Making Surrogacy More Workable in
Australia
What Needs to Change
Sam EveringhamDirector
Families Through Surrogacy
Overview
bull Background Issues
bull Why Australian Surrogacy is Failing
bull International amp Local Law Reform
bull Growing Domestic Capacity
bull Community Attitudes
BACKGROUND ISSUES
Current Environment
bull Australian legislation written by policy-makers who assumed
surrogates would be existing friends or relatives
bull In fact gt50 of Australian surrogates sourced online
bull Surrogacy in less regulated jurisdictions is increasingly available
Australian Surrogacy Model
bull Surrogate recruitment illegal
bull Matching of Intended Parents amp surrogates illegal
bull Fertility counsellors donrsquot screen out surrogatesIPs
bull Only mandatory screen-outs are medically based
bull Surrogacy facilitation amp payments illegal
bull No professional support provided during pregnancy attempts and pregnancy
bull IPs amp Surrogates must manage all aspects
Result of Current Model
Sourcing amp Matching is Tough and Poorly Done
bull Potential surrogates are lsquoput offrsquo by need to self-assess IPs
bull Intended Parents amp Surrogates stalk each other online
bull IPs unwilling to let go of a surrogate even when lsquored flagsrsquo apparent
bull Australian surrogates can be poorly prepared
bull Single No prior children Inadequate social supports
In lead up to first transfer
bull Relationship breakdowns not uncommon
Result of Current Model
During process
bull Conflict often emerges over payments
(IPs terrified by lack of legal certainty on parentage concerned court will reject if
inappropriate payments)
Surrogacy Trends
39
63
52
80
9185
131121
176
157
6
20
7 818 14
21 19
35 36
0
20
40
60
80
100
120
140
160
180
200
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
ANZ Gestational Surrogacy Cycles amp Deliveries
Gest carrier cycles No of live deliveries
~200 domestic gestational surrogacy births in last 8 years
Australian regulatory Frameworks not
meeting needs
Australia UK Canada
lt6 ~50 ~50
~3000 surrogacy births to Australians in last 8 years
Proportion engaging domestically
WHY DO FAR MORE AUSTRALIANS
ENGAGE OFFSHORE
Key Barriers Pushing Australians
offshore
1) Lack of eligibility
2) Regulatory processes harder vs offshore alternatives
3) Significant professional costs
4) Difficulty sourcing a surrogate
5) Lack of certainty over legal parentage
6) Discomfort amongst Aust IVF specialists
7) IVF clinics poorly resourced to meet psychological support needs
IPs uncomfortable managing surrogate relationship themselves
Implications
counsellingbull IPs
Surrogate Counselling
bull Prepare written report
Legal advice for
both parties
bull Assesses eligibility
Review by medical Director
bullDecide on further reports
2) Local Requirements Focus On
Gatekeeping Rather than Support
IVF clinic appointment
bull Assess eligibility
Admin appointment
bull Discuss financials
Surrogate appointment
bull Assesses eligibility
Review by Clinic
Committee
bullDecide on further reports
Surrogate has blood
tests
Consent forms signed
First transfer cycle
Regulatory Model By Country
Australia UK Canada
Regulatory requirements Onerous Flexible Flexible
Mandatory counselling Multiple sessions pre
and post birth
Social worker post birth No
Surrogacy agreements Required for parental
transfer
Not required
Lawyers not allowed to
charge for preparing
contracts
Required by IVF
Clinics
Legal parentage 4-6 mths post birth 2-6 mths post birth
Can self-register for pound250
2 weeks post birth
$31000$20000
$11000 $15000 $13000
$36000
$20000
$20000$26000
$12500 $11500
$18000
$31000
$12000 $21000$2600 $4100
$37000
$19000
$18000$13000
$4800
$5300
$20000 $13000 $8300
$1650
$5900
$5000
$8000$350
$2000
$13000
$5500
$5500$10000
$5500
$4700
$12000
$3000
$20000
$5600
$17000$3300
$8600
$5300
$0
$20000
$40000
$60000
$80000
$100000
$120000
$140000
$160000
$180000
USA Greece Canada Australia Ukraine Laos
Au
st D
olla
rs
Country Engaged In
Agency fee
IVF costs
Legal costs
SurrogatecompensationSurro expenses
ScreeningCounselling
Hospital amp post-birthcostsSurrogate amp newborninsuranceEgg Donor costs
3) Average Costs By Country
Average IV Costs Per cycle
(AUD) low high
UK $3 470 $6 240
Canada $ 300 $8 000
Australia $3 000 $8 000
Aust couples investing in an average of 8 failed embryo transfers before
turning to surrogacy
Equitable Access in Canada
Ontariorsquos State-Sponsored IVF Program
bull one-at-a-time transfer of all viable embryos
bull one additional funded IVF cycle if acting
as a surrogate
bull One fertility preservation cycle including
freezing for medical reasons per patient
bull Annually provides
bull gt 10000 patients with AI and IUI
bull gt 5000 patients with IVF and FP
Eligibility
bull Those trying to start or expand a family
bull any sex gender sexual orientation or family
status
bull Available for surrogacy arrangements
Annual cost
up to $70M
One IVF cycle per patient per lifetime regardless of sexual orientation or
need for surrogacy
Professional Costs For UK
(AUD) UK ndash low
end
UK ndash high
end
Av IVF
(surrogacy)
$6 800 $15 600
Counselling - -
Agreements - $5 000
Parental
orders
$ 340 $10 000
Agency fee - $12 000 -
19 000
Total $ 7 140 $45600
NFP Surrogacy Agencies - UK
Options Review Meeting pound 500
UK Matching amp Management pound12 000
UK Surrogate Screening amp Support pound 8 000
US Management ndash Basic pound 5 500
US Management ndash Enhanced pound 7 500
Professional Costs For Canada
(AUD) UK ndash low
end
UK ndash high
end
Canada
low end
Canada
high end
Av IVF
(surrogacy)
$6 800 $15 600 $ 2 000 $ 12 000
Counselling - - - -
Agreements - $5 000 $ 5 000 $ 6 600
Parental
orders
$ 340 $10 000 - $ 4 250
Agency fee - $12 000 -
19 000
- $ 12 000
Total $ 7 140 $45 600 $7 000 $38 850
Not allowed to charge for matching
Surrogacy Agencies - Canada
Professional Costs For Australia
(AUD) UK ndash low
end
UK ndash high
end
Canada
low end
Canada
high end
Australia
low
Australia
high
Av IVF
(surrogacy)
$6 800 $15 600 $ 2 000 $ 12 000 $ 5 000 $33 000
Counselling - - - - $ 3 000 $5 000
Agreements - $5 000 $ 5 000 $ 6 600 $13 500 $23 500
Parental
orders
$ 340 $10 000 - $ 4 250 $ 6 500 $ 6 500
Agency fee - $12 000 -
19 000
- $ 12 000 - -
Total $ 7 140 $45600 $20000 $42000 $28 000 $68 000
Surrogate Matching amp Support
Australia UK Canada
Organisations to support
surrogate matching
No Yes Yes
Wait time to find
surrogate
4 - 18 mths 4 - 18 mths 5 - 6 mths
screened out 10 80
Support during surrogacy No Limited Yes if agency used
Surrogate Re-imbursement
Australia UK Canada
Surrogate expenses ~$3000 - $10000 ~$12000 - 34000 ~$34500
Risks to Surrogates
Hot flushes
Feeling down or irritable
Headaches
Restlessness
Exhaustion
Nausea (mild to very severe)
Indigestion
Constipation
Weight gain
Bloating
Abdominalvaginal muscle weakness
Pre-eclampsia
Placenta Previa
Placental abruption
Pubic symphysis dysfunction
Gestational diabetes
Backaches
Miscarriage
molar pregnancy
future infertility
permanent disability
Trauma to the Cervix
Perforation of the Uterus
scar tissue at the uterus opening
infection in the uterus lining
Psychological Disturbances
Prolonged or heavy bleeding
Pain
Perineal Tears
Fistula
Permanent disability
Psychological Distress
Post-Partum Depression
Blood clots in the legs
LAW REFORM
Canadian Reform To Granting Parentage
Background
Ontario Family Law courts questioning the
need to clog up the court system with transfer
of parentage cases given none were being
refused
British Columbia has had simpler processes
circumventing Court for 3 years
Initiative
Ontariorsquos All Families Are Equal Act 2016
amended Acts and statutes to update
parentage and birth registration rules
Enacted
October 2016
Canadian Reform To Granting Parentage
Result
Intended parents recognized without a court order if
the surrogate and IP(s)
bull received independent legal advice
bull entered into a written pre-conception agreement
The surrogate provided written consent to give up her
parental status both
bull before conception and
bull seven days after the birth
Saves parents $6000 in legal costs
Frees Family court to prioritise adversarial cases
NSW Reforms
NSW Review of Surrogacy Act 2010
bull mid 2014 Submissions closed
bull Dec 2015 lsquoBaird government pushing ahead with its planned reformrsquo
bull flagged allowing advertising for surrogates
bull Since thenhellip Silence
Commonwealth House of Reps Review
Surrogacy Matters - Inquiry into the regulatory and legislative aspects of international
and domestic surrogacy arrangements
bull 6 days of hearings
bull 124 written submissions
bull 35 page report tabled April 2016
Key Conclusion
bull many Australians pursuing offshore commercial surrogacy because of the difficulties of
negotiating altruistic surrogacy arrangements in Australia
Commonwealth House of Reps Review
bull 10 sensible recommendations
helliphelliphellipNo government response to date
~3000+ Australian children continue to be denied access to legal parentage
SA Family Relationships Amendment Act
Rationale
bull make it possible for a couple to contact a
surrogate via an SA register
bull regulate overseas surrogacy where
proposed agreements assessed by
Minister on case-by-case basis
Introduced by
bull MLC opposition backbencher John
Dawkins in 2014
Limitations
bull No provision for access by same-sex
couples
bull SA Attorney General anti-surrogacy amp
unwilling to co-operate
Enacted
bull in July 2015
Implementation
15 months of inaction
28 Oct 2016
bull Regulations gazetted for consultation
phase in developing new regulations
bull No real commitment to reform
SA Relationships Register Bill
Rationale
bull Recognise same-sex relationships
bull Recognise intersex status
bull amendments to various existing Acts
Introduced by
bull Left wing of State Labor 22 Sept 2016
Slipped in late
bull Part 6 Amendments to Family Relationships Act
(Sect 10)
bull same-sex and single parents able to access
domestic surrogacy
bull Surrogate re-imbursements
On Second Thoughtshellip
bull Bill to be split
bull Improving access to surrogacy to be
separate bill
Surrogacy Eligibility Bill
Law Reform Required
State-Based
bull Rules on surrogacy-related advertising reviewed in the context of non-profit organisations
bull Expenses to allow for inconvenience payments to surrogates
Law Reform
State-Based Law Reform
bull Rules on surrogacy-related advertising reviewed in the context of non-profit organisations
bull Expenses to allow for inconvenience payments to surrogates
Family Court
bull Remove transfer-of-parentage from the Courts system providing much quicker legal
recognition for intended parents
Policy Reform
State-Based Law Reform
bull Rules on surrogacy-related advertising reviewed in the context of non-profit organisations
bull Expenses to allow for inconvenience payments to surrogates
Family Court Law Reform
bull Remove transfer-of-parentage from the Courts system providing much quicker legal
recognition for intended parents
Medicare Reform
bull Medicare rebate for surrogacy-related IVF where there is a medical need
GROWING DOMESTIC
CAPACITY
Well-managed domestic surrogacy so fewer need to go abroad
Evidence-Based Research
Aim
bull Determine what personality traits amp
lifestyle factors best predict a
psychologically healthy surrogacy
arrangement
Outcomes
bull validate the most accurate indicators of
surrogate amp Intended Parent
lsquoappropriatenessrsquo
Rationale
bull Ensure professional counselling practice
supporting by evidence-based research
bull Screen out inappropriate surrogates amp
IPs
Provide understanding of what traits define healthy arrangements
Evidence-Based Research
University partner
bull Ethics Application
bull Funding sought via FSA grant Govt
Design
Retrospective measurement in past Australian
surrogates amp IPs of
bull Personality traits
bull Satisfaction with interpersonal relationships
bull Levels of conflict support
bull Quality of ongoing relationship
Pre-Match Screening
Pilot Project 1
bull Three year project
bull Ethics Approved
bull Provide professional screening of
surrogates and intended parents
BEFORE they meet
Well-managed domestic surrogacy so fewer need to go abroad
Rationale
bull Avoid surrogates amp IPs having to trawl the net
bull Avoid inappropriate matches
bull Screen out surrogates with wrong motives
bull Provide IPs and surrogates with more
confidence about engaging at home
Evaluation
Tracking amongst participants and control group of
bull surrogate amp Intended Parents personality traits
bull surrogacy outcomes amp relationship quality
bull Attract potential surrogates amp IPs via website
amp social media (unpaid)
bull Intended Parents pay membership fee
bull Informed Consent amp Confidentiality
documentation
bull Referred to Psychologist for interview amp
screening
Pre-Match Screening
bull Reports generated amp provided to NFP for
lsquomatchingrsquo
bull Surrogates undergo medical screening
bull Surrogates who pass screening provided
with 2-3 profiles of IPs who are a good
match
bull Surrogate chooses favoured profile and
an introduction is made
Support Post Matching
Pilot Project 2
bull Availability of timely professional support
after surrogacy approval
Rationale
bull Surrogacy a complex emotional and
psychological journey for IPs amp
surrogates
bull Surrogate-run social media support can
only go so far
Some IVF clinics already consideringattempting this
IS POLICY IN LINE WITH
COMMUNITY ATTITUDES
What Do Australians Think of
Surrogacy
bull Which groups should be able to access surrogacy
bull Level of support for financial compensation
bull Concerns with surrogate compensation
bull Support for the use of agencies to recruit screen and place surrogates
Methodology
bull Approach Ethics approved to enable publication
bull Length amp mode 20 item online survey
bull Timing Dec 28th 2015 - Jan 15th 2016
bull Sample size 500 Australians aged 18 - 49 years (reproductive age)
bull Sample make-up Representative age gender and socio-demographic distribution
bull Those with past surrogacy experience ( themselves family member or friend) excluded to
avoid bias
Support for Surrogate Matching in
Australia
Yes should be allowed
50No
17
Donrsquot Know33
References
Harris K Fitzgerald O Paul RC Macaldowie A Lee E amp Chambers GM 2016 Assisted reproductive technology in Australia
and New Zealand 2014 Sydney National Perinatal Epidemiology and Statistics Unit the University of New South Wales
Everingham SG Stafford-Bell MA Hammarberg K Australians Use of surrogacy MJA 2014 201 (5)1-4
Jadva V Blake L Casey P and Golombok S (2012) Surrogacy families 10 years on relationship with the surrogate
decisions over disclosure and childrenrsquos understanding of their surrogacy origins Human Reproduction Vol27 No10 pp
3008ndash3014
Jadva V Imrie S Golombok S (2015) Surrogate mothers 10 years on a longitudinal study of psychological well-being and
relationships with the parents and child Hum Reprod Feb30(2)373-9
Overview
bull Background Issues
bull Why Australian Surrogacy is Failing
bull International amp Local Law Reform
bull Growing Domestic Capacity
bull Community Attitudes
BACKGROUND ISSUES
Current Environment
bull Australian legislation written by policy-makers who assumed
surrogates would be existing friends or relatives
bull In fact gt50 of Australian surrogates sourced online
bull Surrogacy in less regulated jurisdictions is increasingly available
Australian Surrogacy Model
bull Surrogate recruitment illegal
bull Matching of Intended Parents amp surrogates illegal
bull Fertility counsellors donrsquot screen out surrogatesIPs
bull Only mandatory screen-outs are medically based
bull Surrogacy facilitation amp payments illegal
bull No professional support provided during pregnancy attempts and pregnancy
bull IPs amp Surrogates must manage all aspects
Result of Current Model
Sourcing amp Matching is Tough and Poorly Done
bull Potential surrogates are lsquoput offrsquo by need to self-assess IPs
bull Intended Parents amp Surrogates stalk each other online
bull IPs unwilling to let go of a surrogate even when lsquored flagsrsquo apparent
bull Australian surrogates can be poorly prepared
bull Single No prior children Inadequate social supports
In lead up to first transfer
bull Relationship breakdowns not uncommon
Result of Current Model
During process
bull Conflict often emerges over payments
(IPs terrified by lack of legal certainty on parentage concerned court will reject if
inappropriate payments)
Surrogacy Trends
39
63
52
80
9185
131121
176
157
6
20
7 818 14
21 19
35 36
0
20
40
60
80
100
120
140
160
180
200
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
ANZ Gestational Surrogacy Cycles amp Deliveries
Gest carrier cycles No of live deliveries
~200 domestic gestational surrogacy births in last 8 years
Australian regulatory Frameworks not
meeting needs
Australia UK Canada
lt6 ~50 ~50
~3000 surrogacy births to Australians in last 8 years
Proportion engaging domestically
WHY DO FAR MORE AUSTRALIANS
ENGAGE OFFSHORE
Key Barriers Pushing Australians
offshore
1) Lack of eligibility
2) Regulatory processes harder vs offshore alternatives
3) Significant professional costs
4) Difficulty sourcing a surrogate
5) Lack of certainty over legal parentage
6) Discomfort amongst Aust IVF specialists
7) IVF clinics poorly resourced to meet psychological support needs
IPs uncomfortable managing surrogate relationship themselves
Implications
counsellingbull IPs
Surrogate Counselling
bull Prepare written report
Legal advice for
both parties
bull Assesses eligibility
Review by medical Director
bullDecide on further reports
2) Local Requirements Focus On
Gatekeeping Rather than Support
IVF clinic appointment
bull Assess eligibility
Admin appointment
bull Discuss financials
Surrogate appointment
bull Assesses eligibility
Review by Clinic
Committee
bullDecide on further reports
Surrogate has blood
tests
Consent forms signed
First transfer cycle
Regulatory Model By Country
Australia UK Canada
Regulatory requirements Onerous Flexible Flexible
Mandatory counselling Multiple sessions pre
and post birth
Social worker post birth No
Surrogacy agreements Required for parental
transfer
Not required
Lawyers not allowed to
charge for preparing
contracts
Required by IVF
Clinics
Legal parentage 4-6 mths post birth 2-6 mths post birth
Can self-register for pound250
2 weeks post birth
$31000$20000
$11000 $15000 $13000
$36000
$20000
$20000$26000
$12500 $11500
$18000
$31000
$12000 $21000$2600 $4100
$37000
$19000
$18000$13000
$4800
$5300
$20000 $13000 $8300
$1650
$5900
$5000
$8000$350
$2000
$13000
$5500
$5500$10000
$5500
$4700
$12000
$3000
$20000
$5600
$17000$3300
$8600
$5300
$0
$20000
$40000
$60000
$80000
$100000
$120000
$140000
$160000
$180000
USA Greece Canada Australia Ukraine Laos
Au
st D
olla
rs
Country Engaged In
Agency fee
IVF costs
Legal costs
SurrogatecompensationSurro expenses
ScreeningCounselling
Hospital amp post-birthcostsSurrogate amp newborninsuranceEgg Donor costs
3) Average Costs By Country
Average IV Costs Per cycle
(AUD) low high
UK $3 470 $6 240
Canada $ 300 $8 000
Australia $3 000 $8 000
Aust couples investing in an average of 8 failed embryo transfers before
turning to surrogacy
Equitable Access in Canada
Ontariorsquos State-Sponsored IVF Program
bull one-at-a-time transfer of all viable embryos
bull one additional funded IVF cycle if acting
as a surrogate
bull One fertility preservation cycle including
freezing for medical reasons per patient
bull Annually provides
bull gt 10000 patients with AI and IUI
bull gt 5000 patients with IVF and FP
Eligibility
bull Those trying to start or expand a family
bull any sex gender sexual orientation or family
status
bull Available for surrogacy arrangements
Annual cost
up to $70M
One IVF cycle per patient per lifetime regardless of sexual orientation or
need for surrogacy
Professional Costs For UK
(AUD) UK ndash low
end
UK ndash high
end
Av IVF
(surrogacy)
$6 800 $15 600
Counselling - -
Agreements - $5 000
Parental
orders
$ 340 $10 000
Agency fee - $12 000 -
19 000
Total $ 7 140 $45600
NFP Surrogacy Agencies - UK
Options Review Meeting pound 500
UK Matching amp Management pound12 000
UK Surrogate Screening amp Support pound 8 000
US Management ndash Basic pound 5 500
US Management ndash Enhanced pound 7 500
Professional Costs For Canada
(AUD) UK ndash low
end
UK ndash high
end
Canada
low end
Canada
high end
Av IVF
(surrogacy)
$6 800 $15 600 $ 2 000 $ 12 000
Counselling - - - -
Agreements - $5 000 $ 5 000 $ 6 600
Parental
orders
$ 340 $10 000 - $ 4 250
Agency fee - $12 000 -
19 000
- $ 12 000
Total $ 7 140 $45 600 $7 000 $38 850
Not allowed to charge for matching
Surrogacy Agencies - Canada
Professional Costs For Australia
(AUD) UK ndash low
end
UK ndash high
end
Canada
low end
Canada
high end
Australia
low
Australia
high
Av IVF
(surrogacy)
$6 800 $15 600 $ 2 000 $ 12 000 $ 5 000 $33 000
Counselling - - - - $ 3 000 $5 000
Agreements - $5 000 $ 5 000 $ 6 600 $13 500 $23 500
Parental
orders
$ 340 $10 000 - $ 4 250 $ 6 500 $ 6 500
Agency fee - $12 000 -
19 000
- $ 12 000 - -
Total $ 7 140 $45600 $20000 $42000 $28 000 $68 000
Surrogate Matching amp Support
Australia UK Canada
Organisations to support
surrogate matching
No Yes Yes
Wait time to find
surrogate
4 - 18 mths 4 - 18 mths 5 - 6 mths
screened out 10 80
Support during surrogacy No Limited Yes if agency used
Surrogate Re-imbursement
Australia UK Canada
Surrogate expenses ~$3000 - $10000 ~$12000 - 34000 ~$34500
Risks to Surrogates
Hot flushes
Feeling down or irritable
Headaches
Restlessness
Exhaustion
Nausea (mild to very severe)
Indigestion
Constipation
Weight gain
Bloating
Abdominalvaginal muscle weakness
Pre-eclampsia
Placenta Previa
Placental abruption
Pubic symphysis dysfunction
Gestational diabetes
Backaches
Miscarriage
molar pregnancy
future infertility
permanent disability
Trauma to the Cervix
Perforation of the Uterus
scar tissue at the uterus opening
infection in the uterus lining
Psychological Disturbances
Prolonged or heavy bleeding
Pain
Perineal Tears
Fistula
Permanent disability
Psychological Distress
Post-Partum Depression
Blood clots in the legs
LAW REFORM
Canadian Reform To Granting Parentage
Background
Ontario Family Law courts questioning the
need to clog up the court system with transfer
of parentage cases given none were being
refused
British Columbia has had simpler processes
circumventing Court for 3 years
Initiative
Ontariorsquos All Families Are Equal Act 2016
amended Acts and statutes to update
parentage and birth registration rules
Enacted
October 2016
Canadian Reform To Granting Parentage
Result
Intended parents recognized without a court order if
the surrogate and IP(s)
bull received independent legal advice
bull entered into a written pre-conception agreement
The surrogate provided written consent to give up her
parental status both
bull before conception and
bull seven days after the birth
Saves parents $6000 in legal costs
Frees Family court to prioritise adversarial cases
NSW Reforms
NSW Review of Surrogacy Act 2010
bull mid 2014 Submissions closed
bull Dec 2015 lsquoBaird government pushing ahead with its planned reformrsquo
bull flagged allowing advertising for surrogates
bull Since thenhellip Silence
Commonwealth House of Reps Review
Surrogacy Matters - Inquiry into the regulatory and legislative aspects of international
and domestic surrogacy arrangements
bull 6 days of hearings
bull 124 written submissions
bull 35 page report tabled April 2016
Key Conclusion
bull many Australians pursuing offshore commercial surrogacy because of the difficulties of
negotiating altruistic surrogacy arrangements in Australia
Commonwealth House of Reps Review
bull 10 sensible recommendations
helliphelliphellipNo government response to date
~3000+ Australian children continue to be denied access to legal parentage
SA Family Relationships Amendment Act
Rationale
bull make it possible for a couple to contact a
surrogate via an SA register
bull regulate overseas surrogacy where
proposed agreements assessed by
Minister on case-by-case basis
Introduced by
bull MLC opposition backbencher John
Dawkins in 2014
Limitations
bull No provision for access by same-sex
couples
bull SA Attorney General anti-surrogacy amp
unwilling to co-operate
Enacted
bull in July 2015
Implementation
15 months of inaction
28 Oct 2016
bull Regulations gazetted for consultation
phase in developing new regulations
bull No real commitment to reform
SA Relationships Register Bill
Rationale
bull Recognise same-sex relationships
bull Recognise intersex status
bull amendments to various existing Acts
Introduced by
bull Left wing of State Labor 22 Sept 2016
Slipped in late
bull Part 6 Amendments to Family Relationships Act
(Sect 10)
bull same-sex and single parents able to access
domestic surrogacy
bull Surrogate re-imbursements
On Second Thoughtshellip
bull Bill to be split
bull Improving access to surrogacy to be
separate bill
Surrogacy Eligibility Bill
Law Reform Required
State-Based
bull Rules on surrogacy-related advertising reviewed in the context of non-profit organisations
bull Expenses to allow for inconvenience payments to surrogates
Law Reform
State-Based Law Reform
bull Rules on surrogacy-related advertising reviewed in the context of non-profit organisations
bull Expenses to allow for inconvenience payments to surrogates
Family Court
bull Remove transfer-of-parentage from the Courts system providing much quicker legal
recognition for intended parents
Policy Reform
State-Based Law Reform
bull Rules on surrogacy-related advertising reviewed in the context of non-profit organisations
bull Expenses to allow for inconvenience payments to surrogates
Family Court Law Reform
bull Remove transfer-of-parentage from the Courts system providing much quicker legal
recognition for intended parents
Medicare Reform
bull Medicare rebate for surrogacy-related IVF where there is a medical need
GROWING DOMESTIC
CAPACITY
Well-managed domestic surrogacy so fewer need to go abroad
Evidence-Based Research
Aim
bull Determine what personality traits amp
lifestyle factors best predict a
psychologically healthy surrogacy
arrangement
Outcomes
bull validate the most accurate indicators of
surrogate amp Intended Parent
lsquoappropriatenessrsquo
Rationale
bull Ensure professional counselling practice
supporting by evidence-based research
bull Screen out inappropriate surrogates amp
IPs
Provide understanding of what traits define healthy arrangements
Evidence-Based Research
University partner
bull Ethics Application
bull Funding sought via FSA grant Govt
Design
Retrospective measurement in past Australian
surrogates amp IPs of
bull Personality traits
bull Satisfaction with interpersonal relationships
bull Levels of conflict support
bull Quality of ongoing relationship
Pre-Match Screening
Pilot Project 1
bull Three year project
bull Ethics Approved
bull Provide professional screening of
surrogates and intended parents
BEFORE they meet
Well-managed domestic surrogacy so fewer need to go abroad
Rationale
bull Avoid surrogates amp IPs having to trawl the net
bull Avoid inappropriate matches
bull Screen out surrogates with wrong motives
bull Provide IPs and surrogates with more
confidence about engaging at home
Evaluation
Tracking amongst participants and control group of
bull surrogate amp Intended Parents personality traits
bull surrogacy outcomes amp relationship quality
bull Attract potential surrogates amp IPs via website
amp social media (unpaid)
bull Intended Parents pay membership fee
bull Informed Consent amp Confidentiality
documentation
bull Referred to Psychologist for interview amp
screening
Pre-Match Screening
bull Reports generated amp provided to NFP for
lsquomatchingrsquo
bull Surrogates undergo medical screening
bull Surrogates who pass screening provided
with 2-3 profiles of IPs who are a good
match
bull Surrogate chooses favoured profile and
an introduction is made
Support Post Matching
Pilot Project 2
bull Availability of timely professional support
after surrogacy approval
Rationale
bull Surrogacy a complex emotional and
psychological journey for IPs amp
surrogates
bull Surrogate-run social media support can
only go so far
Some IVF clinics already consideringattempting this
IS POLICY IN LINE WITH
COMMUNITY ATTITUDES
What Do Australians Think of
Surrogacy
bull Which groups should be able to access surrogacy
bull Level of support for financial compensation
bull Concerns with surrogate compensation
bull Support for the use of agencies to recruit screen and place surrogates
Methodology
bull Approach Ethics approved to enable publication
bull Length amp mode 20 item online survey
bull Timing Dec 28th 2015 - Jan 15th 2016
bull Sample size 500 Australians aged 18 - 49 years (reproductive age)
bull Sample make-up Representative age gender and socio-demographic distribution
bull Those with past surrogacy experience ( themselves family member or friend) excluded to
avoid bias
Support for Surrogate Matching in
Australia
Yes should be allowed
50No
17
Donrsquot Know33
References
Harris K Fitzgerald O Paul RC Macaldowie A Lee E amp Chambers GM 2016 Assisted reproductive technology in Australia
and New Zealand 2014 Sydney National Perinatal Epidemiology and Statistics Unit the University of New South Wales
Everingham SG Stafford-Bell MA Hammarberg K Australians Use of surrogacy MJA 2014 201 (5)1-4
Jadva V Blake L Casey P and Golombok S (2012) Surrogacy families 10 years on relationship with the surrogate
decisions over disclosure and childrenrsquos understanding of their surrogacy origins Human Reproduction Vol27 No10 pp
3008ndash3014
Jadva V Imrie S Golombok S (2015) Surrogate mothers 10 years on a longitudinal study of psychological well-being and
relationships with the parents and child Hum Reprod Feb30(2)373-9
BACKGROUND ISSUES
Current Environment
bull Australian legislation written by policy-makers who assumed
surrogates would be existing friends or relatives
bull In fact gt50 of Australian surrogates sourced online
bull Surrogacy in less regulated jurisdictions is increasingly available
Australian Surrogacy Model
bull Surrogate recruitment illegal
bull Matching of Intended Parents amp surrogates illegal
bull Fertility counsellors donrsquot screen out surrogatesIPs
bull Only mandatory screen-outs are medically based
bull Surrogacy facilitation amp payments illegal
bull No professional support provided during pregnancy attempts and pregnancy
bull IPs amp Surrogates must manage all aspects
Result of Current Model
Sourcing amp Matching is Tough and Poorly Done
bull Potential surrogates are lsquoput offrsquo by need to self-assess IPs
bull Intended Parents amp Surrogates stalk each other online
bull IPs unwilling to let go of a surrogate even when lsquored flagsrsquo apparent
bull Australian surrogates can be poorly prepared
bull Single No prior children Inadequate social supports
In lead up to first transfer
bull Relationship breakdowns not uncommon
Result of Current Model
During process
bull Conflict often emerges over payments
(IPs terrified by lack of legal certainty on parentage concerned court will reject if
inappropriate payments)
Surrogacy Trends
39
63
52
80
9185
131121
176
157
6
20
7 818 14
21 19
35 36
0
20
40
60
80
100
120
140
160
180
200
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
ANZ Gestational Surrogacy Cycles amp Deliveries
Gest carrier cycles No of live deliveries
~200 domestic gestational surrogacy births in last 8 years
Australian regulatory Frameworks not
meeting needs
Australia UK Canada
lt6 ~50 ~50
~3000 surrogacy births to Australians in last 8 years
Proportion engaging domestically
WHY DO FAR MORE AUSTRALIANS
ENGAGE OFFSHORE
Key Barriers Pushing Australians
offshore
1) Lack of eligibility
2) Regulatory processes harder vs offshore alternatives
3) Significant professional costs
4) Difficulty sourcing a surrogate
5) Lack of certainty over legal parentage
6) Discomfort amongst Aust IVF specialists
7) IVF clinics poorly resourced to meet psychological support needs
IPs uncomfortable managing surrogate relationship themselves
Implications
counsellingbull IPs
Surrogate Counselling
bull Prepare written report
Legal advice for
both parties
bull Assesses eligibility
Review by medical Director
bullDecide on further reports
2) Local Requirements Focus On
Gatekeeping Rather than Support
IVF clinic appointment
bull Assess eligibility
Admin appointment
bull Discuss financials
Surrogate appointment
bull Assesses eligibility
Review by Clinic
Committee
bullDecide on further reports
Surrogate has blood
tests
Consent forms signed
First transfer cycle
Regulatory Model By Country
Australia UK Canada
Regulatory requirements Onerous Flexible Flexible
Mandatory counselling Multiple sessions pre
and post birth
Social worker post birth No
Surrogacy agreements Required for parental
transfer
Not required
Lawyers not allowed to
charge for preparing
contracts
Required by IVF
Clinics
Legal parentage 4-6 mths post birth 2-6 mths post birth
Can self-register for pound250
2 weeks post birth
$31000$20000
$11000 $15000 $13000
$36000
$20000
$20000$26000
$12500 $11500
$18000
$31000
$12000 $21000$2600 $4100
$37000
$19000
$18000$13000
$4800
$5300
$20000 $13000 $8300
$1650
$5900
$5000
$8000$350
$2000
$13000
$5500
$5500$10000
$5500
$4700
$12000
$3000
$20000
$5600
$17000$3300
$8600
$5300
$0
$20000
$40000
$60000
$80000
$100000
$120000
$140000
$160000
$180000
USA Greece Canada Australia Ukraine Laos
Au
st D
olla
rs
Country Engaged In
Agency fee
IVF costs
Legal costs
SurrogatecompensationSurro expenses
ScreeningCounselling
Hospital amp post-birthcostsSurrogate amp newborninsuranceEgg Donor costs
3) Average Costs By Country
Average IV Costs Per cycle
(AUD) low high
UK $3 470 $6 240
Canada $ 300 $8 000
Australia $3 000 $8 000
Aust couples investing in an average of 8 failed embryo transfers before
turning to surrogacy
Equitable Access in Canada
Ontariorsquos State-Sponsored IVF Program
bull one-at-a-time transfer of all viable embryos
bull one additional funded IVF cycle if acting
as a surrogate
bull One fertility preservation cycle including
freezing for medical reasons per patient
bull Annually provides
bull gt 10000 patients with AI and IUI
bull gt 5000 patients with IVF and FP
Eligibility
bull Those trying to start or expand a family
bull any sex gender sexual orientation or family
status
bull Available for surrogacy arrangements
Annual cost
up to $70M
One IVF cycle per patient per lifetime regardless of sexual orientation or
need for surrogacy
Professional Costs For UK
(AUD) UK ndash low
end
UK ndash high
end
Av IVF
(surrogacy)
$6 800 $15 600
Counselling - -
Agreements - $5 000
Parental
orders
$ 340 $10 000
Agency fee - $12 000 -
19 000
Total $ 7 140 $45600
NFP Surrogacy Agencies - UK
Options Review Meeting pound 500
UK Matching amp Management pound12 000
UK Surrogate Screening amp Support pound 8 000
US Management ndash Basic pound 5 500
US Management ndash Enhanced pound 7 500
Professional Costs For Canada
(AUD) UK ndash low
end
UK ndash high
end
Canada
low end
Canada
high end
Av IVF
(surrogacy)
$6 800 $15 600 $ 2 000 $ 12 000
Counselling - - - -
Agreements - $5 000 $ 5 000 $ 6 600
Parental
orders
$ 340 $10 000 - $ 4 250
Agency fee - $12 000 -
19 000
- $ 12 000
Total $ 7 140 $45 600 $7 000 $38 850
Not allowed to charge for matching
Surrogacy Agencies - Canada
Professional Costs For Australia
(AUD) UK ndash low
end
UK ndash high
end
Canada
low end
Canada
high end
Australia
low
Australia
high
Av IVF
(surrogacy)
$6 800 $15 600 $ 2 000 $ 12 000 $ 5 000 $33 000
Counselling - - - - $ 3 000 $5 000
Agreements - $5 000 $ 5 000 $ 6 600 $13 500 $23 500
Parental
orders
$ 340 $10 000 - $ 4 250 $ 6 500 $ 6 500
Agency fee - $12 000 -
19 000
- $ 12 000 - -
Total $ 7 140 $45600 $20000 $42000 $28 000 $68 000
Surrogate Matching amp Support
Australia UK Canada
Organisations to support
surrogate matching
No Yes Yes
Wait time to find
surrogate
4 - 18 mths 4 - 18 mths 5 - 6 mths
screened out 10 80
Support during surrogacy No Limited Yes if agency used
Surrogate Re-imbursement
Australia UK Canada
Surrogate expenses ~$3000 - $10000 ~$12000 - 34000 ~$34500
Risks to Surrogates
Hot flushes
Feeling down or irritable
Headaches
Restlessness
Exhaustion
Nausea (mild to very severe)
Indigestion
Constipation
Weight gain
Bloating
Abdominalvaginal muscle weakness
Pre-eclampsia
Placenta Previa
Placental abruption
Pubic symphysis dysfunction
Gestational diabetes
Backaches
Miscarriage
molar pregnancy
future infertility
permanent disability
Trauma to the Cervix
Perforation of the Uterus
scar tissue at the uterus opening
infection in the uterus lining
Psychological Disturbances
Prolonged or heavy bleeding
Pain
Perineal Tears
Fistula
Permanent disability
Psychological Distress
Post-Partum Depression
Blood clots in the legs
LAW REFORM
Canadian Reform To Granting Parentage
Background
Ontario Family Law courts questioning the
need to clog up the court system with transfer
of parentage cases given none were being
refused
British Columbia has had simpler processes
circumventing Court for 3 years
Initiative
Ontariorsquos All Families Are Equal Act 2016
amended Acts and statutes to update
parentage and birth registration rules
Enacted
October 2016
Canadian Reform To Granting Parentage
Result
Intended parents recognized without a court order if
the surrogate and IP(s)
bull received independent legal advice
bull entered into a written pre-conception agreement
The surrogate provided written consent to give up her
parental status both
bull before conception and
bull seven days after the birth
Saves parents $6000 in legal costs
Frees Family court to prioritise adversarial cases
NSW Reforms
NSW Review of Surrogacy Act 2010
bull mid 2014 Submissions closed
bull Dec 2015 lsquoBaird government pushing ahead with its planned reformrsquo
bull flagged allowing advertising for surrogates
bull Since thenhellip Silence
Commonwealth House of Reps Review
Surrogacy Matters - Inquiry into the regulatory and legislative aspects of international
and domestic surrogacy arrangements
bull 6 days of hearings
bull 124 written submissions
bull 35 page report tabled April 2016
Key Conclusion
bull many Australians pursuing offshore commercial surrogacy because of the difficulties of
negotiating altruistic surrogacy arrangements in Australia
Commonwealth House of Reps Review
bull 10 sensible recommendations
helliphelliphellipNo government response to date
~3000+ Australian children continue to be denied access to legal parentage
SA Family Relationships Amendment Act
Rationale
bull make it possible for a couple to contact a
surrogate via an SA register
bull regulate overseas surrogacy where
proposed agreements assessed by
Minister on case-by-case basis
Introduced by
bull MLC opposition backbencher John
Dawkins in 2014
Limitations
bull No provision for access by same-sex
couples
bull SA Attorney General anti-surrogacy amp
unwilling to co-operate
Enacted
bull in July 2015
Implementation
15 months of inaction
28 Oct 2016
bull Regulations gazetted for consultation
phase in developing new regulations
bull No real commitment to reform
SA Relationships Register Bill
Rationale
bull Recognise same-sex relationships
bull Recognise intersex status
bull amendments to various existing Acts
Introduced by
bull Left wing of State Labor 22 Sept 2016
Slipped in late
bull Part 6 Amendments to Family Relationships Act
(Sect 10)
bull same-sex and single parents able to access
domestic surrogacy
bull Surrogate re-imbursements
On Second Thoughtshellip
bull Bill to be split
bull Improving access to surrogacy to be
separate bill
Surrogacy Eligibility Bill
Law Reform Required
State-Based
bull Rules on surrogacy-related advertising reviewed in the context of non-profit organisations
bull Expenses to allow for inconvenience payments to surrogates
Law Reform
State-Based Law Reform
bull Rules on surrogacy-related advertising reviewed in the context of non-profit organisations
bull Expenses to allow for inconvenience payments to surrogates
Family Court
bull Remove transfer-of-parentage from the Courts system providing much quicker legal
recognition for intended parents
Policy Reform
State-Based Law Reform
bull Rules on surrogacy-related advertising reviewed in the context of non-profit organisations
bull Expenses to allow for inconvenience payments to surrogates
Family Court Law Reform
bull Remove transfer-of-parentage from the Courts system providing much quicker legal
recognition for intended parents
Medicare Reform
bull Medicare rebate for surrogacy-related IVF where there is a medical need
GROWING DOMESTIC
CAPACITY
Well-managed domestic surrogacy so fewer need to go abroad
Evidence-Based Research
Aim
bull Determine what personality traits amp
lifestyle factors best predict a
psychologically healthy surrogacy
arrangement
Outcomes
bull validate the most accurate indicators of
surrogate amp Intended Parent
lsquoappropriatenessrsquo
Rationale
bull Ensure professional counselling practice
supporting by evidence-based research
bull Screen out inappropriate surrogates amp
IPs
Provide understanding of what traits define healthy arrangements
Evidence-Based Research
University partner
bull Ethics Application
bull Funding sought via FSA grant Govt
Design
Retrospective measurement in past Australian
surrogates amp IPs of
bull Personality traits
bull Satisfaction with interpersonal relationships
bull Levels of conflict support
bull Quality of ongoing relationship
Pre-Match Screening
Pilot Project 1
bull Three year project
bull Ethics Approved
