Wendy Norton

Cross-border reproductive care: A review of the literature.

Cross-border reproductive care (CBRC) has attracted considerable attention in media and professional publications. The aim of this review is to present a critical narrative overview of the published evidence on CBRC. A systematic search of key academic databases was undertaken with no time restrictions set for publication. This was supplemented by additional searches of key websites, reference chaining and enquiries to people working in the field. A total of 54 items are included in the review, including both empirical research studies (18) and debate papers (36). The key themes discussed are: terminology and definitions; incidence; experiences; explanations; implications; and policy responses. Significant methodological limitations and gaps in the literature are identified. Evidence on incidence is scant, though it suggests that CBRC is increasing. The literature suggests legal, social and political drivers, which vary in importance geographically and between individuals. Limited findings on patient perceptions suggest a broadly positive patient experience. Suggested policy responses include prohibition, regulatory harmonization and harm minimization. There is a need for better international data collection tools and both quantitative and qualitative work which encompasses views of patients, donors, surrogates and professionals and which explores the implications for healthcare services in sending countries.

Crossing borders for fertility treatment: motivations, destinations and outcomes of UK fertility travellers

BACKGROUND There are few systematic studies of the incidence of cross-border fertility care and even fewer reports of qualitative research with those undertaking treatment outside their country of origin. This paper reports findings from a qualitative study of UK residents with experience of cross-border care: the socio-demographic characteristics of UK travellers; their reasons for seeking treatment abroad; the treatments they sought; the destinations they chose and the outcomes of their treatment. METHODS Data regarding cross-border fertility treatment were collected from a purposive sample of 51 people by means of in-depth, semi-structured interviews between May 2009 and June 2010. Data were analysed using a systematic thematic coding method and also subjected to quantitative translation. RESULTS Patient motivations for travelling abroad are complex. A desire for timely and affordable treatment with donor gametes was evident in a high number of cases (71%). However, most people gave several reasons, including: the cost of UK treatment; higher success rates abroad; treatment in a less stressful environment and dissatisfaction with UK treatment. People travelled to 13 different countries, the most popular being Spain and the Czech Republic. Most organized their own treatment and travel. The mean age of women seeking treatment was 38.8 years (range 29-46 years) and the multiple pregnancy rate was 19%. CONCLUSIONS UK residents have diverse reasons for, and approaches to, seeking overseas treatment and do not conform to media stereotypes. Further research is needed to explore implications of cross-border treatment for donors, offspring and healthcare systems.

Gay men seeking surrogacy to achieve parenthood

Assisted reproduction technologies have developed at an extraordinary rate in recent years. This, combined with the changing landscape of legal, technical and social possibilities, enables gay men to consider their options for fatherhood as new opportunities emerge for them to create families. Media coverage of gay celebrities embracing surrogacy as a way of having a family and high-profile legal cases have raised awareness of surrogacy across the world. However, gay fatherhood achieved through assisted reproduction is a highly under-researched area, both in the UK and internationally. The research that currently exists on gay fatherhood is largely related to gay men who become parents through processes such as adoption and fostering and children conceived through previous heterosexual relationships. Much of this evidence has centred on parenting experiences, the outcomes for children or the legal perspectives. This paper outlines the different types of surrogacy and the legal issues facing gay men who choose this route to parenthood, summarizes the limited research on gay men and surrogacy and discusses gaps in the current knowledge base.

Lesbian intra-partner oocyte donation: A possible shake-up in the Garden of Eden?

Treatment of same-sex couples using infertility therapies has become more acceptable over the years, but remains controversial. In December 2005, two law changes came into force in the UK that impact same-sex couples. Firstly, the Civil Partnership Act acknowledged legal relationships between same-sex couples; and secondly, the Adoption and Children Act allowed same-sex couples to adopt. In view of these law changes, it is timely to consider procreation in same-sex couples and, particularly, the possibility of intra-partner oocyte donation within a lesbian relationship. Such treatment would require one female partner to provide the oocyte and the other female partner to act as embryo recipient. The embryo(s) could be created using IVF with registered anonymous donor sperm. The novelty of allowing a lesbian couple to cause a pregnancy in this way could allow the recipient to give birth to a baby that was genetically related to her partner. If society finds this acceptable, intra-partner oocyte donation using donor sperm for IVF could successfully provide a family for lesbian couples, offering an alternative to individual donor insemination. The ethical aspects of the treatment are discussed.

