Surrogacy in WA Role of the IVF Specialist Dr Lucy Williams MBBS - - PowerPoint PPT Presentation

Surrogacy in WA

Role of the IVF Specialist

Dr Lucy Williams MBBS FRANZCOG Medical Director Concept Fertility Centre

Surrogacy

Surrogacy

Will I need eggs? How do I know I need surrogacy? Are we eligible? Who can be a surrogate? How much does it cost? Can we do this at home? What is the Law?

– Surrogacy arrangements are legal in WA

(WA Surrogacy Act 2008)

– Confidence and familiarity with local medical system – Less disruption for family and work – Several Perth fertility clinics offer surrogacy support

Surrogacy can be at home

• Arrangements must be Altruistic
• Criteria for surrogate

– Over 25 years – Given birth

• Criteria for requisitioning parent(s)

– Medical indication – Access for male couples under review

• Legal contracts/psychological assessments
• Approval by RTC(WA)

Surrogacy can be at home

A whole new language

Gestational surrogacy Traditional Surrogacy

A whole new language

Gestational surrogacy

IP Egg + IP Sperm Embryo transferred to surrogate Donor Egg + IP Sperm Embryo transferred to surrogate Donor Egg + Donor Sperm Embryo transferred to surrogate

A whole new language

Traditional Surrogacy

Intended father sperm Intrauterine Insemination into surrogate Donor Sperm

• r

A whole new language

The Fertility Specialist

Intending Parent(s) Surrogate Egg donor

Fertility Specialist

Fitness for surrogacy pregnancy Specialist opinions, investigations and screening Benchmark higher than own pregnancy Fertility assessment Medical tests/screening tests

Surrogacy / Donor Coordinator

Counseling/cooling off Psychological assessments Legal contracts Counseling/cooling off Psychological assessments Legal contracts Counseling / cooling off

Reproductive Technology Council (RTC) Fertility Specialist Surrogacy / Donor Coordinator

Eligibility Other medical

• pinions / medical

tests / screening

Surrogacy / Donor Coordinator

Fertility Specialist Uterine lining preparation Embryo transfer Past stored embryos Hormonal stimulation Egg collection Fertilisation IVF/ICSI Pregnancy test Surrogacy / Donor Coordinator

positive negative

Intended parents Surrogate Egg donor PGT?

• Altruistic
• “Known”
• WA Law - 5 family limit (in addition to own)

Also applies to imported gametes and embryos

The Egg Donor

Recommended

• Older than 25, younger than 35
• Normal fertility
• Completed family

Very limited access to anonymous* egg donors Australia wide

*donor must consent disclosure of identifying information to child when reaches 16 years of age

The Egg Donor

…Finding a surrogate

Advertising; Clinics are prohibited from advertising Intending parents are permitted Women offering surrogacy also permitted Social media platforms Surrogacy Australia

The Surrogate

Fitness of surrogate for pregnancy

– Current Health / Medications / Age – Details of past pregnancies and births – Physical exam / CST / Ultrasound / screening – Other specialist opinions as needed

Benchmark higher than with own pregnancy

The Surrogate

Medical procedures

– Egg collection

• Transvaginal, laparoscopic

– Egg fertilisation

• IVF or ICSI

– Embryo transfer – Genetic testing

• Preimplantation Genetic Testing

Screening or diagnostic

The Fertility Specialist

What is In-Vitro Fertilisation (IVF)?

• Hormonal injections to grow a woman’s eggs
• Collection or harvesting of the eggs
• Fertilising the eggs in the laboratory to create

embryos

Embryo transfer

• Putting a stored embryo into the uterus

(womb)

• Fresh or Frozen (thawed)

IVF and Surrogacy

The Ovary – antral follicles

TVOPU

• ET
• Blastocyst
• Cleavage

Embryo Growth

• Excess response

– Ovarian Hyper-Stimulation Syndrome (OHSS)

• Poor response - <4 eggs maturing
• Infection/bleeding/pain from OPU

IVF Complications

• Failed implantation
• Miscarriage
• Ectopic pregnancy
• Multiple pregnancy
• Birth Defects

Embryo Transfer Complications

Chance of pregnancy related to age of woman at time of egg collection

• 30-40% with eggs from 30 yr old woman
• 20-25% with eggs from 35 yr old woman
• 8-15% with eggs from 40 yr old woman
• 3-5% with eggs from 42 yr old woman

Success Rates

• Screening or Diagnostic
• Sample of cells from the embryo at day

5 (blastocyst)

• Embryos frozen until results available
• DNA from embryo then analysed for

chromosome number and/or specific gene defect

• Single healthy embryos then transferred

Preimplantation Genetic Testing (PGT)

• Theoretical benefit not seen in practice
• Assists in choice / no improvement of

embryo

• Not all implantation failure is due to

faulty embryo chromosome number

• Small potential for harm to the embryo
• Cost

Finally …to PGT or not to PGT?

Questions?