bull Provide professional screening of
surrogates and intended parents
BEFORE they meet
Well-managed domestic surrogacy so fewer need to go abroad
Rationale
bull Avoid surrogates amp IPs having to trawl the net
bull Avoid inappropriate matches
bull Screen out surrogates with wrong motives
bull Provide IPs and surrogates with more
confidence about engaging at home
Evaluation
Tracking amongst participants and control group of
bull surrogate amp Intended Parents personality traits
bull surrogacy outcomes amp relationship quality
bull Attract potential surrogates amp IPs via website
amp social media (unpaid)
bull Intended Parents pay membership fee
bull Informed Consent amp Confidentiality
documentation
bull Referred to Psychologist for interview amp
screening
Pre-Match Screening
bull Reports generated amp provided to NFP for
lsquomatchingrsquo
bull Surrogates undergo medical screening
bull Surrogates who pass screening provided
with 2-3 profiles of IPs who are a good
match
bull Surrogate chooses favoured profile and
an introduction is made
Support Post Matching
Pilot Project 2
bull Availability of timely professional support
after surrogacy approval
Rationale
bull Surrogacy a complex emotional and
psychological journey for IPs amp
surrogates
bull Surrogate-run social media support can
only go so far
Some IVF clinics already consideringattempting this
IS POLICY IN LINE WITH
COMMUNITY ATTITUDES
What Do Australians Think of
Surrogacy
bull Which groups should be able to access surrogacy
bull Level of support for financial compensation
bull Concerns with surrogate compensation
bull Support for the use of agencies to recruit screen and place surrogates
Methodology
bull Approach Ethics approved to enable publication
bull Length amp mode 20 item online survey
bull Timing Dec 28th 2015 - Jan 15th 2016
bull Sample size 500 Australians aged 18 - 49 years (reproductive age)
bull Sample make-up Representative age gender and socio-demographic distribution
bull Those with past surrogacy experience ( themselves family member or friend) excluded to
avoid bias
Support for Surrogate Matching in
Australia
Yes should be allowed
50No
17
Donrsquot Know33
References
Harris K Fitzgerald O Paul RC Macaldowie A Lee E amp Chambers GM 2016 Assisted reproductive technology in Australia
and New Zealand 2014 Sydney National Perinatal Epidemiology and Statistics Unit the University of New South Wales
Everingham SG Stafford-Bell MA Hammarberg K Australians Use of surrogacy MJA 2014 201 (5)1-4
Jadva V Blake L Casey P and Golombok S (2012) Surrogacy families 10 years on relationship with the surrogate
decisions over disclosure and childrenrsquos understanding of their surrogacy origins Human Reproduction Vol27 No10 pp
3008ndash3014
Jadva V Imrie S Golombok S (2015) Surrogate mothers 10 years on a longitudinal study of psychological well-being and
relationships with the parents and child Hum Reprod Feb30(2)373-9
Current Environment
bull Australian legislation written by policy-makers who assumed
surrogates would be existing friends or relatives
bull In fact gt50 of Australian surrogates sourced online
bull Surrogacy in less regulated jurisdictions is increasingly available
Australian Surrogacy Model
bull Surrogate recruitment illegal
bull Matching of Intended Parents amp surrogates illegal
bull Fertility counsellors donrsquot screen out surrogatesIPs
bull Only mandatory screen-outs are medically based
bull Surrogacy facilitation amp payments illegal
bull No professional support provided during pregnancy attempts and pregnancy
bull IPs amp Surrogates must manage all aspects
Result of Current Model
Sourcing amp Matching is Tough and Poorly Done
bull Potential surrogates are lsquoput offrsquo by need to self-assess IPs
bull Intended Parents amp Surrogates stalk each other online
bull IPs unwilling to let go of a surrogate even when lsquored flagsrsquo apparent
bull Australian surrogates can be poorly prepared
bull Single No prior children Inadequate social supports
In lead up to first transfer
bull Relationship breakdowns not uncommon
Result of Current Model
During process
bull Conflict often emerges over payments
(IPs terrified by lack of legal certainty on parentage concerned court will reject if
inappropriate payments)
Surrogacy Trends
39
63
52
80
9185
131121
176
157
6
20
7 818 14
21 19
35 36
0
20
40
60
80
100
120
140
160
180
200
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
ANZ Gestational Surrogacy Cycles amp Deliveries
Gest carrier cycles No of live deliveries
~200 domestic gestational surrogacy births in last 8 years
Australian regulatory Frameworks not
meeting needs
Australia UK Canada
lt6 ~50 ~50
~3000 surrogacy births to Australians in last 8 years
Proportion engaging domestically
WHY DO FAR MORE AUSTRALIANS
ENGAGE OFFSHORE
Key Barriers Pushing Australians
offshore
1) Lack of eligibility
2) Regulatory processes harder vs offshore alternatives
3) Significant professional costs
4) Difficulty sourcing a surrogate
5) Lack of certainty over legal parentage
6) Discomfort amongst Aust IVF specialists
7) IVF clinics poorly resourced to meet psychological support needs
IPs uncomfortable managing surrogate relationship themselves
Implications
counsellingbull IPs
Surrogate Counselling
bull Prepare written report
Legal advice for
both parties
bull Assesses eligibility
Review by medical Director
bullDecide on further reports
2) Local Requirements Focus On
Gatekeeping Rather than Support
IVF clinic appointment
bull Assess eligibility
Admin appointment
bull Discuss financials
Surrogate appointment
bull Assesses eligibility
Review by Clinic
Committee
bullDecide on further reports
Surrogate has blood
tests
Consent forms signed
First transfer cycle
Regulatory Model By Country
Australia UK Canada
Regulatory requirements Onerous Flexible Flexible
Mandatory counselling Multiple sessions pre
and post birth
Social worker post birth No
Surrogacy agreements Required for parental
transfer
Not required
Lawyers not allowed to
charge for preparing
contracts
Required by IVF
Clinics
Legal parentage 4-6 mths post birth 2-6 mths post birth
Can self-register for pound250
2 weeks post birth
$31000$20000
$11000 $15000 $13000
$36000
$20000
$20000$26000
$12500 $11500
$18000
$31000
$12000 $21000$2600 $4100
$37000
$19000
$18000$13000
$4800
$5300
$20000 $13000 $8300
$1650
$5900
$5000
$8000$350
$2000
$13000
$5500
$5500$10000
$5500
$4700
$12000
$3000
$20000
$5600
$17000$3300
$8600
$5300
$0
$20000
$40000
$60000
$80000
$100000
$120000
$140000
$160000
$180000
USA Greece Canada Australia Ukraine Laos
Au
st D
olla
rs
Country Engaged In
Agency fee
IVF costs
Legal costs
SurrogatecompensationSurro expenses
ScreeningCounselling
Hospital amp post-birthcostsSurrogate amp newborninsuranceEgg Donor costs
3) Average Costs By Country
Average IV Costs Per cycle
(AUD) low high
UK $3 470 $6 240
Canada $ 300 $8 000
Australia $3 000 $8 000
Aust couples investing in an average of 8 failed embryo transfers before
turning to surrogacy
Equitable Access in Canada
Ontariorsquos State-Sponsored IVF Program
bull one-at-a-time transfer of all viable embryos
bull one additional funded IVF cycle if acting
as a surrogate
bull One fertility preservation cycle including
freezing for medical reasons per patient
bull Annually provides
bull gt 10000 patients with AI and IUI
bull gt 5000 patients with IVF and FP
Eligibility
bull Those trying to start or expand a family
bull any sex gender sexual orientation or family
status
bull Available for surrogacy arrangements
Annual cost
up to $70M
One IVF cycle per patient per lifetime regardless of sexual orientation or
need for surrogacy
Professional Costs For UK
(AUD) UK ndash low
end
UK ndash high
end
Av IVF
(surrogacy)
$6 800 $15 600
Counselling - -
Agreements - $5 000
Parental
orders
$ 340 $10 000
Agency fee - $12 000 -
19 000
Total $ 7 140 $45600
NFP Surrogacy Agencies - UK
Options Review Meeting pound 500
UK Matching amp Management pound12 000
UK Surrogate Screening amp Support pound 8 000
US Management ndash Basic pound 5 500
US Management ndash Enhanced pound 7 500
Professional Costs For Canada
(AUD) UK ndash low
end
UK ndash high
end
Canada
low end
Canada
high end
Av IVF
(surrogacy)
$6 800 $15 600 $ 2 000 $ 12 000
Counselling - - - -
Agreements - $5 000 $ 5 000 $ 6 600
Parental
orders
$ 340 $10 000 - $ 4 250
Agency fee - $12 000 -
19 000
- $ 12 000
Total $ 7 140 $45 600 $7 000 $38 850
Not allowed to charge for matching
Surrogacy Agencies - Canada
Professional Costs For Australia
(AUD) UK ndash low
end
UK ndash high
end
Canada
low end
Canada
high end
Australia
low
Australia
high
Av IVF
(surrogacy)
$6 800 $15 600 $ 2 000 $ 12 000 $ 5 000 $33 000
Counselling - - - - $ 3 000 $5 000
Agreements - $5 000 $ 5 000 $ 6 600 $13 500 $23 500
Parental
orders
$ 340 $10 000 - $ 4 250 $ 6 500 $ 6 500
Agency fee - $12 000 -
19 000
- $ 12 000 - -
Total $ 7 140 $45600 $20000 $42000 $28 000 $68 000
Surrogate Matching amp Support
Australia UK Canada
Organisations to support
surrogate matching
No Yes Yes
Wait time to find
surrogate
4 - 18 mths 4 - 18 mths 5 - 6 mths
screened out 10 80
Support during surrogacy No Limited Yes if agency used
Surrogate Re-imbursement
Australia UK Canada
Surrogate expenses ~$3000 - $10000 ~$12000 - 34000 ~$34500
Risks to Surrogates
Hot flushes
Feeling down or irritable
Headaches
Restlessness
Exhaustion
Nausea (mild to very severe)
Indigestion
Constipation
Weight gain
Bloating
Abdominalvaginal muscle weakness
Pre-eclampsia
Placenta Previa
Placental abruption
Pubic symphysis dysfunction
Gestational diabetes
Backaches
Miscarriage
molar pregnancy
future infertility
permanent disability
Trauma to the Cervix
Perforation of the Uterus
scar tissue at the uterus opening
infection in the uterus lining
Psychological Disturbances
Prolonged or heavy bleeding
Pain
Perineal Tears
Fistula
Permanent disability
Psychological Distress
Post-Partum Depression
Blood clots in the legs
LAW REFORM
Canadian Reform To Granting Parentage
Background
Ontario Family Law courts questioning the
need to clog up the court system with transfer
of parentage cases given none were being
refused
British Columbia has had simpler processes
circumventing Court for 3 years
Initiative
Ontariorsquos All Families Are Equal Act 2016
amended Acts and statutes to update
parentage and birth registration rules
Enacted
October 2016
Canadian Reform To Granting Parentage
Result
Intended parents recognized without a court order if
the surrogate and IP(s)
bull received independent legal advice
bull entered into a written pre-conception agreement
The surrogate provided written consent to give up her
parental status both
bull before conception and
bull seven days after the birth
Saves parents $6000 in legal costs
Frees Family court to prioritise adversarial cases
NSW Reforms
NSW Review of Surrogacy Act 2010
bull mid 2014 Submissions closed
bull Dec 2015 lsquoBaird government pushing ahead with its planned reformrsquo
bull flagged allowing advertising for surrogates
bull Since thenhellip Silence
Commonwealth House of Reps Review
Surrogacy Matters - Inquiry into the regulatory and legislative aspects of international
and domestic surrogacy arrangements
bull 6 days of hearings
bull 124 written submissions
bull 35 page report tabled April 2016
Key Conclusion
bull many Australians pursuing offshore commercial surrogacy because of the difficulties of
negotiating altruistic surrogacy arrangements in Australia
Commonwealth House of Reps Review
bull 10 sensible recommendations
helliphelliphellipNo government response to date
~3000+ Australian children continue to be denied access to legal parentage
SA Family Relationships Amendment Act
Rationale
bull make it possible for a couple to contact a
surrogate via an SA register
bull regulate overseas surrogacy where
proposed agreements assessed by
Minister on case-by-case basis
Introduced by
bull MLC opposition backbencher John
Dawkins in 2014
Limitations
bull No provision for access by same-sex
couples
bull SA Attorney General anti-surrogacy amp
unwilling to co-operate
Enacted
bull in July 2015
Implementation
15 months of inaction
28 Oct 2016
bull Regulations gazetted for consultation
phase in developing new regulations
bull No real commitment to reform
SA Relationships Register Bill
Rationale
bull Recognise same-sex relationships
bull Recognise intersex status
bull amendments to various existing Acts
Introduced by
bull Left wing of State Labor 22 Sept 2016
Slipped in late
bull Part 6 Amendments to Family Relationships Act
(Sect 10)
bull same-sex and single parents able to access
domestic surrogacy
bull Surrogate re-imbursements
On Second Thoughtshellip
bull Bill to be split
bull Improving access to surrogacy to be
separate bill
Surrogacy Eligibility Bill
Law Reform Required
State-Based
bull Rules on surrogacy-related advertising reviewed in the context of non-profit organisations
bull Expenses to allow for inconvenience payments to surrogates
Law Reform
State-Based Law Reform
bull Rules on surrogacy-related advertising reviewed in the context of non-profit organisations
bull Expenses to allow for inconvenience payments to surrogates
Family Court
bull Remove transfer-of-parentage from the Courts system providing much quicker legal
recognition for intended parents
Policy Reform
State-Based Law Reform
bull Rules on surrogacy-related advertising reviewed in the context of non-profit organisations
bull Expenses to allow for inconvenience payments to surrogates
Family Court Law Reform
bull Remove transfer-of-parentage from the Courts system providing much quicker legal
recognition for intended parents
Medicare Reform
bull Medicare rebate for surrogacy-related IVF where there is a medical need
GROWING DOMESTIC
CAPACITY
Well-managed domestic surrogacy so fewer need to go abroad
Evidence-Based Research
Aim
bull Determine what personality traits amp
lifestyle factors best predict a
psychologically healthy surrogacy
arrangement
Outcomes
bull validate the most accurate indicators of
surrogate amp Intended Parent
lsquoappropriatenessrsquo
Rationale
bull Ensure professional counselling practice
supporting by evidence-based research
bull Screen out inappropriate surrogates amp
IPs
Provide understanding of what traits define healthy arrangements
Evidence-Based Research
University partner
bull Ethics Application
bull Funding sought via FSA grant Govt
Design
Retrospective measurement in past Australian
surrogates amp IPs of
bull Personality traits
bull Satisfaction with interpersonal relationships
bull Levels of conflict support
bull Quality of ongoing relationship
Pre-Match Screening
Pilot Project 1
bull Three year project
bull Ethics Approved
bull Provide professional screening of
surrogates and intended parents
BEFORE they meet
Well-managed domestic surrogacy so fewer need to go abroad
Rationale
bull Avoid surrogates amp IPs having to trawl the net
bull Avoid inappropriate matches
bull Screen out surrogates with wrong motives
bull Provide IPs and surrogates with more
confidence about engaging at home
Evaluation
Tracking amongst participants and control group of
bull surrogate amp Intended Parents personality traits
bull surrogacy outcomes amp relationship quality
bull Attract potential surrogates amp IPs via website
amp social media (unpaid)
bull Intended Parents pay membership fee
bull Informed Consent amp Confidentiality
documentation
bull Referred to Psychologist for interview amp
screening
Pre-Match Screening
bull Reports generated amp provided to NFP for
lsquomatchingrsquo
bull Surrogates undergo medical screening
bull Surrogates who pass screening provided
with 2-3 profiles of IPs who are a good
match
bull Surrogate chooses favoured profile and
an introduction is made
Support Post Matching
Pilot Project 2
bull Availability of timely professional support
after surrogacy approval
Rationale
bull Surrogacy a complex emotional and
psychological journey for IPs amp
surrogates
bull Surrogate-run social media support can
only go so far
Some IVF clinics already consideringattempting this
IS POLICY IN LINE WITH
COMMUNITY ATTITUDES
What Do Australians Think of
Surrogacy
bull Which groups should be able to access surrogacy
bull Level of support for financial compensation
bull Concerns with surrogate compensation
bull Support for the use of agencies to recruit screen and place surrogates
Methodology
bull Approach Ethics approved to enable publication
bull Length amp mode 20 item online survey
bull Timing Dec 28th 2015 - Jan 15th 2016
bull Sample size 500 Australians aged 18 - 49 years (reproductive age)
bull Sample make-up Representative age gender and socio-demographic distribution
bull Those with past surrogacy experience ( themselves family member or friend) excluded to
avoid bias
Support for Surrogate Matching in
Australia
Yes should be allowed
50No
17
Donrsquot Know33
References
Harris K Fitzgerald O Paul RC Macaldowie A Lee E amp Chambers GM 2016 Assisted reproductive technology in Australia
and New Zealand 2014 Sydney National Perinatal Epidemiology and Statistics Unit the University of New South Wales
Everingham SG Stafford-Bell MA Hammarberg K Australians Use of surrogacy MJA 2014 201 (5)1-4
Jadva V Blake L Casey P and Golombok S (2012) Surrogacy families 10 years on relationship with the surrogate
decisions over disclosure and childrenrsquos understanding of their surrogacy origins Human Reproduction Vol27 No10 pp
3008ndash3014
Jadva V Imrie S Golombok S (2015) Surrogate mothers 10 years on a longitudinal study of psychological well-being and
relationships with the parents and child Hum Reprod Feb30(2)373-9
Australian Surrogacy Model
bull Surrogate recruitment illegal
bull Matching of Intended Parents amp surrogates illegal
bull Fertility counsellors donrsquot screen out surrogatesIPs
bull Only mandatory screen-outs are medically based
bull Surrogacy facilitation amp payments illegal
bull No professional support provided during pregnancy attempts and pregnancy
bull IPs amp Surrogates must manage all aspects
Result of Current Model
Sourcing amp Matching is Tough and Poorly Done
bull Potential surrogates are lsquoput offrsquo by need to self-assess IPs
bull Intended Parents amp Surrogates stalk each other online
bull IPs unwilling to let go of a surrogate even when lsquored flagsrsquo apparent
bull Australian surrogates can be poorly prepared
bull Single No prior children Inadequate social supports
In lead up to first transfer
bull Relationship breakdowns not uncommon
Result of Current Model
During process
bull Conflict often emerges over payments
(IPs terrified by lack of legal certainty on parentage concerned court will reject if
inappropriate payments)
Surrogacy Trends
39
63
52
80
9185
131121
176
157
6
20
7 818 14
21 19
35 36
0
20
40
60
80
100
120
140
160
180
200
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
ANZ Gestational Surrogacy Cycles amp Deliveries
Gest carrier cycles No of live deliveries
~200 domestic gestational surrogacy births in last 8 years
Australian regulatory Frameworks not
meeting needs
Australia UK Canada
lt6 ~50 ~50
~3000 surrogacy births to Australians in last 8 years
Proportion engaging domestically
WHY DO FAR MORE AUSTRALIANS
ENGAGE OFFSHORE
Key Barriers Pushing Australians
offshore
1) Lack of eligibility
2) Regulatory processes harder vs offshore alternatives
3) Significant professional costs
4) Difficulty sourcing a surrogate
5) Lack of certainty over legal parentage
6) Discomfort amongst Aust IVF specialists
7) IVF clinics poorly resourced to meet psychological support needs
IPs uncomfortable managing surrogate relationship themselves
Implications
counsellingbull IPs
Surrogate Counselling
bull Prepare written report
Legal advice for
both parties
bull Assesses eligibility
Review by medical Director
bullDecide on further reports
2) Local Requirements Focus On
Gatekeeping Rather than Support
IVF clinic appointment
bull Assess eligibility
Admin appointment
bull Discuss financials
Surrogate appointment
bull Assesses eligibility
Review by Clinic
Committee
bullDecide on further reports
Surrogate has blood
tests
Consent forms signed
First transfer cycle
Regulatory Model By Country
Australia UK Canada
Regulatory requirements Onerous Flexible Flexible
Mandatory counselling Multiple sessions pre
and post birth
Social worker post birth No
Surrogacy agreements Required for parental
transfer
Not required
Lawyers not allowed to
charge for preparing
contracts
Required by IVF
Clinics
Legal parentage 4-6 mths post birth 2-6 mths post birth
Can self-register for pound250
2 weeks post birth
$31000$20000
$11000 $15000 $13000
$36000
$20000
$20000$26000
$12500 $11500
$18000
$31000
$12000 $21000$2600 $4100
$37000
$19000
$18000$13000
$4800
$5300
$20000 $13000 $8300
$1650
$5900
$5000
$8000$350
$2000
$13000
$5500
$5500$10000
$5500
$4700
$12000
$3000
$20000
$5600
$17000$3300
$8600
$5300
$0
$20000
$40000
$60000
$80000
$100000
$120000
$140000
$160000
$180000
USA Greece Canada Australia Ukraine Laos
Au
st D
olla
rs
Country Engaged In
Agency fee
IVF costs
Legal costs
SurrogatecompensationSurro expenses
ScreeningCounselling
Hospital amp post-birthcostsSurrogate amp newborninsuranceEgg Donor costs
3) Average Costs By Country
Average IV Costs Per cycle
(AUD) low high
UK $3 470 $6 240
Canada $ 300 $8 000
Australia $3 000 $8 000
Aust couples investing in an average of 8 failed embryo transfers before
turning to surrogacy
Equitable Access in Canada
Ontariorsquos State-Sponsored IVF Program
bull one-at-a-time transfer of all viable embryos
bull one additional funded IVF cycle if acting
as a surrogate
bull One fertility preservation cycle including
freezing for medical reasons per patient
bull Annually provides
bull gt 10000 patients with AI and IUI
bull gt 5000 patients with IVF and FP
Eligibility
bull Those trying to start or expand a family
bull any sex gender sexual orientation or family
status
bull Available for surrogacy arrangements
Annual cost
up to $70M
One IVF cycle per patient per lifetime regardless of sexual orientation or
need for surrogacy
Professional Costs For UK
(AUD) UK ndash low
end
UK ndash high
end
Av IVF
(surrogacy)
$6 800 $15 600
Counselling - -
Agreements - $5 000
Parental
orders
$ 340 $10 000
Agency fee - $12 000 -
19 000
Total $ 7 140 $45600
NFP Surrogacy Agencies - UK
Options Review Meeting pound 500
UK Matching amp Management pound12 000
UK Surrogate Screening amp Support pound 8 000
US Management ndash Basic pound 5 500
US Management ndash Enhanced pound 7 500
Professional Costs For Canada
(AUD) UK ndash low
end
UK ndash high
end
Canada
low end
Canada
high end
Av IVF
(surrogacy)
$6 800 $15 600 $ 2 000 $ 12 000
Counselling - - - -
Agreements - $5 000 $ 5 000 $ 6 600
Parental
orders
$ 340 $10 000 - $ 4 250
Agency fee - $12 000 -
19 000
- $ 12 000
Total $ 7 140 $45 600 $7 000 $38 850
Not allowed to charge for matching
Surrogacy Agencies - Canada
Professional Costs For Australia
(AUD) UK ndash low
end
UK ndash high
end
Canada
low end
Canada
high end
Australia
low
Australia
high
Av IVF
(surrogacy)
$6 800 $15 600 $ 2 000 $ 12 000 $ 5 000 $33 000
Counselling - - - - $ 3 000 $5 000
Agreements - $5 000 $ 5 000 $ 6 600 $13 500 $23 500
Parental
orders
$ 340 $10 000 - $ 4 250 $ 6 500 $ 6 500
Agency fee - $12 000 -
19 000
- $ 12 000 - -
Total $ 7 140 $45600 $20000 $42000 $28 000 $68 000
Surrogate Matching amp Support
Australia UK Canada
Organisations to support
surrogate matching
No Yes Yes
Wait time to find
surrogate
4 - 18 mths 4 - 18 mths 5 - 6 mths
screened out 10 80
Support during surrogacy No Limited Yes if agency used
Surrogate Re-imbursement
Australia UK Canada
Surrogate expenses ~$3000 - $10000 ~$12000 - 34000 ~$34500
Risks to Surrogates
Hot flushes
Feeling down or irritable
Headaches
Restlessness
Exhaustion
Nausea (mild to very severe)
Indigestion
Constipation
Weight gain
Bloating
Abdominalvaginal muscle weakness
Pre-eclampsia
Placenta Previa
Placental abruption
Pubic symphysis dysfunction
Gestational diabetes
Backaches
Miscarriage
molar pregnancy
future infertility
permanent disability
Trauma to the Cervix
Perforation of the Uterus
scar tissue at the uterus opening
infection in the uterus lining
Psychological Disturbances
Prolonged or heavy bleeding
Pain
Perineal Tears
Fistula
Permanent disability
Psychological Distress
Post-Partum Depression
Blood clots in the legs
LAW REFORM
Canadian Reform To Granting Parentage
Background
Ontario Family Law courts questioning the
need to clog up the court system with transfer
of parentage cases given none were being
refused
British Columbia has had simpler processes
circumventing Court for 3 years
Initiative
Ontariorsquos All Families Are Equal Act 2016
amended Acts and statutes to update
parentage and birth registration rules
Enacted
October 2016
Canadian Reform To Granting Parentage
Result
Intended parents recognized without a court order if
the surrogate and IP(s)
bull received independent legal advice
bull entered into a written pre-conception agreement
The surrogate provided written consent to give up her
parental status both
bull before conception and
bull seven days after the birth
Saves parents $6000 in legal costs
Frees Family court to prioritise adversarial cases
NSW Reforms
NSW Review of Surrogacy Act 2010
bull mid 2014 Submissions closed
bull Dec 2015 lsquoBaird government pushing ahead with its planned reformrsquo
bull flagged allowing advertising for surrogates
bull Since thenhellip Silence
Commonwealth House of Reps Review
Surrogacy Matters - Inquiry into the regulatory and legislative aspects of international
and domestic surrogacy arrangements
bull 6 days of hearings
bull 124 written submissions
bull 35 page report tabled April 2016
Key Conclusion
bull many Australians pursuing offshore commercial surrogacy because of the difficulties of
negotiating altruistic surrogacy arrangements in Australia
Commonwealth House of Reps Review
bull 10 sensible recommendations
helliphelliphellipNo government response to date
~3000+ Australian children continue to be denied access to legal parentage
SA Family Relationships Amendment Act
Rationale
bull make it possible for a couple to contact a
surrogate via an SA register
bull regulate overseas surrogacy where
proposed agreements assessed by
Minister on case-by-case basis
Introduced by
bull MLC opposition backbencher John
Dawkins in 2014
Limitations
bull No provision for access by same-sex
couples
bull SA Attorney General anti-surrogacy amp
unwilling to co-operate
Enacted
bull in July 2015
Implementation
15 months of inaction
28 Oct 2016
bull Regulations gazetted for consultation
phase in developing new regulations
bull No real commitment to reform
SA Relationships Register Bill
Rationale
bull Recognise same-sex relationships
bull Recognise intersex status
bull amendments to various existing Acts
Introduced by
bull Left wing of State Labor 22 Sept 2016
Slipped in late
bull Part 6 Amendments to Family Relationships Act
(Sect 10)
bull same-sex and single parents able to access
domestic surrogacy
bull Surrogate re-imbursements
On Second Thoughtshellip
bull Bill to be split
bull Improving access to surrogacy to be
separate bill
Surrogacy Eligibility Bill
Law Reform Required
State-Based
bull Rules on surrogacy-related advertising reviewed in the context of non-profit organisations
bull Expenses to allow for inconvenience payments to surrogates
Law Reform
State-Based Law Reform
bull Rules on surrogacy-related advertising reviewed in the context of non-profit organisations
bull Expenses to allow for inconvenience payments to surrogates
Family Court
bull Remove transfer-of-parentage from the Courts system providing much quicker legal
recognition for intended parents
Policy Reform
State-Based Law Reform
bull Rules on surrogacy-related advertising reviewed in the context of non-profit organisations
bull Expenses to allow for inconvenience payments to surrogates
Family Court Law Reform
bull Remove transfer-of-parentage from the Courts system providing much quicker legal
recognition for intended parents
Medicare Reform
bull Medicare rebate for surrogacy-related IVF where there is a medical need
GROWING DOMESTIC
CAPACITY
Well-managed domestic surrogacy so fewer need to go abroad
Evidence-Based Research
Aim
bull Determine what personality traits amp
lifestyle factors best predict a
psychologically healthy surrogacy
arrangement
Outcomes
bull validate the most accurate indicators of
surrogate amp Intended Parent
lsquoappropriatenessrsquo
Rationale
bull Ensure professional counselling practice
supporting by evidence-based research
bull Screen out inappropriate surrogates amp
IPs
Provide understanding of what traits define healthy arrangements
Evidence-Based Research
University partner
bull Ethics Application
bull Funding sought via FSA grant Govt
Design
Retrospective measurement in past Australian
surrogates amp IPs of
bull Personality traits
bull Satisfaction with interpersonal relationships
bull Levels of conflict support
bull Quality of ongoing relationship
Pre-Match Screening
Pilot Project 1
bull Three year project
bull Ethics Approved
bull Provide professional screening of
surrogates and intended parents
BEFORE they meet
Well-managed domestic surrogacy so fewer need to go abroad
Rationale
bull Avoid surrogates amp IPs having to trawl the net
bull Avoid inappropriate matches
bull Screen out surrogates with wrong motives
bull Provide IPs and surrogates with more
confidence about engaging at home
Evaluation
Tracking amongst participants and control group of
bull surrogate amp Intended Parents personality traits
bull surrogacy outcomes amp relationship quality
bull Attract potential surrogates amp IPs via website
amp social media (unpaid)
bull Intended Parents pay membership fee
bull Informed Consent amp Confidentiality
documentation
bull Referred to Psychologist for interview amp
screening
Pre-Match Screening
bull Reports generated amp provided to NFP for
lsquomatchingrsquo
bull Surrogates undergo medical screening
bull Surrogates who pass screening provided
with 2-3 profiles of IPs who are a good
match
bull Surrogate chooses favoured profile and
an introduction is made
Support Post Matching
Pilot Project 2
bull Availability of timely professional support
after surrogacy approval
Rationale
bull Surrogacy a complex emotional and
psychological journey for IPs amp
surrogates
bull Surrogate-run social media support can
only go so far
Some IVF clinics already consideringattempting this
IS POLICY IN LINE WITH
COMMUNITY ATTITUDES
What Do Australians Think of
Surrogacy
bull Which groups should be able to access surrogacy
bull Level of support for financial compensation
bull Concerns with surrogate compensation
bull Support for the use of agencies to recruit screen and place surrogates
Methodology
bull Approach Ethics approved to enable publication
bull Length amp mode 20 item online survey
bull Timing Dec 28th 2015 - Jan 15th 2016
bull Sample size 500 Australians aged 18 - 49 years (reproductive age)
bull Sample make-up Representative age gender and socio-demographic distribution
bull Those with past surrogacy experience ( themselves family member or friend) excluded to
avoid bias
Support for Surrogate Matching in
Australia
Yes should be allowed
50No
17
Donrsquot Know33
References
Harris K Fitzgerald O Paul RC Macaldowie A Lee E amp Chambers GM 2016 Assisted reproductive technology in Australia
and New Zealand 2014 Sydney National Perinatal Epidemiology and Statistics Unit the University of New South Wales
Everingham SG Stafford-Bell MA Hammarberg K Australians Use of surrogacy MJA 2014 201 (5)1-4
Jadva V Blake L Casey P and Golombok S (2012) Surrogacy families 10 years on relationship with the surrogate
decisions over disclosure and childrenrsquos understanding of their surrogacy origins Human Reproduction Vol27 No10 pp
3008ndash3014
Jadva V Imrie S Golombok S (2015) Surrogate mothers 10 years on a longitudinal study of psychological well-being and
relationships with the parents and child Hum Reprod Feb30(2)373-9
Result of Current Model
Sourcing amp Matching is Tough and Poorly Done
bull Potential surrogates are lsquoput offrsquo by need to self-assess IPs
bull Intended Parents amp Surrogates stalk each other online
bull IPs unwilling to let go of a surrogate even when lsquored flagsrsquo apparent
bull Australian surrogates can be poorly prepared
bull Single No prior children Inadequate social supports
In lead up to first transfer
bull Relationship breakdowns not uncommon
Result of Current Model
During process
bull Conflict often emerges over payments
(IPs terrified by lack of legal certainty on parentage concerned court will reject if
inappropriate payments)
Surrogacy Trends
39
63
52
80
9185
131121
176
157
6
20
7 818 14
21 19
35 36
0
20
40
60
80
100
120
140
160
180
200
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
ANZ Gestational Surrogacy Cycles amp Deliveries
Gest carrier cycles No of live deliveries
~200 domestic gestational surrogacy births in last 8 years
Australian regulatory Frameworks not
meeting needs
Australia UK Canada
lt6 ~50 ~50
~3000 surrogacy births to Australians in last 8 years
Proportion engaging domestically
WHY DO FAR MORE AUSTRALIANS
ENGAGE OFFSHORE
Key Barriers Pushing Australians
offshore
1) Lack of eligibility
2) Regulatory processes harder vs offshore alternatives
3) Significant professional costs
4) Difficulty sourcing a surrogate
5) Lack of certainty over legal parentage
6) Discomfort amongst Aust IVF specialists
7) IVF clinics poorly resourced to meet psychological support needs
IPs uncomfortable managing surrogate relationship themselves
Implications
counsellingbull IPs
Surrogate Counselling
bull Prepare written report
Legal advice for
both parties
bull Assesses eligibility
Review by medical Director
bullDecide on further reports
2) Local Requirements Focus On
Gatekeeping Rather than Support
IVF clinic appointment
bull Assess eligibility
Admin appointment
bull Discuss financials
Surrogate appointment
bull Assesses eligibility
Review by Clinic
Committee
bullDecide on further reports
Surrogate has blood
tests
Consent forms signed
First transfer cycle
Regulatory Model By Country
Australia UK Canada
Regulatory requirements Onerous Flexible Flexible
Mandatory counselling Multiple sessions pre
and post birth
Social worker post birth No
Surrogacy agreements Required for parental
transfer
Not required
Lawyers not allowed to
charge for preparing
contracts
Required by IVF
Clinics
Legal parentage 4-6 mths post birth 2-6 mths post birth
Can self-register for pound250
2 weeks post birth
$31000$20000
$11000 $15000 $13000
$36000
$20000
$20000$26000
$12500 $11500
$18000
$31000
$12000 $21000$2600 $4100
$37000
$19000
$18000$13000
$4800
$5300
$20000 $13000 $8300
$1650
$5900
$5000
$8000$350
$2000
$13000
$5500
$5500$10000
$5500
$4700
$12000
$3000
$20000
$5600
$17000$3300
$8600
$5300
$0
$20000
$40000
$60000
$80000
$100000
$120000
$140000
$160000
$180000
USA Greece Canada Australia Ukraine Laos
Au
st D
olla
rs
Country Engaged In
Agency fee
IVF costs
Legal costs
SurrogatecompensationSurro expenses
ScreeningCounselling
Hospital amp post-birthcostsSurrogate amp newborninsuranceEgg Donor costs
3) Average Costs By Country
Average IV Costs Per cycle
(AUD) low high
UK $3 470 $6 240
Canada $ 300 $8 000
Australia $3 000 $8 000
Aust couples investing in an average of 8 failed embryo transfers before
turning to surrogacy
Equitable Access in Canada
Ontariorsquos State-Sponsored IVF Program
bull one-at-a-time transfer of all viable embryos
bull one additional funded IVF cycle if acting
as a surrogate
bull One fertility preservation cycle including
freezing for medical reasons per patient
bull Annually provides
bull gt 10000 patients with AI and IUI
bull gt 5000 patients with IVF and FP
Eligibility
bull Those trying to start or expand a family
bull any sex gender sexual orientation or family
status
bull Available for surrogacy arrangements
Annual cost
up to $70M
One IVF cycle per patient per lifetime regardless of sexual orientation or
need for surrogacy
Professional Costs For UK
(AUD) UK ndash low
end
UK ndash high
end
Av IVF
(surrogacy)
$6 800 $15 600
Counselling - -
Agreements - $5 000
Parental
orders
$ 340 $10 000
Agency fee - $12 000 -
19 000
Total $ 7 140 $45600
NFP Surrogacy Agencies - UK
Options Review Meeting pound 500
UK Matching amp Management pound12 000
UK Surrogate Screening amp Support pound 8 000
US Management ndash Basic pound 5 500
US Management ndash Enhanced pound 7 500
Professional Costs For Canada
(AUD) UK ndash low
end
UK ndash high
end
Canada
low end
Canada
high end
Av IVF
(surrogacy)
$6 800 $15 600 $ 2 000 $ 12 000
Counselling - - - -
Agreements - $5 000 $ 5 000 $ 6 600
Parental
orders
$ 340 $10 000 - $ 4 250
Agency fee - $12 000 -
19 000
- $ 12 000
Total $ 7 140 $45 600 $7 000 $38 850
Not allowed to charge for matching
Surrogacy Agencies - Canada
Professional Costs For Australia
(AUD) UK ndash low
end
UK ndash high
end
Canada
low end
Canada
high end
Australia
low
Australia
high
Av IVF
(surrogacy)
$6 800 $15 600 $ 2 000 $ 12 000 $ 5 000 $33 000
Counselling - - - - $ 3 000 $5 000
Agreements - $5 000 $ 5 000 $ 6 600 $13 500 $23 500
Parental
orders
$ 340 $10 000 - $ 4 250 $ 6 500 $ 6 500
Agency fee - $12 000 -
19 000
- $ 12 000 - -
Total $ 7 140 $45600 $20000 $42000 $28 000 $68 000
Surrogate Matching amp Support
Australia UK Canada
Organisations to support
surrogate matching
No Yes Yes
Wait time to find
surrogate
4 - 18 mths 4 - 18 mths 5 - 6 mths
screened out 10 80
Support during surrogacy No Limited Yes if agency used
Surrogate Re-imbursement
Australia UK Canada
Surrogate expenses ~$3000 - $10000 ~$12000 - 34000 ~$34500
Risks to Surrogates
Hot flushes
Feeling down or irritable
Headaches
Restlessness
Exhaustion
Nausea (mild to very severe)
Indigestion
Constipation
Weight gain
Bloating
Abdominalvaginal muscle weakness
Pre-eclampsia
Placenta Previa
Placental abruption
Pubic symphysis dysfunction
Gestational diabetes
Backaches
Miscarriage
molar pregnancy
future infertility
permanent disability
Trauma to the Cervix
Perforation of the Uterus
scar tissue at the uterus opening
infection in the uterus lining
Psychological Disturbances
Prolonged or heavy bleeding
Pain
Perineal Tears
Fistula
Permanent disability
Psychological Distress
Post-Partum Depression
Blood clots in the legs
LAW REFORM
Canadian Reform To Granting Parentage
Background
Ontario Family Law courts questioning the
need to clog up the court system with transfer
of parentage cases given none were being
refused
British Columbia has had simpler processes
circumventing Court for 3 years
Initiative
Ontariorsquos All Families Are Equal Act 2016
amended Acts and statutes to update
parentage and birth registration rules
Enacted
October 2016
Canadian Reform To Granting Parentage
Result
Intended parents recognized without a court order if
the surrogate and IP(s)
bull received independent legal advice
bull entered into a written pre-conception agreement
The surrogate provided written consent to give up her
parental status both
bull before conception and
bull seven days after the birth
Saves parents $6000 in legal costs
Frees Family court to prioritise adversarial cases
NSW Reforms
NSW Review of Surrogacy Act 2010
bull mid 2014 Submissions closed
bull Dec 2015 lsquoBaird government pushing ahead with its planned reformrsquo
bull flagged allowing advertising for surrogates
bull Since thenhellip Silence
Commonwealth House of Reps Review
Surrogacy Matters - Inquiry into the regulatory and legislative aspects of international
and domestic surrogacy arrangements
bull 6 days of hearings
bull 124 written submissions
bull 35 page report tabled April 2016
Key Conclusion
bull many Australians pursuing offshore commercial surrogacy because of the difficulties of
negotiating altruistic surrogacy arrangements in Australia
Commonwealth House of Reps Review
bull 10 sensible recommendations
helliphelliphellipNo government response to date
~3000+ Australian children continue to be denied access to legal parentage
SA Family Relationships Amendment Act
Rationale
bull make it possible for a couple to contact a
surrogate via an SA register
bull regulate overseas surrogacy where
proposed agreements assessed by
Minister on case-by-case basis
Introduced by
bull MLC opposition backbencher John
Dawkins in 2014
Limitations
bull No provision for access by same-sex
couples
bull SA Attorney General anti-surrogacy amp
unwilling to co-operate
Enacted
bull in July 2015
Implementation
15 months of inaction
28 Oct 2016
bull Regulations gazetted for consultation
phase in developing new regulations
bull No real commitment to reform
SA Relationships Register Bill
Rationale
bull Recognise same-sex relationships
bull Recognise intersex status
bull amendments to various existing Acts
Introduced by
bull Left wing of State Labor 22 Sept 2016
Slipped in late
bull Part 6 Amendments to Family Relationships Act
(Sect 10)
bull same-sex and single parents able to access
domestic surrogacy
bull Surrogate re-imbursements
On Second Thoughtshellip
bull Bill to be split
bull Improving access to surrogacy to be
separate bill
Surrogacy Eligibility Bill
Law Reform Required
State-Based
bull Rules on surrogacy-related advertising reviewed in the context of non-profit organisations
bull Expenses to allow for inconvenience payments to surrogates
Law Reform
State-Based Law Reform
bull Rules on surrogacy-related advertising reviewed in the context of non-profit organisations
bull Expenses to allow for inconvenience payments to surrogates
Family Court
