title: Attitudes towards cross-border reproductive care among infertile Japanese patients.
abstract: OBJECTIVE
  The attitudes towards cross-border reproductive care (CBRC) held by infertile Japanese patients have not been explored. The objective of the present study was to examine interest levels, preferred destinations, motivations, and sources of information related to CBRC. Our findings provide a general outline of CBRC and the future of reproduction and assisted reproductive technology (ART) in Japan.
  
  
  METHODS
  The study used a cross-sectional design. Data were collected from 2,007 infertile Japanese patients from 65 accredited ART clinics in Japan (response rate, 27.4 %) via anonymous questionnaires.
  
  
  RESULTS
  Most of the infertile Japanese patients who responded denied using CBRC. However, by group, 171 (8.5 %) patients in non-donor in vitro fertilization, 150 (7.5 %) in egg donation, 145 (7.2 %) in pre-implantation genetic diagnosis, and 129 (6.4 %) in surrogacy said that, depending on the situation, they might travel abroad in the future. Older respondents were more likely to express an intention to travel overseas for egg donation in the future. The most popular destination for CBRC was the United States. Popular reasons for interest in CBRC among those considering or planning using this approach to third-party reproduction were that egg donation or surrogacy was unavailable or that obtaining ethical approval takes too long in Japan, whereas these processes are legal and affordable overseas. However, high cost was the most common reason for hesitancy regarding CBRC. Among the participants who were considering or planning to travel abroad for this purpose, TV, medical agencies, print media, and message boards on websites were popular sources of information, whereas doctors, friends, and patient self-help groups were not.
  
  
  CONCLUSIONS
  Although CBRC among infertile Japanese patients is not at present common, the demand for and use of this approach may increase in the future in the context of the increasingly aging population. Lack of regulation and unavailability of third-party reproduction is a major cause of CBRC among Japanese patients. Health care provider faces an urgent need for giving useful information for patients regarding CBRC.
authors.affiliation: Department of Environmental and Preventive Medicine, Graduate School of Medical Science, Kanazawa University, Kakumamachi, Kanazawa, 920-1192, Japan, hibino@staff.kanazawa-u.ac.jp.
authors.forename: Yuri
authors.initials: Y
authors.lastname: Hibino
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Shimazono
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Kambayashi
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Hitomi
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Nakamura
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007564:Japan; D008297:Male; D057193:Medical Tourism; D008875:Middle Aged; D027724:Reproductive Techniques, Assisted / Q000523:psychology*; D011795:Surveys and Questionnaires