- OBJECTIVE: To identify the scope and volume of cross-border fertility services in Canada and the U.S. and to evaluate the three-way communication between patients and their service providers in 2008. DESIGN: Mail and on-line surveys of cross-border fertility care activity were sent to 34 Canadian and 392 American fertility clinics and clinicians. MAIN OUTCOME MEASURE(S): Clinician and patient experience with assisted reproductive technologies. RESULT(S): The most commonly reported cross-border treatment sought by Canadians was anonymous donor-oocyte in vitro fertilization (IVF; 363 out of 452, 80%). For patients entering Canada to receive fertility treatment, the largest demand was for IVF (106 out of 146, 73%). The majority of out-of-country patients received by U.S. clinics sought standard IVF (927 out of 1,809, 51%), most of these coming from Europe (25%) and Latin America (39%). The largest proportion of patients leaving the U.S. to receive IVF (41%) or donor-egg IVF (52%) traveled to India/Asia. Concurrence was seen between Canadian and U.S. clinics' ratings of key data that should be provided along with returning patients. Experience of earlier patients with individual centers and perceived safety and effectiveness of care are the key factors in choice of destination. CONCLUSION(S): Anonymous donor-oocyte IVF is the main assisted reproductive technology sought by Canadians traveling to the U.S. India and Asia are the main destinations for U.S. women leaving the country for their fertility care. Three-way communication between patients and sending and receiving clinics is an important element of safe and effective care.