bull Remove transfer-of-parentage from the Courts system providing much quicker legal
recognition for intended parents
Policy Reform
State-Based Law Reform
bull Rules on surrogacy-related advertising reviewed in the context of non-profit organisations
bull Expenses to allow for inconvenience payments to surrogates
Family Court Law Reform
bull Remove transfer-of-parentage from the Courts system providing much quicker legal
recognition for intended parents
Medicare Reform
bull Medicare rebate for surrogacy-related IVF where there is a medical need
GROWING DOMESTIC
CAPACITY
Well-managed domestic surrogacy so fewer need to go abroad
Evidence-Based Research
Aim
bull Determine what personality traits amp
lifestyle factors best predict a
psychologically healthy surrogacy
arrangement
Outcomes
bull validate the most accurate indicators of
surrogate amp Intended Parent
lsquoappropriatenessrsquo
Rationale
bull Ensure professional counselling practice
supporting by evidence-based research
bull Screen out inappropriate surrogates amp
IPs
Provide understanding of what traits define healthy arrangements
Evidence-Based Research
University partner
bull Ethics Application
bull Funding sought via FSA grant Govt
Design
Retrospective measurement in past Australian
surrogates amp IPs of
bull Personality traits
bull Satisfaction with interpersonal relationships
bull Levels of conflict support
bull Quality of ongoing relationship
Pre-Match Screening
Pilot Project 1
bull Three year project
bull Ethics Approved
bull Provide professional screening of
surrogates and intended parents
BEFORE they meet
Well-managed domestic surrogacy so fewer need to go abroad
Rationale
bull Avoid surrogates amp IPs having to trawl the net
bull Avoid inappropriate matches
bull Screen out surrogates with wrong motives
bull Provide IPs and surrogates with more
confidence about engaging at home
Evaluation
Tracking amongst participants and control group of
bull surrogate amp Intended Parents personality traits
bull surrogacy outcomes amp relationship quality
bull Attract potential surrogates amp IPs via website
amp social media (unpaid)
bull Intended Parents pay membership fee
bull Informed Consent amp Confidentiality
documentation
bull Referred to Psychologist for interview amp
screening
Pre-Match Screening
bull Reports generated amp provided to NFP for
lsquomatchingrsquo
bull Surrogates undergo medical screening
bull Surrogates who pass screening provided
with 2-3 profiles of IPs who are a good
match
bull Surrogate chooses favoured profile and
an introduction is made
Support Post Matching
Pilot Project 2
bull Availability of timely professional support
after surrogacy approval
Rationale
bull Surrogacy a complex emotional and
psychological journey for IPs amp
surrogates
bull Surrogate-run social media support can
only go so far
Some IVF clinics already consideringattempting this
IS POLICY IN LINE WITH
COMMUNITY ATTITUDES
What Do Australians Think of
Surrogacy
bull Which groups should be able to access surrogacy
bull Level of support for financial compensation
bull Concerns with surrogate compensation
bull Support for the use of agencies to recruit screen and place surrogates
Methodology
bull Approach Ethics approved to enable publication
bull Length amp mode 20 item online survey
bull Timing Dec 28th 2015 - Jan 15th 2016
bull Sample size 500 Australians aged 18 - 49 years (reproductive age)
bull Sample make-up Representative age gender and socio-demographic distribution
bull Those with past surrogacy experience ( themselves family member or friend) excluded to
avoid bias
Support for Surrogate Matching in
Australia
Yes should be allowed
50No
17
Donrsquot Know33
References
Harris K Fitzgerald O Paul RC Macaldowie A Lee E amp Chambers GM 2016 Assisted reproductive technology in Australia
and New Zealand 2014 Sydney National Perinatal Epidemiology and Statistics Unit the University of New South Wales
Everingham SG Stafford-Bell MA Hammarberg K Australians Use of surrogacy MJA 2014 201 (5)1-4
Jadva V Blake L Casey P and Golombok S (2012) Surrogacy families 10 years on relationship with the surrogate
decisions over disclosure and childrenrsquos understanding of their surrogacy origins Human Reproduction Vol27 No10 pp
3008ndash3014
Jadva V Imrie S Golombok S (2015) Surrogate mothers 10 years on a longitudinal study of psychological well-being and
relationships with the parents and child Hum Reprod Feb30(2)373-9
Result of Current Model
During process
bull Conflict often emerges over payments
(IPs terrified by lack of legal certainty on parentage concerned court will reject if
inappropriate payments)
Surrogacy Trends
39
63
52
80
9185
131121
176
157
6
20
7 818 14
21 19
35 36
0
20
40
60
80
100
120
140
160
180
200
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
ANZ Gestational Surrogacy Cycles amp Deliveries
Gest carrier cycles No of live deliveries
~200 domestic gestational surrogacy births in last 8 years
Australian regulatory Frameworks not
meeting needs
Australia UK Canada
lt6 ~50 ~50
~3000 surrogacy births to Australians in last 8 years
Proportion engaging domestically
WHY DO FAR MORE AUSTRALIANS
ENGAGE OFFSHORE
Key Barriers Pushing Australians
offshore
1) Lack of eligibility
2) Regulatory processes harder vs offshore alternatives
3) Significant professional costs
4) Difficulty sourcing a surrogate
5) Lack of certainty over legal parentage
6) Discomfort amongst Aust IVF specialists
7) IVF clinics poorly resourced to meet psychological support needs
IPs uncomfortable managing surrogate relationship themselves
Implications
counsellingbull IPs
Surrogate Counselling
bull Prepare written report
Legal advice for
both parties
bull Assesses eligibility
Review by medical Director
bullDecide on further reports
2) Local Requirements Focus On
Gatekeeping Rather than Support
IVF clinic appointment
bull Assess eligibility
Admin appointment
bull Discuss financials
Surrogate appointment
bull Assesses eligibility
Review by Clinic
Committee
bullDecide on further reports
Surrogate has blood
tests
Consent forms signed
First transfer cycle
Regulatory Model By Country
Australia UK Canada
Regulatory requirements Onerous Flexible Flexible
Mandatory counselling Multiple sessions pre
and post birth
Social worker post birth No
Surrogacy agreements Required for parental
transfer
Not required
Lawyers not allowed to
charge for preparing
contracts
Required by IVF
Clinics
Legal parentage 4-6 mths post birth 2-6 mths post birth
Can self-register for pound250
2 weeks post birth
$31000$20000
$11000 $15000 $13000
$36000
$20000
$20000$26000
$12500 $11500
$18000
$31000
$12000 $21000$2600 $4100
$37000
$19000
$18000$13000
$4800
$5300
$20000 $13000 $8300
$1650
$5900
$5000
$8000$350
$2000
$13000
$5500
$5500$10000
$5500
$4700
$12000
$3000
$20000
$5600
$17000$3300
$8600
$5300
$0
$20000
$40000
$60000
$80000
$100000
$120000
$140000
$160000
$180000
USA Greece Canada Australia Ukraine Laos
Au
st D
olla
rs
Country Engaged In
Agency fee
IVF costs
Legal costs
SurrogatecompensationSurro expenses
ScreeningCounselling
Hospital amp post-birthcostsSurrogate amp newborninsuranceEgg Donor costs
3) Average Costs By Country
Average IV Costs Per cycle
(AUD) low high
UK $3 470 $6 240
Canada $ 300 $8 000
Australia $3 000 $8 000
Aust couples investing in an average of 8 failed embryo transfers before
turning to surrogacy
Equitable Access in Canada
Ontariorsquos State-Sponsored IVF Program
bull one-at-a-time transfer of all viable embryos
bull one additional funded IVF cycle if acting
as a surrogate
bull One fertility preservation cycle including
freezing for medical reasons per patient
bull Annually provides
bull gt 10000 patients with AI and IUI
bull gt 5000 patients with IVF and FP
Eligibility
bull Those trying to start or expand a family
bull any sex gender sexual orientation or family
status
bull Available for surrogacy arrangements
Annual cost
up to $70M
One IVF cycle per patient per lifetime regardless of sexual orientation or
need for surrogacy
Professional Costs For UK
(AUD) UK ndash low
end
UK ndash high
end
Av IVF
(surrogacy)
$6 800 $15 600
Counselling - -
Agreements - $5 000
Parental
orders
$ 340 $10 000
Agency fee - $12 000 -
19 000
Total $ 7 140 $45600
NFP Surrogacy Agencies - UK
Options Review Meeting pound 500
UK Matching amp Management pound12 000
UK Surrogate Screening amp Support pound 8 000
US Management ndash Basic pound 5 500
US Management ndash Enhanced pound 7 500
Professional Costs For Canada
(AUD) UK ndash low
end
UK ndash high
end
Canada
low end
Canada
high end
Av IVF
(surrogacy)
$6 800 $15 600 $ 2 000 $ 12 000
Counselling - - - -
Agreements - $5 000 $ 5 000 $ 6 600
Parental
orders
$ 340 $10 000 - $ 4 250
Agency fee - $12 000 -
19 000
- $ 12 000
Total $ 7 140 $45 600 $7 000 $38 850
Not allowed to charge for matching
Surrogacy Agencies - Canada
Professional Costs For Australia
(AUD) UK ndash low
end
UK ndash high
end
Canada
low end
Canada
high end
Australia
low
Australia
high
Av IVF
(surrogacy)
$6 800 $15 600 $ 2 000 $ 12 000 $ 5 000 $33 000
Counselling - - - - $ 3 000 $5 000
Agreements - $5 000 $ 5 000 $ 6 600 $13 500 $23 500
Parental
orders
$ 340 $10 000 - $ 4 250 $ 6 500 $ 6 500
Agency fee - $12 000 -
19 000
- $ 12 000 - -
Total $ 7 140 $45600 $20000 $42000 $28 000 $68 000
Surrogate Matching amp Support
Australia UK Canada
Organisations to support
surrogate matching
No Yes Yes
Wait time to find
surrogate
4 - 18 mths 4 - 18 mths 5 - 6 mths
screened out 10 80
Support during surrogacy No Limited Yes if agency used
Surrogate Re-imbursement
Australia UK Canada
Surrogate expenses ~$3000 - $10000 ~$12000 - 34000 ~$34500
Risks to Surrogates
Hot flushes
Feeling down or irritable
Headaches
Restlessness
Exhaustion
Nausea (mild to very severe)
Indigestion
Constipation
Weight gain
Bloating
Abdominalvaginal muscle weakness
Pre-eclampsia
Placenta Previa
Placental abruption
Pubic symphysis dysfunction
Gestational diabetes
Backaches
Miscarriage
molar pregnancy
future infertility
permanent disability
Trauma to the Cervix
Perforation of the Uterus
scar tissue at the uterus opening
infection in the uterus lining
Psychological Disturbances
Prolonged or heavy bleeding
Pain
Perineal Tears
Fistula
Permanent disability
Psychological Distress
Post-Partum Depression
Blood clots in the legs
LAW REFORM
Canadian Reform To Granting Parentage
Background
Ontario Family Law courts questioning the
need to clog up the court system with transfer
of parentage cases given none were being
refused
British Columbia has had simpler processes
circumventing Court for 3 years
Initiative
Ontariorsquos All Families Are Equal Act 2016
amended Acts and statutes to update
parentage and birth registration rules
Enacted
October 2016
Canadian Reform To Granting Parentage
Result
Intended parents recognized without a court order if
the surrogate and IP(s)
bull received independent legal advice
bull entered into a written pre-conception agreement
The surrogate provided written consent to give up her
parental status both
bull before conception and
bull seven days after the birth
Saves parents $6000 in legal costs
Frees Family court to prioritise adversarial cases
NSW Reforms
NSW Review of Surrogacy Act 2010
bull mid 2014 Submissions closed
bull Dec 2015 lsquoBaird government pushing ahead with its planned reformrsquo
bull flagged allowing advertising for surrogates
bull Since thenhellip Silence
Commonwealth House of Reps Review
Surrogacy Matters - Inquiry into the regulatory and legislative aspects of international
and domestic surrogacy arrangements
bull 6 days of hearings
bull 124 written submissions
bull 35 page report tabled April 2016
Key Conclusion
bull many Australians pursuing offshore commercial surrogacy because of the difficulties of
negotiating altruistic surrogacy arrangements in Australia
Commonwealth House of Reps Review
bull 10 sensible recommendations
helliphelliphellipNo government response to date
~3000+ Australian children continue to be denied access to legal parentage
SA Family Relationships Amendment Act
Rationale
bull make it possible for a couple to contact a
surrogate via an SA register
bull regulate overseas surrogacy where
proposed agreements assessed by
Minister on case-by-case basis
Introduced by
bull MLC opposition backbencher John
Dawkins in 2014
Limitations
bull No provision for access by same-sex
couples
bull SA Attorney General anti-surrogacy amp
unwilling to co-operate
Enacted
bull in July 2015
Implementation
15 months of inaction
28 Oct 2016
bull Regulations gazetted for consultation
phase in developing new regulations
bull No real commitment to reform
SA Relationships Register Bill
Rationale
bull Recognise same-sex relationships
bull Recognise intersex status
bull amendments to various existing Acts
Introduced by
bull Left wing of State Labor 22 Sept 2016
Slipped in late
bull Part 6 Amendments to Family Relationships Act
(Sect 10)
bull same-sex and single parents able to access
domestic surrogacy
bull Surrogate re-imbursements
On Second Thoughtshellip
bull Bill to be split
bull Improving access to surrogacy to be
separate bill
Surrogacy Eligibility Bill
Law Reform Required
State-Based
bull Rules on surrogacy-related advertising reviewed in the context of non-profit organisations
bull Expenses to allow for inconvenience payments to surrogates
Law Reform
State-Based Law Reform
bull Rules on surrogacy-related advertising reviewed in the context of non-profit organisations
bull Expenses to allow for inconvenience payments to surrogates
Family Court
bull Remove transfer-of-parentage from the Courts system providing much quicker legal
recognition for intended parents
Policy Reform
State-Based Law Reform
bull Rules on surrogacy-related advertising reviewed in the context of non-profit organisations
bull Expenses to allow for inconvenience payments to surrogates
Family Court Law Reform
bull Remove transfer-of-parentage from the Courts system providing much quicker legal
recognition for intended parents
Medicare Reform
bull Medicare rebate for surrogacy-related IVF where there is a medical need
GROWING DOMESTIC
CAPACITY
Well-managed domestic surrogacy so fewer need to go abroad
Evidence-Based Research
Aim
bull Determine what personality traits amp
lifestyle factors best predict a
psychologically healthy surrogacy
arrangement
Outcomes
bull validate the most accurate indicators of
surrogate amp Intended Parent
lsquoappropriatenessrsquo
Rationale
bull Ensure professional counselling practice
supporting by evidence-based research
bull Screen out inappropriate surrogates amp
IPs
Provide understanding of what traits define healthy arrangements
Evidence-Based Research
University partner
bull Ethics Application
bull Funding sought via FSA grant Govt
Design
Retrospective measurement in past Australian
surrogates amp IPs of
bull Personality traits
bull Satisfaction with interpersonal relationships
bull Levels of conflict support
bull Quality of ongoing relationship
Pre-Match Screening
Pilot Project 1
bull Three year project
bull Ethics Approved
bull Provide professional screening of
surrogates and intended parents
BEFORE they meet
Well-managed domestic surrogacy so fewer need to go abroad
Rationale
bull Avoid surrogates amp IPs having to trawl the net
bull Avoid inappropriate matches
bull Screen out surrogates with wrong motives
bull Provide IPs and surrogates with more
confidence about engaging at home
Evaluation
Tracking amongst participants and control group of
bull surrogate amp Intended Parents personality traits
bull surrogacy outcomes amp relationship quality
bull Attract potential surrogates amp IPs via website
amp social media (unpaid)
bull Intended Parents pay membership fee
bull Informed Consent amp Confidentiality
documentation
bull Referred to Psychologist for interview amp
screening
Pre-Match Screening
bull Reports generated amp provided to NFP for
lsquomatchingrsquo
bull Surrogates undergo medical screening
bull Surrogates who pass screening provided
with 2-3 profiles of IPs who are a good
match
bull Surrogate chooses favoured profile and
an introduction is made
Support Post Matching
Pilot Project 2
bull Availability of timely professional support
after surrogacy approval
Rationale
bull Surrogacy a complex emotional and
psychological journey for IPs amp
surrogates
bull Surrogate-run social media support can
only go so far
Some IVF clinics already consideringattempting this
IS POLICY IN LINE WITH
COMMUNITY ATTITUDES
What Do Australians Think of
Surrogacy
bull Which groups should be able to access surrogacy
bull Level of support for financial compensation
bull Concerns with surrogate compensation
bull Support for the use of agencies to recruit screen and place surrogates
Methodology
bull Approach Ethics approved to enable publication
bull Length amp mode 20 item online survey
bull Timing Dec 28th 2015 - Jan 15th 2016
bull Sample size 500 Australians aged 18 - 49 years (reproductive age)
bull Sample make-up Representative age gender and socio-demographic distribution
bull Those with past surrogacy experience ( themselves family member or friend) excluded to
avoid bias
Support for Surrogate Matching in
Australia
Yes should be allowed
50No
17
Donrsquot Know33
References
Harris K Fitzgerald O Paul RC Macaldowie A Lee E amp Chambers GM 2016 Assisted reproductive technology in Australia
and New Zealand 2014 Sydney National Perinatal Epidemiology and Statistics Unit the University of New South Wales
Everingham SG Stafford-Bell MA Hammarberg K Australians Use of surrogacy MJA 2014 201 (5)1-4
Jadva V Blake L Casey P and Golombok S (2012) Surrogacy families 10 years on relationship with the surrogate
decisions over disclosure and childrenrsquos understanding of their surrogacy origins Human Reproduction Vol27 No10 pp
3008ndash3014
Jadva V Imrie S Golombok S (2015) Surrogate mothers 10 years on a longitudinal study of psychological well-being and
relationships with the parents and child Hum Reprod Feb30(2)373-9
Surrogacy Trends
39
63
52
80
9185
131121
176
157
6
20
7 818 14
21 19
35 36
0
20
40
60
80
100
120
140
160
180
200
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
ANZ Gestational Surrogacy Cycles amp Deliveries
Gest carrier cycles No of live deliveries
~200 domestic gestational surrogacy births in last 8 years
Australian regulatory Frameworks not
meeting needs
Australia UK Canada
lt6 ~50 ~50
~3000 surrogacy births to Australians in last 8 years
Proportion engaging domestically
WHY DO FAR MORE AUSTRALIANS
ENGAGE OFFSHORE
Key Barriers Pushing Australians
offshore
1) Lack of eligibility
2) Regulatory processes harder vs offshore alternatives
3) Significant professional costs
4) Difficulty sourcing a surrogate
5) Lack of certainty over legal parentage
6) Discomfort amongst Aust IVF specialists
7) IVF clinics poorly resourced to meet psychological support needs
IPs uncomfortable managing surrogate relationship themselves
Implications
counsellingbull IPs
Surrogate Counselling
bull Prepare written report
Legal advice for
both parties
bull Assesses eligibility
Review by medical Director
bullDecide on further reports
2) Local Requirements Focus On
Gatekeeping Rather than Support
IVF clinic appointment
bull Assess eligibility
Admin appointment
bull Discuss financials
Surrogate appointment
bull Assesses eligibility
Review by Clinic
Committee
bullDecide on further reports
Surrogate has blood
tests
Consent forms signed
First transfer cycle
Regulatory Model By Country
Australia UK Canada
Regulatory requirements Onerous Flexible Flexible
Mandatory counselling Multiple sessions pre
and post birth
Social worker post birth No
Surrogacy agreements Required for parental
transfer
Not required
Lawyers not allowed to
charge for preparing
contracts
Required by IVF
Clinics
Legal parentage 4-6 mths post birth 2-6 mths post birth
Can self-register for pound250
2 weeks post birth
$31000$20000
$11000 $15000 $13000
$36000
$20000
$20000$26000
$12500 $11500
$18000
$31000
$12000 $21000$2600 $4100
$37000
$19000
$18000$13000
$4800
$5300
$20000 $13000 $8300
$1650
$5900
$5000
$8000$350
$2000
$13000
$5500
$5500$10000
$5500
$4700
$12000
$3000
$20000
$5600
$17000$3300
$8600
$5300
$0
$20000
$40000
$60000
$80000
$100000
$120000
$140000
$160000
$180000
USA Greece Canada Australia Ukraine Laos
Au
st D
olla
rs
Country Engaged In
Agency fee
IVF costs
Legal costs
SurrogatecompensationSurro expenses
ScreeningCounselling
Hospital amp post-birthcostsSurrogate amp newborninsuranceEgg Donor costs
3) Average Costs By Country
Average IV Costs Per cycle
(AUD) low high
UK $3 470 $6 240
Canada $ 300 $8 000
Australia $3 000 $8 000
Aust couples investing in an average of 8 failed embryo transfers before
turning to surrogacy
Equitable Access in Canada
Ontariorsquos State-Sponsored IVF Program
bull one-at-a-time transfer of all viable embryos
bull one additional funded IVF cycle if acting
as a surrogate
bull One fertility preservation cycle including
freezing for medical reasons per patient
bull Annually provides
bull gt 10000 patients with AI and IUI
bull gt 5000 patients with IVF and FP
Eligibility
bull Those trying to start or expand a family
bull any sex gender sexual orientation or family
status
bull Available for surrogacy arrangements
Annual cost
up to $70M
One IVF cycle per patient per lifetime regardless of sexual orientation or
need for surrogacy
Professional Costs For UK
(AUD) UK ndash low
end
UK ndash high
end
Av IVF
(surrogacy)
$6 800 $15 600
Counselling - -
Agreements - $5 000
Parental
orders
$ 340 $10 000
Agency fee - $12 000 -
19 000
Total $ 7 140 $45600
NFP Surrogacy Agencies - UK
Options Review Meeting pound 500
UK Matching amp Management pound12 000
UK Surrogate Screening amp Support pound 8 000
US Management ndash Basic pound 5 500
US Management ndash Enhanced pound 7 500
Professional Costs For Canada
(AUD) UK ndash low
end
UK ndash high
end
Canada
low end
Canada
high end
Av IVF
(surrogacy)
$6 800 $15 600 $ 2 000 $ 12 000
Counselling - - - -
Agreements - $5 000 $ 5 000 $ 6 600
Parental
orders
$ 340 $10 000 - $ 4 250
Agency fee - $12 000 -
19 000
- $ 12 000
Total $ 7 140 $45 600 $7 000 $38 850
Not allowed to charge for matching
Surrogacy Agencies - Canada
Professional Costs For Australia
(AUD) UK ndash low
end
UK ndash high
end
Canada
low end
Canada
high end
Australia
low
Australia
high
Av IVF
(surrogacy)
$6 800 $15 600 $ 2 000 $ 12 000 $ 5 000 $33 000
Counselling - - - - $ 3 000 $5 000
Agreements - $5 000 $ 5 000 $ 6 600 $13 500 $23 500
Parental
orders
$ 340 $10 000 - $ 4 250 $ 6 500 $ 6 500
Agency fee - $12 000 -
19 000
- $ 12 000 - -
Total $ 7 140 $45600 $20000 $42000 $28 000 $68 000
Surrogate Matching amp Support
Australia UK Canada
Organisations to support
surrogate matching
No Yes Yes
Wait time to find
surrogate
4 - 18 mths 4 - 18 mths 5 - 6 mths
screened out 10 80
Support during surrogacy No Limited Yes if agency used
Surrogate Re-imbursement
Australia UK Canada
Surrogate expenses ~$3000 - $10000 ~$12000 - 34000 ~$34500
Risks to Surrogates
Hot flushes
Feeling down or irritable
Headaches
Restlessness
Exhaustion
Nausea (mild to very severe)
Indigestion
Constipation
Weight gain
Bloating
Abdominalvaginal muscle weakness
Pre-eclampsia
Placenta Previa
Placental abruption
Pubic symphysis dysfunction
Gestational diabetes
Backaches
Miscarriage
molar pregnancy
future infertility
permanent disability
Trauma to the Cervix
Perforation of the Uterus
scar tissue at the uterus opening
infection in the uterus lining
Psychological Disturbances
Prolonged or heavy bleeding
Pain
Perineal Tears
Fistula
Permanent disability
Psychological Distress
Post-Partum Depression
Blood clots in the legs
LAW REFORM
Canadian Reform To Granting Parentage
Background
Ontario Family Law courts questioning the
need to clog up the court system with transfer
of parentage cases given none were being
refused
British Columbia has had simpler processes
circumventing Court for 3 years
Initiative
Ontariorsquos All Families Are Equal Act 2016
amended Acts and statutes to update
parentage and birth registration rules
Enacted
October 2016
Canadian Reform To Granting Parentage
Result
Intended parents recognized without a court order if
the surrogate and IP(s)
bull received independent legal advice
bull entered into a written pre-conception agreement
The surrogate provided written consent to give up her
parental status both
bull before conception and
bull seven days after the birth
Saves parents $6000 in legal costs
Frees Family court to prioritise adversarial cases
NSW Reforms
NSW Review of Surrogacy Act 2010
bull mid 2014 Submissions closed
bull Dec 2015 lsquoBaird government pushing ahead with its planned reformrsquo
bull flagged allowing advertising for surrogates
bull Since thenhellip Silence
Commonwealth House of Reps Review
Surrogacy Matters - Inquiry into the regulatory and legislative aspects of international
and domestic surrogacy arrangements
bull 6 days of hearings
bull 124 written submissions
bull 35 page report tabled April 2016
Key Conclusion
bull many Australians pursuing offshore commercial surrogacy because of the difficulties of
negotiating altruistic surrogacy arrangements in Australia
Commonwealth House of Reps Review
bull 10 sensible recommendations
helliphelliphellipNo government response to date
~3000+ Australian children continue to be denied access to legal parentage
SA Family Relationships Amendment Act
Rationale
bull make it possible for a couple to contact a
surrogate via an SA register
bull regulate overseas surrogacy where
proposed agreements assessed by
Minister on case-by-case basis
Introduced by
bull MLC opposition backbencher John
Dawkins in 2014
Limitations
bull No provision for access by same-sex
couples
bull SA Attorney General anti-surrogacy amp
unwilling to co-operate
Enacted
bull in July 2015
Implementation
15 months of inaction
28 Oct 2016
bull Regulations gazetted for consultation
phase in developing new regulations
bull No real commitment to reform
SA Relationships Register Bill
Rationale
bull Recognise same-sex relationships
bull Recognise intersex status
bull amendments to various existing Acts
Introduced by
bull Left wing of State Labor 22 Sept 2016
Slipped in late
bull Part 6 Amendments to Family Relationships Act
(Sect 10)
bull same-sex and single parents able to access
domestic surrogacy
bull Surrogate re-imbursements
On Second Thoughtshellip
bull Bill to be split
bull Improving access to surrogacy to be
separate bill
Surrogacy Eligibility Bill
Law Reform Required
State-Based
bull Rules on surrogacy-related advertising reviewed in the context of non-profit organisations
bull Expenses to allow for inconvenience payments to surrogates
Law Reform
State-Based Law Reform
bull Rules on surrogacy-related advertising reviewed in the context of non-profit organisations
bull Expenses to allow for inconvenience payments to surrogates
Family Court
bull Remove transfer-of-parentage from the Courts system providing much quicker legal
recognition for intended parents
Policy Reform
State-Based Law Reform
bull Rules on surrogacy-related advertising reviewed in the context of non-profit organisations
bull Expenses to allow for inconvenience payments to surrogates
Family Court Law Reform
bull Remove transfer-of-parentage from the Courts system providing much quicker legal
recognition for intended parents
Medicare Reform
bull Medicare rebate for surrogacy-related IVF where there is a medical need
GROWING DOMESTIC
CAPACITY
Well-managed domestic surrogacy so fewer need to go abroad
Evidence-Based Research
Aim
bull Determine what personality traits amp
lifestyle factors best predict a
psychologically healthy surrogacy
arrangement
Outcomes
bull validate the most accurate indicators of
surrogate amp Intended Parent
lsquoappropriatenessrsquo
Rationale
bull Ensure professional counselling practice
supporting by evidence-based research
bull Screen out inappropriate surrogates amp
IPs
Provide understanding of what traits define healthy arrangements
Evidence-Based Research
University partner
bull Ethics Application
bull Funding sought via FSA grant Govt
Design
Retrospective measurement in past Australian
surrogates amp IPs of
bull Personality traits
bull Satisfaction with interpersonal relationships
bull Levels of conflict support
bull Quality of ongoing relationship
Pre-Match Screening
Pilot Project 1
bull Three year project
bull Ethics Approved
bull Provide professional screening of
surrogates and intended parents
BEFORE they meet
Well-managed domestic surrogacy so fewer need to go abroad
Rationale
bull Avoid surrogates amp IPs having to trawl the net
bull Avoid inappropriate matches
bull Screen out surrogates with wrong motives
bull Provide IPs and surrogates with more
confidence about engaging at home
Evaluation
Tracking amongst participants and control group of
bull surrogate amp Intended Parents personality traits
bull surrogacy outcomes amp relationship quality
bull Attract potential surrogates amp IPs via website
amp social media (unpaid)
bull Intended Parents pay membership fee
bull Informed Consent amp Confidentiality
documentation
bull Referred to Psychologist for interview amp
screening
Pre-Match Screening
bull Reports generated amp provided to NFP for
lsquomatchingrsquo
bull Surrogates undergo medical screening
bull Surrogates who pass screening provided
with 2-3 profiles of IPs who are a good
match
bull Surrogate chooses favoured profile and
an introduction is made
Support Post Matching
Pilot Project 2
bull Availability of timely professional support
after surrogacy approval
Rationale
bull Surrogacy a complex emotional and
psychological journey for IPs amp
surrogates
bull Surrogate-run social media support can
only go so far
Some IVF clinics already consideringattempting this
IS POLICY IN LINE WITH
COMMUNITY ATTITUDES
What Do Australians Think of
Surrogacy
bull Which groups should be able to access surrogacy
bull Level of support for financial compensation
bull Concerns with surrogate compensation
bull Support for the use of agencies to recruit screen and place surrogates
Methodology
bull Approach Ethics approved to enable publication
bull Length amp mode 20 item online survey
bull Timing Dec 28th 2015 - Jan 15th 2016
bull Sample size 500 Australians aged 18 - 49 years (reproductive age)
bull Sample make-up Representative age gender and socio-demographic distribution
bull Those with past surrogacy experience ( themselves family member or friend) excluded to
avoid bias
Support for Surrogate Matching in
Australia
Yes should be allowed
50No
17
Donrsquot Know33
References
Harris K Fitzgerald O Paul RC Macaldowie A Lee E amp Chambers GM 2016 Assisted reproductive technology in Australia
and New Zealand 2014 Sydney National Perinatal Epidemiology and Statistics Unit the University of New South Wales
Everingham SG Stafford-Bell MA Hammarberg K Australians Use of surrogacy MJA 2014 201 (5)1-4
Jadva V Blake L Casey P and Golombok S (2012) Surrogacy families 10 years on relationship with the surrogate
decisions over disclosure and childrenrsquos understanding of their surrogacy origins Human Reproduction Vol27 No10 pp
3008ndash3014
Jadva V Imrie S Golombok S (2015) Surrogate mothers 10 years on a longitudinal study of psychological well-being and
relationships with the parents and child Hum Reprod Feb30(2)373-9
Australian regulatory Frameworks not
meeting needs
Australia UK Canada
lt6 ~50 ~50
~3000 surrogacy births to Australians in last 8 years
Proportion engaging domestically
WHY DO FAR MORE AUSTRALIANS
ENGAGE OFFSHORE
Key Barriers Pushing Australians
offshore
1) Lack of eligibility
2) Regulatory processes harder vs offshore alternatives
3) Significant professional costs
4) Difficulty sourcing a surrogate
5) Lack of certainty over legal parentage
6) Discomfort amongst Aust IVF specialists
7) IVF clinics poorly resourced to meet psychological support needs
IPs uncomfortable managing surrogate relationship themselves
Implications
counsellingbull IPs
Surrogate Counselling
bull Prepare written report
Legal advice for
both parties
bull Assesses eligibility
Review by medical Director
bullDecide on further reports
2) Local Requirements Focus On
Gatekeeping Rather than Support
IVF clinic appointment
bull Assess eligibility
Admin appointment
bull Discuss financials
Surrogate appointment
bull Assesses eligibility
Review by Clinic
Committee
bullDecide on further reports
Surrogate has blood
tests
Consent forms signed
First transfer cycle
Regulatory Model By Country
Australia UK Canada
Regulatory requirements Onerous Flexible Flexible
Mandatory counselling Multiple sessions pre
and post birth
Social worker post birth No
Surrogacy agreements Required for parental
transfer
Not required
Lawyers not allowed to
charge for preparing
contracts
Required by IVF
Clinics
Legal parentage 4-6 mths post birth 2-6 mths post birth
Can self-register for pound250
2 weeks post birth
$31000$20000
$11000 $15000 $13000
$36000
$20000
$20000$26000
$12500 $11500
$18000
$31000
$12000 $21000$2600 $4100
$37000
$19000
$18000$13000
$4800
$5300
$20000 $13000 $8300
$1650
$5900
$5000
$8000$350
$2000
$13000
$5500
$5500$10000
$5500
$4700
$12000
$3000
$20000
$5600
$17000$3300
$8600
$5300
$0
$20000
$40000
$60000
$80000
$100000
$120000
$140000
$160000
$180000
USA Greece Canada Australia Ukraine Laos
Au
st D
olla
rs
Country Engaged In
Agency fee
IVF costs
Legal costs
SurrogatecompensationSurro expenses
ScreeningCounselling
Hospital amp post-birthcostsSurrogate amp newborninsuranceEgg Donor costs
3) Average Costs By Country
Average IV Costs Per cycle
(AUD) low high
UK $3 470 $6 240
Canada $ 300 $8 000
Australia $3 000 $8 000
Aust couples investing in an average of 8 failed embryo transfers before
turning to surrogacy
Equitable Access in Canada
Ontariorsquos State-Sponsored IVF Program
bull one-at-a-time transfer of all viable embryos
bull one additional funded IVF cycle if acting
as a surrogate
bull One fertility preservation cycle including
freezing for medical reasons per patient
bull Annually provides
bull gt 10000 patients with AI and IUI
bull gt 5000 patients with IVF and FP
Eligibility
bull Those trying to start or expand a family
bull any sex gender sexual orientation or family
status
bull Available for surrogacy arrangements
Annual cost
up to $70M
One IVF cycle per patient per lifetime regardless of sexual orientation or
need for surrogacy
Professional Costs For UK
(AUD) UK ndash low
end
UK ndash high
end
Av IVF
(surrogacy)
$6 800 $15 600
Counselling - -
Agreements - $5 000
Parental
orders
$ 340 $10 000
Agency fee - $12 000 -
19 000
Total $ 7 140 $45600
NFP Surrogacy Agencies - UK
Options Review Meeting pound 500
UK Matching amp Management pound12 000
UK Surrogate Screening amp Support pound 8 000
US Management ndash Basic pound 5 500
US Management ndash Enhanced pound 7 500
Professional Costs For Canada
(AUD) UK ndash low
end
UK ndash high
end
Canada
low end
Canada
high end
Av IVF
(surrogacy)
$6 800 $15 600 $ 2 000 $ 12 000
Counselling - - - -
Agreements - $5 000 $ 5 000 $ 6 600
Parental
orders
$ 340 $10 000 - $ 4 250
Agency fee - $12 000 -
19 000
- $ 12 000
Total $ 7 140 $45 600 $7 000 $38 850
Not allowed to charge for matching
Surrogacy Agencies - Canada
Professional Costs For Australia
(AUD) UK ndash low
end
UK ndash high
end
Canada
low end
Canada
high end
Australia
low
Australia
high
Av IVF
(surrogacy)
$6 800 $15 600 $ 2 000 $ 12 000 $ 5 000 $33 000
Counselling - - - - $ 3 000 $5 000
Agreements - $5 000 $ 5 000 $ 6 600 $13 500 $23 500
Parental
orders
$ 340 $10 000 - $ 4 250 $ 6 500 $ 6 500
Agency fee - $12 000 -
19 000
- $ 12 000 - -
Total $ 7 140 $45600 $20000 $42000 $28 000 $68 000
Surrogate Matching amp Support
Australia UK Canada
Organisations to support
surrogate matching
No Yes Yes
Wait time to find
surrogate
4 - 18 mths 4 - 18 mths 5 - 6 mths
screened out 10 80
Support during surrogacy No Limited Yes if agency used
Surrogate Re-imbursement
Australia UK Canada
Surrogate expenses ~$3000 - $10000 ~$12000 - 34000 ~$34500
Risks to Surrogates
Hot flushes
Feeling down or irritable
Headaches
Restlessness
Exhaustion
Nausea (mild to very severe)
Indigestion
Constipation
Weight gain
Bloating
Abdominalvaginal muscle weakness
Pre-eclampsia
Placenta Previa
Placental abruption
Pubic symphysis dysfunction
Gestational diabetes
Backaches
Miscarriage
molar pregnancy
future infertility
permanent disability
Trauma to the Cervix
Perforation of the Uterus
scar tissue at the uterus opening
infection in the uterus lining
Psychological Disturbances
Prolonged or heavy bleeding
Pain
Perineal Tears
Fistula
Permanent disability
Psychological Distress
Post-Partum Depression
Blood clots in the legs
LAW REFORM
Canadian Reform To Granting Parentage
Background
Ontario Family Law courts questioning the
need to clog up the court system with transfer
of parentage cases given none were being
refused
British Columbia has had simpler processes
circumventing Court for 3 years
Initiative
Ontariorsquos All Families Are Equal Act 2016
amended Acts and statutes to update
parentage and birth registration rules
Enacted
October 2016
Canadian Reform To Granting Parentage
Result
Intended parents recognized without a court order if
the surrogate and IP(s)
bull received independent legal advice
bull entered into a written pre-conception agreement
The surrogate provided written consent to give up her
parental status both
bull before conception and
bull seven days after the birth
Saves parents $6000 in legal costs
Frees Family court to prioritise adversarial cases
NSW Reforms
NSW Review of Surrogacy Act 2010
bull mid 2014 Submissions closed
bull Dec 2015 lsquoBaird government pushing ahead with its planned reformrsquo
bull flagged allowing advertising for surrogates
bull Since thenhellip Silence
Commonwealth House of Reps Review
Surrogacy Matters - Inquiry into the regulatory and legislative aspects of international
and domestic surrogacy arrangements
bull 6 days of hearings
bull 124 written submissions
bull 35 page report tabled April 2016
Key Conclusion
bull many Australians pursuing offshore commercial surrogacy because of the difficulties of
negotiating altruistic surrogacy arrangements in Australia
Commonwealth House of Reps Review
bull 10 sensible recommendations
helliphelliphellipNo government response to date
~3000+ Australian children continue to be denied access to legal parentage
SA Family Relationships Amendment Act
Rationale
bull make it possible for a couple to contact a
surrogate via an SA register
bull regulate overseas surrogacy where
proposed agreements assessed by
Minister on case-by-case basis
Introduced by
bull MLC opposition backbencher John
Dawkins in 2014
Limitations
bull No provision for access by same-sex
couples
bull SA Attorney General anti-surrogacy amp
unwilling to co-operate
Enacted
bull in July 2015
Implementation
15 months of inaction
28 Oct 2016
bull Regulations gazetted for consultation
phase in developing new regulations
bull No real commitment to reform
SA Relationships Register Bill
Rationale
bull Recognise same-sex relationships
bull Recognise intersex status
bull amendments to various existing Acts
Introduced by
bull Left wing of State Labor 22 Sept 2016
Slipped in late
bull Part 6 Amendments to Family Relationships Act
(Sect 10)
bull same-sex and single parents able to access
domestic surrogacy
bull Surrogate re-imbursements
On Second Thoughtshellip
bull Bill to be split
bull Improving access to surrogacy to be
separate bill
Surrogacy Eligibility Bill
Law Reform Required
State-Based
bull Rules on surrogacy-related advertising reviewed in the context of non-profit organisations
bull Expenses to allow for inconvenience payments to surrogates
Law Reform
State-Based Law Reform
bull Rules on surrogacy-related advertising reviewed in the context of non-profit organisations
bull Expenses to allow for inconvenience payments to surrogates
Family Court
bull Remove transfer-of-parentage from the Courts system providing much quicker legal
recognition for intended parents
Policy Reform
State-Based Law Reform
bull Rules on surrogacy-related advertising reviewed in the context of non-profit organisations
bull Expenses to allow for inconvenience payments to surrogates
Family Court Law Reform
bull Remove transfer-of-parentage from the Courts system providing much quicker legal
recognition for intended parents
Medicare Reform
bull Medicare rebate for surrogacy-related IVF where there is a medical need
GROWING DOMESTIC
CAPACITY
Well-managed domestic surrogacy so fewer need to go abroad
Evidence-Based Research
Aim
bull Determine what personality traits amp
lifestyle factors best predict a
psychologically healthy surrogacy
arrangement
Outcomes
bull validate the most accurate indicators of
surrogate amp Intended Parent
lsquoappropriatenessrsquo
Rationale
bull Ensure professional counselling practice
supporting by evidence-based research
bull Screen out inappropriate surrogates amp
IPs
Provide understanding of what traits define healthy arrangements
Evidence-Based Research
University partner
bull Ethics Application
bull Funding sought via FSA grant Govt
Design
Retrospective measurement in past Australian
surrogates amp IPs of
bull Personality traits
bull Satisfaction with interpersonal relationships
bull Levels of conflict support
bull Quality of ongoing relationship
Pre-Match Screening
Pilot Project 1
bull Three year project
bull Ethics Approved
bull Provide professional screening of
surrogates and intended parents
BEFORE they meet
Well-managed domestic surrogacy so fewer need to go abroad
Rationale
bull Avoid surrogates amp IPs having to trawl the net
bull Avoid inappropriate matches
