Daniel Horsfall
- Department of Social Policy and Social Work, University of York, York, UK
| | - Laura Machin
- The York Management School, University of York, York, UK
| | - Hannah King
- Department of Social Policy and Social Work, University of York, York, UK
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Hudson N, Culley L. ‘The bloke can be a bit hazy about what’s going on’: men and cross-border reproductive treatment. Reprod Biomed Online 2013; 27:253-60. [DOI: 10.1016/j.rbmo.2013.06.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2013] [Revised: 06/12/2013] [Accepted: 06/13/2013] [Indexed: 11/30/2022]
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Rozée Gomez V, de La Rochebrochard E. Cross-border reproductive care among French patients: experiences in Greece, Spain and Belgium. Hum Reprod 2013; 28:3103-10. [PMID: 23943796 PMCID: PMC3795470 DOI: 10.1093/humrep/det326] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
STUDY QUESTION What are the characteristics, motivation and experience of French patients seeking cross-border reproductive care (CBRC)? SUMMARY ANSWER French patients seeking CBRC are same-sex couples, single women who are not eligible for assisted reproduction technologies (ARTs) in France and heterosexual couples seeking oocyte donation due to extremely limited access to this technique in France, while their choice of Greece as a destination is influenced by financial issues. WHAT IS KNOWN ALREADY CBRC is a new, increasing, complex and poorly understood phenomenon. A few studies have investigated UK, German or Italian CBRC patients, but none have specifically investigated French patients although France is one of the top four countries of origin of CBRC patients in Europe. STUDY DESIGN, SIZE, DURATION A cross-sectional study was carried out in 2010-2012 in three ART centres in Greece, Belgium and Spain in order to investigate French patients treated in these centres. Recruitment was prospective in Greece and Belgium and retrospective in Spain. The overall response rate was 68%, with 128 French patients participating. PARTICIPANTS/MATERIALS, SETTING, METHODS French patients filled in a questionnaire. Information was collected on their socio-economic characteristics and their search for ART treatment in France and in other countries. MAIN RESULTS AND THE ROLE OF CHANCE In the Belgian centre, 89% of French patients used sperm donation whereas oocyte donation was used by 100% of patients in the Greek centre and 74% of patients in the Spanish centre. The majority (94%) of French patients using sperm donation in Belgium were not legally eligible for access to ART in France as they were same-sex couples or single women, and the main criterion of choice of centre was its geographical proximity (71%). Most of the French patients using oocyte donation in Greece and Spain fulfilled criteria for fully reimbursed oocyte donation treatment in France as they were heterosexual couples (99%) with the woman aged <43 years (65%). For these couples, CBRC was motivated by the extremely limited access to oocyte donation in France. Half of French CBRC patients using oocyte donation in Spain had a low/intermediate occupational level (such as primary school teachers, nurses, administrative officers or sales agents, workers and employees) and this proportion was much higher in Greece (82%, P < 0.01). LIMITATIONS, REASONS FOR CAUTION Larger and more wide-ranging studies are needed as this study included only 128 patients who may not be representative of all French CBRC patients, especially because the study was carried out only in three ART centres and these too may not be representative. WIDER IMPLICATIONS OF THE FINDINGS CBRC among French patients had been thought to reflect mainly law evasion. This study showed that the reality is much more complex and that CBRC among French patients reflects both law evasion and limited access to oocyte donation in France. It also brings new insight into the characteristics of the patients by suggesting a certain degree of 'democratization' in access to such care. However, the choice of centre seemed related to socio-economic characteristics, in that the Greek centre treated a less advantaged population than the Spanish centre. STUDY FUNDING/COMPETING INTEREST(S) This study was supported by French public research funds, the Institute Emilie du Châtelet from the Ile-de-France Region, the Biomedicine Agency and the Research Institute of Public Health (IReSP). There are no conflicts of interest. TRIAL REGISTRATION NUMBER Not applicable.
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Growing families in a shrinking world: legal and ethical challenges in cross-border surrogacy. Reprod Biomed Online 2013; 27:733-41. [PMID: 24120561 DOI: 10.1016/j.rbmo.2013.06.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Revised: 05/24/2013] [Accepted: 06/04/2013] [Indexed: 11/22/2022]
Abstract
Crossing national borders to have children is a rapidly growing phenomenon, fuelled by restrictions on access and technologies in some countries and for some patients, by high costs in others, and all generating a burgeoning multibillion dollar international industry. Cross-border gestational surrogacy is one form of family building that challenges legal, policy and ethical norms between countries and puts both intended parents and gestational surrogates at risk, and can leave the offspring of these arrangements vulnerable in a variety of ways, including parent-child, immigration and citizenship status. The widely varying political, religious and legal views amongst countries make line drawing and rule making challenging. This article reviews recent court decisions about and explores the legal dimensions of cross-border surrogacy.
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Culley L, Hudson N, Blyth E, Norton W, Pacey A, Rapport F. ‘What are you going to do, confiscate their passports?’ Professional perspectives on cross-border reproductive travel. J Reprod Infant Psychol 2013. [DOI: 10.1080/02646838.2012.762084] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Couture V, Drouin R, Ponsot AS, Duplain-Laferrière F, Bouffard C. Gender eugenics between medicine, culture, and society. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2013; 13:57-59. [PMID: 24024814 DOI: 10.1080/15265161.2013.828129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Thorn P, Wischmann T. German guidelines for psychosocial counselling in the area of “cross border reproductive services”. Arch Gynecol Obstet 2012; 287:599-606. [DOI: 10.1007/s00404-012-2599-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Accepted: 10/09/2012] [Indexed: 11/28/2022]
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Inhorn MC, Shrivastav P, Patrizio P. Assisted Reproductive Technologies and Fertility “Tourism”: Examples from Global Dubai and the Ivy League. Med Anthropol 2012; 31:249-65. [DOI: 10.1080/01459740.2011.596495] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Inhorn MC, Gürtin ZB. Cross-border reproductive care: a future research agenda. Reprod Biomed Online 2011; 23:665-76. [DOI: 10.1016/j.rbmo.2011.08.002] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Accepted: 08/05/2011] [Indexed: 11/26/2022]
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Storrow RF. Assisted reproduction on treacherous terrain: the legal hazards of cross-border reproductive travel. Reprod Biomed Online 2011; 23:538-45. [DOI: 10.1016/j.rbmo.2011.07.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2011] [Revised: 06/09/2011] [Accepted: 07/06/2011] [Indexed: 10/18/2022]
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Zanini G. Abandoned by the State, betrayed by the Church: Italian experiences of cross-border reproductive care. Reprod Biomed Online 2011; 23:565-72. [DOI: 10.1016/j.rbmo.2011.08.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2011] [Revised: 06/30/2011] [Accepted: 08/17/2011] [Indexed: 10/17/2022]
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Bergmann S. Reproductive agency and projects: Germans searching for egg donation in Spain and the Czech Republic. Reprod Biomed Online 2011; 23:600-8. [DOI: 10.1016/j.rbmo.2011.06.014] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2011] [Revised: 06/07/2011] [Accepted: 06/27/2011] [Indexed: 10/18/2022]
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