1. MRKH & IVF SURROGACY National Centre for Congenital Abnormalities of the Genital Tract Queen Charlottes and Chelsea Hospital Gillian Rose Keith Edmonds Julie Quek

2. SURROGACY DEFINITIONS FULL/HOST SURROGACY: FULL/HOST SURROGACY: Commissioning couple use IVF to create embryos of own sperm/egg to replace in uterus of surrogate – commissioning parents are genetic parents PARTIAL/STRAIGHT SURROGACY: PARTIAL/STRAIGHT SURROGACY: Surrogate woman becomes pregnant by self-insemination of intended father. Commissioning father and surrogate mother are genetic parents

3. QCCH/Hammersmith IVF Unit Lead Consultants: Mr Geoff Trew and Mr Stuart Lavery Lead Consultants: Mr Geoff Trew and Mr Stuart Lavery Infertility Counsellors arranged for all those involved to ensure full information and opportunity to talk through all aspects Infertility Counsellors arranged for all those involved to ensure full information and opportunity to talk through all aspects No charge for counselling – 0208 383 8184 No charge for counselling – 0208 383 8184

4. SCREENING TESTS Blood Group, Rhesus typing Blood Group, Rhesus typing Hepatitis B, C Hepatitis B, C HIV, TPHA, CMV HIV, TPHA, CMV Chromosomes Chromosomes Cystic Fibrosis screening Cystic Fibrosis screening Ultrasound scan of uterus – surrogate Ultrasound scan of uterus – surrogate Laparoscopy – commissioning mother for ovarian accessibility Laparoscopy – commissioning mother for ovarian accessibility ALL WITHIN 3 MONTHS OF TREATMENT ALL WITHIN 3 MONTHS OF TREATMENT

5. SCREENING & QUARANTINE Embryos (like gametes –eggs and sperm) need to be frozen for 180 days before replacement into uterus for rescreening for viral infections Embryos (like gametes –eggs and sperm) need to be frozen for 180 days before replacement into uterus for rescreening for viral infections

6. THE LEGAL ISSUES 2 Acts of Parliament regulate surrogacy: 2 Acts of Parliament regulate surrogacy: Surrogacy Arrangements Act 1985 Surrogacy Arrangements Act 1985 Section 30 of Human Fertilistion and Embryology Act 1990 Section 30 of Human Fertilistion and Embryology Act 1990

7. THE LEGAL ISSUES Illegal to advertise to find or be a surrogate Illegal to advertise to find or be a surrogate Illegal to receive payment for involvement in surrogacy Illegal to receive payment for involvement in surrogacy Only reasonable expenses paid to surrogate (suggested up to max £12,000 & 2 year life insurance policy) Only reasonable expenses paid to surrogate (suggested up to max £12,000 & 2 year life insurance policy) Agencies can assist so long as no payment for services Agencies can assist so long as no payment for services Woman who gives birth to baby is legal mother when born Woman who gives birth to baby is legal mother when born Legal father at birth is surrogates husband, surrogates partner if consented, commissioning father if surrogate has no partner Legal father at birth is surrogates husband, surrogates partner if consented, commissioning father if surrogate has no partner

8. THE LEGAL ISSUES Not possible to enforce a surrogacy arrangement Not possible to enforce a surrogacy arrangement The surrogate has the right to keep the baby The surrogate has the right to keep the baby The commissioning couple can decide not to take the baby The commissioning couple can decide not to take the baby Surrogate parents are legal parents until legal parentage is transferred to the commissioning couple Surrogate parents are legal parents until legal parentage is transferred to the commissioning couple

9. PARENTAL ORDERS In order for commissioning parents to become legal parents, need Parental Order In order for commissioning parents to become legal parents, need Parental Order Forms available from Family Proceedings Court/Magistrates Court or County Court in local area Forms available from Family Proceedings Court/Magistrates Court or County Court in local area If comply with HEFA, legal advice not necessary. Help from Parental Order Reporter If comply with HEFA, legal advice not necessary. Help from Parental Order Reporter

10. Legal Conditions for Parental Order Child carried by woman other than commissioning mother and genetically related to at least 1 of the couple Child carried by woman other than commissioning mother and genetically related to at least 1 of the couple Surrogate and husband/father must freely and unconditionally give consent Surrogate and husband/father must freely and unconditionally give consent Consent > 6weeks 6weeks < 6 months Commissioning couple must be married and both >18 years old Commissioning couple must be married and both >18 years old No money other than reasonable expenses No money other than reasonable expenses to surrogate Couple must be domiciled in UK and child living with commissioning couple Couple must be domiciled in UK and child living with commissioning couple

11. Registration via Parental Order Entry in separate PO Register to re-register child. Entry in separate PO Register to re-register child. Cross-referenced with original entry in Register of Births Cross-referenced with original entry in Register of Births Public cannot access link Public cannot access link Child > 18 years can have copy of original birth certificate after offered counselling Child > 18 years can have copy of original birth certificate after offered counselling Intended parents receive new birth certificate stating they are legal mother and father of child Intended parents receive new birth certificate stating they are legal mother and father of child Until PO granted, surrogate can apply for Residence Order to seek return of child Until PO granted, surrogate can apply for Residence Order to seek return of child

12. FURTHER INFORMATION COTS (Childlessness Overcome Through Surrogacy) COTS (Childlessness Overcome Through Surrogacy) Lairg, Sutherland IU27 4EF Tel: 0844 414 0181 AP/FAX: 01549 402777 AP/FAX: 01549 402777 www.surrogacy.org.uk SURROGACY UK SURROGACY UK PO Box 24, Newent GL 18 1YS Tel: 01531 821889 (10am-2pm) E-mail: admin@surrogacyuk.org admin@surrogacyuk.org www.surrogacyuk.org

13. Normal Pelvis

14. MRKH Pelvis

15. MRKH Ovary

16. MRKH Laparoscopy

17. Ovarian Follicle

18. Egg Collection