title: The contribution of multiple pregnancies from overseas fertility treatment to obstetric services in a Western Australian tertiary obstetric hospital.
abstract: BACKGROUND
  Increasingly couples are travelling overseas to access assisted reproductive technology, known as cross border reproductive care, although the incidence, pregnancy outcomes and healthcare costs are unknown.
  
  
  OBJECTIVE
  To determine obstetric and neonatal outcomes for multiple pregnancies conceived through fertility treatment overseas, and estimate cost of these pregnancies to the health system.
  
  
  METHODS
  Retrospective study of women receiving care for a multiple gestation between July 2013 and June 2015 at Western Australia's sole tertiary obstetric hospital, where conception was by overseas fertility treatment. Obstetric and neonatal outcomes were recorded and cost estimates calculated.
  
  
  RESULTS
  Of 11 710 births, 422 were multiple pregnancies. Thirty-seven pregnancies were conceived with fertility treatment, with 11 (29.7%) conceived overseas. Median antenatal clinic attendances, ultrasound examinations, and fetal assessments for the overseas fertility cases were six, 10, and nine, respectively. The gestational age at delivery ranged from 30 to 38 weeks (median 34 + 1). Median neonatal admission duration was 18 days (range 0-47). Cost for obstetric care was estimated between $170 000 and $216 000, and cost of neonatal care was estimated as $810 000, giving a combined total cost of between $980 000 and $1 026 000.
  
  
  CONCLUSIONS
  At the sole tertiary obstetric centre in WA, approximately one-third of all multiple pregnancies conceived with fertility treatment resulted from treatment overseas. The Australian healthcare cost for these 11 women and their infants exceeded $1 000 000. This study suggests that overseas fertility treatment has a significant health-related cost to the mother and infant, and the local healthcare system.
authors.affiliation: King Edward Memorial Hospital, Perth, Western Australia, Australia.
authors.forename: Kylie Anne
authors.identifier: http://orcid.org/0000-0002-9128-4912
authors.initials: KA
authors.lastname: Waller
authors.affiliation: King Edward Memorial Hospital, Perth, Western Australia, Australia.|School of Women's and Infants' Health, University of Western Australia, Perth, Western Australia, Australia.
authors.forename: Jan E
authors.identifier: http://orcid.org/0000-0003-3928-3290
authors.initials: JE
authors.lastname: Dickinson
authors.affiliation: King Edward Memorial Hospital, Perth, Western Australia, Australia.|School of Women's and Infants' Health, University of Western Australia, Perth, Western Australia, Australia.|Fertility Specialists of Western Australia, Bethesda Hospital, Perth, Western Australia, Australia.
authors.forename: Roger J
authors.initials: RJ
authors.lastname: Hart
mesh_terms: D000328:Adult; D005260:Female; D005865:Gestational Age; D017048:Health Care Costs / Q000706:statistics & numerical data*; D017721:Hospital Costs / Q000706:statistics & numerical data; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000191:economics; D057193:Medical Tourism / Q000191:economics*; D008875:Middle Aged; D009775:Obstetrics and Gynecology Department, Hospital / Q000191:economics*; D011247:Pregnancy; D011272:Pregnancy, Multiple; D027724:Reproductive Techniques, Assisted / Q000191:economics; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D014904:Western Australia
keywords: 
  in vitro fertilisation
  ; cost; cross border reproductive care; infertility; multiple pregnancy