1. Interdisciplinary cooperation in gestational surrogacy care
Ellen Van Moer
Midwife - Coordinator Oncofertility & Surrogacy
CARE4 – Thursday 9 February 2017

2. What is surrogacy?
Surrogacy implies that a woman becomes pregnant and gives birth to a child on behalf of another couple.
A surrogate is the woman who carries and gives birth to the child and the intended parents or commissioning couple are the persons who intend to raise the child.
ESHRE Task Force on Ethics and Law 10: Surrogacy Shenfield et al., Human Reproduction 2005
Third party reproduction

3. Types of surrogacy
Gestational or full/host surrogacy High technological surrogacy
Gametes of commissioning couple and/or donors
IVF/ICSI
No genetic link with surrogate mother
Traditional or genetic/partial surrogacy Low technological surrogacy
Oocytes of the surrogate are used
Artificial insemination
Genetic link with the surrogate
Two forms in surrogacy – in fertility centers in Belgium only gestational surrogacy is performed. - No legislation in Belgium
Commercial vs altruistic

4. Implementation process of altruistic gestational surrogacy
Interdisciplinary team
Prospective visits to: - lawyer - two experienced fertility centers
Literature study
Dar et al., Human Reproduction 2015 Norton et al., Reproductive BioMedicine online 2015 Ethics Committee of ASRM., Fertil Steril 2013
De Wert et al., Human Reproduction 2011
Dermout et al., Human Reproduction 2010
Shenfield et al., Human Reproduction 2005

5. Surrogacy team CARE4 Ethical Committee Midwives Psychologist
Gynaecologists
Lawyer
CARE4
Demands a cooperation between different disciplines. Medical disciplines such as: midwifery, psychology, obstetrics and reproductive medicine, a lawyer practising
+ ethical commitee
Surrogate + family
Intended parents
Future child

6. Clinical path surrogacy @ UZ Brussel

7. Clinical path: Prescreening
Request for surrogacy Contact Centre
General information on:
Indication
Demographics
State of health
Medical/Obstetrical history
Marital status
Social background
Questionnaire
Prescreening Q by midwife/team discussion
Fulfill criteria? GO
Planning screening visits

8. Clinical path: Screening & counseling visits
Legal procedure: Lineage, Recognition, adoption, risks
Consultation lawyer
Consultation Fertility specialist
Medical history
Evaluation indication Medical examination
Team discussion
Consultation midwife
Couns: steps of pathway
Aspects and risks Possible scenarios
Consultation Psychologist
Relationships / motivation
Social/life experiences
Psychological questionnaires
Resilience/coping strategies
Submission to E.C.
Consultation Obstetrician
Exclusion obstetrical risk Medical examination SUR GO

9. Clinical path: IVF treatment
Consultation Midwife/Psychologist
Pregnancy- and birthplan Psychological guidance
Consultation Fertility specialist
Prescription IVF treatment
Consultation Midwife
Counseling/planning IVF treatment
Team discussion
2nd approval E.C.?
Follow-up by Gynaecologist,midwife, psychologist
Start ovarian stimulation / IVF
Single Embryo Transfer
Pregnancy

10. Clinical path: Pregnancy and Birth
Clinical pregnancy
Normal US at 7w
Pregnancy FU by obstetrician
Completion birth plan
Consultation psychologist at 7w, 14w, 22w, 34w
Psychological guidance
Delivery/birth
Guidance by obstetrician and delivery room and maternity ward
Handing over newborn
Postnatal consultation psychologist
Adoption procedure
Guidance by lawyer

11. Hurdles to overcome Complex procedure Cost-efficiency Legal framework
Expand interdisciplinary team with a public authority committee
Higher awareness in midwifery/obstetrics
Increase clinical research
In cooperation with family court. Purpose of surrogacy legislation: register descencent on the moment of the acceptance and start treatment, not at birth.
Söderström-Anttila et al., Human reproduction Update 2016 Jadva et al., Human Reproduction 2015

12. Thank you Guy Demesmaecker Saskia Van Ginderdeuren Lize Leunens
Dominic Stoop
Herman Tournaye
Leonardo Gucciardo
Katrien Beeckman

13. Questions?