bull Screen out surrogates with wrong motives
bull Provide IPs and surrogates with more
confidence about engaging at home
Evaluation
Tracking amongst participants and control group of
bull surrogate amp Intended Parents personality traits
bull surrogacy outcomes amp relationship quality
bull Attract potential surrogates amp IPs via website
amp social media (unpaid)
bull Intended Parents pay membership fee
bull Informed Consent amp Confidentiality
documentation
bull Referred to Psychologist for interview amp
screening
Pre-Match Screening
bull Reports generated amp provided to NFP for
lsquomatchingrsquo
bull Surrogates undergo medical screening
bull Surrogates who pass screening provided
with 2-3 profiles of IPs who are a good
match
bull Surrogate chooses favoured profile and
an introduction is made
Support Post Matching
Pilot Project 2
bull Availability of timely professional support
after surrogacy approval
Rationale
bull Surrogacy a complex emotional and
psychological journey for IPs amp
surrogates
bull Surrogate-run social media support can
only go so far
Some IVF clinics already consideringattempting this
IS POLICY IN LINE WITH
COMMUNITY ATTITUDES
What Do Australians Think of
Surrogacy
bull Which groups should be able to access surrogacy
bull Level of support for financial compensation
bull Concerns with surrogate compensation
bull Support for the use of agencies to recruit screen and place surrogates
Methodology
bull Approach Ethics approved to enable publication
bull Length amp mode 20 item online survey
bull Timing Dec 28th 2015 - Jan 15th 2016
bull Sample size 500 Australians aged 18 - 49 years (reproductive age)
bull Sample make-up Representative age gender and socio-demographic distribution
bull Those with past surrogacy experience ( themselves family member or friend) excluded to
avoid bias
Support for Surrogate Matching in
Australia
Yes should be allowed
50No
17
Donrsquot Know33
References
Harris K Fitzgerald O Paul RC Macaldowie A Lee E amp Chambers GM 2016 Assisted reproductive technology in Australia
and New Zealand 2014 Sydney National Perinatal Epidemiology and Statistics Unit the University of New South Wales
Everingham SG Stafford-Bell MA Hammarberg K Australians Use of surrogacy MJA 2014 201 (5)1-4
Jadva V Blake L Casey P and Golombok S (2012) Surrogacy families 10 years on relationship with the surrogate
decisions over disclosure and childrenrsquos understanding of their surrogacy origins Human Reproduction Vol27 No10 pp
3008ndash3014
Jadva V Imrie S Golombok S (2015) Surrogate mothers 10 years on a longitudinal study of psychological well-being and
relationships with the parents and child Hum Reprod Feb30(2)373-9
WHY DO FAR MORE AUSTRALIANS
ENGAGE OFFSHORE
Key Barriers Pushing Australians
offshore
1) Lack of eligibility
2) Regulatory processes harder vs offshore alternatives
3) Significant professional costs
4) Difficulty sourcing a surrogate
5) Lack of certainty over legal parentage
6) Discomfort amongst Aust IVF specialists
7) IVF clinics poorly resourced to meet psychological support needs
IPs uncomfortable managing surrogate relationship themselves
Implications
counsellingbull IPs
Surrogate Counselling
bull Prepare written report
Legal advice for
both parties
bull Assesses eligibility
Review by medical Director
bullDecide on further reports
2) Local Requirements Focus On
Gatekeeping Rather than Support
IVF clinic appointment
bull Assess eligibility
Admin appointment
bull Discuss financials
Surrogate appointment
bull Assesses eligibility
Review by Clinic
Committee
bullDecide on further reports
Surrogate has blood
tests
Consent forms signed
First transfer cycle
Regulatory Model By Country
Australia UK Canada
Regulatory requirements Onerous Flexible Flexible
Mandatory counselling Multiple sessions pre
and post birth
Social worker post birth No
Surrogacy agreements Required for parental
transfer
Not required
Lawyers not allowed to
charge for preparing
contracts
Required by IVF
Clinics
Legal parentage 4-6 mths post birth 2-6 mths post birth
Can self-register for pound250
2 weeks post birth
$31000$20000
$11000 $15000 $13000
$36000
$20000
$20000$26000
$12500 $11500
$18000
$31000
$12000 $21000$2600 $4100
$37000
$19000
$18000$13000
$4800
$5300
$20000 $13000 $8300
$1650
$5900
$5000
$8000$350
$2000
$13000
$5500
$5500$10000
$5500
$4700
$12000
$3000
$20000
$5600
$17000$3300
$8600
$5300
$0
$20000
$40000
$60000
$80000
$100000
$120000
$140000
$160000
$180000
USA Greece Canada Australia Ukraine Laos
Au
st D
olla
rs
Country Engaged In
Agency fee
IVF costs
Legal costs
SurrogatecompensationSurro expenses
ScreeningCounselling
Hospital amp post-birthcostsSurrogate amp newborninsuranceEgg Donor costs
3) Average Costs By Country
Average IV Costs Per cycle
(AUD) low high
UK $3 470 $6 240
Canada $ 300 $8 000
Australia $3 000 $8 000
Aust couples investing in an average of 8 failed embryo transfers before
turning to surrogacy
Equitable Access in Canada
Ontariorsquos State-Sponsored IVF Program
bull one-at-a-time transfer of all viable embryos
bull one additional funded IVF cycle if acting
as a surrogate
bull One fertility preservation cycle including
freezing for medical reasons per patient
bull Annually provides
bull gt 10000 patients with AI and IUI
bull gt 5000 patients with IVF and FP
Eligibility
bull Those trying to start or expand a family
bull any sex gender sexual orientation or family
status
bull Available for surrogacy arrangements
Annual cost
up to $70M
One IVF cycle per patient per lifetime regardless of sexual orientation or
need for surrogacy
Professional Costs For UK
(AUD) UK ndash low
end
UK ndash high
end
Av IVF
(surrogacy)
$6 800 $15 600
Counselling - -
Agreements - $5 000
Parental
orders
$ 340 $10 000
Agency fee - $12 000 -
19 000
Total $ 7 140 $45600
NFP Surrogacy Agencies - UK
Options Review Meeting pound 500
UK Matching amp Management pound12 000
UK Surrogate Screening amp Support pound 8 000
US Management ndash Basic pound 5 500
US Management ndash Enhanced pound 7 500
Professional Costs For Canada
(AUD) UK ndash low
end
UK ndash high
end
Canada
low end
Canada
high end
Av IVF
(surrogacy)
$6 800 $15 600 $ 2 000 $ 12 000
Counselling - - - -
Agreements - $5 000 $ 5 000 $ 6 600
Parental
orders
$ 340 $10 000 - $ 4 250
Agency fee - $12 000 -
19 000
- $ 12 000
Total $ 7 140 $45 600 $7 000 $38 850
Not allowed to charge for matching
Surrogacy Agencies - Canada
Professional Costs For Australia
(AUD) UK ndash low
end
UK ndash high
end
Canada
low end
Canada
high end
Australia
low
Australia
high
Av IVF
(surrogacy)
$6 800 $15 600 $ 2 000 $ 12 000 $ 5 000 $33 000
Counselling - - - - $ 3 000 $5 000
Agreements - $5 000 $ 5 000 $ 6 600 $13 500 $23 500
Parental
orders
$ 340 $10 000 - $ 4 250 $ 6 500 $ 6 500
Agency fee - $12 000 -
19 000
- $ 12 000 - -
Total $ 7 140 $45600 $20000 $42000 $28 000 $68 000
Surrogate Matching amp Support
Australia UK Canada
Organisations to support
surrogate matching
No Yes Yes
Wait time to find
surrogate
4 - 18 mths 4 - 18 mths 5 - 6 mths
screened out 10 80
Support during surrogacy No Limited Yes if agency used
Surrogate Re-imbursement
Australia UK Canada
Surrogate expenses ~$3000 - $10000 ~$12000 - 34000 ~$34500
Risks to Surrogates
Hot flushes
Feeling down or irritable
Headaches
Restlessness
Exhaustion
Nausea (mild to very severe)
Indigestion
Constipation
Weight gain
Bloating
Abdominalvaginal muscle weakness
Pre-eclampsia
Placenta Previa
Placental abruption
Pubic symphysis dysfunction
Gestational diabetes
Backaches
Miscarriage
molar pregnancy
future infertility
permanent disability
Trauma to the Cervix
Perforation of the Uterus
scar tissue at the uterus opening
infection in the uterus lining
Psychological Disturbances
Prolonged or heavy bleeding
Pain
Perineal Tears
Fistula
Permanent disability
Psychological Distress
Post-Partum Depression
Blood clots in the legs
LAW REFORM
Canadian Reform To Granting Parentage
Background
Ontario Family Law courts questioning the
need to clog up the court system with transfer
of parentage cases given none were being
refused
British Columbia has had simpler processes
circumventing Court for 3 years
Initiative
Ontariorsquos All Families Are Equal Act 2016
amended Acts and statutes to update
parentage and birth registration rules
Enacted
October 2016
Canadian Reform To Granting Parentage
Result
Intended parents recognized without a court order if
the surrogate and IP(s)
bull received independent legal advice
bull entered into a written pre-conception agreement
The surrogate provided written consent to give up her
parental status both
bull before conception and
bull seven days after the birth
Saves parents $6000 in legal costs
Frees Family court to prioritise adversarial cases
NSW Reforms
NSW Review of Surrogacy Act 2010
bull mid 2014 Submissions closed
bull Dec 2015 lsquoBaird government pushing ahead with its planned reformrsquo
bull flagged allowing advertising for surrogates
bull Since thenhellip Silence
Commonwealth House of Reps Review
Surrogacy Matters - Inquiry into the regulatory and legislative aspects of international
and domestic surrogacy arrangements
bull 6 days of hearings
bull 124 written submissions
bull 35 page report tabled April 2016
Key Conclusion
bull many Australians pursuing offshore commercial surrogacy because of the difficulties of
negotiating altruistic surrogacy arrangements in Australia
Commonwealth House of Reps Review
bull 10 sensible recommendations
helliphelliphellipNo government response to date
~3000+ Australian children continue to be denied access to legal parentage
SA Family Relationships Amendment Act
Rationale
bull make it possible for a couple to contact a
surrogate via an SA register
bull regulate overseas surrogacy where
proposed agreements assessed by
Minister on case-by-case basis
Introduced by
bull MLC opposition backbencher John
Dawkins in 2014
Limitations
bull No provision for access by same-sex
couples
bull SA Attorney General anti-surrogacy amp
unwilling to co-operate
Enacted
bull in July 2015
Implementation
15 months of inaction
28 Oct 2016
bull Regulations gazetted for consultation
phase in developing new regulations
bull No real commitment to reform
SA Relationships Register Bill
Rationale
bull Recognise same-sex relationships
bull Recognise intersex status
bull amendments to various existing Acts
Introduced by
bull Left wing of State Labor 22 Sept 2016
Slipped in late
bull Part 6 Amendments to Family Relationships Act
(Sect 10)
bull same-sex and single parents able to access
domestic surrogacy
bull Surrogate re-imbursements
On Second Thoughtshellip
bull Bill to be split
bull Improving access to surrogacy to be
separate bill
Surrogacy Eligibility Bill
Law Reform Required
State-Based
bull Rules on surrogacy-related advertising reviewed in the context of non-profit organisations
bull Expenses to allow for inconvenience payments to surrogates
Law Reform
State-Based Law Reform
bull Rules on surrogacy-related advertising reviewed in the context of non-profit organisations
bull Expenses to allow for inconvenience payments to surrogates
Family Court
bull Remove transfer-of-parentage from the Courts system providing much quicker legal
recognition for intended parents
Policy Reform
State-Based Law Reform
bull Rules on surrogacy-related advertising reviewed in the context of non-profit organisations
bull Expenses to allow for inconvenience payments to surrogates
Family Court Law Reform
bull Remove transfer-of-parentage from the Courts system providing much quicker legal
recognition for intended parents
Medicare Reform
bull Medicare rebate for surrogacy-related IVF where there is a medical need
GROWING DOMESTIC
CAPACITY
Well-managed domestic surrogacy so fewer need to go abroad
Evidence-Based Research
Aim
bull Determine what personality traits amp
lifestyle factors best predict a
psychologically healthy surrogacy
arrangement
Outcomes
bull validate the most accurate indicators of
surrogate amp Intended Parent
lsquoappropriatenessrsquo
Rationale
bull Ensure professional counselling practice
supporting by evidence-based research
bull Screen out inappropriate surrogates amp
IPs
Provide understanding of what traits define healthy arrangements
Evidence-Based Research
University partner
bull Ethics Application
bull Funding sought via FSA grant Govt
Design
Retrospective measurement in past Australian
surrogates amp IPs of
bull Personality traits
bull Satisfaction with interpersonal relationships
bull Levels of conflict support
bull Quality of ongoing relationship
Pre-Match Screening
Pilot Project 1
bull Three year project
bull Ethics Approved
bull Provide professional screening of
surrogates and intended parents
BEFORE they meet
Well-managed domestic surrogacy so fewer need to go abroad
Rationale
bull Avoid surrogates amp IPs having to trawl the net
bull Avoid inappropriate matches
bull Screen out surrogates with wrong motives
bull Provide IPs and surrogates with more
confidence about engaging at home
Evaluation
Tracking amongst participants and control group of
bull surrogate amp Intended Parents personality traits
bull surrogacy outcomes amp relationship quality
bull Attract potential surrogates amp IPs via website
amp social media (unpaid)
bull Intended Parents pay membership fee
bull Informed Consent amp Confidentiality
documentation
bull Referred to Psychologist for interview amp
screening
Pre-Match Screening
bull Reports generated amp provided to NFP for
lsquomatchingrsquo
bull Surrogates undergo medical screening
bull Surrogates who pass screening provided
with 2-3 profiles of IPs who are a good
match
bull Surrogate chooses favoured profile and
an introduction is made
Support Post Matching
Pilot Project 2
bull Availability of timely professional support
after surrogacy approval
Rationale
bull Surrogacy a complex emotional and
psychological journey for IPs amp
surrogates
bull Surrogate-run social media support can
only go so far
Some IVF clinics already consideringattempting this
IS POLICY IN LINE WITH
COMMUNITY ATTITUDES
What Do Australians Think of
Surrogacy
bull Which groups should be able to access surrogacy
bull Level of support for financial compensation
bull Concerns with surrogate compensation
bull Support for the use of agencies to recruit screen and place surrogates
Methodology
bull Approach Ethics approved to enable publication
bull Length amp mode 20 item online survey
bull Timing Dec 28th 2015 - Jan 15th 2016
bull Sample size 500 Australians aged 18 - 49 years (reproductive age)
bull Sample make-up Representative age gender and socio-demographic distribution
bull Those with past surrogacy experience ( themselves family member or friend) excluded to
avoid bias
Support for Surrogate Matching in
Australia
Yes should be allowed
50No
17
Donrsquot Know33
References
Harris K Fitzgerald O Paul RC Macaldowie A Lee E amp Chambers GM 2016 Assisted reproductive technology in Australia
and New Zealand 2014 Sydney National Perinatal Epidemiology and Statistics Unit the University of New South Wales
Everingham SG Stafford-Bell MA Hammarberg K Australians Use of surrogacy MJA 2014 201 (5)1-4
Jadva V Blake L Casey P and Golombok S (2012) Surrogacy families 10 years on relationship with the surrogate
decisions over disclosure and childrenrsquos understanding of their surrogacy origins Human Reproduction Vol27 No10 pp
3008ndash3014
Jadva V Imrie S Golombok S (2015) Surrogate mothers 10 years on a longitudinal study of psychological well-being and
relationships with the parents and child Hum Reprod Feb30(2)373-9
Key Barriers Pushing Australians
offshore
1) Lack of eligibility
2) Regulatory processes harder vs offshore alternatives
3) Significant professional costs
4) Difficulty sourcing a surrogate
5) Lack of certainty over legal parentage
6) Discomfort amongst Aust IVF specialists
7) IVF clinics poorly resourced to meet psychological support needs
IPs uncomfortable managing surrogate relationship themselves
Implications
counsellingbull IPs
Surrogate Counselling
bull Prepare written report
Legal advice for
both parties
bull Assesses eligibility
Review by medical Director
bullDecide on further reports
2) Local Requirements Focus On
Gatekeeping Rather than Support
IVF clinic appointment
bull Assess eligibility
Admin appointment
bull Discuss financials
Surrogate appointment
bull Assesses eligibility
Review by Clinic
Committee
bullDecide on further reports
Surrogate has blood
tests
Consent forms signed
First transfer cycle
Regulatory Model By Country
Australia UK Canada
Regulatory requirements Onerous Flexible Flexible
Mandatory counselling Multiple sessions pre
and post birth
Social worker post birth No
Surrogacy agreements Required for parental
transfer
Not required
Lawyers not allowed to
charge for preparing
contracts
Required by IVF
Clinics
Legal parentage 4-6 mths post birth 2-6 mths post birth
Can self-register for pound250
2 weeks post birth
$31000$20000
$11000 $15000 $13000
$36000
$20000
$20000$26000
$12500 $11500
$18000
$31000
$12000 $21000$2600 $4100
$37000
$19000
$18000$13000
$4800
$5300
$20000 $13000 $8300
$1650
$5900
$5000
$8000$350
$2000
$13000
$5500
$5500$10000
$5500
$4700
$12000
$3000
$20000
$5600
$17000$3300
$8600
$5300
$0
$20000
$40000
$60000
$80000
$100000
$120000
$140000
$160000
$180000
USA Greece Canada Australia Ukraine Laos
Au
st D
olla
rs
Country Engaged In
Agency fee
IVF costs
Legal costs
SurrogatecompensationSurro expenses
ScreeningCounselling
Hospital amp post-birthcostsSurrogate amp newborninsuranceEgg Donor costs
3) Average Costs By Country
Average IV Costs Per cycle
(AUD) low high
UK $3 470 $6 240
Canada $ 300 $8 000
Australia $3 000 $8 000
Aust couples investing in an average of 8 failed embryo transfers before
turning to surrogacy
Equitable Access in Canada
Ontariorsquos State-Sponsored IVF Program
bull one-at-a-time transfer of all viable embryos
bull one additional funded IVF cycle if acting
as a surrogate
bull One fertility preservation cycle including
freezing for medical reasons per patient
bull Annually provides
bull gt 10000 patients with AI and IUI
bull gt 5000 patients with IVF and FP
Eligibility
bull Those trying to start or expand a family
bull any sex gender sexual orientation or family
status
bull Available for surrogacy arrangements
Annual cost
up to $70M
One IVF cycle per patient per lifetime regardless of sexual orientation or
need for surrogacy
Professional Costs For UK
(AUD) UK ndash low
end
UK ndash high
end
Av IVF
(surrogacy)
$6 800 $15 600
Counselling - -
Agreements - $5 000
Parental
orders
$ 340 $10 000
Agency fee - $12 000 -
19 000
Total $ 7 140 $45600
NFP Surrogacy Agencies - UK
Options Review Meeting pound 500
UK Matching amp Management pound12 000
UK Surrogate Screening amp Support pound 8 000
US Management ndash Basic pound 5 500
US Management ndash Enhanced pound 7 500
Professional Costs For Canada
(AUD) UK ndash low
end
UK ndash high
end
Canada
low end
Canada
high end
Av IVF
(surrogacy)
$6 800 $15 600 $ 2 000 $ 12 000
Counselling - - - -
Agreements - $5 000 $ 5 000 $ 6 600
Parental
orders
$ 340 $10 000 - $ 4 250
Agency fee - $12 000 -
19 000
- $ 12 000
Total $ 7 140 $45 600 $7 000 $38 850
Not allowed to charge for matching
Surrogacy Agencies - Canada
Professional Costs For Australia
(AUD) UK ndash low
end
UK ndash high
end
Canada
low end
Canada
high end
Australia
low
Australia
high
Av IVF
(surrogacy)
$6 800 $15 600 $ 2 000 $ 12 000 $ 5 000 $33 000
Counselling - - - - $ 3 000 $5 000
Agreements - $5 000 $ 5 000 $ 6 600 $13 500 $23 500
Parental
orders
$ 340 $10 000 - $ 4 250 $ 6 500 $ 6 500
Agency fee - $12 000 -
19 000
- $ 12 000 - -
Total $ 7 140 $45600 $20000 $42000 $28 000 $68 000
Surrogate Matching amp Support
Australia UK Canada
Organisations to support
surrogate matching
No Yes Yes
Wait time to find
surrogate
4 - 18 mths 4 - 18 mths 5 - 6 mths
screened out 10 80
Support during surrogacy No Limited Yes if agency used
Surrogate Re-imbursement
Australia UK Canada
Surrogate expenses ~$3000 - $10000 ~$12000 - 34000 ~$34500
Risks to Surrogates
Hot flushes
Feeling down or irritable
Headaches
Restlessness
Exhaustion
Nausea (mild to very severe)
Indigestion
Constipation
Weight gain
Bloating
Abdominalvaginal muscle weakness
Pre-eclampsia
Placenta Previa
Placental abruption
Pubic symphysis dysfunction
Gestational diabetes
Backaches
Miscarriage
molar pregnancy
future infertility
permanent disability
Trauma to the Cervix
Perforation of the Uterus
scar tissue at the uterus opening
infection in the uterus lining
Psychological Disturbances
Prolonged or heavy bleeding
Pain
Perineal Tears
Fistula
Permanent disability
Psychological Distress
Post-Partum Depression
Blood clots in the legs
LAW REFORM
Canadian Reform To Granting Parentage
Background
Ontario Family Law courts questioning the
need to clog up the court system with transfer
of parentage cases given none were being
refused
British Columbia has had simpler processes
circumventing Court for 3 years
Initiative
Ontariorsquos All Families Are Equal Act 2016
amended Acts and statutes to update
parentage and birth registration rules
Enacted
October 2016
Canadian Reform To Granting Parentage
Result
Intended parents recognized without a court order if
the surrogate and IP(s)
bull received independent legal advice
bull entered into a written pre-conception agreement
The surrogate provided written consent to give up her
parental status both
bull before conception and
bull seven days after the birth
Saves parents $6000 in legal costs
Frees Family court to prioritise adversarial cases
NSW Reforms
NSW Review of Surrogacy Act 2010
bull mid 2014 Submissions closed
bull Dec 2015 lsquoBaird government pushing ahead with its planned reformrsquo
bull flagged allowing advertising for surrogates
bull Since thenhellip Silence
Commonwealth House of Reps Review
Surrogacy Matters - Inquiry into the regulatory and legislative aspects of international
and domestic surrogacy arrangements
bull 6 days of hearings
bull 124 written submissions
bull 35 page report tabled April 2016
Key Conclusion
bull many Australians pursuing offshore commercial surrogacy because of the difficulties of
negotiating altruistic surrogacy arrangements in Australia
Commonwealth House of Reps Review
bull 10 sensible recommendations
helliphelliphellipNo government response to date
~3000+ Australian children continue to be denied access to legal parentage
SA Family Relationships Amendment Act
Rationale
bull make it possible for a couple to contact a
surrogate via an SA register
bull regulate overseas surrogacy where
proposed agreements assessed by
Minister on case-by-case basis
Introduced by
bull MLC opposition backbencher John
Dawkins in 2014
Limitations
bull No provision for access by same-sex
couples
bull SA Attorney General anti-surrogacy amp
unwilling to co-operate
Enacted
bull in July 2015
Implementation
15 months of inaction
28 Oct 2016
bull Regulations gazetted for consultation
phase in developing new regulations
bull No real commitment to reform
SA Relationships Register Bill
Rationale
bull Recognise same-sex relationships
bull Recognise intersex status
bull amendments to various existing Acts
Introduced by
bull Left wing of State Labor 22 Sept 2016
Slipped in late
bull Part 6 Amendments to Family Relationships Act
(Sect 10)
bull same-sex and single parents able to access
domestic surrogacy
bull Surrogate re-imbursements
On Second Thoughtshellip
bull Bill to be split
bull Improving access to surrogacy to be
separate bill
Surrogacy Eligibility Bill
Law Reform Required
State-Based
bull Rules on surrogacy-related advertising reviewed in the context of non-profit organisations
bull Expenses to allow for inconvenience payments to surrogates
Law Reform
State-Based Law Reform
bull Rules on surrogacy-related advertising reviewed in the context of non-profit organisations
bull Expenses to allow for inconvenience payments to surrogates
Family Court
bull Remove transfer-of-parentage from the Courts system providing much quicker legal
recognition for intended parents
Policy Reform
State-Based Law Reform
bull Rules on surrogacy-related advertising reviewed in the context of non-profit organisations
bull Expenses to allow for inconvenience payments to surrogates
Family Court Law Reform
bull Remove transfer-of-parentage from the Courts system providing much quicker legal
recognition for intended parents
Medicare Reform
bull Medicare rebate for surrogacy-related IVF where there is a medical need
GROWING DOMESTIC
CAPACITY
Well-managed domestic surrogacy so fewer need to go abroad
Evidence-Based Research
Aim
bull Determine what personality traits amp
lifestyle factors best predict a
psychologically healthy surrogacy
arrangement
Outcomes
bull validate the most accurate indicators of
surrogate amp Intended Parent
lsquoappropriatenessrsquo
Rationale
bull Ensure professional counselling practice
supporting by evidence-based research
bull Screen out inappropriate surrogates amp
IPs
Provide understanding of what traits define healthy arrangements
Evidence-Based Research
University partner
bull Ethics Application
bull Funding sought via FSA grant Govt
Design
Retrospective measurement in past Australian
surrogates amp IPs of
bull Personality traits
bull Satisfaction with interpersonal relationships
bull Levels of conflict support
bull Quality of ongoing relationship
Pre-Match Screening
Pilot Project 1
bull Three year project
bull Ethics Approved
bull Provide professional screening of
surrogates and intended parents
BEFORE they meet
Well-managed domestic surrogacy so fewer need to go abroad
Rationale
bull Avoid surrogates amp IPs having to trawl the net
bull Avoid inappropriate matches
bull Screen out surrogates with wrong motives
bull Provide IPs and surrogates with more
confidence about engaging at home
Evaluation
Tracking amongst participants and control group of
bull surrogate amp Intended Parents personality traits
bull surrogacy outcomes amp relationship quality
bull Attract potential surrogates amp IPs via website
amp social media (unpaid)
bull Intended Parents pay membership fee
bull Informed Consent amp Confidentiality
documentation
bull Referred to Psychologist for interview amp
screening
Pre-Match Screening
bull Reports generated amp provided to NFP for
lsquomatchingrsquo
bull Surrogates undergo medical screening
bull Surrogates who pass screening provided
with 2-3 profiles of IPs who are a good
match
bull Surrogate chooses favoured profile and
an introduction is made
Support Post Matching
Pilot Project 2
bull Availability of timely professional support
after surrogacy approval
Rationale
bull Surrogacy a complex emotional and
psychological journey for IPs amp
surrogates
bull Surrogate-run social media support can
only go so far
Some IVF clinics already consideringattempting this
IS POLICY IN LINE WITH
COMMUNITY ATTITUDES
What Do Australians Think of
Surrogacy
bull Which groups should be able to access surrogacy
bull Level of support for financial compensation
bull Concerns with surrogate compensation
bull Support for the use of agencies to recruit screen and place surrogates
Methodology
bull Approach Ethics approved to enable publication
bull Length amp mode 20 item online survey
bull Timing Dec 28th 2015 - Jan 15th 2016
bull Sample size 500 Australians aged 18 - 49 years (reproductive age)
bull Sample make-up Representative age gender and socio-demographic distribution
bull Those with past surrogacy experience ( themselves family member or friend) excluded to
avoid bias
Support for Surrogate Matching in
Australia
Yes should be allowed
50No
17
Donrsquot Know33
References
Harris K Fitzgerald O Paul RC Macaldowie A Lee E amp Chambers GM 2016 Assisted reproductive technology in Australia
and New Zealand 2014 Sydney National Perinatal Epidemiology and Statistics Unit the University of New South Wales
Everingham SG Stafford-Bell MA Hammarberg K Australians Use of surrogacy MJA 2014 201 (5)1-4
Jadva V Blake L Casey P and Golombok S (2012) Surrogacy families 10 years on relationship with the surrogate
decisions over disclosure and childrenrsquos understanding of their surrogacy origins Human Reproduction Vol27 No10 pp
3008ndash3014
Jadva V Imrie S Golombok S (2015) Surrogate mothers 10 years on a longitudinal study of psychological well-being and
relationships with the parents and child Hum Reprod Feb30(2)373-9
Implications
counsellingbull IPs
Surrogate Counselling
bull Prepare written report
Legal advice for
both parties
bull Assesses eligibility
Review by medical Director
bullDecide on further reports
2) Local Requirements Focus On
Gatekeeping Rather than Support
IVF clinic appointment
bull Assess eligibility
Admin appointment
bull Discuss financials
Surrogate appointment
bull Assesses eligibility
Review by Clinic
Committee
bullDecide on further reports
Surrogate has blood
tests
Consent forms signed
First transfer cycle
Regulatory Model By Country
Australia UK Canada
Regulatory requirements Onerous Flexible Flexible
Mandatory counselling Multiple sessions pre
and post birth
Social worker post birth No
Surrogacy agreements Required for parental
transfer
Not required
Lawyers not allowed to
charge for preparing
contracts
Required by IVF
Clinics
Legal parentage 4-6 mths post birth 2-6 mths post birth
Can self-register for pound250
2 weeks post birth
$31000$20000
$11000 $15000 $13000
$36000
$20000
$20000$26000
$12500 $11500
$18000
$31000
$12000 $21000$2600 $4100
$37000
$19000
$18000$13000
$4800
$5300
$20000 $13000 $8300
$1650
$5900
$5000
$8000$350
$2000
$13000
$5500
$5500$10000
$5500
$4700
$12000
$3000
$20000
$5600
$17000$3300
$8600
$5300
$0
$20000
$40000
$60000
$80000
$100000
$120000
$140000
$160000
$180000
USA Greece Canada Australia Ukraine Laos
Au
st D
olla
rs
Country Engaged In
Agency fee
IVF costs
Legal costs
SurrogatecompensationSurro expenses
ScreeningCounselling
Hospital amp post-birthcostsSurrogate amp newborninsuranceEgg Donor costs
3) Average Costs By Country
Average IV Costs Per cycle
(AUD) low high
UK $3 470 $6 240
Canada $ 300 $8 000
Australia $3 000 $8 000
Aust couples investing in an average of 8 failed embryo transfers before
turning to surrogacy
Equitable Access in Canada
Ontariorsquos State-Sponsored IVF Program
bull one-at-a-time transfer of all viable embryos
bull one additional funded IVF cycle if acting
as a surrogate
bull One fertility preservation cycle including
freezing for medical reasons per patient
bull Annually provides
bull gt 10000 patients with AI and IUI
bull gt 5000 patients with IVF and FP
Eligibility
bull Those trying to start or expand a family
bull any sex gender sexual orientation or family
status
bull Available for surrogacy arrangements
Annual cost
up to $70M
One IVF cycle per patient per lifetime regardless of sexual orientation or
need for surrogacy
Professional Costs For UK
(AUD) UK ndash low
end
UK ndash high
end
Av IVF
(surrogacy)
$6 800 $15 600
Counselling - -
Agreements - $5 000
Parental
orders
$ 340 $10 000
Agency fee - $12 000 -
19 000
Total $ 7 140 $45600
NFP Surrogacy Agencies - UK
Options Review Meeting pound 500
UK Matching amp Management pound12 000
UK Surrogate Screening amp Support pound 8 000
US Management ndash Basic pound 5 500
US Management ndash Enhanced pound 7 500
Professional Costs For Canada
(AUD) UK ndash low
end
UK ndash high
end
Canada
low end
Canada
high end
Av IVF
(surrogacy)
$6 800 $15 600 $ 2 000 $ 12 000
Counselling - - - -
Agreements - $5 000 $ 5 000 $ 6 600
Parental
orders
$ 340 $10 000 - $ 4 250
Agency fee - $12 000 -
19 000
- $ 12 000
Total $ 7 140 $45 600 $7 000 $38 850
Not allowed to charge for matching
Surrogacy Agencies - Canada
Professional Costs For Australia
(AUD) UK ndash low
end
UK ndash high
end
Canada
low end
Canada
high end
Australia
low
Australia
high
Av IVF
(surrogacy)
$6 800 $15 600 $ 2 000 $ 12 000 $ 5 000 $33 000
Counselling - - - - $ 3 000 $5 000
Agreements - $5 000 $ 5 000 $ 6 600 $13 500 $23 500
Parental
orders
$ 340 $10 000 - $ 4 250 $ 6 500 $ 6 500
Agency fee - $12 000 -
19 000
- $ 12 000 - -
Total $ 7 140 $45600 $20000 $42000 $28 000 $68 000
Surrogate Matching amp Support
Australia UK Canada
Organisations to support
surrogate matching
No Yes Yes
Wait time to find
surrogate
4 - 18 mths 4 - 18 mths 5 - 6 mths
screened out 10 80
Support during surrogacy No Limited Yes if agency used
Surrogate Re-imbursement
Australia UK Canada
Surrogate expenses ~$3000 - $10000 ~$12000 - 34000 ~$34500
Risks to Surrogates
Hot flushes
Feeling down or irritable
Headaches
Restlessness
Exhaustion
Nausea (mild to very severe)
Indigestion
Constipation
Weight gain
Bloating
Abdominalvaginal muscle weakness
Pre-eclampsia
Placenta Previa
Placental abruption
Pubic symphysis dysfunction
Gestational diabetes
Backaches
Miscarriage
molar pregnancy
future infertility
permanent disability
Trauma to the Cervix
Perforation of the Uterus
scar tissue at the uterus opening
infection in the uterus lining
Psychological Disturbances
Prolonged or heavy bleeding
Pain
Perineal Tears
Fistula
Permanent disability
Psychological Distress
Post-Partum Depression
Blood clots in the legs
LAW REFORM
Canadian Reform To Granting Parentage
Background
Ontario Family Law courts questioning the
need to clog up the court system with transfer
of parentage cases given none were being
refused
British Columbia has had simpler processes
circumventing Court for 3 years
Initiative
Ontariorsquos All Families Are Equal Act 2016
amended Acts and statutes to update
parentage and birth registration rules
Enacted
October 2016
Canadian Reform To Granting Parentage
Result
Intended parents recognized without a court order if
the surrogate and IP(s)
bull received independent legal advice
bull entered into a written pre-conception agreement
The surrogate provided written consent to give up her
parental status both
bull before conception and
bull seven days after the birth
Saves parents $6000 in legal costs
Frees Family court to prioritise adversarial cases
NSW Reforms
NSW Review of Surrogacy Act 2010
bull mid 2014 Submissions closed
bull Dec 2015 lsquoBaird government pushing ahead with its planned reformrsquo
bull flagged allowing advertising for surrogates
bull Since thenhellip Silence
Commonwealth House of Reps Review
Surrogacy Matters - Inquiry into the regulatory and legislative aspects of international
and domestic surrogacy arrangements
bull 6 days of hearings
bull 124 written submissions
bull 35 page report tabled April 2016
Key Conclusion
bull many Australians pursuing offshore commercial surrogacy because of the difficulties of
negotiating altruistic surrogacy arrangements in Australia
Commonwealth House of Reps Review
bull 10 sensible recommendations
helliphelliphellipNo government response to date
~3000+ Australian children continue to be denied access to legal parentage
SA Family Relationships Amendment Act
Rationale
bull make it possible for a couple to contact a
surrogate via an SA register
bull regulate overseas surrogacy where
proposed agreements assessed by
Minister on case-by-case basis
Introduced by
bull MLC opposition backbencher John
Dawkins in 2014
Limitations
bull No provision for access by same-sex
couples
bull SA Attorney General anti-surrogacy amp
unwilling to co-operate
Enacted
bull in July 2015
Implementation
15 months of inaction
28 Oct 2016
bull Regulations gazetted for consultation
phase in developing new regulations
bull No real commitment to reform
SA Relationships Register Bill
Rationale
bull Recognise same-sex relationships
bull Recognise intersex status
bull amendments to various existing Acts
Introduced by
bull Left wing of State Labor 22 Sept 2016
Slipped in late
bull Part 6 Amendments to Family Relationships Act
(Sect 10)
bull same-sex and single parents able to access
domestic surrogacy
bull Surrogate re-imbursements
On Second Thoughtshellip
bull Bill to be split
bull Improving access to surrogacy to be
separate bill
Surrogacy Eligibility Bill
Law Reform Required
State-Based
bull Rules on surrogacy-related advertising reviewed in the context of non-profit organisations
bull Expenses to allow for inconvenience payments to surrogates
Law Reform
State-Based Law Reform
bull Rules on surrogacy-related advertising reviewed in the context of non-profit organisations
bull Expenses to allow for inconvenience payments to surrogates
Family Court
bull Remove transfer-of-parentage from the Courts system providing much quicker legal
recognition for intended parents
Policy Reform
State-Based Law Reform
bull Rules on surrogacy-related advertising reviewed in the context of non-profit organisations
bull Expenses to allow for inconvenience payments to surrogates
Family Court Law Reform
bull Remove transfer-of-parentage from the Courts system providing much quicker legal
recognition for intended parents
Medicare Reform
bull Medicare rebate for surrogacy-related IVF where there is a medical need
GROWING DOMESTIC
CAPACITY
Well-managed domestic surrogacy so fewer need to go abroad
Evidence-Based Research
Aim
bull Determine what personality traits amp
lifestyle factors best predict a
psychologically healthy surrogacy
arrangement
Outcomes
bull validate the most accurate indicators of
surrogate amp Intended Parent
lsquoappropriatenessrsquo
Rationale
bull Ensure professional counselling practice
supporting by evidence-based research
bull Screen out inappropriate surrogates amp
IPs
Provide understanding of what traits define healthy arrangements
Evidence-Based Research
University partner
bull Ethics Application
bull Funding sought via FSA grant Govt
Design
Retrospective measurement in past Australian
surrogates amp IPs of
bull Personality traits
bull Satisfaction with interpersonal relationships
bull Levels of conflict support
bull Quality of ongoing relationship
Pre-Match Screening
Pilot Project 1
bull Three year project
bull Ethics Approved
bull Provide professional screening of
surrogates and intended parents
BEFORE they meet
Well-managed domestic surrogacy so fewer need to go abroad
Rationale
bull Avoid surrogates amp IPs having to trawl the net
bull Avoid inappropriate matches
bull Screen out surrogates with wrong motives
bull Provide IPs and surrogates with more
confidence about engaging at home
Evaluation
Tracking amongst participants and control group of
bull surrogate amp Intended Parents personality traits
bull surrogacy outcomes amp relationship quality
bull Attract potential surrogates amp IPs via website
amp social media (unpaid)
bull Intended Parents pay membership fee
bull Informed Consent amp Confidentiality
documentation
bull Referred to Psychologist for interview amp
screening
Pre-Match Screening
bull Reports generated amp provided to NFP for
lsquomatchingrsquo
bull Surrogates undergo medical screening
bull Surrogates who pass screening provided
with 2-3 profiles of IPs who are a good
match
bull Surrogate chooses favoured profile and
an introduction is made
Support Post Matching
Pilot Project 2
bull Availability of timely professional support
after surrogacy approval
Rationale
bull Surrogacy a complex emotional and
psychological journey for IPs amp
surrogates
bull Surrogate-run social media support can
only go so far
Some IVF clinics already consideringattempting this
IS POLICY IN LINE WITH
COMMUNITY ATTITUDES
What Do Australians Think of
Surrogacy
bull Which groups should be able to access surrogacy
bull Level of support for financial compensation
bull Concerns with surrogate compensation
bull Support for the use of agencies to recruit screen and place surrogates
Methodology
bull Approach Ethics approved to enable publication
bull Length amp mode 20 item online survey
bull Timing Dec 28th 2015 - Jan 15th 2016
bull Sample size 500 Australians aged 18 - 49 years (reproductive age)
bull Sample make-up Representative age gender and socio-demographic distribution
bull Those with past surrogacy experience ( themselves family member or friend) excluded to
avoid bias
Support for Surrogate Matching in
Australia
Yes should be allowed
50No
17
Donrsquot Know33
References
Harris K Fitzgerald O Paul RC Macaldowie A Lee E amp Chambers GM 2016 Assisted reproductive technology in Australia
and New Zealand 2014 Sydney National Perinatal Epidemiology and Statistics Unit the University of New South Wales
Everingham SG Stafford-Bell MA Hammarberg K Australians Use of surrogacy MJA 2014 201 (5)1-4
Jadva V Blake L Casey P and Golombok S (2012) Surrogacy families 10 years on relationship with the surrogate
decisions over disclosure and childrenrsquos understanding of their surrogacy origins Human Reproduction Vol27 No10 pp
3008ndash3014
Jadva V Imrie S Golombok S (2015) Surrogate mothers 10 years on a longitudinal study of psychological well-being and
relationships with the parents and child Hum Reprod Feb30(2)373-9
Regulatory Model By Country
Australia UK Canada
Regulatory requirements Onerous Flexible Flexible
Mandatory counselling Multiple sessions pre
and post birth
Social worker post birth No
Surrogacy agreements Required for parental
transfer
Not required
Lawyers not allowed to
charge for preparing
contracts
Required by IVF
Clinics
Legal parentage 4-6 mths post birth 2-6 mths post birth
Can self-register for pound250
2 weeks post birth
$31000$20000
$11000 $15000 $13000
$36000
$20000
$20000$26000
$12500 $11500
$18000
$31000
$12000 $21000$2600 $4100
$37000
$19000
$18000$13000
$4800
$5300
$20000 $13000 $8300
$1650
$5900
$5000
$8000$350
$2000
$13000
$5500
$5500$10000
$5500
$4700
$12000
$3000
$20000
$5600
$17000$3300
$8600
$5300
$0
$20000
$40000
$60000
$80000
$100000
$120000
$140000
$160000
$180000
USA Greece Canada Australia Ukraine Laos
