Cross-border reproductive care commonly used or considered by women with infertility

Nearly one in six women with infertility in Hong Kong have used cross-border reproductive care (CBRC), while more than one-third have planned or would consider using CBRC services, a recent cross-sectional questionnaire study has shown.

Among 1,204 women with infertility (mean age, 34.7 years) who attended Hospital Authority or Family Planning Association infertility clinics between February 2017 and March 2019, 178 women (14.8 percent) had used CBRC previously. Among those who had not received CBRC previously, 36.3 precent had plans to or would consider receiving such treatment outside Hong Kong. [Hong Kong Med J 2020;26:492-499]

Nondonor in vitro fertilization (IVF) was preferred by 54.4 percent of respondents as the CBRC treatment of choice, while intrauterine insemination (IUI) was preferred by 40.6 percent. Few respondents were interested in oocyte donation (0.6 percent), sperm donation (0.2 percent) or surrogacy (0.4 percent).

The main factors that motivated CBRC use were long waiting times in the public sector (80.9 percent) and high treatment costs in the private sector (12 percent). Only 0.5 percent of respondents reported law evasion as a reason for using or considering CBRC.

Taiwan was the most preferred (69.9 percent) destination for CBRC, followed by mainland China (25.8 percent). However, 61.1 percent of respondents reported difficulty in allocating time to leave Hong Kong for CBRC, while 14.5 percent cited concerns about substandard medical technology in the destination countries as a reason for their hesitation.

More than half (57.1 percent) of the respondents who had used or would consider using CBRC obtained relevant information from the Internet, while 32.7 percent obtained information from friends. Only 4 percent of these respondents obtained information on CBRC from professional sources.

Among respondents who had used or would consider using CBRC, 61.8 percent had received counselling in Hong Kong to assist them in CBRC treatment, while 37.6 percent of those who had used CBRC reported involvement from doctors in Hong Kong during CBRC treatment.

Surprisingly, while the number of embryos transferred in CBRC was two in most of the cases (n=40 of 59; 67.8 percent), three respondents (5.1 percent) had undergone transfer of four embryos despite the risk of maternal and foetal morbidity and mortality associated with high-order multiple pregnancies.

In terms of complications, 1.7 percent of respondents who had received CBRC reported ovarian hyperstimulation syndrome (OHSS), while 1.7 percent experienced other types of complications. Most of the respondents (70.2 percent) believed that authorities in Hong Kong should formulate regulations or guidance regarding CBRC.

Most respondents in the study had primary infertility (76.6 percent) and had attempted conception for <5 years (72 percent). Among those who had received CBRC previously, 30 percent were <35 years of age with unexplained infertility, for whom both stimulated IUI and IVF are appropriate first-line treatment options.

“The largest potential problem related to CBRC involves patient health and safety. In the context of assisted reproduction treatment, this could include multiple pregnancies, OHSS, and infectious disease transmission,” the researchers wrote.

As such, they suggested that patients should obtain more information about potential complications and success rate in the destination country centre to make informed CBRC choices, while clinicians should educate patients about the potential risks of CBRC. Clinicians collaborating with doctors in other countries to facilitate CBRC should formulate a clear plan on the role of patient management and resume care of a patient who has returned after receiving CBRC, especially in case of complications.

“The Hong Kong government can formulate guidance for clinicians and publish advice for patients who are considering CBRC,” they added.