Surrogacy What You Should Know Sam Everingham Director Families Through Surrogacy Surrogacy What You Should Know

What is FTS? Not-for-profit organisation Global events Australia UK Ireland Hong Kong Europe www.familiesthrusurrogacy.com

What is FTS? Best-practice conferences & seminars Events run by parents & surrogates Focus on education Website resources Consultancy to assist intended parents www.familiesthrusurrogacy.com

Overview Key Factors for Getting Started Options available Typical Problems Stabilising Factors Outcomes for Children

Factors Needed Goodwill Professional expertise Support Experienced provider Good planning Luck

Key Decisions for Getting Started Timing – when do you want to be a parent? What size family do you want? Who will be a genetic parent? What relationship do you want with your surrogate? What is your budget?

Which Countries Allow For citizens + foreigners (legal) For foreigners (no laws) For citizens Australia, Israel, South Africa, New Zealand, Netherlands, India, Thailand, UK, Czech Republic USA, Canada, Ukraine, Greece, Georgia, Russia, Brazil Kenya, Mexico, Albania, Laos

Legal Status & Who is Eligible

Other Countries

Changes in use

Surrogacy Usage Globally ~ 10,000 engage in agency-facilitated surrogacy globally each year Within Europe, UK the 2nd largest user nation of cross-border surrogacy Most UK couples going offshore using US or Ukraine

PROBLEMS

Impact of Market Closures Greater pressure on US, Canadian & Ukraine surrogacy Lower cost US options Growth of hybrid programs Eg Canadian surrogate + US IVF

Lack of Options Higher demand for surrogates in fewer countries Countries with smaller populations (eg Georgia) don’t have sufficient surrogates Increasing wait times Poorer surrogate screening -> higher drop out, lower success More use of countries with no laws (Kenya, Mexico, Laos)

Restrictive Laws Banning advertising - In Canada & Greece Banning payment – in Canada & Greece Excluding gay couples – in Greece, Ukraine, Georgia

Poorer Success with Altruistic Parents using altruistic often report Longer wait times to match with a surrogate (12- 18 mths) Surrogates dropping out Unsuccessful transfers / poor success rates spiralling timelines, costs & stress as surrogates and donors are changed after repeated failure

Average Timelines - US About 18 Months IVF Physician Surrogate Match, Legal, Medical Surrogate Waiting for a Surrogate Pregnancy, Parental Rights Legal IVF Physician Surrogate’s OB/GYN Donor Selecting a Donor, Creating Embryos

Selecting a Donor, Creating Embryos Timelines - Ukraine About 17 Months 1.5 mths 3 months 9 months 3 months Country exit Surrogate Wait for Surrogate Legal, Medical Pregnancy IVF Physician Surrogate’s OB/GYN Donor Selecting a Donor, Creating Embryos

Average Timelines - Canada 19 - 27 Months 4 months 4-6 months 2 - 8 months 9 months Surrogate medicals, transfers and new attempts Find Donor, Creae Embryos Surrogate queque Pregnancy, Parental Rights Legal Donor Agency, IVF Physician Surrogacy Agency IVF Physician, Surrogacy Agency Surrogate’s OB/GYN

Cost Containment Surrogacy costs can typically increase 50% over ‘baseline’ costs failed transfers Early miscarriages Switching from own to donor eggs Pregnancy complications Surrogate needing additional time off work

Desire for Twins Increasingly surrogates will not accept double embryo transfer, as its harder on their bodies Twin pregnancies come with far higher risks

Stabilising factors

Professional Support Surrogates who carry without agency support often find it very difficult So…. Independent Surrogacy can be tough on all parties US, Canada, Greece & Ukraine offer professional support

Surrogate Compensation Countries which can compensate surrogates tend to Have better screen-out criteria attract surrogates who are medically more suited

PGS testing of embryos increases success & is recommended

Cost Containment Costs can typically increase 50% over ‘baseline’ costs failed transfers Early miscarriages Switching from own to donor eggs Pregnancy complications Surrogate needing additional time off work

Higher Cost ‘Guarantee’ programs provide peace-of-mind & more popular Cost Containment Costs can typically increase 50% over ‘baseline’ costs failed transfers Early miscarriages Switching from own to donor eggs Pregnancy complications Surrogate needing additional time off work Higher Cost ‘Guarantee’ programs provide peace-of-mind & more popular

Outcomes for children

Surrogacy Outcomes for Children Academic research shows lack of a genetic or gestational link between parent and child has no negative effect on parent/child relationships or psychological well-being of mother, father or children1 no major psychological differences between 10 yr olds born via surrogacy vs children born via other ART or natural conception2 1 Golombok et al Human Reproduction 21, (7) pp. 1918–1924, 2006 2 Soderstrom-Anttila Surrogacy: outcomes for surrogate mothers, children and the resulting families—a systematic review Human Reproduction Update, 22, (2) pp. 260–276, 2016

Surrogacy Outcomes for Children Children in gay father families1 show low levels of behavioral and emotional problems significantly lower levels of internalizing problems than children in lesbian mother families 1 Golombok et al Child Development, 2017 Parenting and the Adjustment of Children Born to Gay Fathers Through Surrogacy