Are there any published case studies which illustrate the clinical and ethical issues of managing pregnancies that
originated through fertility tourism, specifically UK patients seeking egg donation abroad?
Session leader: Sarah Lewis, Buckinghamshire Healthcare NHS Trust
31 July 2014, Royal Berkshire Hospital
1. Sources
Embase
Medline
CINAHL
PsycINFO
AMED
HMIC
Google
BMJ Case Studies
Human Fertilization and Embryology Authority
TRIP
2. Search terms listed during group discussion
Terms in bold indicate Mesh headings
Patient (1)
Women
Patient (2)
Infertility
Patient (3)
Fertility tourism
Infertility / female
Infertility / therapy
Fertility tourist
Travellers
Tourism
Reproductive
tourism
Medical tourism
Cross border
Overseas
Abroad
Intervention
Reproductive techniques
(assisted)
Oocyte donation
Egg donation
Egg*
Ova*
Ovu*
Oocyt*
Cross border reproductive
care
“Reproductive treatment”
Comparison
Outcome
Ethical analysis
Ethical review
Ethical theory
Delivery of health care
/ethics
Healthcare sector /
ethics
Morals
Morality
3. Limits
 English Language
 Case studies / case reports
 Great Britain / United Kingdom / UK / NHS
4. Results compilation
11 attendees returned their top 5-10 results. These were compiled into one table comprising of 50 results – see associated document.
The most commonly selected paper was The impact of cross-border reproductive care or ‘fertility tourism’ on NHS maternity services. McKelvey, A.
BJOG: an international journal of obstetrics and gynaecology. October 2009, 116/11(1520-3) – 10 library staff selected this paper
The original requestor was particularly interested in case reports. Several case reports were retrieved by the group

Heterotopic pregnancy in a cross border oocyte donation patient: the importance of cooperation between centers. Mancini, F. Fertility
and Sterility, June 2011 95(7), e13-5 – selected by 3 of the group

Maternal death after oocyte donation at high maternal age : case report. Scutte, J. Reproductive health, 2008 5(1) - found by one
member of the group as well as the original search

Oocyte donation and pregnancy risk: a case report. Mancini, F. Journal fur Reproduktionsmedizin und Endokrinologie 2010 7(4) 326327- found by one member of the group as well as the original search

Reproductive agency and projects: Germans searching for egg donation in Spain and the Czech Republic. Bergmann, S. Reproductive
Biomedicine Online, 2011 23(5), 600-8 – not chosen by the group but found in the original search
Several papers were retrieved by the group which focussed on the NHS perspective on this issue – including the McKelvey paper listed above. A
couple of these were found via google as they did not appear on the bibliographic databases

Assisted reproductive travel: UK patient trajectories. Hudson, N. Reproductive Biomedicine Online November 2011 23(5), 573-81 –

Cross border treatment for infertility: the counselling perspective in the UK. Hunt, J. Human Fertility 16(10, pp64-67.

Crossing borders for fertility treatment: motivations, destinations and outcomes of UK fertility travellers. Culley. L. Human
Reproduction 2011 26(9), 273-81

Implications for the NHS of inward and outward medical tourism: a policy and economic analysis using literature review and mixedmethods approaches. Lunt, N. Health Services and Delivery Research 2014(2)2.


Transnational reproduction: an explanatory study of UK residents who travel abroad for fertility treatment. Culley, L. 2011
Dissertation.

Travelling abroad for fertility treatment: an exploratory study of UK residents seeking cross-border care. Culley, L. Human
Reproduction, June 2010 25.

7th International Scientific Meeting in Montreal has looked at the impact of higher order multiple pregnancies within the NHS and the
link with fertility treatment received overseas. Royal College of Obstetricians and Gynaecologists.
5. Further analysis of results
A simple search of Pubmed using the terms Egg donation and Medical tourism retrieved a number of results. The related citation feature was used for the
paper Attitudes towards cross-border reproductive care among infertile Japanese patients. This retrieved a number of additional papers (see associated
documents) including:

Impact of egg donation deliveries from domestic and overseas sources on maternal care: a questionnaire survey of Japanese perinatal physicians.
Hibino, Y. Environ Health Prev Med July 2014 19(4) 271-8. This paper had not been fully indexed with Mesh terms due to its recent publication.

Cross-border reproductive care: quality and safety challenges for the regulator(UK) Fertility and Sterility, 2010 June. This paper had the indexing terms
Reproductive techniques, assisted and Internationality (rather than medical tourism)
Go Pubmed
All results retrieved by the group plus relevant ones from the Pubmed related citation search were added to the Clipboard in Gopubmed. This in turn
retrieved some useful related publications



Cross-border reproductive services – suggestions for ethically based minimum standards of care in Europe. Thorn, P
Are there implications for quality of care for patients who participate in international medical tourism? Lunt, N
Is it ethically justifiable for fertility doctors to refer or recommend local patients to foreign clinics for oocyte donation? Heng
Using the statistics feature in GoPubmed, it was possible to view the publication trends for this topic. The main findings were



The most popular journal for papers on this topic was Reproductive Biomedicine Online, followed by Fertility and Sterility.
The UK was the top country for research in this area.
The most common Mesh terms were
o Reproductive techniques, assisted
o Medical tourism
o Internationalty
o Tissue donors
o Travel
o Fertilization
Additional Mesh terms found through analysis of existing search results and Gopubmed– most common ones in bold
Patient (1)
Patient (2)
Reproductive health
Birth
Female fertility
Reproduction
Patient (3)
Internationality
Travel
Interinstitutional
International cooperation
Intervention
Tissue donors
Fertilization
Fertilization in vitro
Surrogate mothers
Donor
Reproductive technology
Embryo tansfer
Embryology
Comparison
Outcome
Health care policy
Health care system
Treatment outcome
Health care delivery
Management
Healthcare services
Safety
Maternal health
service
Policy / policy making
Ethics