Cross-border Reproductive Care


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What is cross-border reproductive care (CBRC)?

CBRC is traveling from where you live to another country to obtain reproductive services and treatment. It could also be defined as traveling from where you live to another state. Another definition is: “CBRC is the movement of persons from one jurisdiction to another in order to access or provide fertility treatments.”

CBRC is becoming increasingly common, but the absence of any kind of global registry and the minimal international monitoring of CBRC make the collection of accurate statistics challenging. It is estimated that tens of thousands of patients cross borders to obtain care each year. The incidence of US patients traveling abroad is actually estimated to be lower than the rate of patients coming to the US.

Why do patients choose CBRC?

There are several reasons that patients choose to travel outside their region for care. Some of the main reasons are:
  • Access to more resources and more extensive higher quality of care.
  • Lower cost of treatment/reduced costs overall. Avoidance of legal, religious, and ethical restrictions and regulations from a departure country. 
  • Privacy or cultural comfort in a destination country.

What are the potential benefits of CBRC?

  • Reduced costs 
  • High overall costs for treatment and services in departure country. 
  • Lower third-party service costs (e.g., gamete/embryo donation and gestational carriers) in destination countries.
  • Improved Access
    • There may be long wait times in the departure country that could delay the time it takes to receive treatment. 
    • There may be few available donors and/or gestational carriers in the departure country. This can be due to restrictive regulations, low compensation, and/or the requirement to reveal the donor’s identity. 
    • The departure country may restrict access to care based on patient age, marital status, and sexual orientation. 
    • The departure country may restrict treatment options such as preimplantation genetic testing (PGT), sex selection, payment for gamete donation, and embryo freezing.
  • Comfort
    • Destination clinics may have more highly trained staff, use more up-to-date equipment, and have more specialized services.
    • Patients may choose a destination country where they have family support or cultural comfort. They may also wish to have access to donor gametes that are the same ethnicity or race as they are.

What are concerns about CBRC?

Health and safety

The most serious concern for CRBC is for patient health and safety, including preventing the transmission of infectious diseases to patients or genetic disorders to their children. There are no international policies or laws about quality control measures and standard of care for CBRC patients.

It is difficult to measure the quality and expertise of the physicians and embryology staff, the surgical and laboratory technology, or cleanliness to avoid contamination of eggs, sperm, and embryos. It is also difficult to determine if a gamete donor or gestational carrier is suitable.

Harm to the offspring may also occur in the case of a multiple pregnancy, which can lead to health problems, birth complications, and loss of life.

Information

Language and access to information may be obstacles for the patient. Receiving understandable information, adequate translation, a valid informed consent, and clear education and instruction may be difficult. For children born from donor eggs or sperm, information about their genetic history can be scarce. Follow-up care can be affected due to inadequate medical records about the care received abroad.

Legal


In the event of patient harm abroad, it may be difficult to obtain legal advice and remedies. There can be problems with obtaining immigration paperwork for donor and gestational carrier-conceived offspring.

Emotional

There has been concern about the exploitation of gamete donors and gestational carriers in some destination countries. This may lead to physical, social, and psychological harm to the donors/carriers.

Economic

Local patients may suffer if service prices in their community are raised. This can make access more difficult for reproductive and other health care.

Fact Sheets/Booklets

View more fact sheets and booklets written by the ASRM Patient Education Committee.
Patient Factsheet teaser

Hormonal Contraception

Hormonal contraceptives contain a progestin (progesterone medicine) with or without an estrogen.
Patient Factsheet teaser

Menopausal Transition (Perimenopause): What Is It?

The menopausal transition (perimenopause) is the period that links a woman’s reproductive (childbearing) years and menopause.
Patient Factsheet teaser

Embryo Donation: What Should I Know?

In the current practice of in vitro fertilization (IVF), some patients may create more embryos (fertilized eggs) than they need. The extra embryos may be cryopreserved (frozen) so that they can be transferred later.
Patient Factsheet teaser

Hypothyroidism and pregnancy: what should I know?

Hypothyroidism (underactive thyroid) is when the thyroid gland produces less  thyroid hormone than it should.

Resources For You

The American Society for Reproductive Medicine (ASRM) is committed to providing patients with the highest quality information about reproductive care.

Third-Party Reproduction

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SART Fertility Experts - Egg Donor Screening

This podcast discusses who are typical egg donor candidates and also describes the screening process to be an egg donor and give the gift of life! Listen to the Episode
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SART Fertility Experts - Gestational Carrier and Intended Parents

Some fertility patients are unable to carry a pregnancy to term. 
Listen to the Episode
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SART Fertility Experts - LGBTQ Fertility

With more available options for family building for the LGBTQ community, two women describe their experience with reciprocal IVF. Listen to the Episode
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SART Fertility Experts - Egg Donor and Recipient

Yuki describes her challenges with infertility and pathway to parenthood through egg donation with Dr. Cristin Slater.
Listen to the Episode
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SART Fertility Experts - Fertility and LGBTQ

In this episode, Dr. Daniel Grow interviews Dr. Mark Leondires, the founder of Gay Parents To Be.  Listen to the Episode
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SART Fertility Experts - Gestational Carriers

What’s the difference between a surrogate and a gestational carrier?   Listen to the Episode
Patient Ed Icon

Third-Party Reproduction

The phrase “third-party reproduction” refers to involving someone other than the individual or couple that plans to raise the child (intended parent[s]) in the process of reproduction. View the Booklet
Patient Ed Icon

Avoiding Conflict in Third-party Reproduction

Third-party reproduction is an arrangement where a person or couple receives help from other(s) to have a child. This help can be in the form of donated eggs, sperm, or embryos; carrying the pregnancy; or a combination of these types of reproductive assistance. View the Fact Sheet
Patient Ed Icon

What do I need to know about Turner syndrome and having children?

Turner syndrome (TS) is an infrequent genetic disorder in females. View the fact sheet
Patient Ed Icon

Gestational Carrier (Surrogate)

A gestational carrier (GC), also called a gestational surrogate, is an arrangement where a woman carries and delivers a child for another couple or person (intended parent[s]). When using a GC, the eggs used to make the embryos do not come from the carrier.  View this Fact Sheet
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SART FAQ About IVF

Created by the Society for Assisted Reproductive Technology (SART) the following are answers to frequently asked questions concerning in vitro fertilization (IVF). Learn the facts

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