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

Surrogacy can be at home – 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)

A whole new language Gestational surrogacy Traditional Surrogacy

A whole new language Gestational surrogacy Donor Egg IP Egg Donor Egg + + + Donor IP Sperm IP Sperm Sperm Embryo Embryo Embryo transferred transferred transferred to surrogate to surrogate to surrogate

A whole new language Traditional Surrogacy Intended father Donor Sperm or sperm Intrauterine Insemination into surrogate

A whole new language

The Fertility Specialist

Intending Parent(s) Surrogate Egg donor Fertility Specialist Fitness for surrogacy pregnancy Eligibility Fertility Specialist opinions, Other medical assessment investigations and screening opinions / medical Medical Benchmark higher than own tests / screening tests/screening pregnancy tests Surrogacy / Donor Coordinator Counseling/cooling off Counseling/cooling off Counseling / Psychological assessments Psychological assessments cooling off Legal contracts Legal contracts Surrogacy / Donor Coordinator Reproductive Technology Council (RTC) Surrogacy / Donor Coordinator Fertility Specialist

Fertility Specialist Intended Surrogate Egg donor parents Hormonal stimulation Uterine lining preparation Egg collection Embryo transfer Fertilisation PGT? IVF/ICSI Pregnancy test Past stored embryos negative positive Surrogacy / Donor Coordinator

The Egg Donor • 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 Surrogate …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 Fertility Specialist Medical procedures – Egg collection • Transvaginal, laparoscopic – Egg fertilisation • IVF or ICSI – Embryo transfer – Genetic testing • Preimplantation Genetic Testing Screening or diagnostic

IVF and Surrogacy 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)

The Ovary – antral follicles

TVOPU

Embryo Growth • ET • Blastocyst • Cleavage

IVF Complications • Excess response – Ovarian Hyper-Stimulation Syndrome (OHSS) • Poor response - <4 eggs maturing • Infection/bleeding/pain from OPU

Embryo Transfer Complications • Failed implantation • Miscarriage • Ectopic pregnancy • Multiple pregnancy • Birth Defects

Success Rates 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

Preimplantation Genetic Testing (PGT) • 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

Finally … to PGT or not to 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

Questions?