Au
st D
olla
rs
Country Engaged In
Agency fee
IVF costs
Legal costs
SurrogatecompensationSurro expenses
ScreeningCounselling
Hospital amp post-birthcostsSurrogate amp newborninsuranceEgg Donor costs
3) Average Costs By Country
Average IV Costs Per cycle
(AUD) low high
UK $3 470 $6 240
Canada $ 300 $8 000
Australia $3 000 $8 000
Aust couples investing in an average of 8 failed embryo transfers before
turning to surrogacy
Equitable Access in Canada
Ontariorsquos State-Sponsored IVF Program
bull one-at-a-time transfer of all viable embryos
bull one additional funded IVF cycle if acting
as a surrogate
bull One fertility preservation cycle including
freezing for medical reasons per patient
bull Annually provides
bull gt 10000 patients with AI and IUI
bull gt 5000 patients with IVF and FP
Eligibility
bull Those trying to start or expand a family
bull any sex gender sexual orientation or family
status
bull Available for surrogacy arrangements
Annual cost
up to $70M
One IVF cycle per patient per lifetime regardless of sexual orientation or
need for surrogacy
Professional Costs For UK
(AUD) UK ndash low
end
UK ndash high
end
Av IVF
(surrogacy)
$6 800 $15 600
Counselling - -
Agreements - $5 000
Parental
orders
$ 340 $10 000
Agency fee - $12 000 -
19 000
Total $ 7 140 $45600
NFP Surrogacy Agencies - UK
Options Review Meeting pound 500
UK Matching amp Management pound12 000
UK Surrogate Screening amp Support pound 8 000
US Management ndash Basic pound 5 500
US Management ndash Enhanced pound 7 500
Professional Costs For Canada
(AUD) UK ndash low
end
UK ndash high
end
Canada
low end
Canada
high end
Av IVF
(surrogacy)
$6 800 $15 600 $ 2 000 $ 12 000
Counselling - - - -
Agreements - $5 000 $ 5 000 $ 6 600
Parental
orders
$ 340 $10 000 - $ 4 250
Agency fee - $12 000 -
19 000
- $ 12 000
Total $ 7 140 $45 600 $7 000 $38 850
Not allowed to charge for matching
Surrogacy Agencies - Canada
Professional Costs For Australia
(AUD) UK ndash low
end
UK ndash high
end
Canada
low end
Canada
high end
Australia
low
Australia
high
Av IVF
(surrogacy)
$6 800 $15 600 $ 2 000 $ 12 000 $ 5 000 $33 000
Counselling - - - - $ 3 000 $5 000
Agreements - $5 000 $ 5 000 $ 6 600 $13 500 $23 500
Parental
orders
$ 340 $10 000 - $ 4 250 $ 6 500 $ 6 500
Agency fee - $12 000 -
19 000
- $ 12 000 - -
Total $ 7 140 $45600 $20000 $42000 $28 000 $68 000
Surrogate Matching amp Support
Australia UK Canada
Organisations to support
surrogate matching
No Yes Yes
Wait time to find
surrogate
4 - 18 mths 4 - 18 mths 5 - 6 mths
screened out 10 80
Support during surrogacy No Limited Yes if agency used
Surrogate Re-imbursement
Australia UK Canada
Surrogate expenses ~$3000 - $10000 ~$12000 - 34000 ~$34500
Risks to Surrogates
Hot flushes
Feeling down or irritable
Headaches
Restlessness
Exhaustion
Nausea (mild to very severe)
Indigestion
Constipation
Weight gain
Bloating
Abdominalvaginal muscle weakness
Pre-eclampsia
Placenta Previa
Placental abruption
Pubic symphysis dysfunction
Gestational diabetes
Backaches
Miscarriage
molar pregnancy
future infertility
permanent disability
Trauma to the Cervix
Perforation of the Uterus
scar tissue at the uterus opening
infection in the uterus lining
Psychological Disturbances
Prolonged or heavy bleeding
Pain
Perineal Tears
Fistula
Permanent disability
Psychological Distress
Post-Partum Depression
Blood clots in the legs
LAW REFORM
Canadian Reform To Granting Parentage
Background
Ontario Family Law courts questioning the
need to clog up the court system with transfer
of parentage cases given none were being
refused
British Columbia has had simpler processes
circumventing Court for 3 years
Initiative
Ontariorsquos All Families Are Equal Act 2016
amended Acts and statutes to update
parentage and birth registration rules
Enacted
October 2016
Canadian Reform To Granting Parentage
Result
Intended parents recognized without a court order if
the surrogate and IP(s)
bull received independent legal advice
bull entered into a written pre-conception agreement
The surrogate provided written consent to give up her
parental status both
bull before conception and
bull seven days after the birth
Saves parents $6000 in legal costs
Frees Family court to prioritise adversarial cases
NSW Reforms
NSW Review of Surrogacy Act 2010
bull mid 2014 Submissions closed
bull Dec 2015 lsquoBaird government pushing ahead with its planned reformrsquo
bull flagged allowing advertising for surrogates
bull Since thenhellip Silence
Commonwealth House of Reps Review
Surrogacy Matters - Inquiry into the regulatory and legislative aspects of international
and domestic surrogacy arrangements
bull 6 days of hearings
bull 124 written submissions
bull 35 page report tabled April 2016
Key Conclusion
bull many Australians pursuing offshore commercial surrogacy because of the difficulties of
negotiating altruistic surrogacy arrangements in Australia
Commonwealth House of Reps Review
bull 10 sensible recommendations
helliphelliphellipNo government response to date
~3000+ Australian children continue to be denied access to legal parentage
SA Family Relationships Amendment Act
Rationale
bull make it possible for a couple to contact a
surrogate via an SA register
bull regulate overseas surrogacy where
proposed agreements assessed by
Minister on case-by-case basis
Introduced by
bull MLC opposition backbencher John
Dawkins in 2014
Limitations
bull No provision for access by same-sex
couples
bull SA Attorney General anti-surrogacy amp
unwilling to co-operate
Enacted
bull in July 2015
Implementation
15 months of inaction
28 Oct 2016
bull Regulations gazetted for consultation
phase in developing new regulations
bull No real commitment to reform
SA Relationships Register Bill
Rationale
bull Recognise same-sex relationships
bull Recognise intersex status
bull amendments to various existing Acts
Introduced by
bull Left wing of State Labor 22 Sept 2016
Slipped in late
bull Part 6 Amendments to Family Relationships Act
(Sect 10)
bull same-sex and single parents able to access
domestic surrogacy
bull Surrogate re-imbursements
On Second Thoughtshellip
bull Bill to be split
bull Improving access to surrogacy to be
separate bill
Surrogacy Eligibility Bill
Law Reform Required
State-Based
bull Rules on surrogacy-related advertising reviewed in the context of non-profit organisations
bull Expenses to allow for inconvenience payments to surrogates
Law Reform
State-Based Law Reform
bull Rules on surrogacy-related advertising reviewed in the context of non-profit organisations
bull Expenses to allow for inconvenience payments to surrogates
Family Court
bull Remove transfer-of-parentage from the Courts system providing much quicker legal
recognition for intended parents
Policy Reform
State-Based Law Reform
bull Rules on surrogacy-related advertising reviewed in the context of non-profit organisations
bull Expenses to allow for inconvenience payments to surrogates
Family Court Law Reform
bull Remove transfer-of-parentage from the Courts system providing much quicker legal
recognition for intended parents
Medicare Reform
bull Medicare rebate for surrogacy-related IVF where there is a medical need
GROWING DOMESTIC
CAPACITY
Well-managed domestic surrogacy so fewer need to go abroad
Evidence-Based Research
Aim
bull Determine what personality traits amp
lifestyle factors best predict a
psychologically healthy surrogacy
arrangement
Outcomes
bull validate the most accurate indicators of
surrogate amp Intended Parent
lsquoappropriatenessrsquo
Rationale
bull Ensure professional counselling practice
supporting by evidence-based research
bull Screen out inappropriate surrogates amp
IPs
Provide understanding of what traits define healthy arrangements
Evidence-Based Research
University partner
bull Ethics Application
bull Funding sought via FSA grant Govt
Design
Retrospective measurement in past Australian
surrogates amp IPs of
bull Personality traits
bull Satisfaction with interpersonal relationships
bull Levels of conflict support
bull Quality of ongoing relationship
Pre-Match Screening
Pilot Project 1
bull Three year project
bull Ethics Approved
bull Provide professional screening of
surrogates and intended parents
BEFORE they meet
Well-managed domestic surrogacy so fewer need to go abroad
Rationale
bull Avoid surrogates amp IPs having to trawl the net
bull Avoid inappropriate matches
bull Screen out surrogates with wrong motives
bull Provide IPs and surrogates with more
confidence about engaging at home
Evaluation
Tracking amongst participants and control group of
bull surrogate amp Intended Parents personality traits
bull surrogacy outcomes amp relationship quality
bull Attract potential surrogates amp IPs via website
amp social media (unpaid)
bull Intended Parents pay membership fee
bull Informed Consent amp Confidentiality
documentation
bull Referred to Psychologist for interview amp
screening
Pre-Match Screening
bull Reports generated amp provided to NFP for
lsquomatchingrsquo
bull Surrogates undergo medical screening
bull Surrogates who pass screening provided
with 2-3 profiles of IPs who are a good
match
bull Surrogate chooses favoured profile and
an introduction is made
Support Post Matching
Pilot Project 2
bull Availability of timely professional support
after surrogacy approval
Rationale
bull Surrogacy a complex emotional and
psychological journey for IPs amp
surrogates
bull Surrogate-run social media support can
only go so far
Some IVF clinics already consideringattempting this
IS POLICY IN LINE WITH
COMMUNITY ATTITUDES
What Do Australians Think of
Surrogacy
bull Which groups should be able to access surrogacy
bull Level of support for financial compensation
bull Concerns with surrogate compensation
bull Support for the use of agencies to recruit screen and place surrogates
Methodology
bull Approach Ethics approved to enable publication
bull Length amp mode 20 item online survey
bull Timing Dec 28th 2015 - Jan 15th 2016
bull Sample size 500 Australians aged 18 - 49 years (reproductive age)
bull Sample make-up Representative age gender and socio-demographic distribution
bull Those with past surrogacy experience ( themselves family member or friend) excluded to
avoid bias
Support for Surrogate Matching in
Australia
Yes should be allowed
50No
17
Donrsquot Know33
References
Harris K Fitzgerald O Paul RC Macaldowie A Lee E amp Chambers GM 2016 Assisted reproductive technology in Australia
and New Zealand 2014 Sydney National Perinatal Epidemiology and Statistics Unit the University of New South Wales
Everingham SG Stafford-Bell MA Hammarberg K Australians Use of surrogacy MJA 2014 201 (5)1-4
Jadva V Blake L Casey P and Golombok S (2012) Surrogacy families 10 years on relationship with the surrogate
decisions over disclosure and childrenrsquos understanding of their surrogacy origins Human Reproduction Vol27 No10 pp
3008ndash3014
Jadva V Imrie S Golombok S (2015) Surrogate mothers 10 years on a longitudinal study of psychological well-being and
relationships with the parents and child Hum Reprod Feb30(2)373-9
$31000$20000
$11000 $15000 $13000
$36000
$20000
$20000$26000
$12500 $11500
$18000
$31000
$12000 $21000$2600 $4100
$37000
$19000
$18000$13000
$4800
$5300
$20000 $13000 $8300
$1650
$5900
$5000
$8000$350
$2000
$13000
$5500
$5500$10000
$5500
$4700
$12000
$3000
$20000
$5600
$17000$3300
$8600
$5300
$0
$20000
$40000
$60000
$80000
$100000
$120000
$140000
$160000
$180000
USA Greece Canada Australia Ukraine Laos
Au
st D
olla
rs
Country Engaged In
Agency fee
IVF costs
Legal costs
SurrogatecompensationSurro expenses
ScreeningCounselling
Hospital amp post-birthcostsSurrogate amp newborninsuranceEgg Donor costs
3) Average Costs By Country
Average IV Costs Per cycle
(AUD) low high
UK $3 470 $6 240
Canada $ 300 $8 000
Australia $3 000 $8 000
Aust couples investing in an average of 8 failed embryo transfers before
turning to surrogacy
Equitable Access in Canada
Ontariorsquos State-Sponsored IVF Program
bull one-at-a-time transfer of all viable embryos
bull one additional funded IVF cycle if acting
as a surrogate
bull One fertility preservation cycle including
freezing for medical reasons per patient
bull Annually provides
bull gt 10000 patients with AI and IUI
bull gt 5000 patients with IVF and FP
Eligibility
bull Those trying to start or expand a family
bull any sex gender sexual orientation or family
status
bull Available for surrogacy arrangements
Annual cost
up to $70M
One IVF cycle per patient per lifetime regardless of sexual orientation or
need for surrogacy
Professional Costs For UK
(AUD) UK ndash low
end
UK ndash high
end
Av IVF
(surrogacy)
$6 800 $15 600
Counselling - -
Agreements - $5 000
Parental
orders
$ 340 $10 000
Agency fee - $12 000 -
19 000
Total $ 7 140 $45600
NFP Surrogacy Agencies - UK
Options Review Meeting pound 500
UK Matching amp Management pound12 000
UK Surrogate Screening amp Support pound 8 000
US Management ndash Basic pound 5 500
US Management ndash Enhanced pound 7 500
Professional Costs For Canada
(AUD) UK ndash low
end
UK ndash high
end
Canada
low end
Canada
high end
Av IVF
(surrogacy)
$6 800 $15 600 $ 2 000 $ 12 000
Counselling - - - -
Agreements - $5 000 $ 5 000 $ 6 600
Parental
orders
$ 340 $10 000 - $ 4 250
Agency fee - $12 000 -
19 000
- $ 12 000
Total $ 7 140 $45 600 $7 000 $38 850
Not allowed to charge for matching
Surrogacy Agencies - Canada
Professional Costs For Australia
(AUD) UK ndash low
end
UK ndash high
end
Canada
low end
Canada
high end
Australia
low
Australia
high
Av IVF
(surrogacy)
$6 800 $15 600 $ 2 000 $ 12 000 $ 5 000 $33 000
Counselling - - - - $ 3 000 $5 000
Agreements - $5 000 $ 5 000 $ 6 600 $13 500 $23 500
Parental
orders
$ 340 $10 000 - $ 4 250 $ 6 500 $ 6 500
Agency fee - $12 000 -
19 000
- $ 12 000 - -
Total $ 7 140 $45600 $20000 $42000 $28 000 $68 000
Surrogate Matching amp Support
Australia UK Canada
Organisations to support
surrogate matching
No Yes Yes
Wait time to find
surrogate
4 - 18 mths 4 - 18 mths 5 - 6 mths
screened out 10 80
Support during surrogacy No Limited Yes if agency used
Surrogate Re-imbursement
Australia UK Canada
Surrogate expenses ~$3000 - $10000 ~$12000 - 34000 ~$34500
Risks to Surrogates
Hot flushes
Feeling down or irritable
Headaches
Restlessness
Exhaustion
Nausea (mild to very severe)
Indigestion
Constipation
Weight gain
Bloating
Abdominalvaginal muscle weakness
Pre-eclampsia
Placenta Previa
Placental abruption
Pubic symphysis dysfunction
Gestational diabetes
Backaches
Miscarriage
molar pregnancy
future infertility
permanent disability
Trauma to the Cervix
Perforation of the Uterus
scar tissue at the uterus opening
infection in the uterus lining
Psychological Disturbances
Prolonged or heavy bleeding
Pain
Perineal Tears
Fistula
Permanent disability
Psychological Distress
Post-Partum Depression
Blood clots in the legs
LAW REFORM
Canadian Reform To Granting Parentage
Background
Ontario Family Law courts questioning the
need to clog up the court system with transfer
of parentage cases given none were being
refused
British Columbia has had simpler processes
circumventing Court for 3 years
Initiative
Ontariorsquos All Families Are Equal Act 2016
amended Acts and statutes to update
parentage and birth registration rules
Enacted
October 2016
Canadian Reform To Granting Parentage
Result
Intended parents recognized without a court order if
the surrogate and IP(s)
bull received independent legal advice
bull entered into a written pre-conception agreement
The surrogate provided written consent to give up her
parental status both
bull before conception and
bull seven days after the birth
Saves parents $6000 in legal costs
Frees Family court to prioritise adversarial cases
NSW Reforms
NSW Review of Surrogacy Act 2010
bull mid 2014 Submissions closed
bull Dec 2015 lsquoBaird government pushing ahead with its planned reformrsquo
bull flagged allowing advertising for surrogates
bull Since thenhellip Silence
Commonwealth House of Reps Review
Surrogacy Matters - Inquiry into the regulatory and legislative aspects of international
and domestic surrogacy arrangements
bull 6 days of hearings
bull 124 written submissions
bull 35 page report tabled April 2016
Key Conclusion
bull many Australians pursuing offshore commercial surrogacy because of the difficulties of
negotiating altruistic surrogacy arrangements in Australia
Commonwealth House of Reps Review
bull 10 sensible recommendations
helliphelliphellipNo government response to date
~3000+ Australian children continue to be denied access to legal parentage
SA Family Relationships Amendment Act
Rationale
bull make it possible for a couple to contact a
surrogate via an SA register
bull regulate overseas surrogacy where
proposed agreements assessed by
Minister on case-by-case basis
Introduced by
bull MLC opposition backbencher John
Dawkins in 2014
Limitations
bull No provision for access by same-sex
couples
bull SA Attorney General anti-surrogacy amp
unwilling to co-operate
Enacted
bull in July 2015
Implementation
15 months of inaction
28 Oct 2016
bull Regulations gazetted for consultation
phase in developing new regulations
bull No real commitment to reform
SA Relationships Register Bill
Rationale
bull Recognise same-sex relationships
bull Recognise intersex status
bull amendments to various existing Acts
Introduced by
bull Left wing of State Labor 22 Sept 2016
Slipped in late
bull Part 6 Amendments to Family Relationships Act
(Sect 10)
bull same-sex and single parents able to access
domestic surrogacy
bull Surrogate re-imbursements
On Second Thoughtshellip
bull Bill to be split
bull Improving access to surrogacy to be
separate bill
Surrogacy Eligibility Bill
Law Reform Required
State-Based
bull Rules on surrogacy-related advertising reviewed in the context of non-profit organisations
bull Expenses to allow for inconvenience payments to surrogates
Law Reform
State-Based Law Reform
bull Rules on surrogacy-related advertising reviewed in the context of non-profit organisations
bull Expenses to allow for inconvenience payments to surrogates
Family Court
bull Remove transfer-of-parentage from the Courts system providing much quicker legal
recognition for intended parents
Policy Reform
State-Based Law Reform
bull Rules on surrogacy-related advertising reviewed in the context of non-profit organisations
bull Expenses to allow for inconvenience payments to surrogates
Family Court Law Reform
bull Remove transfer-of-parentage from the Courts system providing much quicker legal
recognition for intended parents
Medicare Reform
bull Medicare rebate for surrogacy-related IVF where there is a medical need
GROWING DOMESTIC
CAPACITY
Well-managed domestic surrogacy so fewer need to go abroad
Evidence-Based Research
Aim
bull Determine what personality traits amp
lifestyle factors best predict a
psychologically healthy surrogacy
arrangement
Outcomes
bull validate the most accurate indicators of
surrogate amp Intended Parent
lsquoappropriatenessrsquo
Rationale
bull Ensure professional counselling practice
supporting by evidence-based research
bull Screen out inappropriate surrogates amp
IPs
Provide understanding of what traits define healthy arrangements
Evidence-Based Research
University partner
bull Ethics Application
bull Funding sought via FSA grant Govt
Design
Retrospective measurement in past Australian
surrogates amp IPs of
bull Personality traits
bull Satisfaction with interpersonal relationships
bull Levels of conflict support
bull Quality of ongoing relationship
Pre-Match Screening
Pilot Project 1
bull Three year project
bull Ethics Approved
bull Provide professional screening of
surrogates and intended parents
BEFORE they meet
Well-managed domestic surrogacy so fewer need to go abroad
Rationale
bull Avoid surrogates amp IPs having to trawl the net
bull Avoid inappropriate matches
bull Screen out surrogates with wrong motives
bull Provide IPs and surrogates with more
confidence about engaging at home
Evaluation
Tracking amongst participants and control group of
bull surrogate amp Intended Parents personality traits
bull surrogacy outcomes amp relationship quality
bull Attract potential surrogates amp IPs via website
amp social media (unpaid)
bull Intended Parents pay membership fee
bull Informed Consent amp Confidentiality
documentation
bull Referred to Psychologist for interview amp
screening
Pre-Match Screening
bull Reports generated amp provided to NFP for
lsquomatchingrsquo
bull Surrogates undergo medical screening
bull Surrogates who pass screening provided
with 2-3 profiles of IPs who are a good
match
bull Surrogate chooses favoured profile and
an introduction is made
Support Post Matching
Pilot Project 2
bull Availability of timely professional support
after surrogacy approval
Rationale
bull Surrogacy a complex emotional and
psychological journey for IPs amp
surrogates
bull Surrogate-run social media support can
only go so far
Some IVF clinics already consideringattempting this
IS POLICY IN LINE WITH
COMMUNITY ATTITUDES
What Do Australians Think of
Surrogacy
bull Which groups should be able to access surrogacy
bull Level of support for financial compensation
bull Concerns with surrogate compensation
bull Support for the use of agencies to recruit screen and place surrogates
Methodology
bull Approach Ethics approved to enable publication
bull Length amp mode 20 item online survey
bull Timing Dec 28th 2015 - Jan 15th 2016
bull Sample size 500 Australians aged 18 - 49 years (reproductive age)
bull Sample make-up Representative age gender and socio-demographic distribution
bull Those with past surrogacy experience ( themselves family member or friend) excluded to
avoid bias
Support for Surrogate Matching in
Australia
Yes should be allowed
50No
17
Donrsquot Know33
References
Harris K Fitzgerald O Paul RC Macaldowie A Lee E amp Chambers GM 2016 Assisted reproductive technology in Australia
and New Zealand 2014 Sydney National Perinatal Epidemiology and Statistics Unit the University of New South Wales
Everingham SG Stafford-Bell MA Hammarberg K Australians Use of surrogacy MJA 2014 201 (5)1-4
Jadva V Blake L Casey P and Golombok S (2012) Surrogacy families 10 years on relationship with the surrogate
decisions over disclosure and childrenrsquos understanding of their surrogacy origins Human Reproduction Vol27 No10 pp
3008ndash3014
Jadva V Imrie S Golombok S (2015) Surrogate mothers 10 years on a longitudinal study of psychological well-being and
relationships with the parents and child Hum Reprod Feb30(2)373-9
Average IV Costs Per cycle
(AUD) low high
UK $3 470 $6 240
Canada $ 300 $8 000
Australia $3 000 $8 000
Aust couples investing in an average of 8 failed embryo transfers before
turning to surrogacy
Equitable Access in Canada
Ontariorsquos State-Sponsored IVF Program
bull one-at-a-time transfer of all viable embryos
bull one additional funded IVF cycle if acting
as a surrogate
bull One fertility preservation cycle including
freezing for medical reasons per patient
bull Annually provides
bull gt 10000 patients with AI and IUI
bull gt 5000 patients with IVF and FP
Eligibility
bull Those trying to start or expand a family
bull any sex gender sexual orientation or family
status
bull Available for surrogacy arrangements
Annual cost
up to $70M
One IVF cycle per patient per lifetime regardless of sexual orientation or
need for surrogacy
Professional Costs For UK
(AUD) UK ndash low
end
UK ndash high
end
Av IVF
(surrogacy)
$6 800 $15 600
Counselling - -
Agreements - $5 000
Parental
orders
$ 340 $10 000
Agency fee - $12 000 -
19 000
Total $ 7 140 $45600
NFP Surrogacy Agencies - UK
Options Review Meeting pound 500
UK Matching amp Management pound12 000
UK Surrogate Screening amp Support pound 8 000
US Management ndash Basic pound 5 500
US Management ndash Enhanced pound 7 500
Professional Costs For Canada
(AUD) UK ndash low
end
UK ndash high
end
Canada
low end
Canada
high end
Av IVF
(surrogacy)
$6 800 $15 600 $ 2 000 $ 12 000
Counselling - - - -
Agreements - $5 000 $ 5 000 $ 6 600
Parental
orders
$ 340 $10 000 - $ 4 250
Agency fee - $12 000 -
19 000
- $ 12 000
Total $ 7 140 $45 600 $7 000 $38 850
Not allowed to charge for matching
Surrogacy Agencies - Canada
Professional Costs For Australia
(AUD) UK ndash low
end
UK ndash high
end
Canada
low end
Canada
high end
Australia
low
Australia
high
Av IVF
(surrogacy)
$6 800 $15 600 $ 2 000 $ 12 000 $ 5 000 $33 000
Counselling - - - - $ 3 000 $5 000
Agreements - $5 000 $ 5 000 $ 6 600 $13 500 $23 500
Parental
orders
$ 340 $10 000 - $ 4 250 $ 6 500 $ 6 500
Agency fee - $12 000 -
19 000
- $ 12 000 - -
Total $ 7 140 $45600 $20000 $42000 $28 000 $68 000
Surrogate Matching amp Support
Australia UK Canada
Organisations to support
surrogate matching
No Yes Yes
Wait time to find
surrogate
4 - 18 mths 4 - 18 mths 5 - 6 mths
screened out 10 80
Support during surrogacy No Limited Yes if agency used
Surrogate Re-imbursement
Australia UK Canada
Surrogate expenses ~$3000 - $10000 ~$12000 - 34000 ~$34500
Risks to Surrogates
Hot flushes
Feeling down or irritable
Headaches
Restlessness
Exhaustion
Nausea (mild to very severe)
Indigestion
Constipation
Weight gain
Bloating
Abdominalvaginal muscle weakness
Pre-eclampsia
Placenta Previa
Placental abruption
Pubic symphysis dysfunction
Gestational diabetes
Backaches
Miscarriage
molar pregnancy
future infertility
permanent disability
Trauma to the Cervix
Perforation of the Uterus
scar tissue at the uterus opening
infection in the uterus lining
Psychological Disturbances
Prolonged or heavy bleeding
Pain
Perineal Tears
Fistula
Permanent disability
Psychological Distress
Post-Partum Depression
Blood clots in the legs
LAW REFORM
Canadian Reform To Granting Parentage
Background
Ontario Family Law courts questioning the
need to clog up the court system with transfer
of parentage cases given none were being
refused
British Columbia has had simpler processes
circumventing Court for 3 years
Initiative
Ontariorsquos All Families Are Equal Act 2016
amended Acts and statutes to update
parentage and birth registration rules
Enacted
October 2016
Canadian Reform To Granting Parentage
Result
Intended parents recognized without a court order if
the surrogate and IP(s)
bull received independent legal advice
bull entered into a written pre-conception agreement
The surrogate provided written consent to give up her
parental status both
bull before conception and
bull seven days after the birth
Saves parents $6000 in legal costs
Frees Family court to prioritise adversarial cases
NSW Reforms
NSW Review of Surrogacy Act 2010
bull mid 2014 Submissions closed
bull Dec 2015 lsquoBaird government pushing ahead with its planned reformrsquo
bull flagged allowing advertising for surrogates
bull Since thenhellip Silence
Commonwealth House of Reps Review
Surrogacy Matters - Inquiry into the regulatory and legislative aspects of international
and domestic surrogacy arrangements
bull 6 days of hearings
bull 124 written submissions
bull 35 page report tabled April 2016
Key Conclusion
bull many Australians pursuing offshore commercial surrogacy because of the difficulties of
negotiating altruistic surrogacy arrangements in Australia
Commonwealth House of Reps Review
bull 10 sensible recommendations
helliphelliphellipNo government response to date
~3000+ Australian children continue to be denied access to legal parentage
SA Family Relationships Amendment Act
Rationale
bull make it possible for a couple to contact a
surrogate via an SA register
bull regulate overseas surrogacy where
proposed agreements assessed by
Minister on case-by-case basis
Introduced by
bull MLC opposition backbencher John
Dawkins in 2014
Limitations
bull No provision for access by same-sex
couples
bull SA Attorney General anti-surrogacy amp
unwilling to co-operate
Enacted
bull in July 2015
Implementation
15 months of inaction
28 Oct 2016
bull Regulations gazetted for consultation
phase in developing new regulations
bull No real commitment to reform
SA Relationships Register Bill
Rationale
bull Recognise same-sex relationships
bull Recognise intersex status
bull amendments to various existing Acts
Introduced by
bull Left wing of State Labor 22 Sept 2016
Slipped in late
bull Part 6 Amendments to Family Relationships Act
(Sect 10)
bull same-sex and single parents able to access
domestic surrogacy
bull Surrogate re-imbursements
On Second Thoughtshellip
bull Bill to be split
bull Improving access to surrogacy to be
separate bill
Surrogacy Eligibility Bill
Law Reform Required
State-Based
bull Rules on surrogacy-related advertising reviewed in the context of non-profit organisations
bull Expenses to allow for inconvenience payments to surrogates
Law Reform
State-Based Law Reform
bull Rules on surrogacy-related advertising reviewed in the context of non-profit organisations
bull Expenses to allow for inconvenience payments to surrogates
Family Court
bull Remove transfer-of-parentage from the Courts system providing much quicker legal
recognition for intended parents
Policy Reform
State-Based Law Reform
bull Rules on surrogacy-related advertising reviewed in the context of non-profit organisations
bull Expenses to allow for inconvenience payments to surrogates
Family Court Law Reform
bull Remove transfer-of-parentage from the Courts system providing much quicker legal
recognition for intended parents
Medicare Reform
bull Medicare rebate for surrogacy-related IVF where there is a medical need
GROWING DOMESTIC
CAPACITY
Well-managed domestic surrogacy so fewer need to go abroad
Evidence-Based Research
Aim
bull Determine what personality traits amp
lifestyle factors best predict a
psychologically healthy surrogacy
arrangement
Outcomes
bull validate the most accurate indicators of
surrogate amp Intended Parent
lsquoappropriatenessrsquo
Rationale
bull Ensure professional counselling practice
supporting by evidence-based research
bull Screen out inappropriate surrogates amp
IPs
Provide understanding of what traits define healthy arrangements
Evidence-Based Research
University partner
bull Ethics Application
bull Funding sought via FSA grant Govt
Design
Retrospective measurement in past Australian
surrogates amp IPs of
bull Personality traits
bull Satisfaction with interpersonal relationships
bull Levels of conflict support
bull Quality of ongoing relationship
Pre-Match Screening
Pilot Project 1
bull Three year project
bull Ethics Approved
bull Provide professional screening of
surrogates and intended parents
BEFORE they meet
Well-managed domestic surrogacy so fewer need to go abroad
Rationale
bull Avoid surrogates amp IPs having to trawl the net
bull Avoid inappropriate matches
bull Screen out surrogates with wrong motives
bull Provide IPs and surrogates with more
confidence about engaging at home
Evaluation
Tracking amongst participants and control group of
bull surrogate amp Intended Parents personality traits
bull surrogacy outcomes amp relationship quality
bull Attract potential surrogates amp IPs via website
amp social media (unpaid)
bull Intended Parents pay membership fee
bull Informed Consent amp Confidentiality
documentation
bull Referred to Psychologist for interview amp
screening
Pre-Match Screening
bull Reports generated amp provided to NFP for
lsquomatchingrsquo
bull Surrogates undergo medical screening
bull Surrogates who pass screening provided
with 2-3 profiles of IPs who are a good
match
bull Surrogate chooses favoured profile and
an introduction is made
Support Post Matching
Pilot Project 2
bull Availability of timely professional support
after surrogacy approval
Rationale
bull Surrogacy a complex emotional and
psychological journey for IPs amp
surrogates
bull Surrogate-run social media support can
only go so far
Some IVF clinics already consideringattempting this
IS POLICY IN LINE WITH
COMMUNITY ATTITUDES
What Do Australians Think of
Surrogacy
bull Which groups should be able to access surrogacy
bull Level of support for financial compensation
bull Concerns with surrogate compensation
bull Support for the use of agencies to recruit screen and place surrogates
Methodology
bull Approach Ethics approved to enable publication
bull Length amp mode 20 item online survey
bull Timing Dec 28th 2015 - Jan 15th 2016
bull Sample size 500 Australians aged 18 - 49 years (reproductive age)
bull Sample make-up Representative age gender and socio-demographic distribution
bull Those with past surrogacy experience ( themselves family member or friend) excluded to
avoid bias
Support for Surrogate Matching in
Australia
Yes should be allowed
50No
17
Donrsquot Know33
References
Harris K Fitzgerald O Paul RC Macaldowie A Lee E amp Chambers GM 2016 Assisted reproductive technology in Australia
and New Zealand 2014 Sydney National Perinatal Epidemiology and Statistics Unit the University of New South Wales
Everingham SG Stafford-Bell MA Hammarberg K Australians Use of surrogacy MJA 2014 201 (5)1-4
Jadva V Blake L Casey P and Golombok S (2012) Surrogacy families 10 years on relationship with the surrogate
decisions over disclosure and childrenrsquos understanding of their surrogacy origins Human Reproduction Vol27 No10 pp
3008ndash3014
Jadva V Imrie S Golombok S (2015) Surrogate mothers 10 years on a longitudinal study of psychological well-being and
relationships with the parents and child Hum Reprod Feb30(2)373-9
Equitable Access in Canada
Ontariorsquos State-Sponsored IVF Program
bull one-at-a-time transfer of all viable embryos
bull one additional funded IVF cycle if acting
as a surrogate
bull One fertility preservation cycle including
freezing for medical reasons per patient
bull Annually provides
bull gt 10000 patients with AI and IUI
bull gt 5000 patients with IVF and FP
Eligibility
bull Those trying to start or expand a family
bull any sex gender sexual orientation or family
status
bull Available for surrogacy arrangements
Annual cost
up to $70M
One IVF cycle per patient per lifetime regardless of sexual orientation or
need for surrogacy
Professional Costs For UK
(AUD) UK ndash low
end
UK ndash high
end
Av IVF
(surrogacy)
$6 800 $15 600
Counselling - -
Agreements - $5 000
Parental
orders
$ 340 $10 000
Agency fee - $12 000 -
19 000
Total $ 7 140 $45600
NFP Surrogacy Agencies - UK
Options Review Meeting pound 500
UK Matching amp Management pound12 000
UK Surrogate Screening amp Support pound 8 000
US Management ndash Basic pound 5 500
US Management ndash Enhanced pound 7 500
Professional Costs For Canada
(AUD) UK ndash low
end
UK ndash high
end
Canada
low end
Canada
high end
Av IVF
(surrogacy)
$6 800 $15 600 $ 2 000 $ 12 000
Counselling - - - -
Agreements - $5 000 $ 5 000 $ 6 600
Parental
orders
$ 340 $10 000 - $ 4 250
Agency fee - $12 000 -
19 000
- $ 12 000
Total $ 7 140 $45 600 $7 000 $38 850
Not allowed to charge for matching
Surrogacy Agencies - Canada
Professional Costs For Australia
(AUD) UK ndash low
end
UK ndash high
end
Canada
low end
Canada
high end
Australia
low
Australia
high
Av IVF
(surrogacy)
$6 800 $15 600 $ 2 000 $ 12 000 $ 5 000 $33 000
Counselling - - - - $ 3 000 $5 000
Agreements - $5 000 $ 5 000 $ 6 600 $13 500 $23 500
Parental
orders
$ 340 $10 000 - $ 4 250 $ 6 500 $ 6 500
Agency fee - $12 000 -
19 000
- $ 12 000 - -
Total $ 7 140 $45600 $20000 $42000 $28 000 $68 000
Surrogate Matching amp Support
Australia UK Canada
Organisations to support
surrogate matching
No Yes Yes
Wait time to find
surrogate
4 - 18 mths 4 - 18 mths 5 - 6 mths
screened out 10 80
Support during surrogacy No Limited Yes if agency used
Surrogate Re-imbursement
Australia UK Canada
Surrogate expenses ~$3000 - $10000 ~$12000 - 34000 ~$34500
Risks to Surrogates
Hot flushes
Feeling down or irritable
Headaches
Restlessness
Exhaustion
Nausea (mild to very severe)
Indigestion
Constipation
Weight gain
Bloating
Abdominalvaginal muscle weakness
Pre-eclampsia
Placenta Previa
Placental abruption
Pubic symphysis dysfunction
Gestational diabetes
Backaches
Miscarriage
molar pregnancy
future infertility
permanent disability
Trauma to the Cervix
Perforation of the Uterus
scar tissue at the uterus opening
infection in the uterus lining
Psychological Disturbances
Prolonged or heavy bleeding
Pain
Perineal Tears
Fistula
Permanent disability
Psychological Distress
Post-Partum Depression
Blood clots in the legs
LAW REFORM
Canadian Reform To Granting Parentage
Background
Ontario Family Law courts questioning the
need to clog up the court system with transfer
of parentage cases given none were being
refused
British Columbia has had simpler processes
circumventing Court for 3 years
Initiative
Ontariorsquos All Families Are Equal Act 2016
amended Acts and statutes to update
parentage and birth registration rules
Enacted
October 2016
Canadian Reform To Granting Parentage
Result
Intended parents recognized without a court order if
the surrogate and IP(s)
bull received independent legal advice
bull entered into a written pre-conception agreement
The surrogate provided written consent to give up her
parental status both
bull before conception and
bull seven days after the birth
Saves parents $6000 in legal costs
Frees Family court to prioritise adversarial cases
NSW Reforms
NSW Review of Surrogacy Act 2010
bull mid 2014 Submissions closed
bull Dec 2015 lsquoBaird government pushing ahead with its planned reformrsquo
bull flagged allowing advertising for surrogates
bull Since thenhellip Silence
Commonwealth House of Reps Review
Surrogacy Matters - Inquiry into the regulatory and legislative aspects of international
and domestic surrogacy arrangements
bull 6 days of hearings
bull 124 written submissions
bull 35 page report tabled April 2016
Key Conclusion
bull many Australians pursuing offshore commercial surrogacy because of the difficulties of
negotiating altruistic surrogacy arrangements in Australia
Commonwealth House of Reps Review
bull 10 sensible recommendations
helliphelliphellipNo government response to date
~3000+ Australian children continue to be denied access to legal parentage
SA Family Relationships Amendment Act
Rationale
bull make it possible for a couple to contact a
surrogate via an SA register
bull regulate overseas surrogacy where
proposed agreements assessed by
Minister on case-by-case basis
Introduced by
bull MLC opposition backbencher John
Dawkins in 2014
Limitations
bull No provision for access by same-sex
couples
bull SA Attorney General anti-surrogacy amp
unwilling to co-operate
Enacted
bull in July 2015
Implementation
15 months of inaction
28 Oct 2016
bull Regulations gazetted for consultation
phase in developing new regulations
bull No real commitment to reform
SA Relationships Register Bill
Rationale
bull Recognise same-sex relationships
bull Recognise intersex status
bull amendments to various existing Acts
Introduced by
bull Left wing of State Labor 22 Sept 2016
Slipped in late
bull Part 6 Amendments to Family Relationships Act
(Sect 10)
bull same-sex and single parents able to access
domestic surrogacy
bull Surrogate re-imbursements
On Second Thoughtshellip
bull Bill to be split
bull Improving access to surrogacy to be
separate bill
Surrogacy Eligibility Bill
Law Reform Required
State-Based
bull Rules on surrogacy-related advertising reviewed in the context of non-profit organisations
bull Expenses to allow for inconvenience payments to surrogates
Law Reform
State-Based Law Reform
bull Rules on surrogacy-related advertising reviewed in the context of non-profit organisations
bull Expenses to allow for inconvenience payments to surrogates
Family Court
bull Remove transfer-of-parentage from the Courts system providing much quicker legal
recognition for intended parents
Policy Reform
State-Based Law Reform
bull Rules on surrogacy-related advertising reviewed in the context of non-profit organisations
bull Expenses to allow for inconvenience payments to surrogates
Family Court Law Reform
bull Remove transfer-of-parentage from the Courts system providing much quicker legal
recognition for intended parents
Medicare Reform
bull Medicare rebate for surrogacy-related IVF where there is a medical need
GROWING DOMESTIC
CAPACITY
Well-managed domestic surrogacy so fewer need to go abroad
Evidence-Based Research
Aim
bull Determine what personality traits amp
lifestyle factors best predict a
psychologically healthy surrogacy
arrangement
Outcomes
bull validate the most accurate indicators of
surrogate amp Intended Parent
lsquoappropriatenessrsquo
Rationale
bull Ensure professional counselling practice
supporting by evidence-based research
bull Screen out inappropriate surrogates amp
IPs
Provide understanding of what traits define healthy arrangements
Evidence-Based Research
University partner
bull Ethics Application
bull Funding sought via FSA grant Govt
Design
Retrospective measurement in past Australian
surrogates amp IPs of
bull Personality traits
bull Satisfaction with interpersonal relationships
bull Levels of conflict support
bull Quality of ongoing relationship
Pre-Match Screening
Pilot Project 1
bull Three year project
bull Ethics Approved
bull Provide professional screening of
surrogates and intended parents
BEFORE they meet
Well-managed domestic surrogacy so fewer need to go abroad
Rationale
bull Avoid surrogates amp IPs having to trawl the net
bull Avoid inappropriate matches
bull Screen out surrogates with wrong motives
bull Provide IPs and surrogates with more
confidence about engaging at home
Evaluation
Tracking amongst participants and control group of
bull surrogate amp Intended Parents personality traits
bull surrogacy outcomes amp relationship quality
bull Attract potential surrogates amp IPs via website
amp social media (unpaid)
