Cross Border Reproductive Care
In hopes of attracting patients on a global basis, many fertility programs have opened their doors in recent years and are marketing to potential customers in the United States. The term cross-border reproductive care (“CBRC”) is the commonly accepted term to describe the process of international travel to undergo fertility treatments, often involving donors and gestational surrogates. In the U.S., we mostly hear about the availability of gestational surrogacy in India, but programs in Greece, Ukraine and other countries are also actively seeking out clients. Advertising campaigns promise expert care, low prices and a relaxing vacation as part of the arrangement. Clients seeking CBRC are motivated by many factors, including access to care, quality of, and quicker access to, that care, affordability, less restrictive regulation, and privacy. When considering any of these services, the consumer should be aware of many factors and weight the risks and potential benefits very carefully.
1. Cost: The main attraction for U.S. citizens seeking CBRC appears to be the relative affordability of the medical services abroad. While the cost may be thousands of dollars less than at home, the figures quoted may not tell the entire story. Any planning must account for the cost of travel, time lost from work, shipment of embryos (if this is a factor), and post-birth hospitalization for the child (see below).
2. Premature delivery: The potential, life-long consequences of a premature or otherwise medically fragile newborn must be weighed in any plans for care abroad. Adding to this concern is the frustration and difficulty of dealing with caregivers who may not speak a language the parents can understand.
3. Access to care: Many countries, most notably India, restrict CBRC on the basis of marital status, sexual orientation, or both.
4. Quality of care: travelers should thoroughly research the qualifications and experience of the reproductive endocrinologist and the fertility center. This should include a visit to the Society for Assisted Reproductive Technology’s website (“SART” is an affiliated society of the American Society for Reproductive Medicine) so establish whether the clinic and the director are international members of the organization. While international membership does not require IVF- lab certification as it would for stateside practitioners, it will show, at a minimum, that the clinic is a recipient of the latest medical advances in this field.
5. Safety of the delivery facility: Research into the delivery facilities, accreditation of the caregivers and the facility, and other assessment factors are critically important, but may be difficult to obtain, and even if available, hard to understand and properly interpret. Quality assurance is manifestly lacking in many third-world countries, and lack of reliable oversight can result in a dangerous situation for the child and the surrogate.
6. Working with a gestational carrier off-shore: Intended parents who have strong concerns about gestational carrier lifestyle issues, or who envision a close and involved relationship with the surrogate and who would like the ability to have longstanding relationships post delivery are not suited to these arrangements. Similarly, intended parents who would like a donor conceived child to have the option of learning more about the donor and possibly meeting the donor in the future will not have those opportunities with CBRC.
7. Legal issues: Perhaps most vexing of all are the legal issues involved in these arrangements. Obtaining the correct Consular Report of Abroad Birth, travel documents and citizenship status for the child are imperatives in these arrangements. Consultation with a reproductive law attorney who is experienced in this area, and also with an immigration attorney, are a must before finalizing any travel plans.