Infertility Patients' Motivation for, Experiences of, Cross-Border Reproductive Services (CBRS): An Asynchronous Online Investigation

The desire for, and provision of, cross border reproductive services (CBRS) (i.e. gamete donation and surrogacy) is a growing international phenomenon. CBRS describes the travel by infertile patients from one country or jurisdiction where access to treatment is limited or unavailable to another country or jurisdiction to seek infertility treatment. There are numerous reasons for CBRS and it is an under- researched and undertheorised area of health research. The aim of this thesis was to explore patients’ motivations for and experiences of CBRS. This study provided themes on the decision making process of CBRS patients and contextualised them within a partial trans-Theoretical Model. Data regarding CBRS were collected from 26 international participants by means of asynchronous email in-depth semi-structured interviews via two international infertility networks. SPSS was used to analyse the quantitative data whereas NVivo 10 software aided the systematic thematic coding method within an Interpretative Grounded Theory. Participants’ motivations for and experiences of CBRS are complex. Seven stages of patients’ infertility journeys emerged: 1. Pre-contemplation: participants had no awareness of their own infertility; 2. Contemplation: participants became aware of their infertility and treatment at home and / or CBRS; 3. Preparation: participants researched CBRS using internet/infertility networks; 4. Action: participants took specific steps to initiate CBRS; 5: Maintenance: participants’ expectations and experiences were important to whether or not they would continue with CBRS; 6: Exit: some participants successfully built their family. Others’ overall experience was negative, their expectations were not met and they decided to quit treatment; 7: Re-engagement: some participants re-engaged with infertility treatment; some participants re-considered their decision regarding infertility treatment either at home or CBRS. A partial Trans-Theoretical Model could explain some of the decision-making process in seeking CBRS. Future research is needed to explore the implications of CBRS for patients, donors, offspring and healthcare systems.