bull Intended Parents pay membership fee
bull Informed Consent amp Confidentiality
documentation
bull Referred to Psychologist for interview amp
screening
Pre-Match Screening
bull Reports generated amp provided to NFP for
lsquomatchingrsquo
bull Surrogates undergo medical screening
bull Surrogates who pass screening provided
with 2-3 profiles of IPs who are a good
match
bull Surrogate chooses favoured profile and
an introduction is made
Support Post Matching
Pilot Project 2
bull Availability of timely professional support
after surrogacy approval
Rationale
bull Surrogacy a complex emotional and
psychological journey for IPs amp
surrogates
bull Surrogate-run social media support can
only go so far
Some IVF clinics already consideringattempting this
IS POLICY IN LINE WITH
COMMUNITY ATTITUDES
What Do Australians Think of
Surrogacy
bull Which groups should be able to access surrogacy
bull Level of support for financial compensation
bull Concerns with surrogate compensation
bull Support for the use of agencies to recruit screen and place surrogates
Methodology
bull Approach Ethics approved to enable publication
bull Length amp mode 20 item online survey
bull Timing Dec 28th 2015 - Jan 15th 2016
bull Sample size 500 Australians aged 18 - 49 years (reproductive age)
bull Sample make-up Representative age gender and socio-demographic distribution
bull Those with past surrogacy experience ( themselves family member or friend) excluded to
avoid bias
Support for Surrogate Matching in
Australia
Yes should be allowed
50No
17
Donrsquot Know33
References
Harris K Fitzgerald O Paul RC Macaldowie A Lee E amp Chambers GM 2016 Assisted reproductive technology in Australia
and New Zealand 2014 Sydney National Perinatal Epidemiology and Statistics Unit the University of New South Wales
Everingham SG Stafford-Bell MA Hammarberg K Australians Use of surrogacy MJA 2014 201 (5)1-4
Jadva V Blake L Casey P and Golombok S (2012) Surrogacy families 10 years on relationship with the surrogate
decisions over disclosure and childrenrsquos understanding of their surrogacy origins Human Reproduction Vol27 No10 pp
3008ndash3014
Jadva V Imrie S Golombok S (2015) Surrogate mothers 10 years on a longitudinal study of psychological well-being and
relationships with the parents and child Hum Reprod Feb30(2)373-9
Professional Costs For UK
(AUD) UK ndash low
end
UK ndash high
end
Av IVF
(surrogacy)
$6 800 $15 600
Counselling - -
Agreements - $5 000
Parental
orders
$ 340 $10 000
Agency fee - $12 000 -
19 000
Total $ 7 140 $45600
NFP Surrogacy Agencies - UK
Options Review Meeting pound 500
UK Matching amp Management pound12 000
UK Surrogate Screening amp Support pound 8 000
US Management ndash Basic pound 5 500
US Management ndash Enhanced pound 7 500
Professional Costs For Canada
(AUD) UK ndash low
end
UK ndash high
end
Canada
low end
Canada
high end
Av IVF
(surrogacy)
$6 800 $15 600 $ 2 000 $ 12 000
Counselling - - - -
Agreements - $5 000 $ 5 000 $ 6 600
Parental
orders
$ 340 $10 000 - $ 4 250
Agency fee - $12 000 -
19 000
- $ 12 000
Total $ 7 140 $45 600 $7 000 $38 850
Not allowed to charge for matching
Surrogacy Agencies - Canada
Professional Costs For Australia
(AUD) UK ndash low
end
UK ndash high
end
Canada
low end
Canada
high end
Australia
low
Australia
high
Av IVF
(surrogacy)
$6 800 $15 600 $ 2 000 $ 12 000 $ 5 000 $33 000
Counselling - - - - $ 3 000 $5 000
Agreements - $5 000 $ 5 000 $ 6 600 $13 500 $23 500
Parental
orders
$ 340 $10 000 - $ 4 250 $ 6 500 $ 6 500
Agency fee - $12 000 -
19 000
- $ 12 000 - -
Total $ 7 140 $45600 $20000 $42000 $28 000 $68 000
Surrogate Matching amp Support
Australia UK Canada
Organisations to support
surrogate matching
No Yes Yes
Wait time to find
surrogate
4 - 18 mths 4 - 18 mths 5 - 6 mths
screened out 10 80
Support during surrogacy No Limited Yes if agency used
Surrogate Re-imbursement
Australia UK Canada
Surrogate expenses ~$3000 - $10000 ~$12000 - 34000 ~$34500
Risks to Surrogates
Hot flushes
Feeling down or irritable
Headaches
Restlessness
Exhaustion
Nausea (mild to very severe)
Indigestion
Constipation
Weight gain
Bloating
Abdominalvaginal muscle weakness
Pre-eclampsia
Placenta Previa
Placental abruption
Pubic symphysis dysfunction
Gestational diabetes
Backaches
Miscarriage
molar pregnancy
future infertility
permanent disability
Trauma to the Cervix
Perforation of the Uterus
scar tissue at the uterus opening
infection in the uterus lining
Psychological Disturbances
Prolonged or heavy bleeding
Pain
Perineal Tears
Fistula
Permanent disability
Psychological Distress
Post-Partum Depression
Blood clots in the legs
LAW REFORM
Canadian Reform To Granting Parentage
Background
Ontario Family Law courts questioning the
need to clog up the court system with transfer
of parentage cases given none were being
refused
British Columbia has had simpler processes
circumventing Court for 3 years
Initiative
Ontariorsquos All Families Are Equal Act 2016
amended Acts and statutes to update
parentage and birth registration rules
Enacted
October 2016
Canadian Reform To Granting Parentage
Result
Intended parents recognized without a court order if
the surrogate and IP(s)
bull received independent legal advice
bull entered into a written pre-conception agreement
The surrogate provided written consent to give up her
parental status both
bull before conception and
bull seven days after the birth
Saves parents $6000 in legal costs
Frees Family court to prioritise adversarial cases
NSW Reforms
NSW Review of Surrogacy Act 2010
bull mid 2014 Submissions closed
bull Dec 2015 lsquoBaird government pushing ahead with its planned reformrsquo
bull flagged allowing advertising for surrogates
bull Since thenhellip Silence
Commonwealth House of Reps Review
Surrogacy Matters - Inquiry into the regulatory and legislative aspects of international
and domestic surrogacy arrangements
bull 6 days of hearings
bull 124 written submissions
bull 35 page report tabled April 2016
Key Conclusion
bull many Australians pursuing offshore commercial surrogacy because of the difficulties of
negotiating altruistic surrogacy arrangements in Australia
Commonwealth House of Reps Review
bull 10 sensible recommendations
helliphelliphellipNo government response to date
~3000+ Australian children continue to be denied access to legal parentage
SA Family Relationships Amendment Act
Rationale
bull make it possible for a couple to contact a
surrogate via an SA register
bull regulate overseas surrogacy where
proposed agreements assessed by
Minister on case-by-case basis
Introduced by
bull MLC opposition backbencher John
Dawkins in 2014
Limitations
bull No provision for access by same-sex
couples
bull SA Attorney General anti-surrogacy amp
unwilling to co-operate
Enacted
bull in July 2015
Implementation
15 months of inaction
28 Oct 2016
bull Regulations gazetted for consultation
phase in developing new regulations
bull No real commitment to reform
SA Relationships Register Bill
Rationale
bull Recognise same-sex relationships
bull Recognise intersex status
bull amendments to various existing Acts
Introduced by
bull Left wing of State Labor 22 Sept 2016
Slipped in late
bull Part 6 Amendments to Family Relationships Act
(Sect 10)
bull same-sex and single parents able to access
domestic surrogacy
bull Surrogate re-imbursements
On Second Thoughtshellip
bull Bill to be split
bull Improving access to surrogacy to be
separate bill
Surrogacy Eligibility Bill
Law Reform Required
State-Based
bull Rules on surrogacy-related advertising reviewed in the context of non-profit organisations
bull Expenses to allow for inconvenience payments to surrogates
Law Reform
State-Based Law Reform
bull Rules on surrogacy-related advertising reviewed in the context of non-profit organisations
bull Expenses to allow for inconvenience payments to surrogates
Family Court
bull Remove transfer-of-parentage from the Courts system providing much quicker legal
recognition for intended parents
Policy Reform
State-Based Law Reform
bull Rules on surrogacy-related advertising reviewed in the context of non-profit organisations
bull Expenses to allow for inconvenience payments to surrogates
Family Court Law Reform
bull Remove transfer-of-parentage from the Courts system providing much quicker legal
recognition for intended parents
Medicare Reform
bull Medicare rebate for surrogacy-related IVF where there is a medical need
GROWING DOMESTIC
CAPACITY
Well-managed domestic surrogacy so fewer need to go abroad
Evidence-Based Research
Aim
bull Determine what personality traits amp
lifestyle factors best predict a
psychologically healthy surrogacy
arrangement
Outcomes
bull validate the most accurate indicators of
surrogate amp Intended Parent
lsquoappropriatenessrsquo
Rationale
bull Ensure professional counselling practice
supporting by evidence-based research
bull Screen out inappropriate surrogates amp
IPs
Provide understanding of what traits define healthy arrangements
Evidence-Based Research
University partner
bull Ethics Application
bull Funding sought via FSA grant Govt
Design
Retrospective measurement in past Australian
surrogates amp IPs of
bull Personality traits
bull Satisfaction with interpersonal relationships
bull Levels of conflict support
bull Quality of ongoing relationship
Pre-Match Screening
Pilot Project 1
bull Three year project
bull Ethics Approved
bull Provide professional screening of
surrogates and intended parents
BEFORE they meet
Well-managed domestic surrogacy so fewer need to go abroad
Rationale
bull Avoid surrogates amp IPs having to trawl the net
bull Avoid inappropriate matches
bull Screen out surrogates with wrong motives
bull Provide IPs and surrogates with more
confidence about engaging at home
Evaluation
Tracking amongst participants and control group of
bull surrogate amp Intended Parents personality traits
bull surrogacy outcomes amp relationship quality
bull Attract potential surrogates amp IPs via website
amp social media (unpaid)
bull Intended Parents pay membership fee
bull Informed Consent amp Confidentiality
documentation
bull Referred to Psychologist for interview amp
screening
Pre-Match Screening
bull Reports generated amp provided to NFP for
lsquomatchingrsquo
bull Surrogates undergo medical screening
bull Surrogates who pass screening provided
with 2-3 profiles of IPs who are a good
match
bull Surrogate chooses favoured profile and
an introduction is made
Support Post Matching
Pilot Project 2
bull Availability of timely professional support
after surrogacy approval
Rationale
bull Surrogacy a complex emotional and
psychological journey for IPs amp
surrogates
bull Surrogate-run social media support can
only go so far
Some IVF clinics already consideringattempting this
IS POLICY IN LINE WITH
COMMUNITY ATTITUDES
What Do Australians Think of
Surrogacy
bull Which groups should be able to access surrogacy
bull Level of support for financial compensation
bull Concerns with surrogate compensation
bull Support for the use of agencies to recruit screen and place surrogates
Methodology
bull Approach Ethics approved to enable publication
bull Length amp mode 20 item online survey
bull Timing Dec 28th 2015 - Jan 15th 2016
bull Sample size 500 Australians aged 18 - 49 years (reproductive age)
bull Sample make-up Representative age gender and socio-demographic distribution
bull Those with past surrogacy experience ( themselves family member or friend) excluded to
avoid bias
Support for Surrogate Matching in
Australia
Yes should be allowed
50No
17
Donrsquot Know33
References
Harris K Fitzgerald O Paul RC Macaldowie A Lee E amp Chambers GM 2016 Assisted reproductive technology in Australia
and New Zealand 2014 Sydney National Perinatal Epidemiology and Statistics Unit the University of New South Wales
Everingham SG Stafford-Bell MA Hammarberg K Australians Use of surrogacy MJA 2014 201 (5)1-4
Jadva V Blake L Casey P and Golombok S (2012) Surrogacy families 10 years on relationship with the surrogate
decisions over disclosure and childrenrsquos understanding of their surrogacy origins Human Reproduction Vol27 No10 pp
3008ndash3014
Jadva V Imrie S Golombok S (2015) Surrogate mothers 10 years on a longitudinal study of psychological well-being and
relationships with the parents and child Hum Reprod Feb30(2)373-9
NFP Surrogacy Agencies - UK
Options Review Meeting pound 500
UK Matching amp Management pound12 000
UK Surrogate Screening amp Support pound 8 000
US Management ndash Basic pound 5 500
US Management ndash Enhanced pound 7 500
Professional Costs For Canada
(AUD) UK ndash low
end
UK ndash high
end
Canada
low end
Canada
high end
Av IVF
(surrogacy)
$6 800 $15 600 $ 2 000 $ 12 000
Counselling - - - -
Agreements - $5 000 $ 5 000 $ 6 600
Parental
orders
$ 340 $10 000 - $ 4 250
Agency fee - $12 000 -
19 000
- $ 12 000
Total $ 7 140 $45 600 $7 000 $38 850
Not allowed to charge for matching
Surrogacy Agencies - Canada
Professional Costs For Australia
(AUD) UK ndash low
end
UK ndash high
end
Canada
low end
Canada
high end
Australia
low
Australia
high
Av IVF
(surrogacy)
$6 800 $15 600 $ 2 000 $ 12 000 $ 5 000 $33 000
Counselling - - - - $ 3 000 $5 000
Agreements - $5 000 $ 5 000 $ 6 600 $13 500 $23 500
Parental
orders
$ 340 $10 000 - $ 4 250 $ 6 500 $ 6 500
Agency fee - $12 000 -
19 000
- $ 12 000 - -
Total $ 7 140 $45600 $20000 $42000 $28 000 $68 000
Surrogate Matching amp Support
Australia UK Canada
Organisations to support
surrogate matching
No Yes Yes
Wait time to find
surrogate
4 - 18 mths 4 - 18 mths 5 - 6 mths
screened out 10 80
Support during surrogacy No Limited Yes if agency used
Surrogate Re-imbursement
Australia UK Canada
Surrogate expenses ~$3000 - $10000 ~$12000 - 34000 ~$34500
Risks to Surrogates
Hot flushes
Feeling down or irritable
Headaches
Restlessness
Exhaustion
Nausea (mild to very severe)
Indigestion
Constipation
Weight gain
Bloating
Abdominalvaginal muscle weakness
Pre-eclampsia
Placenta Previa
Placental abruption
Pubic symphysis dysfunction
Gestational diabetes
Backaches
Miscarriage
molar pregnancy
future infertility
permanent disability
Trauma to the Cervix
Perforation of the Uterus
scar tissue at the uterus opening
infection in the uterus lining
Psychological Disturbances
Prolonged or heavy bleeding
Pain
Perineal Tears
Fistula
Permanent disability
Psychological Distress
Post-Partum Depression
Blood clots in the legs
LAW REFORM
Canadian Reform To Granting Parentage
Background
Ontario Family Law courts questioning the
need to clog up the court system with transfer
of parentage cases given none were being
refused
British Columbia has had simpler processes
circumventing Court for 3 years
Initiative
Ontariorsquos All Families Are Equal Act 2016
amended Acts and statutes to update
parentage and birth registration rules
Enacted
October 2016
Canadian Reform To Granting Parentage
Result
Intended parents recognized without a court order if
the surrogate and IP(s)
bull received independent legal advice
bull entered into a written pre-conception agreement
The surrogate provided written consent to give up her
parental status both
bull before conception and
bull seven days after the birth
Saves parents $6000 in legal costs
Frees Family court to prioritise adversarial cases
NSW Reforms
NSW Review of Surrogacy Act 2010
bull mid 2014 Submissions closed
bull Dec 2015 lsquoBaird government pushing ahead with its planned reformrsquo
bull flagged allowing advertising for surrogates
bull Since thenhellip Silence
Commonwealth House of Reps Review
Surrogacy Matters - Inquiry into the regulatory and legislative aspects of international
and domestic surrogacy arrangements
bull 6 days of hearings
bull 124 written submissions
bull 35 page report tabled April 2016
Key Conclusion
bull many Australians pursuing offshore commercial surrogacy because of the difficulties of
negotiating altruistic surrogacy arrangements in Australia
Commonwealth House of Reps Review
bull 10 sensible recommendations
helliphelliphellipNo government response to date
~3000+ Australian children continue to be denied access to legal parentage
SA Family Relationships Amendment Act
Rationale
bull make it possible for a couple to contact a
surrogate via an SA register
bull regulate overseas surrogacy where
proposed agreements assessed by
Minister on case-by-case basis
Introduced by
bull MLC opposition backbencher John
Dawkins in 2014
Limitations
bull No provision for access by same-sex
couples
bull SA Attorney General anti-surrogacy amp
unwilling to co-operate
Enacted
bull in July 2015
Implementation
15 months of inaction
28 Oct 2016
bull Regulations gazetted for consultation
phase in developing new regulations
bull No real commitment to reform
SA Relationships Register Bill
Rationale
bull Recognise same-sex relationships
bull Recognise intersex status
bull amendments to various existing Acts
Introduced by
bull Left wing of State Labor 22 Sept 2016
Slipped in late
bull Part 6 Amendments to Family Relationships Act
(Sect 10)
bull same-sex and single parents able to access
domestic surrogacy
bull Surrogate re-imbursements
On Second Thoughtshellip
bull Bill to be split
bull Improving access to surrogacy to be
separate bill
Surrogacy Eligibility Bill
Law Reform Required
State-Based
bull Rules on surrogacy-related advertising reviewed in the context of non-profit organisations
bull Expenses to allow for inconvenience payments to surrogates
Law Reform
State-Based Law Reform
bull Rules on surrogacy-related advertising reviewed in the context of non-profit organisations
bull Expenses to allow for inconvenience payments to surrogates
Family Court
bull Remove transfer-of-parentage from the Courts system providing much quicker legal
recognition for intended parents
Policy Reform
State-Based Law Reform
bull Rules on surrogacy-related advertising reviewed in the context of non-profit organisations
bull Expenses to allow for inconvenience payments to surrogates
Family Court Law Reform
bull Remove transfer-of-parentage from the Courts system providing much quicker legal
recognition for intended parents
Medicare Reform
bull Medicare rebate for surrogacy-related IVF where there is a medical need
GROWING DOMESTIC
CAPACITY
Well-managed domestic surrogacy so fewer need to go abroad
Evidence-Based Research
Aim
bull Determine what personality traits amp
lifestyle factors best predict a
psychologically healthy surrogacy
arrangement
Outcomes
bull validate the most accurate indicators of
surrogate amp Intended Parent
lsquoappropriatenessrsquo
Rationale
bull Ensure professional counselling practice
supporting by evidence-based research
bull Screen out inappropriate surrogates amp
IPs
Provide understanding of what traits define healthy arrangements
Evidence-Based Research
University partner
bull Ethics Application
bull Funding sought via FSA grant Govt
Design
Retrospective measurement in past Australian
surrogates amp IPs of
bull Personality traits
bull Satisfaction with interpersonal relationships
bull Levels of conflict support
bull Quality of ongoing relationship
Pre-Match Screening
Pilot Project 1
bull Three year project
bull Ethics Approved
bull Provide professional screening of
surrogates and intended parents
BEFORE they meet
Well-managed domestic surrogacy so fewer need to go abroad
Rationale
bull Avoid surrogates amp IPs having to trawl the net
bull Avoid inappropriate matches
bull Screen out surrogates with wrong motives
bull Provide IPs and surrogates with more
confidence about engaging at home
Evaluation
Tracking amongst participants and control group of
bull surrogate amp Intended Parents personality traits
bull surrogacy outcomes amp relationship quality
bull Attract potential surrogates amp IPs via website
amp social media (unpaid)
bull Intended Parents pay membership fee
bull Informed Consent amp Confidentiality
documentation
bull Referred to Psychologist for interview amp
screening
Pre-Match Screening
bull Reports generated amp provided to NFP for
lsquomatchingrsquo
bull Surrogates undergo medical screening
bull Surrogates who pass screening provided
with 2-3 profiles of IPs who are a good
match
bull Surrogate chooses favoured profile and
an introduction is made
Support Post Matching
Pilot Project 2
bull Availability of timely professional support
after surrogacy approval
Rationale
bull Surrogacy a complex emotional and
psychological journey for IPs amp
surrogates
bull Surrogate-run social media support can
only go so far
Some IVF clinics already consideringattempting this
IS POLICY IN LINE WITH
COMMUNITY ATTITUDES
What Do Australians Think of
Surrogacy
bull Which groups should be able to access surrogacy
bull Level of support for financial compensation
bull Concerns with surrogate compensation
bull Support for the use of agencies to recruit screen and place surrogates
Methodology
bull Approach Ethics approved to enable publication
bull Length amp mode 20 item online survey
bull Timing Dec 28th 2015 - Jan 15th 2016
bull Sample size 500 Australians aged 18 - 49 years (reproductive age)
bull Sample make-up Representative age gender and socio-demographic distribution
bull Those with past surrogacy experience ( themselves family member or friend) excluded to
avoid bias
Support for Surrogate Matching in
Australia
Yes should be allowed
50No
17
Donrsquot Know33
References
Harris K Fitzgerald O Paul RC Macaldowie A Lee E amp Chambers GM 2016 Assisted reproductive technology in Australia
and New Zealand 2014 Sydney National Perinatal Epidemiology and Statistics Unit the University of New South Wales
Everingham SG Stafford-Bell MA Hammarberg K Australians Use of surrogacy MJA 2014 201 (5)1-4
Jadva V Blake L Casey P and Golombok S (2012) Surrogacy families 10 years on relationship with the surrogate
decisions over disclosure and childrenrsquos understanding of their surrogacy origins Human Reproduction Vol27 No10 pp
3008ndash3014
Jadva V Imrie S Golombok S (2015) Surrogate mothers 10 years on a longitudinal study of psychological well-being and
relationships with the parents and child Hum Reprod Feb30(2)373-9
Professional Costs For Canada
(AUD) UK ndash low
end
UK ndash high
end
Canada
low end
Canada
high end
Av IVF
(surrogacy)
$6 800 $15 600 $ 2 000 $ 12 000
Counselling - - - -
Agreements - $5 000 $ 5 000 $ 6 600
Parental
orders
$ 340 $10 000 - $ 4 250
Agency fee - $12 000 -
19 000
- $ 12 000
Total $ 7 140 $45 600 $7 000 $38 850
Not allowed to charge for matching
Surrogacy Agencies - Canada
Professional Costs For Australia
(AUD) UK ndash low
end
UK ndash high
end
Canada
low end
Canada
high end
Australia
low
Australia
high
Av IVF
(surrogacy)
$6 800 $15 600 $ 2 000 $ 12 000 $ 5 000 $33 000
Counselling - - - - $ 3 000 $5 000
Agreements - $5 000 $ 5 000 $ 6 600 $13 500 $23 500
Parental
orders
$ 340 $10 000 - $ 4 250 $ 6 500 $ 6 500
Agency fee - $12 000 -
19 000
- $ 12 000 - -
Total $ 7 140 $45600 $20000 $42000 $28 000 $68 000
Surrogate Matching amp Support
Australia UK Canada
Organisations to support
surrogate matching
No Yes Yes
Wait time to find
surrogate
4 - 18 mths 4 - 18 mths 5 - 6 mths
screened out 10 80
Support during surrogacy No Limited Yes if agency used
Surrogate Re-imbursement
Australia UK Canada
Surrogate expenses ~$3000 - $10000 ~$12000 - 34000 ~$34500
Risks to Surrogates
Hot flushes
Feeling down or irritable
Headaches
Restlessness
Exhaustion
Nausea (mild to very severe)
Indigestion
Constipation
Weight gain
Bloating
Abdominalvaginal muscle weakness
Pre-eclampsia
Placenta Previa
Placental abruption
Pubic symphysis dysfunction
Gestational diabetes
Backaches
Miscarriage
molar pregnancy
future infertility
permanent disability
Trauma to the Cervix
Perforation of the Uterus
scar tissue at the uterus opening
infection in the uterus lining
Psychological Disturbances
Prolonged or heavy bleeding
Pain
Perineal Tears
Fistula
Permanent disability
Psychological Distress
Post-Partum Depression
Blood clots in the legs
LAW REFORM
Canadian Reform To Granting Parentage
Background
Ontario Family Law courts questioning the
need to clog up the court system with transfer
of parentage cases given none were being
refused
British Columbia has had simpler processes
circumventing Court for 3 years
Initiative
Ontariorsquos All Families Are Equal Act 2016
amended Acts and statutes to update
parentage and birth registration rules
Enacted
October 2016
Canadian Reform To Granting Parentage
Result
Intended parents recognized without a court order if
the surrogate and IP(s)
bull received independent legal advice
bull entered into a written pre-conception agreement
The surrogate provided written consent to give up her
parental status both
bull before conception and
bull seven days after the birth
Saves parents $6000 in legal costs
Frees Family court to prioritise adversarial cases
NSW Reforms
NSW Review of Surrogacy Act 2010
bull mid 2014 Submissions closed
bull Dec 2015 lsquoBaird government pushing ahead with its planned reformrsquo
bull flagged allowing advertising for surrogates
bull Since thenhellip Silence
Commonwealth House of Reps Review
Surrogacy Matters - Inquiry into the regulatory and legislative aspects of international
and domestic surrogacy arrangements
bull 6 days of hearings
bull 124 written submissions
bull 35 page report tabled April 2016
Key Conclusion
bull many Australians pursuing offshore commercial surrogacy because of the difficulties of
negotiating altruistic surrogacy arrangements in Australia
Commonwealth House of Reps Review
bull 10 sensible recommendations
helliphelliphellipNo government response to date
~3000+ Australian children continue to be denied access to legal parentage
SA Family Relationships Amendment Act
Rationale
bull make it possible for a couple to contact a
surrogate via an SA register
bull regulate overseas surrogacy where
proposed agreements assessed by
Minister on case-by-case basis
Introduced by
bull MLC opposition backbencher John
Dawkins in 2014
Limitations
bull No provision for access by same-sex
couples
bull SA Attorney General anti-surrogacy amp
unwilling to co-operate
Enacted
bull in July 2015
Implementation
15 months of inaction
28 Oct 2016
bull Regulations gazetted for consultation
phase in developing new regulations
bull No real commitment to reform
SA Relationships Register Bill
Rationale
bull Recognise same-sex relationships
bull Recognise intersex status
bull amendments to various existing Acts
Introduced by
bull Left wing of State Labor 22 Sept 2016
Slipped in late
bull Part 6 Amendments to Family Relationships Act
(Sect 10)
bull same-sex and single parents able to access
domestic surrogacy
bull Surrogate re-imbursements
On Second Thoughtshellip
bull Bill to be split
bull Improving access to surrogacy to be
separate bill
Surrogacy Eligibility Bill
Law Reform Required
State-Based
bull Rules on surrogacy-related advertising reviewed in the context of non-profit organisations
bull Expenses to allow for inconvenience payments to surrogates
Law Reform
State-Based Law Reform
bull Rules on surrogacy-related advertising reviewed in the context of non-profit organisations
bull Expenses to allow for inconvenience payments to surrogates
Family Court
bull Remove transfer-of-parentage from the Courts system providing much quicker legal
recognition for intended parents
Policy Reform
State-Based Law Reform
bull Rules on surrogacy-related advertising reviewed in the context of non-profit organisations
bull Expenses to allow for inconvenience payments to surrogates
Family Court Law Reform
bull Remove transfer-of-parentage from the Courts system providing much quicker legal
recognition for intended parents
Medicare Reform
bull Medicare rebate for surrogacy-related IVF where there is a medical need
GROWING DOMESTIC
CAPACITY
Well-managed domestic surrogacy so fewer need to go abroad
Evidence-Based Research
Aim
bull Determine what personality traits amp
lifestyle factors best predict a
psychologically healthy surrogacy
arrangement
Outcomes
bull validate the most accurate indicators of
surrogate amp Intended Parent
lsquoappropriatenessrsquo
Rationale
bull Ensure professional counselling practice
supporting by evidence-based research
bull Screen out inappropriate surrogates amp
IPs
Provide understanding of what traits define healthy arrangements
Evidence-Based Research
University partner
bull Ethics Application
bull Funding sought via FSA grant Govt
Design
Retrospective measurement in past Australian
surrogates amp IPs of
bull Personality traits
bull Satisfaction with interpersonal relationships
bull Levels of conflict support
bull Quality of ongoing relationship
Pre-Match Screening
Pilot Project 1
bull Three year project
bull Ethics Approved
bull Provide professional screening of
surrogates and intended parents
BEFORE they meet
Well-managed domestic surrogacy so fewer need to go abroad
Rationale
bull Avoid surrogates amp IPs having to trawl the net
bull Avoid inappropriate matches
bull Screen out surrogates with wrong motives
bull Provide IPs and surrogates with more
confidence about engaging at home
Evaluation
Tracking amongst participants and control group of
bull surrogate amp Intended Parents personality traits
bull surrogacy outcomes amp relationship quality
bull Attract potential surrogates amp IPs via website
amp social media (unpaid)
bull Intended Parents pay membership fee
bull Informed Consent amp Confidentiality
documentation
bull Referred to Psychologist for interview amp
screening
Pre-Match Screening
bull Reports generated amp provided to NFP for
lsquomatchingrsquo
bull Surrogates undergo medical screening
bull Surrogates who pass screening provided
with 2-3 profiles of IPs who are a good
match
bull Surrogate chooses favoured profile and
an introduction is made
Support Post Matching
Pilot Project 2
bull Availability of timely professional support
after surrogacy approval
Rationale
bull Surrogacy a complex emotional and
psychological journey for IPs amp
surrogates
bull Surrogate-run social media support can
only go so far
Some IVF clinics already consideringattempting this
IS POLICY IN LINE WITH
COMMUNITY ATTITUDES
What Do Australians Think of
Surrogacy
bull Which groups should be able to access surrogacy
bull Level of support for financial compensation
bull Concerns with surrogate compensation
bull Support for the use of agencies to recruit screen and place surrogates
Methodology
bull Approach Ethics approved to enable publication
bull Length amp mode 20 item online survey
bull Timing Dec 28th 2015 - Jan 15th 2016
bull Sample size 500 Australians aged 18 - 49 years (reproductive age)
bull Sample make-up Representative age gender and socio-demographic distribution
bull Those with past surrogacy experience ( themselves family member or friend) excluded to
avoid bias
Support for Surrogate Matching in
Australia
Yes should be allowed
50No
17
Donrsquot Know33
References
Harris K Fitzgerald O Paul RC Macaldowie A Lee E amp Chambers GM 2016 Assisted reproductive technology in Australia
and New Zealand 2014 Sydney National Perinatal Epidemiology and Statistics Unit the University of New South Wales
Everingham SG Stafford-Bell MA Hammarberg K Australians Use of surrogacy MJA 2014 201 (5)1-4
Jadva V Blake L Casey P and Golombok S (2012) Surrogacy families 10 years on relationship with the surrogate
decisions over disclosure and childrenrsquos understanding of their surrogacy origins Human Reproduction Vol27 No10 pp
3008ndash3014
Jadva V Imrie S Golombok S (2015) Surrogate mothers 10 years on a longitudinal study of psychological well-being and
relationships with the parents and child Hum Reprod Feb30(2)373-9
Surrogacy Agencies - Canada
Professional Costs For Australia
(AUD) UK ndash low
end
UK ndash high
end
Canada
low end
Canada
high end
Australia
low
Australia
high
Av IVF
(surrogacy)
$6 800 $15 600 $ 2 000 $ 12 000 $ 5 000 $33 000
Counselling - - - - $ 3 000 $5 000
Agreements - $5 000 $ 5 000 $ 6 600 $13 500 $23 500
Parental
orders
$ 340 $10 000 - $ 4 250 $ 6 500 $ 6 500
Agency fee - $12 000 -
19 000
- $ 12 000 - -
Total $ 7 140 $45600 $20000 $42000 $28 000 $68 000
Surrogate Matching amp Support
Australia UK Canada
Organisations to support
surrogate matching
No Yes Yes
Wait time to find
surrogate
4 - 18 mths 4 - 18 mths 5 - 6 mths
screened out 10 80
Support during surrogacy No Limited Yes if agency used
Surrogate Re-imbursement
Australia UK Canada
Surrogate expenses ~$3000 - $10000 ~$12000 - 34000 ~$34500
Risks to Surrogates
Hot flushes
Feeling down or irritable
Headaches
Restlessness
Exhaustion
Nausea (mild to very severe)
Indigestion
Constipation
Weight gain
Bloating
Abdominalvaginal muscle weakness
Pre-eclampsia
Placenta Previa
Placental abruption
Pubic symphysis dysfunction
Gestational diabetes
Backaches
Miscarriage
molar pregnancy
future infertility
permanent disability
Trauma to the Cervix
Perforation of the Uterus
scar tissue at the uterus opening
infection in the uterus lining
Psychological Disturbances
Prolonged or heavy bleeding
Pain
Perineal Tears
Fistula
Permanent disability
Psychological Distress
Post-Partum Depression
Blood clots in the legs
LAW REFORM
Canadian Reform To Granting Parentage
Background
Ontario Family Law courts questioning the
need to clog up the court system with transfer
of parentage cases given none were being
refused
British Columbia has had simpler processes
circumventing Court for 3 years
Initiative
Ontariorsquos All Families Are Equal Act 2016
amended Acts and statutes to update
parentage and birth registration rules
Enacted
October 2016
Canadian Reform To Granting Parentage
Result
Intended parents recognized without a court order if
the surrogate and IP(s)
bull received independent legal advice
bull entered into a written pre-conception agreement
The surrogate provided written consent to give up her
parental status both
bull before conception and
bull seven days after the birth
Saves parents $6000 in legal costs
Frees Family court to prioritise adversarial cases
NSW Reforms
NSW Review of Surrogacy Act 2010
bull mid 2014 Submissions closed
bull Dec 2015 lsquoBaird government pushing ahead with its planned reformrsquo
bull flagged allowing advertising for surrogates
bull Since thenhellip Silence
Commonwealth House of Reps Review
Surrogacy Matters - Inquiry into the regulatory and legislative aspects of international
and domestic surrogacy arrangements
bull 6 days of hearings
bull 124 written submissions
bull 35 page report tabled April 2016
Key Conclusion
bull many Australians pursuing offshore commercial surrogacy because of the difficulties of
negotiating altruistic surrogacy arrangements in Australia
Commonwealth House of Reps Review
bull 10 sensible recommendations
helliphelliphellipNo government response to date
~3000+ Australian children continue to be denied access to legal parentage
SA Family Relationships Amendment Act
Rationale
bull make it possible for a couple to contact a
surrogate via an SA register
bull regulate overseas surrogacy where
proposed agreements assessed by
Minister on case-by-case basis
Introduced by
bull MLC opposition backbencher John
Dawkins in 2014
Limitations
bull No provision for access by same-sex
couples
bull SA Attorney General anti-surrogacy amp
unwilling to co-operate
Enacted
bull in July 2015
Implementation
15 months of inaction
28 Oct 2016
bull Regulations gazetted for consultation
phase in developing new regulations
bull No real commitment to reform
SA Relationships Register Bill
Rationale
bull Recognise same-sex relationships
bull Recognise intersex status
bull amendments to various existing Acts
Introduced by
bull Left wing of State Labor 22 Sept 2016
Slipped in late
bull Part 6 Amendments to Family Relationships Act
(Sect 10)
bull same-sex and single parents able to access
domestic surrogacy
bull Surrogate re-imbursements
On Second Thoughtshellip
bull Bill to be split
bull Improving access to surrogacy to be
separate bill
Surrogacy Eligibility Bill
Law Reform Required
State-Based
bull Rules on surrogacy-related advertising reviewed in the context of non-profit organisations
bull Expenses to allow for inconvenience payments to surrogates
Law Reform
State-Based Law Reform
bull Rules on surrogacy-related advertising reviewed in the context of non-profit organisations
bull Expenses to allow for inconvenience payments to surrogates
Family Court
bull Remove transfer-of-parentage from the Courts system providing much quicker legal
recognition for intended parents
Policy Reform
State-Based Law Reform
bull Rules on surrogacy-related advertising reviewed in the context of non-profit organisations
bull Expenses to allow for inconvenience payments to surrogates
Family Court Law Reform
bull Remove transfer-of-parentage from the Courts system providing much quicker legal
recognition for intended parents
Medicare Reform
bull Medicare rebate for surrogacy-related IVF where there is a medical need
GROWING DOMESTIC
CAPACITY
Well-managed domestic surrogacy so fewer need to go abroad
Evidence-Based Research
Aim
bull Determine what personality traits amp
lifestyle factors best predict a
psychologically healthy surrogacy
arrangement
Outcomes
bull validate the most accurate indicators of
surrogate amp Intended Parent
lsquoappropriatenessrsquo
Rationale
bull Ensure professional counselling practice
supporting by evidence-based research
bull Screen out inappropriate surrogates amp
IPs
Provide understanding of what traits define healthy arrangements
Evidence-Based Research
University partner
bull Ethics Application
bull Funding sought via FSA grant Govt
Design
Retrospective measurement in past Australian
surrogates amp IPs of
bull Personality traits
bull Satisfaction with interpersonal relationships
bull Levels of conflict support
bull Quality of ongoing relationship
Pre-Match Screening
Pilot Project 1
bull Three year project
bull Ethics Approved
bull Provide professional screening of
surrogates and intended parents
BEFORE they meet
Well-managed domestic surrogacy so fewer need to go abroad
Rationale
bull Avoid surrogates amp IPs having to trawl the net
bull Avoid inappropriate matches
bull Screen out surrogates with wrong motives
bull Provide IPs and surrogates with more
confidence about engaging at home
Evaluation
Tracking amongst participants and control group of
bull surrogate amp Intended Parents personality traits
bull surrogacy outcomes amp relationship quality
bull Attract potential surrogates amp IPs via website
amp social media (unpaid)
bull Intended Parents pay membership fee
bull Informed Consent amp Confidentiality
documentation
bull Referred to Psychologist for interview amp
screening
Pre-Match Screening
bull Reports generated amp provided to NFP for
lsquomatchingrsquo
bull Surrogates undergo medical screening
bull Surrogates who pass screening provided
with 2-3 profiles of IPs who are a good
match
bull Surrogate chooses favoured profile and
an introduction is made
Support Post Matching
Pilot Project 2
bull Availability of timely professional support
after surrogacy approval
Rationale
bull Surrogacy a complex emotional and
psychological journey for IPs amp
surrogates
bull Surrogate-run social media support can
only go so far
Some IVF clinics already consideringattempting this
IS POLICY IN LINE WITH
COMMUNITY ATTITUDES
What Do Australians Think of
Surrogacy
bull Which groups should be able to access surrogacy
bull Level of support for financial compensation
bull Concerns with surrogate compensation
bull Support for the use of agencies to recruit screen and place surrogates
Methodology
bull Approach Ethics approved to enable publication
bull Length amp mode 20 item online survey
bull Timing Dec 28th 2015 - Jan 15th 2016
bull Sample size 500 Australians aged 18 - 49 years (reproductive age)
bull Sample make-up Representative age gender and socio-demographic distribution
bull Those with past surrogacy experience ( themselves family member or friend) excluded to
avoid bias
Support for Surrogate Matching in
Australia
Yes should be allowed
50No
17
Donrsquot Know33
References
Harris K Fitzgerald O Paul RC Macaldowie A Lee E amp Chambers GM 2016 Assisted reproductive technology in Australia
and New Zealand 2014 Sydney National Perinatal Epidemiology and Statistics Unit the University of New South Wales
Everingham SG Stafford-Bell MA Hammarberg K Australians Use of surrogacy MJA 2014 201 (5)1-4
Jadva V Blake L Casey P and Golombok S (2012) Surrogacy families 10 years on relationship with the surrogate
decisions over disclosure and childrenrsquos understanding of their surrogacy origins Human Reproduction Vol27 No10 pp
3008ndash3014
Jadva V Imrie S Golombok S (2015) Surrogate mothers 10 years on a longitudinal study of psychological well-being and
relationships with the parents and child Hum Reprod Feb30(2)373-9
Professional Costs For Australia
(AUD) UK ndash low
end
UK ndash high
end
Canada
low end
Canada
high end
Australia
low
Australia
high
Av IVF
(surrogacy)
$6 800 $15 600 $ 2 000 $ 12 000 $ 5 000 $33 000
Counselling - - - - $ 3 000 $5 000
Agreements - $5 000 $ 5 000 $ 6 600 $13 500 $23 500
Parental
orders
$ 340 $10 000 - $ 4 250 $ 6 500 $ 6 500
Agency fee - $12 000 -
19 000
- $ 12 000 - -
Total $ 7 140 $45600 $20000 $42000 $28 000 $68 000
Surrogate Matching amp Support
Australia UK Canada
Organisations to support
surrogate matching
No Yes Yes
Wait time to find
surrogate
4 - 18 mths 4 - 18 mths 5 - 6 mths
screened out 10 80
Support during surrogacy No Limited Yes if agency used
Surrogate Re-imbursement
Australia UK Canada
Surrogate expenses ~$3000 - $10000 ~$12000 - 34000 ~$34500
Risks to Surrogates
Hot flushes
Feeling down or irritable
Headaches
Restlessness
Exhaustion
