Crossing Borders for Reproductive Care: A Systematic Review and Meta-Synthesis of Intended Parents' Experiences

Abstract

Cross border reproductive care (CBRC) is a growing global phenomenon where individuals travel abroad seeking assisted and third-party reproductive services. Infertility rates are rising, and the increased accessibility of travel has produced global 'hubs' where intended parents seek fertility treatment to fulfil their parenthood desires. While CBRC has faced social commentary fraught with ethical and moral debate, less attention has been paid to exploring intended parents’ experiences, with much of this understanding remaining fragmented and providing only a partial account of CBRC. Consequently, this research explored intended parents’ experiences embarking on their treatment abroad, their care overseas and their navigation of ethical concerns, by systematically reviewing and synthesising existing CBRC qualitative literature. Seven databases were searched, with 24 included studies synthesised using a meta-aggregative approach following screening and quality appraisal. Key findings concerning the experience of CBRC included: exhaustion of local options for family formation; varied care and assistance from local clinicians; a reliance on peer support to facilitate CBRC; trust as core to the experience of care abroad; overall satisfaction with care abroad; and dissatisfying aspects of overseas care. Additionally, key findings relating to intended parents’ navigation of ethics included: disillusion with and rejection of the exploitation discourse; and attempts to identify, minimise and avoid exploitation. Going beyond the scope of discrete studies, the findings from this meta-synthesis reveal the overall landscape of CBRC and helps inform future practice for all stakeholders, including policy makers and clinicians, to maximise support and positive outcomes throughout the CBRC experience.