A survey of UK fertility clinics' approach to surrogacy arrangements

This paper draws on the findings of the first survey of surrogacy arrangements in Human Fertilisation and Embryology Authority (HFEA) licensed fertility clinics since 1998. Given the complex social, ethical and legal issues involved, surrogacy continues to raise debate worldwide and fuel calls for increased domestic provision in developed countries. However, little is known about how recent changes have affected HFEA licensed clinics. A 24-item online survey was undertaken between August and October 2013, designed to improve understanding of recent trends and current practices associated with UK-based surrogacy, and consider the implications for future policy and practice in UK and cross-border surrogacy arrangements. The response rate was 51.4%, comprising 54 clinics. Quantitative data were analysed using descriptive statistics, and open-ended qualitative responses analysed for extending understanding. Of the participating clinics, 42.6% offered surrogacy (mostly gestational surrogacy). Heterosexual couples using gestational surrogacy were the largest group currently using services followed by male same-sex couples. Most clinics reported having encountered problems with surrogacy treatments, suggesting barriers still exist to expanding the UK provision of surrogacy arrangements. It is important that professionals are well informed about the legal implications of surrogacy and that clinics have consistent and appropriate operational protocols for surrogacy arrangements.

Case report: grandmother, mother and another – an intergenerational surrogacy using anonymous donated embryos

Surrogacy and embryo donation remain beneficial but controversial infertility therapies. This is the first report of a pregnancy and subsequent birth of healthy twins following a surrogacy involving a female patients biological mother as surrogate, but using anonymously donated embryos. Due to the novelty of combining intergenerational surrogacy with embryo donation, the legal side of adoption has taken over 3 years to complete. Intergenerational surrogacy using donated embryos can successfully provide a family with a third generation, offering an alternative to adoption of genetically unrelated children without involvement in the pregnancy. The legal and ethical aspects of the treatment and eventual adoption are discussed.

Cross-border-assisted reproduction: a qualitative account of UK travellers’ experiences

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.

Sex and the older man

Sexual health is an important part of an individuals physical and emotional wellbeing. Sexuality and sexual wellbeing are often associated with young people and therefore the needs of the older person can be overlooked. Such discrimination is unjustifiable given that statistics show a rise in sexually transmitted infections (STIs) and new diagnoses of HIV in the older man. These worrying trends emphasise the legitimate need for nurses to address sexuality and sexual wellbeing as an essential component of health care.

Sexuality and the older woman

Sexual health is a key public health issue. The older woman faces a number of changes to her sexual health, wellbeing and sexuality. These changes result in many older women having to adapt to a series of complex transitions that can be challenging. This article aims to identify and explore some of these changes and how they can have a significant impact on womens quality of life. Nurses play an important role in assessing and helping women to manage normal and pathological age-related changes in order to improve the sexual health of older women and ensure they receive the advice and support needed at this stage of their life.

'What are you going to do, confiscate their passports?' Professional perspectives on cross-border reproductive travel

Objective: This article reports findings from a UK-based study which explored the phenomenon of overseas travel for fertility treatment. The first phase of this project aimed to explore how infertility clinicians and others professionally involved in fertility treatment understand the nature and consequences of cross-border reproductive travel. Background: There are indications that, for a variety of reasons, people from the UK are increasingly travelling across national borders to access assisted reproductive technologies. While research with patients is growing, little is known about how ‘fertility tourism’ is perceived by health professionals and others with a close association with infertility patients. Methods: Using an interpretivist approach, this exploratory research included focussed discussions with 20 people professionally knowledgeable about patients who had either been abroad or were considering having treatment outside the UK. Semi-structured interviews were recorded, transcribed verbatim and subjected to a thematic analysis. Results: Three conceptual categories are developed from the data: ‘the autonomous patient’; ‘cross-border travel as risk’, and ‘professional responsibilities in harm minimisation’. Professionals construct nuanced, complex and sometimes contradictory narratives of the ‘fertility traveller’, as vulnerable and knowledgeable; as engaged in risky behaviour and in its active minimisation. Conclusions: There is little support for the suggestion that states should seek to prevent cross-border treatment. Rather, an argument is made for less direct strategies to safeguard patient interests. Further research is required to assess the impact of professional views and actions on patient choices and patient experiences of treatment, before, during and after travelling abroad.