Nausea (mild to very severe)
Indigestion
Constipation
Weight gain
Bloating
Abdominalvaginal muscle weakness
Pre-eclampsia
Placenta Previa
Placental abruption
Pubic symphysis dysfunction
Gestational diabetes
Backaches
Miscarriage
molar pregnancy
future infertility
permanent disability
Trauma to the Cervix
Perforation of the Uterus
scar tissue at the uterus opening
infection in the uterus lining
Psychological Disturbances
Prolonged or heavy bleeding
Pain
Perineal Tears
Fistula
Permanent disability
Psychological Distress
Post-Partum Depression
Blood clots in the legs
LAW REFORM
Canadian Reform To Granting Parentage
Background
Ontario Family Law courts questioning the
need to clog up the court system with transfer
of parentage cases given none were being
refused
British Columbia has had simpler processes
circumventing Court for 3 years
Initiative
Ontariorsquos All Families Are Equal Act 2016
amended Acts and statutes to update
parentage and birth registration rules
Enacted
October 2016
Canadian Reform To Granting Parentage
Result
Intended parents recognized without a court order if
the surrogate and IP(s)
bull received independent legal advice
bull entered into a written pre-conception agreement
The surrogate provided written consent to give up her
parental status both
bull before conception and
bull seven days after the birth
Saves parents $6000 in legal costs
Frees Family court to prioritise adversarial cases
NSW Reforms
NSW Review of Surrogacy Act 2010
bull mid 2014 Submissions closed
bull Dec 2015 lsquoBaird government pushing ahead with its planned reformrsquo
bull flagged allowing advertising for surrogates
bull Since thenhellip Silence
Commonwealth House of Reps Review
Surrogacy Matters - Inquiry into the regulatory and legislative aspects of international
and domestic surrogacy arrangements
bull 6 days of hearings
bull 124 written submissions
bull 35 page report tabled April 2016
Key Conclusion
bull many Australians pursuing offshore commercial surrogacy because of the difficulties of
negotiating altruistic surrogacy arrangements in Australia
Commonwealth House of Reps Review
bull 10 sensible recommendations
helliphelliphellipNo government response to date
~3000+ Australian children continue to be denied access to legal parentage
SA Family Relationships Amendment Act
Rationale
bull make it possible for a couple to contact a
surrogate via an SA register
bull regulate overseas surrogacy where
proposed agreements assessed by
Minister on case-by-case basis
Introduced by
bull MLC opposition backbencher John
Dawkins in 2014
Limitations
bull No provision for access by same-sex
couples
bull SA Attorney General anti-surrogacy amp
unwilling to co-operate
Enacted
bull in July 2015
Implementation
15 months of inaction
28 Oct 2016
bull Regulations gazetted for consultation
phase in developing new regulations
bull No real commitment to reform
SA Relationships Register Bill
Rationale
bull Recognise same-sex relationships
bull Recognise intersex status
bull amendments to various existing Acts
Introduced by
bull Left wing of State Labor 22 Sept 2016
Slipped in late
bull Part 6 Amendments to Family Relationships Act
(Sect 10)
bull same-sex and single parents able to access
domestic surrogacy
bull Surrogate re-imbursements
On Second Thoughtshellip
bull Bill to be split
bull Improving access to surrogacy to be
separate bill
Surrogacy Eligibility Bill
Law Reform Required
State-Based
bull Rules on surrogacy-related advertising reviewed in the context of non-profit organisations
bull Expenses to allow for inconvenience payments to surrogates
Law Reform
State-Based Law Reform
bull Rules on surrogacy-related advertising reviewed in the context of non-profit organisations
bull Expenses to allow for inconvenience payments to surrogates
Family Court
bull Remove transfer-of-parentage from the Courts system providing much quicker legal
recognition for intended parents
Policy Reform
State-Based Law Reform
bull Rules on surrogacy-related advertising reviewed in the context of non-profit organisations
bull Expenses to allow for inconvenience payments to surrogates
Family Court Law Reform
bull Remove transfer-of-parentage from the Courts system providing much quicker legal
recognition for intended parents
Medicare Reform
bull Medicare rebate for surrogacy-related IVF where there is a medical need
GROWING DOMESTIC
CAPACITY
Well-managed domestic surrogacy so fewer need to go abroad
Evidence-Based Research
Aim
bull Determine what personality traits amp
lifestyle factors best predict a
psychologically healthy surrogacy
arrangement
Outcomes
bull validate the most accurate indicators of
surrogate amp Intended Parent
lsquoappropriatenessrsquo
Rationale
bull Ensure professional counselling practice
supporting by evidence-based research
bull Screen out inappropriate surrogates amp
IPs
Provide understanding of what traits define healthy arrangements
Evidence-Based Research
University partner
bull Ethics Application
bull Funding sought via FSA grant Govt
Design
Retrospective measurement in past Australian
surrogates amp IPs of
bull Personality traits
bull Satisfaction with interpersonal relationships
bull Levels of conflict support
bull Quality of ongoing relationship
Pre-Match Screening
Pilot Project 1
bull Three year project
bull Ethics Approved
bull Provide professional screening of
surrogates and intended parents
BEFORE they meet
Well-managed domestic surrogacy so fewer need to go abroad
Rationale
bull Avoid surrogates amp IPs having to trawl the net
bull Avoid inappropriate matches
bull Screen out surrogates with wrong motives
bull Provide IPs and surrogates with more
confidence about engaging at home
Evaluation
Tracking amongst participants and control group of
bull surrogate amp Intended Parents personality traits
bull surrogacy outcomes amp relationship quality
bull Attract potential surrogates amp IPs via website
amp social media (unpaid)
bull Intended Parents pay membership fee
bull Informed Consent amp Confidentiality
documentation
bull Referred to Psychologist for interview amp
screening
Pre-Match Screening
bull Reports generated amp provided to NFP for
lsquomatchingrsquo
bull Surrogates undergo medical screening
bull Surrogates who pass screening provided
with 2-3 profiles of IPs who are a good
match
bull Surrogate chooses favoured profile and
an introduction is made
Support Post Matching
Pilot Project 2
bull Availability of timely professional support
after surrogacy approval
Rationale
bull Surrogacy a complex emotional and
psychological journey for IPs amp
surrogates
bull Surrogate-run social media support can
only go so far
Some IVF clinics already consideringattempting this
IS POLICY IN LINE WITH
COMMUNITY ATTITUDES
What Do Australians Think of
Surrogacy
bull Which groups should be able to access surrogacy
bull Level of support for financial compensation
bull Concerns with surrogate compensation
bull Support for the use of agencies to recruit screen and place surrogates
Methodology
bull Approach Ethics approved to enable publication
bull Length amp mode 20 item online survey
bull Timing Dec 28th 2015 - Jan 15th 2016
bull Sample size 500 Australians aged 18 - 49 years (reproductive age)
bull Sample make-up Representative age gender and socio-demographic distribution
bull Those with past surrogacy experience ( themselves family member or friend) excluded to
avoid bias
Support for Surrogate Matching in
Australia
Yes should be allowed
50No
17
Donrsquot Know33
References
Harris K Fitzgerald O Paul RC Macaldowie A Lee E amp Chambers GM 2016 Assisted reproductive technology in Australia
and New Zealand 2014 Sydney National Perinatal Epidemiology and Statistics Unit the University of New South Wales
Everingham SG Stafford-Bell MA Hammarberg K Australians Use of surrogacy MJA 2014 201 (5)1-4
Jadva V Blake L Casey P and Golombok S (2012) Surrogacy families 10 years on relationship with the surrogate
decisions over disclosure and childrenrsquos understanding of their surrogacy origins Human Reproduction Vol27 No10 pp
3008ndash3014
Jadva V Imrie S Golombok S (2015) Surrogate mothers 10 years on a longitudinal study of psychological well-being and
relationships with the parents and child Hum Reprod Feb30(2)373-9
Surrogate Matching amp Support
Australia UK Canada
Organisations to support
surrogate matching
No Yes Yes
Wait time to find
surrogate
4 - 18 mths 4 - 18 mths 5 - 6 mths
screened out 10 80
Support during surrogacy No Limited Yes if agency used
Surrogate Re-imbursement
Australia UK Canada
Surrogate expenses ~$3000 - $10000 ~$12000 - 34000 ~$34500
Risks to Surrogates
Hot flushes
Feeling down or irritable
Headaches
Restlessness
Exhaustion
Nausea (mild to very severe)
Indigestion
Constipation
Weight gain
Bloating
Abdominalvaginal muscle weakness
Pre-eclampsia
Placenta Previa
Placental abruption
Pubic symphysis dysfunction
Gestational diabetes
Backaches
Miscarriage
molar pregnancy
future infertility
permanent disability
Trauma to the Cervix
Perforation of the Uterus
scar tissue at the uterus opening
infection in the uterus lining
Psychological Disturbances
Prolonged or heavy bleeding
Pain
Perineal Tears
Fistula
Permanent disability
Psychological Distress
Post-Partum Depression
Blood clots in the legs
LAW REFORM
Canadian Reform To Granting Parentage
Background
Ontario Family Law courts questioning the
need to clog up the court system with transfer
of parentage cases given none were being
refused
British Columbia has had simpler processes
circumventing Court for 3 years
Initiative
Ontariorsquos All Families Are Equal Act 2016
amended Acts and statutes to update
parentage and birth registration rules
Enacted
October 2016
Canadian Reform To Granting Parentage
Result
Intended parents recognized without a court order if
the surrogate and IP(s)
bull received independent legal advice
bull entered into a written pre-conception agreement
The surrogate provided written consent to give up her
parental status both
bull before conception and
bull seven days after the birth
Saves parents $6000 in legal costs
Frees Family court to prioritise adversarial cases
NSW Reforms
NSW Review of Surrogacy Act 2010
bull mid 2014 Submissions closed
bull Dec 2015 lsquoBaird government pushing ahead with its planned reformrsquo
bull flagged allowing advertising for surrogates
bull Since thenhellip Silence
Commonwealth House of Reps Review
Surrogacy Matters - Inquiry into the regulatory and legislative aspects of international
and domestic surrogacy arrangements
bull 6 days of hearings
bull 124 written submissions
bull 35 page report tabled April 2016
Key Conclusion
bull many Australians pursuing offshore commercial surrogacy because of the difficulties of
negotiating altruistic surrogacy arrangements in Australia
Commonwealth House of Reps Review
bull 10 sensible recommendations
helliphelliphellipNo government response to date
~3000+ Australian children continue to be denied access to legal parentage
SA Family Relationships Amendment Act
Rationale
bull make it possible for a couple to contact a
surrogate via an SA register
bull regulate overseas surrogacy where
proposed agreements assessed by
Minister on case-by-case basis
Introduced by
bull MLC opposition backbencher John
Dawkins in 2014
Limitations
bull No provision for access by same-sex
couples
bull SA Attorney General anti-surrogacy amp
unwilling to co-operate
Enacted
bull in July 2015
Implementation
15 months of inaction
28 Oct 2016
bull Regulations gazetted for consultation
phase in developing new regulations
bull No real commitment to reform
SA Relationships Register Bill
Rationale
bull Recognise same-sex relationships
bull Recognise intersex status
bull amendments to various existing Acts
Introduced by
bull Left wing of State Labor 22 Sept 2016
Slipped in late
bull Part 6 Amendments to Family Relationships Act
(Sect 10)
bull same-sex and single parents able to access
domestic surrogacy
bull Surrogate re-imbursements
On Second Thoughtshellip
bull Bill to be split
bull Improving access to surrogacy to be
separate bill
Surrogacy Eligibility Bill
Law Reform Required
State-Based
bull Rules on surrogacy-related advertising reviewed in the context of non-profit organisations
bull Expenses to allow for inconvenience payments to surrogates
Law Reform
State-Based Law Reform
bull Rules on surrogacy-related advertising reviewed in the context of non-profit organisations
bull Expenses to allow for inconvenience payments to surrogates
Family Court
bull Remove transfer-of-parentage from the Courts system providing much quicker legal
recognition for intended parents
Policy Reform
State-Based Law Reform
bull Rules on surrogacy-related advertising reviewed in the context of non-profit organisations
bull Expenses to allow for inconvenience payments to surrogates
Family Court Law Reform
bull Remove transfer-of-parentage from the Courts system providing much quicker legal
recognition for intended parents
Medicare Reform
bull Medicare rebate for surrogacy-related IVF where there is a medical need
GROWING DOMESTIC
CAPACITY
Well-managed domestic surrogacy so fewer need to go abroad
Evidence-Based Research
Aim
bull Determine what personality traits amp
lifestyle factors best predict a
psychologically healthy surrogacy
arrangement
Outcomes
bull validate the most accurate indicators of
surrogate amp Intended Parent
lsquoappropriatenessrsquo
Rationale
bull Ensure professional counselling practice
supporting by evidence-based research
bull Screen out inappropriate surrogates amp
IPs
Provide understanding of what traits define healthy arrangements
Evidence-Based Research
University partner
bull Ethics Application
bull Funding sought via FSA grant Govt
Design
Retrospective measurement in past Australian
surrogates amp IPs of
bull Personality traits
bull Satisfaction with interpersonal relationships
bull Levels of conflict support
bull Quality of ongoing relationship
Pre-Match Screening
Pilot Project 1
bull Three year project
bull Ethics Approved
bull Provide professional screening of
surrogates and intended parents
BEFORE they meet
Well-managed domestic surrogacy so fewer need to go abroad
Rationale
bull Avoid surrogates amp IPs having to trawl the net
bull Avoid inappropriate matches
bull Screen out surrogates with wrong motives
bull Provide IPs and surrogates with more
confidence about engaging at home
Evaluation
Tracking amongst participants and control group of
bull surrogate amp Intended Parents personality traits
bull surrogacy outcomes amp relationship quality
bull Attract potential surrogates amp IPs via website
amp social media (unpaid)
bull Intended Parents pay membership fee
bull Informed Consent amp Confidentiality
documentation
bull Referred to Psychologist for interview amp
screening
Pre-Match Screening
bull Reports generated amp provided to NFP for
lsquomatchingrsquo
bull Surrogates undergo medical screening
bull Surrogates who pass screening provided
with 2-3 profiles of IPs who are a good
match
bull Surrogate chooses favoured profile and
an introduction is made
Support Post Matching
Pilot Project 2
bull Availability of timely professional support
after surrogacy approval
Rationale
bull Surrogacy a complex emotional and
psychological journey for IPs amp
surrogates
bull Surrogate-run social media support can
only go so far
Some IVF clinics already consideringattempting this
IS POLICY IN LINE WITH
COMMUNITY ATTITUDES
What Do Australians Think of
Surrogacy
bull Which groups should be able to access surrogacy
bull Level of support for financial compensation
bull Concerns with surrogate compensation
bull Support for the use of agencies to recruit screen and place surrogates
Methodology
bull Approach Ethics approved to enable publication
bull Length amp mode 20 item online survey
bull Timing Dec 28th 2015 - Jan 15th 2016
bull Sample size 500 Australians aged 18 - 49 years (reproductive age)
bull Sample make-up Representative age gender and socio-demographic distribution
bull Those with past surrogacy experience ( themselves family member or friend) excluded to
avoid bias
Support for Surrogate Matching in
Australia
Yes should be allowed
50No
17
Donrsquot Know33
References
Harris K Fitzgerald O Paul RC Macaldowie A Lee E amp Chambers GM 2016 Assisted reproductive technology in Australia
and New Zealand 2014 Sydney National Perinatal Epidemiology and Statistics Unit the University of New South Wales
Everingham SG Stafford-Bell MA Hammarberg K Australians Use of surrogacy MJA 2014 201 (5)1-4
Jadva V Blake L Casey P and Golombok S (2012) Surrogacy families 10 years on relationship with the surrogate
decisions over disclosure and childrenrsquos understanding of their surrogacy origins Human Reproduction Vol27 No10 pp
3008ndash3014
Jadva V Imrie S Golombok S (2015) Surrogate mothers 10 years on a longitudinal study of psychological well-being and
relationships with the parents and child Hum Reprod Feb30(2)373-9
Surrogate Re-imbursement
Australia UK Canada
Surrogate expenses ~$3000 - $10000 ~$12000 - 34000 ~$34500
Risks to Surrogates
Hot flushes
Feeling down or irritable
Headaches
Restlessness
Exhaustion
Nausea (mild to very severe)
Indigestion
Constipation
Weight gain
Bloating
Abdominalvaginal muscle weakness
Pre-eclampsia
Placenta Previa
Placental abruption
Pubic symphysis dysfunction
Gestational diabetes
Backaches
Miscarriage
molar pregnancy
future infertility
permanent disability
Trauma to the Cervix
Perforation of the Uterus
scar tissue at the uterus opening
infection in the uterus lining
Psychological Disturbances
Prolonged or heavy bleeding
Pain
Perineal Tears
Fistula
Permanent disability
Psychological Distress
Post-Partum Depression
Blood clots in the legs
LAW REFORM
Canadian Reform To Granting Parentage
Background
Ontario Family Law courts questioning the
need to clog up the court system with transfer
of parentage cases given none were being
refused
British Columbia has had simpler processes
circumventing Court for 3 years
Initiative
Ontariorsquos All Families Are Equal Act 2016
amended Acts and statutes to update
parentage and birth registration rules
Enacted
October 2016
Canadian Reform To Granting Parentage
Result
Intended parents recognized without a court order if
the surrogate and IP(s)
bull received independent legal advice
bull entered into a written pre-conception agreement
The surrogate provided written consent to give up her
parental status both
bull before conception and
bull seven days after the birth
Saves parents $6000 in legal costs
Frees Family court to prioritise adversarial cases
NSW Reforms
NSW Review of Surrogacy Act 2010
bull mid 2014 Submissions closed
bull Dec 2015 lsquoBaird government pushing ahead with its planned reformrsquo
bull flagged allowing advertising for surrogates
bull Since thenhellip Silence
Commonwealth House of Reps Review
Surrogacy Matters - Inquiry into the regulatory and legislative aspects of international
and domestic surrogacy arrangements
bull 6 days of hearings
bull 124 written submissions
bull 35 page report tabled April 2016
Key Conclusion
bull many Australians pursuing offshore commercial surrogacy because of the difficulties of
negotiating altruistic surrogacy arrangements in Australia
Commonwealth House of Reps Review
bull 10 sensible recommendations
helliphelliphellipNo government response to date
~3000+ Australian children continue to be denied access to legal parentage
SA Family Relationships Amendment Act
Rationale
bull make it possible for a couple to contact a
surrogate via an SA register
bull regulate overseas surrogacy where
proposed agreements assessed by
Minister on case-by-case basis
Introduced by
bull MLC opposition backbencher John
Dawkins in 2014
Limitations
bull No provision for access by same-sex
couples
bull SA Attorney General anti-surrogacy amp
unwilling to co-operate
Enacted
bull in July 2015
Implementation
15 months of inaction
28 Oct 2016
bull Regulations gazetted for consultation
phase in developing new regulations
bull No real commitment to reform
SA Relationships Register Bill
Rationale
bull Recognise same-sex relationships
bull Recognise intersex status
bull amendments to various existing Acts
Introduced by
bull Left wing of State Labor 22 Sept 2016
Slipped in late
bull Part 6 Amendments to Family Relationships Act
(Sect 10)
bull same-sex and single parents able to access
domestic surrogacy
bull Surrogate re-imbursements
On Second Thoughtshellip
bull Bill to be split
bull Improving access to surrogacy to be
separate bill
Surrogacy Eligibility Bill
Law Reform Required
State-Based
bull Rules on surrogacy-related advertising reviewed in the context of non-profit organisations
bull Expenses to allow for inconvenience payments to surrogates
Law Reform
State-Based Law Reform
bull Rules on surrogacy-related advertising reviewed in the context of non-profit organisations
bull Expenses to allow for inconvenience payments to surrogates
Family Court
bull Remove transfer-of-parentage from the Courts system providing much quicker legal
recognition for intended parents
Policy Reform
State-Based Law Reform
bull Rules on surrogacy-related advertising reviewed in the context of non-profit organisations
bull Expenses to allow for inconvenience payments to surrogates
Family Court Law Reform
bull Remove transfer-of-parentage from the Courts system providing much quicker legal
recognition for intended parents
Medicare Reform
bull Medicare rebate for surrogacy-related IVF where there is a medical need
GROWING DOMESTIC
CAPACITY
Well-managed domestic surrogacy so fewer need to go abroad
Evidence-Based Research
Aim
bull Determine what personality traits amp
lifestyle factors best predict a
psychologically healthy surrogacy
arrangement
Outcomes
bull validate the most accurate indicators of
surrogate amp Intended Parent
lsquoappropriatenessrsquo
Rationale
bull Ensure professional counselling practice
supporting by evidence-based research
bull Screen out inappropriate surrogates amp
IPs
Provide understanding of what traits define healthy arrangements
Evidence-Based Research
University partner
bull Ethics Application
bull Funding sought via FSA grant Govt
Design
Retrospective measurement in past Australian
surrogates amp IPs of
bull Personality traits
bull Satisfaction with interpersonal relationships
bull Levels of conflict support
bull Quality of ongoing relationship
Pre-Match Screening
Pilot Project 1
bull Three year project
bull Ethics Approved
bull Provide professional screening of
surrogates and intended parents
BEFORE they meet
Well-managed domestic surrogacy so fewer need to go abroad
Rationale
bull Avoid surrogates amp IPs having to trawl the net
bull Avoid inappropriate matches
bull Screen out surrogates with wrong motives
bull Provide IPs and surrogates with more
confidence about engaging at home
Evaluation
Tracking amongst participants and control group of
bull surrogate amp Intended Parents personality traits
bull surrogacy outcomes amp relationship quality
bull Attract potential surrogates amp IPs via website
amp social media (unpaid)
bull Intended Parents pay membership fee
bull Informed Consent amp Confidentiality
documentation
bull Referred to Psychologist for interview amp
screening
Pre-Match Screening
bull Reports generated amp provided to NFP for
lsquomatchingrsquo
bull Surrogates undergo medical screening
bull Surrogates who pass screening provided
with 2-3 profiles of IPs who are a good
match
bull Surrogate chooses favoured profile and
an introduction is made
Support Post Matching
Pilot Project 2
bull Availability of timely professional support
after surrogacy approval
Rationale
bull Surrogacy a complex emotional and
psychological journey for IPs amp
surrogates
bull Surrogate-run social media support can
only go so far
Some IVF clinics already consideringattempting this
IS POLICY IN LINE WITH
COMMUNITY ATTITUDES
What Do Australians Think of
Surrogacy
bull Which groups should be able to access surrogacy
bull Level of support for financial compensation
bull Concerns with surrogate compensation
bull Support for the use of agencies to recruit screen and place surrogates
Methodology
bull Approach Ethics approved to enable publication
bull Length amp mode 20 item online survey
bull Timing Dec 28th 2015 - Jan 15th 2016
bull Sample size 500 Australians aged 18 - 49 years (reproductive age)
bull Sample make-up Representative age gender and socio-demographic distribution
bull Those with past surrogacy experience ( themselves family member or friend) excluded to
avoid bias
Support for Surrogate Matching in
Australia
Yes should be allowed
50No
17
Donrsquot Know33
References
Harris K Fitzgerald O Paul RC Macaldowie A Lee E amp Chambers GM 2016 Assisted reproductive technology in Australia
and New Zealand 2014 Sydney National Perinatal Epidemiology and Statistics Unit the University of New South Wales
Everingham SG Stafford-Bell MA Hammarberg K Australians Use of surrogacy MJA 2014 201 (5)1-4
Jadva V Blake L Casey P and Golombok S (2012) Surrogacy families 10 years on relationship with the surrogate
decisions over disclosure and childrenrsquos understanding of their surrogacy origins Human Reproduction Vol27 No10 pp
3008ndash3014
Jadva V Imrie S Golombok S (2015) Surrogate mothers 10 years on a longitudinal study of psychological well-being and
relationships with the parents and child Hum Reprod Feb30(2)373-9
Risks to Surrogates
Hot flushes
Feeling down or irritable
Headaches
Restlessness
Exhaustion
Nausea (mild to very severe)
Indigestion
Constipation
Weight gain
Bloating
Abdominalvaginal muscle weakness
Pre-eclampsia
Placenta Previa
Placental abruption
Pubic symphysis dysfunction
Gestational diabetes
Backaches
Miscarriage
molar pregnancy
future infertility
permanent disability
Trauma to the Cervix
Perforation of the Uterus
scar tissue at the uterus opening
infection in the uterus lining
Psychological Disturbances
Prolonged or heavy bleeding
Pain
Perineal Tears
Fistula
Permanent disability
Psychological Distress
Post-Partum Depression
Blood clots in the legs
LAW REFORM
Canadian Reform To Granting Parentage
Background
Ontario Family Law courts questioning the
need to clog up the court system with transfer
of parentage cases given none were being
refused
British Columbia has had simpler processes
circumventing Court for 3 years
Initiative
Ontariorsquos All Families Are Equal Act 2016
amended Acts and statutes to update
parentage and birth registration rules
Enacted
October 2016
Canadian Reform To Granting Parentage
Result
Intended parents recognized without a court order if
the surrogate and IP(s)
bull received independent legal advice
bull entered into a written pre-conception agreement
The surrogate provided written consent to give up her
parental status both
bull before conception and
bull seven days after the birth
Saves parents $6000 in legal costs
Frees Family court to prioritise adversarial cases
NSW Reforms
NSW Review of Surrogacy Act 2010
bull mid 2014 Submissions closed
bull Dec 2015 lsquoBaird government pushing ahead with its planned reformrsquo
bull flagged allowing advertising for surrogates
bull Since thenhellip Silence
Commonwealth House of Reps Review
Surrogacy Matters - Inquiry into the regulatory and legislative aspects of international
and domestic surrogacy arrangements
bull 6 days of hearings
bull 124 written submissions
bull 35 page report tabled April 2016
Key Conclusion
bull many Australians pursuing offshore commercial surrogacy because of the difficulties of
negotiating altruistic surrogacy arrangements in Australia
Commonwealth House of Reps Review
bull 10 sensible recommendations
helliphelliphellipNo government response to date
~3000+ Australian children continue to be denied access to legal parentage
SA Family Relationships Amendment Act
Rationale
bull make it possible for a couple to contact a
surrogate via an SA register
bull regulate overseas surrogacy where
proposed agreements assessed by
Minister on case-by-case basis
Introduced by
bull MLC opposition backbencher John
Dawkins in 2014
Limitations
bull No provision for access by same-sex
couples
bull SA Attorney General anti-surrogacy amp
unwilling to co-operate
Enacted
bull in July 2015
Implementation
15 months of inaction
28 Oct 2016
bull Regulations gazetted for consultation
phase in developing new regulations
bull No real commitment to reform
SA Relationships Register Bill
Rationale
bull Recognise same-sex relationships
bull Recognise intersex status
bull amendments to various existing Acts
Introduced by
bull Left wing of State Labor 22 Sept 2016
Slipped in late
bull Part 6 Amendments to Family Relationships Act
(Sect 10)
bull same-sex and single parents able to access
domestic surrogacy
bull Surrogate re-imbursements
On Second Thoughtshellip
bull Bill to be split
bull Improving access to surrogacy to be
separate bill
Surrogacy Eligibility Bill
Law Reform Required
State-Based
bull Rules on surrogacy-related advertising reviewed in the context of non-profit organisations
bull Expenses to allow for inconvenience payments to surrogates
Law Reform
State-Based Law Reform
bull Rules on surrogacy-related advertising reviewed in the context of non-profit organisations
bull Expenses to allow for inconvenience payments to surrogates
Family Court
bull Remove transfer-of-parentage from the Courts system providing much quicker legal
recognition for intended parents
Policy Reform
State-Based Law Reform
bull Rules on surrogacy-related advertising reviewed in the context of non-profit organisations
bull Expenses to allow for inconvenience payments to surrogates
Family Court Law Reform
bull Remove transfer-of-parentage from the Courts system providing much quicker legal
recognition for intended parents
Medicare Reform
bull Medicare rebate for surrogacy-related IVF where there is a medical need
GROWING DOMESTIC
CAPACITY
Well-managed domestic surrogacy so fewer need to go abroad
Evidence-Based Research
Aim
bull Determine what personality traits amp
lifestyle factors best predict a
psychologically healthy surrogacy
arrangement
Outcomes
bull validate the most accurate indicators of
surrogate amp Intended Parent
lsquoappropriatenessrsquo
Rationale
bull Ensure professional counselling practice
supporting by evidence-based research
bull Screen out inappropriate surrogates amp
IPs
Provide understanding of what traits define healthy arrangements
Evidence-Based Research
University partner
bull Ethics Application
bull Funding sought via FSA grant Govt
Design
Retrospective measurement in past Australian
surrogates amp IPs of
bull Personality traits
bull Satisfaction with interpersonal relationships
bull Levels of conflict support
bull Quality of ongoing relationship
Pre-Match Screening
Pilot Project 1
bull Three year project
bull Ethics Approved
bull Provide professional screening of
surrogates and intended parents
BEFORE they meet
Well-managed domestic surrogacy so fewer need to go abroad
Rationale
bull Avoid surrogates amp IPs having to trawl the net
bull Avoid inappropriate matches
bull Screen out surrogates with wrong motives
bull Provide IPs and surrogates with more
confidence about engaging at home
Evaluation
Tracking amongst participants and control group of
bull surrogate amp Intended Parents personality traits
bull surrogacy outcomes amp relationship quality
bull Attract potential surrogates amp IPs via website
amp social media (unpaid)
bull Intended Parents pay membership fee
bull Informed Consent amp Confidentiality
documentation
bull Referred to Psychologist for interview amp
screening
Pre-Match Screening
bull Reports generated amp provided to NFP for
lsquomatchingrsquo
bull Surrogates undergo medical screening
bull Surrogates who pass screening provided
with 2-3 profiles of IPs who are a good
match
bull Surrogate chooses favoured profile and
an introduction is made
Support Post Matching
Pilot Project 2
bull Availability of timely professional support
after surrogacy approval
Rationale
bull Surrogacy a complex emotional and
psychological journey for IPs amp
surrogates
bull Surrogate-run social media support can
only go so far
Some IVF clinics already consideringattempting this
IS POLICY IN LINE WITH
COMMUNITY ATTITUDES
What Do Australians Think of
Surrogacy
bull Which groups should be able to access surrogacy
bull Level of support for financial compensation
bull Concerns with surrogate compensation
bull Support for the use of agencies to recruit screen and place surrogates
Methodology
bull Approach Ethics approved to enable publication
bull Length amp mode 20 item online survey
bull Timing Dec 28th 2015 - Jan 15th 2016
bull Sample size 500 Australians aged 18 - 49 years (reproductive age)
bull Sample make-up Representative age gender and socio-demographic distribution
bull Those with past surrogacy experience ( themselves family member or friend) excluded to
avoid bias
Support for Surrogate Matching in
Australia
Yes should be allowed
50No
17
Donrsquot Know33
References
Harris K Fitzgerald O Paul RC Macaldowie A Lee E amp Chambers GM 2016 Assisted reproductive technology in Australia
and New Zealand 2014 Sydney National Perinatal Epidemiology and Statistics Unit the University of New South Wales
Everingham SG Stafford-Bell MA Hammarberg K Australians Use of surrogacy MJA 2014 201 (5)1-4
Jadva V Blake L Casey P and Golombok S (2012) Surrogacy families 10 years on relationship with the surrogate
decisions over disclosure and childrenrsquos understanding of their surrogacy origins Human Reproduction Vol27 No10 pp
3008ndash3014
Jadva V Imrie S Golombok S (2015) Surrogate mothers 10 years on a longitudinal study of psychological well-being and
relationships with the parents and child Hum Reprod Feb30(2)373-9
LAW REFORM
Canadian Reform To Granting Parentage
Background
Ontario Family Law courts questioning the
need to clog up the court system with transfer
of parentage cases given none were being
refused
British Columbia has had simpler processes
circumventing Court for 3 years
Initiative
Ontariorsquos All Families Are Equal Act 2016
amended Acts and statutes to update
parentage and birth registration rules
Enacted
October 2016
Canadian Reform To Granting Parentage
Result
Intended parents recognized without a court order if
the surrogate and IP(s)
bull received independent legal advice
bull entered into a written pre-conception agreement
The surrogate provided written consent to give up her
parental status both
bull before conception and
bull seven days after the birth
Saves parents $6000 in legal costs
Frees Family court to prioritise adversarial cases
NSW Reforms
NSW Review of Surrogacy Act 2010
bull mid 2014 Submissions closed
bull Dec 2015 lsquoBaird government pushing ahead with its planned reformrsquo
bull flagged allowing advertising for surrogates
bull Since thenhellip Silence
Commonwealth House of Reps Review
Surrogacy Matters - Inquiry into the regulatory and legislative aspects of international
and domestic surrogacy arrangements
bull 6 days of hearings
bull 124 written submissions
bull 35 page report tabled April 2016
Key Conclusion
bull many Australians pursuing offshore commercial surrogacy because of the difficulties of
negotiating altruistic surrogacy arrangements in Australia
Commonwealth House of Reps Review
bull 10 sensible recommendations
helliphelliphellipNo government response to date
~3000+ Australian children continue to be denied access to legal parentage
SA Family Relationships Amendment Act
Rationale
bull make it possible for a couple to contact a
surrogate via an SA register
bull regulate overseas surrogacy where
proposed agreements assessed by
Minister on case-by-case basis
Introduced by
bull MLC opposition backbencher John
Dawkins in 2014
Limitations
bull No provision for access by same-sex
couples
bull SA Attorney General anti-surrogacy amp
unwilling to co-operate
Enacted
bull in July 2015
Implementation
15 months of inaction
28 Oct 2016
bull Regulations gazetted for consultation
phase in developing new regulations
bull No real commitment to reform
SA Relationships Register Bill
Rationale
bull Recognise same-sex relationships
bull Recognise intersex status
bull amendments to various existing Acts
Introduced by
bull Left wing of State Labor 22 Sept 2016
Slipped in late
bull Part 6 Amendments to Family Relationships Act
(Sect 10)
bull same-sex and single parents able to access
domestic surrogacy
bull Surrogate re-imbursements
On Second Thoughtshellip
bull Bill to be split
bull Improving access to surrogacy to be
separate bill
Surrogacy Eligibility Bill
Law Reform Required
State-Based
bull Rules on surrogacy-related advertising reviewed in the context of non-profit organisations
bull Expenses to allow for inconvenience payments to surrogates
Law Reform
State-Based Law Reform
bull Rules on surrogacy-related advertising reviewed in the context of non-profit organisations
bull Expenses to allow for inconvenience payments to surrogates
Family Court
bull Remove transfer-of-parentage from the Courts system providing much quicker legal
recognition for intended parents
Policy Reform
State-Based Law Reform
bull Rules on surrogacy-related advertising reviewed in the context of non-profit organisations
bull Expenses to allow for inconvenience payments to surrogates
Family Court Law Reform
bull Remove transfer-of-parentage from the Courts system providing much quicker legal
recognition for intended parents
Medicare Reform
bull Medicare rebate for surrogacy-related IVF where there is a medical need
GROWING DOMESTIC
CAPACITY
Well-managed domestic surrogacy so fewer need to go abroad
Evidence-Based Research
Aim
bull Determine what personality traits amp
lifestyle factors best predict a
psychologically healthy surrogacy
arrangement
Outcomes
bull validate the most accurate indicators of
surrogate amp Intended Parent
lsquoappropriatenessrsquo
Rationale
bull Ensure professional counselling practice
supporting by evidence-based research
bull Screen out inappropriate surrogates amp
IPs
Provide understanding of what traits define healthy arrangements
Evidence-Based Research
University partner
bull Ethics Application
bull Funding sought via FSA grant Govt
Design
Retrospective measurement in past Australian
surrogates amp IPs of
bull Personality traits
bull Satisfaction with interpersonal relationships
bull Levels of conflict support
bull Quality of ongoing relationship
Pre-Match Screening
Pilot Project 1
bull Three year project
bull Ethics Approved
bull Provide professional screening of
surrogates and intended parents
BEFORE they meet
Well-managed domestic surrogacy so fewer need to go abroad
Rationale
bull Avoid surrogates amp IPs having to trawl the net
bull Avoid inappropriate matches
bull Screen out surrogates with wrong motives
bull Provide IPs and surrogates with more
confidence about engaging at home
Evaluation
Tracking amongst participants and control group of
bull surrogate amp Intended Parents personality traits
bull surrogacy outcomes amp relationship quality
bull Attract potential surrogates amp IPs via website
amp social media (unpaid)
bull Intended Parents pay membership fee
bull Informed Consent amp Confidentiality
documentation
bull Referred to Psychologist for interview amp
screening
Pre-Match Screening
bull Reports generated amp provided to NFP for
lsquomatchingrsquo
bull Surrogates undergo medical screening
bull Surrogates who pass screening provided
with 2-3 profiles of IPs who are a good
match
bull Surrogate chooses favoured profile and
an introduction is made
Support Post Matching
Pilot Project 2
bull Availability of timely professional support
after surrogacy approval
Rationale
bull Surrogacy a complex emotional and
psychological journey for IPs amp
surrogates
bull Surrogate-run social media support can
only go so far
Some IVF clinics already consideringattempting this
IS POLICY IN LINE WITH
COMMUNITY ATTITUDES
What Do Australians Think of
Surrogacy
bull Which groups should be able to access surrogacy
bull Level of support for financial compensation
bull Concerns with surrogate compensation
bull Support for the use of agencies to recruit screen and place surrogates
Methodology
bull Approach Ethics approved to enable publication
bull Length amp mode 20 item online survey
bull Timing Dec 28th 2015 - Jan 15th 2016
bull Sample size 500 Australians aged 18 - 49 years (reproductive age)
bull Sample make-up Representative age gender and socio-demographic distribution
bull Those with past surrogacy experience ( themselves family member or friend) excluded to
avoid bias
Support for Surrogate Matching in
Australia
Yes should be allowed
50No
17
Donrsquot Know33
References
Harris K Fitzgerald O Paul RC Macaldowie A Lee E amp Chambers GM 2016 Assisted reproductive technology in Australia
and New Zealand 2014 Sydney National Perinatal Epidemiology and Statistics Unit the University of New South Wales
Everingham SG Stafford-Bell MA Hammarberg K Australians Use of surrogacy MJA 2014 201 (5)1-4
Jadva V Blake L Casey P and Golombok S (2012) Surrogacy families 10 years on relationship with the surrogate
decisions over disclosure and childrenrsquos understanding of their surrogacy origins Human Reproduction Vol27 No10 pp
3008ndash3014
Jadva V Imrie S Golombok S (2015) Surrogate mothers 10 years on a longitudinal study of psychological well-being and
relationships with the parents and child Hum Reprod Feb30(2)373-9
Canadian Reform To Granting Parentage
Background
Ontario Family Law courts questioning the
need to clog up the court system with transfer
of parentage cases given none were being
refused
