title: The impact of cross-border reproductive care or 'fertility tourism' on NHS maternity services.
abstract: High order multiple pregnancies have substantial morbidity and mortality. Fertility treatment is commonly responsible for their conception and is available globally with variable regulation. We investigated cross-border fertility treatment in these pregnancies in a UK fetal medicine unit, recording mode of conception, country of fertility treatment, reason for non-UK treatment and fetal reduction. Over an 11-year period, 109 women had a high order multiple pregnancy. Ninety-four women (86%) conceived with fertility treatment of whom 24 (26%) had this performed overseas. Cross-border fertility treatment poses an increasing challenge to obstetricians. National data on its occurrence is urgently needed.
authors.affiliation: Fetal Medicine Unit, Elizabeth Garrett Anderson Wing, University College Hospitals NHS Foundation Trust, London, UK. alastairmckelvey@doctors.org.uk
authors.forename: A
authors.initials: A
authors.lastname: McKelvey
authors.forename: A L
authors.initials: AL
authors.lastname: David
authors.forename: F
authors.initials: F
authors.lastname: Shenfield
authors.forename: E R
authors.initials: ER
authors.lastname: Jauniaux
mesh_terms: D000349:Africa; D001208:Asia; D005060:Europe; D005260:Female; D006801:Humans; D007246:Infertility / Q000628:therapy*; D008131:London / Q000453:epidemiology; D008427:Maternal Health Services / Q000706:statistics & numerical data*; D011247:Pregnancy; D011272:Pregnancy, Multiple / Q000706:statistics & numerical data*; D027724:Reproductive Techniques, Assisted / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013222:State Medicine; D006113:United Kingdom; D014481:United States