In a commentary to be published in BJOG: An International Journal of Obstetrics and Gynaecology, doctors reveal the numbers of women travelling abroad for Assisted Reproductive Technology (ART) treatment and examine their motivations for doing so.
Researchers at the Fetal Medicine Unit at the Elizabeth Garrett Anderson Wing, University College Hospitals NHS Foundation Trust in London, analysed the records of 109 women who had ‘high order’ multiple pregnancies (defined as having more than two viable embryos at the ultrasound examination before 14 weeks gestation) between February 1996 – July 2007.
Within this group of women, 94 (86%) disclosed that they had received fertility treatment, a quarter of whom had treatment outside of the UK. 89 pregnancies were triplet pregnancies, four were quadruplets and one was a quintuplet pregnancy. The countries where women had their IVF treatment were varied and included Israel, Germany, Algeria, Cyprus and South Africa. Researchers found that women who had their treatment overseas were less likely to have had selective embryo reduction compared to those who had treatment in the UK.
The respondents cited several reasons why overseas treatment was sought. These were: the high cost of treatment in the UK, the ability to have multiple implantations to increase their pregnancy success, the faster speed of treatment, the availability of an ethnically acceptable donor egg and because they were receiving treatment in their home country.
Researchers caution that with freer movement of European citizens within the eurozone, the numbers of British women seeking ART elsewhere in the EU, especially in countries where the practice is less well regulated, may increase. Likewise, researchers warn that the EU’s proposed cross-border healthcare directive may mean that member states may have to fund the ART treatment of their citizens obtained in another EU country. There may also be other inherent problems for women when they seek treatment from a different healthcare system such as understanding medical advice in another language and being subject to different informed consent procedures.
Researchers note that high order multiple pregnancies have financial implications for the NHS such as additional antenatal and neonatal care and longer hospital stays because of the increased risk of obstetric complications developing throughout the pregnancy and after delivery.
Lead researcher, Dr Alastair McKelvey said “We have seen an increase in the numbers of high order multiple pregnancies (triplets, quadruplets and above) in women who have received fertility treatment overseas. In a lot of cases, treatment was sought in countries where the practice is more loosely regulated than the UK, or has no regulation at all. The rigorous consent processes in this country are not practised in many countries.
"We are concerned because these pregnancies are often very high-risk and present the NHS with considerable challenges in the care of mother and babies. Couples are understandably desperate to have children and may think that these treatments are a quick-fix or a good bargain, without considering the potential adverse outcomes. In fact they may not be properly counselled about the risks – both to them and the babies. These risks are real and potentially serious. There are genuine concerns about complications such as cerebral palsy and even maternal death.
"We need international protocols on this urgently, to be agreed by the professionals performing the fertility treatment and those caring for the women."
Professor Philip Steer, BJOG editor-in-chief said, “We are witnessing the growth of a new industry in fertility treatment overseas. In some countries, treatment is unregulated and methods are questionable. Women are prepared to undergo treatment because they are desperate to have children but they may be unaware of the potential dangers of having multiple implants.
“We should follow the advice of the British Fertility Society, that is, for single embryo transfer in women below 40 years of age. But for that to be a reality, women must first have access to the three free cycles of IVF, as recommended by NICE. This helps alleviate the pressure to have a successful pregnancy at the first try.”
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Reference
McKelvey A, David A, Shenfield F, Jauniaux E. The impact of cross-border reproductive care or ‘fertility tourism’ on NHS maternity services. BJOG 2009; DOI: 10.1111/j.1471-0528.2009.02294.x.