British Columbia has had simpler processes
circumventing Court for 3 years
Initiative
Ontariorsquos All Families Are Equal Act 2016
amended Acts and statutes to update
parentage and birth registration rules
Enacted
October 2016
Canadian Reform To Granting Parentage
Result
Intended parents recognized without a court order if
the surrogate and IP(s)
bull received independent legal advice
bull entered into a written pre-conception agreement
The surrogate provided written consent to give up her
parental status both
bull before conception and
bull seven days after the birth
Saves parents $6000 in legal costs
Frees Family court to prioritise adversarial cases
NSW Reforms
NSW Review of Surrogacy Act 2010
bull mid 2014 Submissions closed
bull Dec 2015 lsquoBaird government pushing ahead with its planned reformrsquo
bull flagged allowing advertising for surrogates
bull Since thenhellip Silence
Commonwealth House of Reps Review
Surrogacy Matters - Inquiry into the regulatory and legislative aspects of international
and domestic surrogacy arrangements
bull 6 days of hearings
bull 124 written submissions
bull 35 page report tabled April 2016
Key Conclusion
bull many Australians pursuing offshore commercial surrogacy because of the difficulties of
negotiating altruistic surrogacy arrangements in Australia
Commonwealth House of Reps Review
bull 10 sensible recommendations
helliphelliphellipNo government response to date
~3000+ Australian children continue to be denied access to legal parentage
SA Family Relationships Amendment Act
Rationale
bull make it possible for a couple to contact a
surrogate via an SA register
bull regulate overseas surrogacy where
proposed agreements assessed by
Minister on case-by-case basis
Introduced by
bull MLC opposition backbencher John
Dawkins in 2014
Limitations
bull No provision for access by same-sex
couples
bull SA Attorney General anti-surrogacy amp
unwilling to co-operate
Enacted
bull in July 2015
Implementation
15 months of inaction
28 Oct 2016
bull Regulations gazetted for consultation
phase in developing new regulations
bull No real commitment to reform
SA Relationships Register Bill
Rationale
bull Recognise same-sex relationships
bull Recognise intersex status
bull amendments to various existing Acts
Introduced by
bull Left wing of State Labor 22 Sept 2016
Slipped in late
bull Part 6 Amendments to Family Relationships Act
(Sect 10)
bull same-sex and single parents able to access
domestic surrogacy
bull Surrogate re-imbursements
On Second Thoughtshellip
bull Bill to be split
bull Improving access to surrogacy to be
separate bill
Surrogacy Eligibility Bill
Law Reform Required
State-Based
bull Rules on surrogacy-related advertising reviewed in the context of non-profit organisations
bull Expenses to allow for inconvenience payments to surrogates
Law Reform
State-Based Law Reform
bull Rules on surrogacy-related advertising reviewed in the context of non-profit organisations
bull Expenses to allow for inconvenience payments to surrogates
Family Court
bull Remove transfer-of-parentage from the Courts system providing much quicker legal
recognition for intended parents
Policy Reform
State-Based Law Reform
bull Rules on surrogacy-related advertising reviewed in the context of non-profit organisations
bull Expenses to allow for inconvenience payments to surrogates
Family Court Law Reform
bull Remove transfer-of-parentage from the Courts system providing much quicker legal
recognition for intended parents
Medicare Reform
bull Medicare rebate for surrogacy-related IVF where there is a medical need
GROWING DOMESTIC
CAPACITY
Well-managed domestic surrogacy so fewer need to go abroad
Evidence-Based Research
Aim
bull Determine what personality traits amp
lifestyle factors best predict a
psychologically healthy surrogacy
arrangement
Outcomes
bull validate the most accurate indicators of
surrogate amp Intended Parent
lsquoappropriatenessrsquo
Rationale
bull Ensure professional counselling practice
supporting by evidence-based research
bull Screen out inappropriate surrogates amp
IPs
Provide understanding of what traits define healthy arrangements
Evidence-Based Research
University partner
bull Ethics Application
bull Funding sought via FSA grant Govt
Design
Retrospective measurement in past Australian
surrogates amp IPs of
bull Personality traits
bull Satisfaction with interpersonal relationships
bull Levels of conflict support
bull Quality of ongoing relationship
Pre-Match Screening
Pilot Project 1
bull Three year project
bull Ethics Approved
bull Provide professional screening of
surrogates and intended parents
BEFORE they meet
Well-managed domestic surrogacy so fewer need to go abroad
Rationale
bull Avoid surrogates amp IPs having to trawl the net
bull Avoid inappropriate matches
bull Screen out surrogates with wrong motives
bull Provide IPs and surrogates with more
confidence about engaging at home
Evaluation
Tracking amongst participants and control group of
bull surrogate amp Intended Parents personality traits
bull surrogacy outcomes amp relationship quality
bull Attract potential surrogates amp IPs via website
amp social media (unpaid)
bull Intended Parents pay membership fee
bull Informed Consent amp Confidentiality
documentation
bull Referred to Psychologist for interview amp
screening
Pre-Match Screening
bull Reports generated amp provided to NFP for
lsquomatchingrsquo
bull Surrogates undergo medical screening
bull Surrogates who pass screening provided
with 2-3 profiles of IPs who are a good
match
bull Surrogate chooses favoured profile and
an introduction is made
Support Post Matching
Pilot Project 2
bull Availability of timely professional support
after surrogacy approval
Rationale
bull Surrogacy a complex emotional and
psychological journey for IPs amp
surrogates
bull Surrogate-run social media support can
only go so far
Some IVF clinics already consideringattempting this
IS POLICY IN LINE WITH
COMMUNITY ATTITUDES
What Do Australians Think of
Surrogacy
bull Which groups should be able to access surrogacy
bull Level of support for financial compensation
bull Concerns with surrogate compensation
bull Support for the use of agencies to recruit screen and place surrogates
Methodology
bull Approach Ethics approved to enable publication
bull Length amp mode 20 item online survey
bull Timing Dec 28th 2015 - Jan 15th 2016
bull Sample size 500 Australians aged 18 - 49 years (reproductive age)
bull Sample make-up Representative age gender and socio-demographic distribution
bull Those with past surrogacy experience ( themselves family member or friend) excluded to
avoid bias
Support for Surrogate Matching in
Australia
Yes should be allowed
50No
17
Donrsquot Know33
References
Harris K Fitzgerald O Paul RC Macaldowie A Lee E amp Chambers GM 2016 Assisted reproductive technology in Australia
and New Zealand 2014 Sydney National Perinatal Epidemiology and Statistics Unit the University of New South Wales
Everingham SG Stafford-Bell MA Hammarberg K Australians Use of surrogacy MJA 2014 201 (5)1-4
Jadva V Blake L Casey P and Golombok S (2012) Surrogacy families 10 years on relationship with the surrogate
decisions over disclosure and childrenrsquos understanding of their surrogacy origins Human Reproduction Vol27 No10 pp
3008ndash3014
Jadva V Imrie S Golombok S (2015) Surrogate mothers 10 years on a longitudinal study of psychological well-being and
relationships with the parents and child Hum Reprod Feb30(2)373-9
Canadian Reform To Granting Parentage
Result
Intended parents recognized without a court order if
the surrogate and IP(s)
bull received independent legal advice
bull entered into a written pre-conception agreement
The surrogate provided written consent to give up her
parental status both
bull before conception and
bull seven days after the birth
Saves parents $6000 in legal costs
Frees Family court to prioritise adversarial cases
NSW Reforms
NSW Review of Surrogacy Act 2010
bull mid 2014 Submissions closed
bull Dec 2015 lsquoBaird government pushing ahead with its planned reformrsquo
bull flagged allowing advertising for surrogates
bull Since thenhellip Silence
Commonwealth House of Reps Review
Surrogacy Matters - Inquiry into the regulatory and legislative aspects of international
and domestic surrogacy arrangements
bull 6 days of hearings
bull 124 written submissions
bull 35 page report tabled April 2016
Key Conclusion
bull many Australians pursuing offshore commercial surrogacy because of the difficulties of
negotiating altruistic surrogacy arrangements in Australia
Commonwealth House of Reps Review
bull 10 sensible recommendations
helliphelliphellipNo government response to date
~3000+ Australian children continue to be denied access to legal parentage
SA Family Relationships Amendment Act
Rationale
bull make it possible for a couple to contact a
surrogate via an SA register
bull regulate overseas surrogacy where
proposed agreements assessed by
Minister on case-by-case basis
Introduced by
bull MLC opposition backbencher John
Dawkins in 2014
Limitations
bull No provision for access by same-sex
couples
bull SA Attorney General anti-surrogacy amp
unwilling to co-operate
Enacted
bull in July 2015
Implementation
15 months of inaction
28 Oct 2016
bull Regulations gazetted for consultation
phase in developing new regulations
bull No real commitment to reform
SA Relationships Register Bill
Rationale
bull Recognise same-sex relationships
bull Recognise intersex status
bull amendments to various existing Acts
Introduced by
bull Left wing of State Labor 22 Sept 2016
Slipped in late
bull Part 6 Amendments to Family Relationships Act
(Sect 10)
bull same-sex and single parents able to access
domestic surrogacy
bull Surrogate re-imbursements
On Second Thoughtshellip
bull Bill to be split
bull Improving access to surrogacy to be
separate bill
Surrogacy Eligibility Bill
Law Reform Required
State-Based
bull Rules on surrogacy-related advertising reviewed in the context of non-profit organisations
bull Expenses to allow for inconvenience payments to surrogates
Law Reform
State-Based Law Reform
bull Rules on surrogacy-related advertising reviewed in the context of non-profit organisations
bull Expenses to allow for inconvenience payments to surrogates
Family Court
bull Remove transfer-of-parentage from the Courts system providing much quicker legal
recognition for intended parents
Policy Reform
State-Based Law Reform
bull Rules on surrogacy-related advertising reviewed in the context of non-profit organisations
bull Expenses to allow for inconvenience payments to surrogates
Family Court Law Reform
bull Remove transfer-of-parentage from the Courts system providing much quicker legal
recognition for intended parents
Medicare Reform
bull Medicare rebate for surrogacy-related IVF where there is a medical need
GROWING DOMESTIC
CAPACITY
Well-managed domestic surrogacy so fewer need to go abroad
Evidence-Based Research
Aim
bull Determine what personality traits amp
lifestyle factors best predict a
psychologically healthy surrogacy
arrangement
Outcomes
bull validate the most accurate indicators of
surrogate amp Intended Parent
lsquoappropriatenessrsquo
Rationale
bull Ensure professional counselling practice
supporting by evidence-based research
bull Screen out inappropriate surrogates amp
IPs
Provide understanding of what traits define healthy arrangements
Evidence-Based Research
University partner
bull Ethics Application
bull Funding sought via FSA grant Govt
Design
Retrospective measurement in past Australian
surrogates amp IPs of
bull Personality traits
bull Satisfaction with interpersonal relationships
bull Levels of conflict support
bull Quality of ongoing relationship
Pre-Match Screening
Pilot Project 1
bull Three year project
bull Ethics Approved
bull Provide professional screening of
surrogates and intended parents
BEFORE they meet
Well-managed domestic surrogacy so fewer need to go abroad
Rationale
bull Avoid surrogates amp IPs having to trawl the net
bull Avoid inappropriate matches
bull Screen out surrogates with wrong motives
bull Provide IPs and surrogates with more
confidence about engaging at home
Evaluation
Tracking amongst participants and control group of
bull surrogate amp Intended Parents personality traits
bull surrogacy outcomes amp relationship quality
bull Attract potential surrogates amp IPs via website
amp social media (unpaid)
bull Intended Parents pay membership fee
bull Informed Consent amp Confidentiality
documentation
bull Referred to Psychologist for interview amp
screening
Pre-Match Screening
bull Reports generated amp provided to NFP for
lsquomatchingrsquo
bull Surrogates undergo medical screening
bull Surrogates who pass screening provided
with 2-3 profiles of IPs who are a good
match
bull Surrogate chooses favoured profile and
an introduction is made
Support Post Matching
Pilot Project 2
bull Availability of timely professional support
after surrogacy approval
Rationale
bull Surrogacy a complex emotional and
psychological journey for IPs amp
surrogates
bull Surrogate-run social media support can
only go so far
Some IVF clinics already consideringattempting this
IS POLICY IN LINE WITH
COMMUNITY ATTITUDES
What Do Australians Think of
Surrogacy
bull Which groups should be able to access surrogacy
bull Level of support for financial compensation
bull Concerns with surrogate compensation
bull Support for the use of agencies to recruit screen and place surrogates
Methodology
bull Approach Ethics approved to enable publication
bull Length amp mode 20 item online survey
bull Timing Dec 28th 2015 - Jan 15th 2016
bull Sample size 500 Australians aged 18 - 49 years (reproductive age)
bull Sample make-up Representative age gender and socio-demographic distribution
bull Those with past surrogacy experience ( themselves family member or friend) excluded to
avoid bias
Support for Surrogate Matching in
Australia
Yes should be allowed
50No
17
Donrsquot Know33
References
Harris K Fitzgerald O Paul RC Macaldowie A Lee E amp Chambers GM 2016 Assisted reproductive technology in Australia
and New Zealand 2014 Sydney National Perinatal Epidemiology and Statistics Unit the University of New South Wales
Everingham SG Stafford-Bell MA Hammarberg K Australians Use of surrogacy MJA 2014 201 (5)1-4
Jadva V Blake L Casey P and Golombok S (2012) Surrogacy families 10 years on relationship with the surrogate
decisions over disclosure and childrenrsquos understanding of their surrogacy origins Human Reproduction Vol27 No10 pp
3008ndash3014
Jadva V Imrie S Golombok S (2015) Surrogate mothers 10 years on a longitudinal study of psychological well-being and
relationships with the parents and child Hum Reprod Feb30(2)373-9
NSW Reforms
NSW Review of Surrogacy Act 2010
bull mid 2014 Submissions closed
bull Dec 2015 lsquoBaird government pushing ahead with its planned reformrsquo
bull flagged allowing advertising for surrogates
bull Since thenhellip Silence
Commonwealth House of Reps Review
Surrogacy Matters - Inquiry into the regulatory and legislative aspects of international
and domestic surrogacy arrangements
bull 6 days of hearings
bull 124 written submissions
bull 35 page report tabled April 2016
Key Conclusion
bull many Australians pursuing offshore commercial surrogacy because of the difficulties of
negotiating altruistic surrogacy arrangements in Australia
Commonwealth House of Reps Review
bull 10 sensible recommendations
helliphelliphellipNo government response to date
~3000+ Australian children continue to be denied access to legal parentage
SA Family Relationships Amendment Act
Rationale
bull make it possible for a couple to contact a
surrogate via an SA register
bull regulate overseas surrogacy where
proposed agreements assessed by
Minister on case-by-case basis
Introduced by
bull MLC opposition backbencher John
Dawkins in 2014
Limitations
bull No provision for access by same-sex
couples
bull SA Attorney General anti-surrogacy amp
unwilling to co-operate
Enacted
bull in July 2015
Implementation
15 months of inaction
28 Oct 2016
bull Regulations gazetted for consultation
phase in developing new regulations
bull No real commitment to reform
SA Relationships Register Bill
Rationale
bull Recognise same-sex relationships
bull Recognise intersex status
bull amendments to various existing Acts
Introduced by
bull Left wing of State Labor 22 Sept 2016
Slipped in late
bull Part 6 Amendments to Family Relationships Act
(Sect 10)
bull same-sex and single parents able to access
domestic surrogacy
bull Surrogate re-imbursements
On Second Thoughtshellip
bull Bill to be split
bull Improving access to surrogacy to be
separate bill
Surrogacy Eligibility Bill
Law Reform Required
State-Based
bull Rules on surrogacy-related advertising reviewed in the context of non-profit organisations
bull Expenses to allow for inconvenience payments to surrogates
Law Reform
State-Based Law Reform
bull Rules on surrogacy-related advertising reviewed in the context of non-profit organisations
bull Expenses to allow for inconvenience payments to surrogates
Family Court
bull Remove transfer-of-parentage from the Courts system providing much quicker legal
recognition for intended parents
Policy Reform
State-Based Law Reform
bull Rules on surrogacy-related advertising reviewed in the context of non-profit organisations
bull Expenses to allow for inconvenience payments to surrogates
Family Court Law Reform
bull Remove transfer-of-parentage from the Courts system providing much quicker legal
recognition for intended parents
Medicare Reform
bull Medicare rebate for surrogacy-related IVF where there is a medical need
GROWING DOMESTIC
CAPACITY
Well-managed domestic surrogacy so fewer need to go abroad
Evidence-Based Research
Aim
bull Determine what personality traits amp
lifestyle factors best predict a
psychologically healthy surrogacy
arrangement
Outcomes
bull validate the most accurate indicators of
surrogate amp Intended Parent
lsquoappropriatenessrsquo
Rationale
bull Ensure professional counselling practice
supporting by evidence-based research
bull Screen out inappropriate surrogates amp
IPs
Provide understanding of what traits define healthy arrangements
Evidence-Based Research
University partner
bull Ethics Application
bull Funding sought via FSA grant Govt
Design
Retrospective measurement in past Australian
surrogates amp IPs of
bull Personality traits
bull Satisfaction with interpersonal relationships
bull Levels of conflict support
bull Quality of ongoing relationship
Pre-Match Screening
Pilot Project 1
bull Three year project
bull Ethics Approved
bull Provide professional screening of
surrogates and intended parents
BEFORE they meet
Well-managed domestic surrogacy so fewer need to go abroad
Rationale
bull Avoid surrogates amp IPs having to trawl the net
bull Avoid inappropriate matches
bull Screen out surrogates with wrong motives
bull Provide IPs and surrogates with more
confidence about engaging at home
Evaluation
Tracking amongst participants and control group of
bull surrogate amp Intended Parents personality traits
bull surrogacy outcomes amp relationship quality
bull Attract potential surrogates amp IPs via website
amp social media (unpaid)
bull Intended Parents pay membership fee
bull Informed Consent amp Confidentiality
documentation
bull Referred to Psychologist for interview amp
screening
Pre-Match Screening
bull Reports generated amp provided to NFP for
lsquomatchingrsquo
bull Surrogates undergo medical screening
bull Surrogates who pass screening provided
with 2-3 profiles of IPs who are a good
match
bull Surrogate chooses favoured profile and
an introduction is made
Support Post Matching
Pilot Project 2
bull Availability of timely professional support
after surrogacy approval
Rationale
bull Surrogacy a complex emotional and
psychological journey for IPs amp
surrogates
bull Surrogate-run social media support can
only go so far
Some IVF clinics already consideringattempting this
IS POLICY IN LINE WITH
COMMUNITY ATTITUDES
What Do Australians Think of
Surrogacy
bull Which groups should be able to access surrogacy
bull Level of support for financial compensation
bull Concerns with surrogate compensation
bull Support for the use of agencies to recruit screen and place surrogates
Methodology
bull Approach Ethics approved to enable publication
bull Length amp mode 20 item online survey
bull Timing Dec 28th 2015 - Jan 15th 2016
bull Sample size 500 Australians aged 18 - 49 years (reproductive age)
bull Sample make-up Representative age gender and socio-demographic distribution
bull Those with past surrogacy experience ( themselves family member or friend) excluded to
avoid bias
Support for Surrogate Matching in
Australia
Yes should be allowed
50No
17
Donrsquot Know33
References
Harris K Fitzgerald O Paul RC Macaldowie A Lee E amp Chambers GM 2016 Assisted reproductive technology in Australia
and New Zealand 2014 Sydney National Perinatal Epidemiology and Statistics Unit the University of New South Wales
Everingham SG Stafford-Bell MA Hammarberg K Australians Use of surrogacy MJA 2014 201 (5)1-4
Jadva V Blake L Casey P and Golombok S (2012) Surrogacy families 10 years on relationship with the surrogate
decisions over disclosure and childrenrsquos understanding of their surrogacy origins Human Reproduction Vol27 No10 pp
3008ndash3014
Jadva V Imrie S Golombok S (2015) Surrogate mothers 10 years on a longitudinal study of psychological well-being and
relationships with the parents and child Hum Reprod Feb30(2)373-9
Commonwealth House of Reps Review
Surrogacy Matters - Inquiry into the regulatory and legislative aspects of international
and domestic surrogacy arrangements
bull 6 days of hearings
bull 124 written submissions
bull 35 page report tabled April 2016
Key Conclusion
bull many Australians pursuing offshore commercial surrogacy because of the difficulties of
negotiating altruistic surrogacy arrangements in Australia
Commonwealth House of Reps Review
bull 10 sensible recommendations
helliphelliphellipNo government response to date
~3000+ Australian children continue to be denied access to legal parentage
SA Family Relationships Amendment Act
Rationale
bull make it possible for a couple to contact a
surrogate via an SA register
bull regulate overseas surrogacy where
proposed agreements assessed by
Minister on case-by-case basis
Introduced by
bull MLC opposition backbencher John
Dawkins in 2014
Limitations
bull No provision for access by same-sex
couples
bull SA Attorney General anti-surrogacy amp
unwilling to co-operate
Enacted
bull in July 2015
Implementation
15 months of inaction
28 Oct 2016
bull Regulations gazetted for consultation
phase in developing new regulations
bull No real commitment to reform
SA Relationships Register Bill
Rationale
bull Recognise same-sex relationships
bull Recognise intersex status
bull amendments to various existing Acts
Introduced by
bull Left wing of State Labor 22 Sept 2016
Slipped in late
bull Part 6 Amendments to Family Relationships Act
(Sect 10)
bull same-sex and single parents able to access
domestic surrogacy
bull Surrogate re-imbursements
On Second Thoughtshellip
bull Bill to be split
bull Improving access to surrogacy to be
separate bill
Surrogacy Eligibility Bill
Law Reform Required
State-Based
bull Rules on surrogacy-related advertising reviewed in the context of non-profit organisations
bull Expenses to allow for inconvenience payments to surrogates
Law Reform
State-Based Law Reform
bull Rules on surrogacy-related advertising reviewed in the context of non-profit organisations
bull Expenses to allow for inconvenience payments to surrogates
Family Court
bull Remove transfer-of-parentage from the Courts system providing much quicker legal
recognition for intended parents
Policy Reform
State-Based Law Reform
bull Rules on surrogacy-related advertising reviewed in the context of non-profit organisations
bull Expenses to allow for inconvenience payments to surrogates
Family Court Law Reform
bull Remove transfer-of-parentage from the Courts system providing much quicker legal
recognition for intended parents
Medicare Reform
bull Medicare rebate for surrogacy-related IVF where there is a medical need
GROWING DOMESTIC
CAPACITY
Well-managed domestic surrogacy so fewer need to go abroad
Evidence-Based Research
Aim
bull Determine what personality traits amp
lifestyle factors best predict a
psychologically healthy surrogacy
arrangement
Outcomes
bull validate the most accurate indicators of
surrogate amp Intended Parent
lsquoappropriatenessrsquo
Rationale
bull Ensure professional counselling practice
supporting by evidence-based research
bull Screen out inappropriate surrogates amp
IPs
Provide understanding of what traits define healthy arrangements
Evidence-Based Research
University partner
bull Ethics Application
bull Funding sought via FSA grant Govt
Design
Retrospective measurement in past Australian
surrogates amp IPs of
bull Personality traits
bull Satisfaction with interpersonal relationships
bull Levels of conflict support
bull Quality of ongoing relationship
Pre-Match Screening
Pilot Project 1
bull Three year project
bull Ethics Approved
bull Provide professional screening of
surrogates and intended parents
BEFORE they meet
Well-managed domestic surrogacy so fewer need to go abroad
Rationale
bull Avoid surrogates amp IPs having to trawl the net
bull Avoid inappropriate matches
bull Screen out surrogates with wrong motives
bull Provide IPs and surrogates with more
confidence about engaging at home
Evaluation
Tracking amongst participants and control group of
bull surrogate amp Intended Parents personality traits
bull surrogacy outcomes amp relationship quality
bull Attract potential surrogates amp IPs via website
amp social media (unpaid)
bull Intended Parents pay membership fee
bull Informed Consent amp Confidentiality
documentation
bull Referred to Psychologist for interview amp
screening
Pre-Match Screening
bull Reports generated amp provided to NFP for
lsquomatchingrsquo
bull Surrogates undergo medical screening
bull Surrogates who pass screening provided
with 2-3 profiles of IPs who are a good
match
bull Surrogate chooses favoured profile and
an introduction is made
Support Post Matching
Pilot Project 2
bull Availability of timely professional support
after surrogacy approval
Rationale
bull Surrogacy a complex emotional and
psychological journey for IPs amp
surrogates
bull Surrogate-run social media support can
only go so far
Some IVF clinics already consideringattempting this
IS POLICY IN LINE WITH
COMMUNITY ATTITUDES
What Do Australians Think of
Surrogacy
bull Which groups should be able to access surrogacy
bull Level of support for financial compensation
bull Concerns with surrogate compensation
bull Support for the use of agencies to recruit screen and place surrogates
Methodology
bull Approach Ethics approved to enable publication
bull Length amp mode 20 item online survey
bull Timing Dec 28th 2015 - Jan 15th 2016
bull Sample size 500 Australians aged 18 - 49 years (reproductive age)
bull Sample make-up Representative age gender and socio-demographic distribution
bull Those with past surrogacy experience ( themselves family member or friend) excluded to
avoid bias
Support for Surrogate Matching in
Australia
Yes should be allowed
50No
17
Donrsquot Know33
References
Harris K Fitzgerald O Paul RC Macaldowie A Lee E amp Chambers GM 2016 Assisted reproductive technology in Australia
and New Zealand 2014 Sydney National Perinatal Epidemiology and Statistics Unit the University of New South Wales
Everingham SG Stafford-Bell MA Hammarberg K Australians Use of surrogacy MJA 2014 201 (5)1-4
Jadva V Blake L Casey P and Golombok S (2012) Surrogacy families 10 years on relationship with the surrogate
decisions over disclosure and childrenrsquos understanding of their surrogacy origins Human Reproduction Vol27 No10 pp
3008ndash3014
Jadva V Imrie S Golombok S (2015) Surrogate mothers 10 years on a longitudinal study of psychological well-being and
relationships with the parents and child Hum Reprod Feb30(2)373-9
Commonwealth House of Reps Review
bull 10 sensible recommendations
helliphelliphellipNo government response to date
~3000+ Australian children continue to be denied access to legal parentage
SA Family Relationships Amendment Act
Rationale
bull make it possible for a couple to contact a
surrogate via an SA register
bull regulate overseas surrogacy where
proposed agreements assessed by
Minister on case-by-case basis
Introduced by
bull MLC opposition backbencher John
Dawkins in 2014
Limitations
bull No provision for access by same-sex
couples
bull SA Attorney General anti-surrogacy amp
unwilling to co-operate
Enacted
bull in July 2015
Implementation
15 months of inaction
28 Oct 2016
bull Regulations gazetted for consultation
phase in developing new regulations
bull No real commitment to reform
SA Relationships Register Bill
Rationale
bull Recognise same-sex relationships
bull Recognise intersex status
bull amendments to various existing Acts
Introduced by
bull Left wing of State Labor 22 Sept 2016
Slipped in late
bull Part 6 Amendments to Family Relationships Act
(Sect 10)
bull same-sex and single parents able to access
domestic surrogacy
bull Surrogate re-imbursements
On Second Thoughtshellip
bull Bill to be split
bull Improving access to surrogacy to be
separate bill
Surrogacy Eligibility Bill
Law Reform Required
State-Based
bull Rules on surrogacy-related advertising reviewed in the context of non-profit organisations
bull Expenses to allow for inconvenience payments to surrogates
Law Reform
State-Based Law Reform
bull Rules on surrogacy-related advertising reviewed in the context of non-profit organisations
bull Expenses to allow for inconvenience payments to surrogates
Family Court
bull Remove transfer-of-parentage from the Courts system providing much quicker legal
recognition for intended parents
Policy Reform
State-Based Law Reform
bull Rules on surrogacy-related advertising reviewed in the context of non-profit organisations
bull Expenses to allow for inconvenience payments to surrogates
Family Court Law Reform
bull Remove transfer-of-parentage from the Courts system providing much quicker legal
recognition for intended parents
Medicare Reform
bull Medicare rebate for surrogacy-related IVF where there is a medical need
GROWING DOMESTIC
CAPACITY
Well-managed domestic surrogacy so fewer need to go abroad
Evidence-Based Research
Aim
bull Determine what personality traits amp
lifestyle factors best predict a
psychologically healthy surrogacy
arrangement
Outcomes
bull validate the most accurate indicators of
surrogate amp Intended Parent
lsquoappropriatenessrsquo
Rationale
bull Ensure professional counselling practice
supporting by evidence-based research
bull Screen out inappropriate surrogates amp
IPs
Provide understanding of what traits define healthy arrangements
Evidence-Based Research
University partner
bull Ethics Application
bull Funding sought via FSA grant Govt
Design
Retrospective measurement in past Australian
surrogates amp IPs of
bull Personality traits
bull Satisfaction with interpersonal relationships
bull Levels of conflict support
bull Quality of ongoing relationship
Pre-Match Screening
Pilot Project 1
bull Three year project
bull Ethics Approved
bull Provide professional screening of
surrogates and intended parents
BEFORE they meet
Well-managed domestic surrogacy so fewer need to go abroad
Rationale
bull Avoid surrogates amp IPs having to trawl the net
bull Avoid inappropriate matches
bull Screen out surrogates with wrong motives
bull Provide IPs and surrogates with more
confidence about engaging at home
Evaluation
Tracking amongst participants and control group of
bull surrogate amp Intended Parents personality traits
bull surrogacy outcomes amp relationship quality
bull Attract potential surrogates amp IPs via website
amp social media (unpaid)
bull Intended Parents pay membership fee
bull Informed Consent amp Confidentiality
documentation
bull Referred to Psychologist for interview amp
screening
Pre-Match Screening
bull Reports generated amp provided to NFP for
lsquomatchingrsquo
bull Surrogates undergo medical screening
bull Surrogates who pass screening provided
with 2-3 profiles of IPs who are a good
match
bull Surrogate chooses favoured profile and
an introduction is made
Support Post Matching
Pilot Project 2
bull Availability of timely professional support
after surrogacy approval
Rationale
bull Surrogacy a complex emotional and
psychological journey for IPs amp
surrogates
bull Surrogate-run social media support can
only go so far
Some IVF clinics already consideringattempting this
IS POLICY IN LINE WITH
COMMUNITY ATTITUDES
What Do Australians Think of
Surrogacy
bull Which groups should be able to access surrogacy
bull Level of support for financial compensation
bull Concerns with surrogate compensation
bull Support for the use of agencies to recruit screen and place surrogates
Methodology
bull Approach Ethics approved to enable publication
bull Length amp mode 20 item online survey
bull Timing Dec 28th 2015 - Jan 15th 2016
bull Sample size 500 Australians aged 18 - 49 years (reproductive age)
bull Sample make-up Representative age gender and socio-demographic distribution
bull Those with past surrogacy experience ( themselves family member or friend) excluded to
avoid bias
Support for Surrogate Matching in
Australia
Yes should be allowed
50No
17
Donrsquot Know33
References
Harris K Fitzgerald O Paul RC Macaldowie A Lee E amp Chambers GM 2016 Assisted reproductive technology in Australia
and New Zealand 2014 Sydney National Perinatal Epidemiology and Statistics Unit the University of New South Wales
Everingham SG Stafford-Bell MA Hammarberg K Australians Use of surrogacy MJA 2014 201 (5)1-4
Jadva V Blake L Casey P and Golombok S (2012) Surrogacy families 10 years on relationship with the surrogate
decisions over disclosure and childrenrsquos understanding of their surrogacy origins Human Reproduction Vol27 No10 pp
3008ndash3014
Jadva V Imrie S Golombok S (2015) Surrogate mothers 10 years on a longitudinal study of psychological well-being and
relationships with the parents and child Hum Reprod Feb30(2)373-9
SA Family Relationships Amendment Act
Rationale
bull make it possible for a couple to contact a
surrogate via an SA register
bull regulate overseas surrogacy where
proposed agreements assessed by
Minister on case-by-case basis
Introduced by
bull MLC opposition backbencher John
Dawkins in 2014
Limitations
bull No provision for access by same-sex
couples
bull SA Attorney General anti-surrogacy amp
unwilling to co-operate
Enacted
bull in July 2015
Implementation
15 months of inaction
28 Oct 2016
bull Regulations gazetted for consultation
phase in developing new regulations
bull No real commitment to reform
SA Relationships Register Bill
Rationale
bull Recognise same-sex relationships
bull Recognise intersex status
bull amendments to various existing Acts
Introduced by
bull Left wing of State Labor 22 Sept 2016
Slipped in late
bull Part 6 Amendments to Family Relationships Act
(Sect 10)
bull same-sex and single parents able to access
domestic surrogacy
bull Surrogate re-imbursements
On Second Thoughtshellip
bull Bill to be split
bull Improving access to surrogacy to be
separate bill
Surrogacy Eligibility Bill
Law Reform Required
State-Based
bull Rules on surrogacy-related advertising reviewed in the context of non-profit organisations
bull Expenses to allow for inconvenience payments to surrogates
Law Reform
State-Based Law Reform
bull Rules on surrogacy-related advertising reviewed in the context of non-profit organisations
bull Expenses to allow for inconvenience payments to surrogates
Family Court
bull Remove transfer-of-parentage from the Courts system providing much quicker legal
recognition for intended parents
Policy Reform
State-Based Law Reform
bull Rules on surrogacy-related advertising reviewed in the context of non-profit organisations
bull Expenses to allow for inconvenience payments to surrogates
Family Court Law Reform
bull Remove transfer-of-parentage from the Courts system providing much quicker legal
recognition for intended parents
Medicare Reform
bull Medicare rebate for surrogacy-related IVF where there is a medical need
GROWING DOMESTIC
CAPACITY
Well-managed domestic surrogacy so fewer need to go abroad
Evidence-Based Research
Aim
bull Determine what personality traits amp
lifestyle factors best predict a
psychologically healthy surrogacy
arrangement
Outcomes
bull validate the most accurate indicators of
surrogate amp Intended Parent
lsquoappropriatenessrsquo
Rationale
bull Ensure professional counselling practice
supporting by evidence-based research
bull Screen out inappropriate surrogates amp
IPs
Provide understanding of what traits define healthy arrangements
Evidence-Based Research
University partner
bull Ethics Application
bull Funding sought via FSA grant Govt
Design
Retrospective measurement in past Australian
surrogates amp IPs of
bull Personality traits
bull Satisfaction with interpersonal relationships
bull Levels of conflict support
bull Quality of ongoing relationship
Pre-Match Screening
Pilot Project 1
bull Three year project
bull Ethics Approved
bull Provide professional screening of
surrogates and intended parents
BEFORE they meet
Well-managed domestic surrogacy so fewer need to go abroad
Rationale
bull Avoid surrogates amp IPs having to trawl the net
bull Avoid inappropriate matches
bull Screen out surrogates with wrong motives
bull Provide IPs and surrogates with more
confidence about engaging at home
Evaluation
Tracking amongst participants and control group of
bull surrogate amp Intended Parents personality traits
bull surrogacy outcomes amp relationship quality
bull Attract potential surrogates amp IPs via website
amp social media (unpaid)
bull Intended Parents pay membership fee
bull Informed Consent amp Confidentiality
documentation
bull Referred to Psychologist for interview amp
screening
Pre-Match Screening
bull Reports generated amp provided to NFP for
lsquomatchingrsquo
bull Surrogates undergo medical screening
bull Surrogates who pass screening provided
with 2-3 profiles of IPs who are a good
match
bull Surrogate chooses favoured profile and
an introduction is made
Support Post Matching
Pilot Project 2
bull Availability of timely professional support
after surrogacy approval
Rationale
bull Surrogacy a complex emotional and
psychological journey for IPs amp
surrogates
bull Surrogate-run social media support can
only go so far
Some IVF clinics already consideringattempting this
IS POLICY IN LINE WITH
COMMUNITY ATTITUDES
What Do Australians Think of
Surrogacy
bull Which groups should be able to access surrogacy
bull Level of support for financial compensation
bull Concerns with surrogate compensation
bull Support for the use of agencies to recruit screen and place surrogates
Methodology
bull Approach Ethics approved to enable publication
bull Length amp mode 20 item online survey
bull Timing Dec 28th 2015 - Jan 15th 2016
bull Sample size 500 Australians aged 18 - 49 years (reproductive age)
bull Sample make-up Representative age gender and socio-demographic distribution
bull Those with past surrogacy experience ( themselves family member or friend) excluded to
avoid bias
Support for Surrogate Matching in
Australia
Yes should be allowed
50No
17
Donrsquot Know33
References
Harris K Fitzgerald O Paul RC Macaldowie A Lee E amp Chambers GM 2016 Assisted reproductive technology in Australia
and New Zealand 2014 Sydney National Perinatal Epidemiology and Statistics Unit the University of New South Wales
Everingham SG Stafford-Bell MA Hammarberg K Australians Use of surrogacy MJA 2014 201 (5)1-4
Jadva V Blake L Casey P and Golombok S (2012) Surrogacy families 10 years on relationship with the surrogate
decisions over disclosure and childrenrsquos understanding of their surrogacy origins Human Reproduction Vol27 No10 pp
3008ndash3014
Jadva V Imrie S Golombok S (2015) Surrogate mothers 10 years on a longitudinal study of psychological well-being and
relationships with the parents and child Hum Reprod Feb30(2)373-9
SA Relationships Register Bill
Rationale
bull Recognise same-sex relationships
bull Recognise intersex status
bull amendments to various existing Acts
Introduced by
bull Left wing of State Labor 22 Sept 2016
Slipped in late
bull Part 6 Amendments to Family Relationships Act
(Sect 10)
bull same-sex and single parents able to access
domestic surrogacy
bull Surrogate re-imbursements
On Second Thoughtshellip
bull Bill to be split
bull Improving access to surrogacy to be
separate bill
Surrogacy Eligibility Bill
Law Reform Required
State-Based
bull Rules on surrogacy-related advertising reviewed in the context of non-profit organisations
bull Expenses to allow for inconvenience payments to surrogates
Law Reform
State-Based Law Reform
bull Rules on surrogacy-related advertising reviewed in the context of non-profit organisations
bull Expenses to allow for inconvenience payments to surrogates
Family Court
bull Remove transfer-of-parentage from the Courts system providing much quicker legal
recognition for intended parents
Policy Reform
State-Based Law Reform
bull Rules on surrogacy-related advertising reviewed in the context of non-profit organisations
bull Expenses to allow for inconvenience payments to surrogates
Family Court Law Reform
bull Remove transfer-of-parentage from the Courts system providing much quicker legal
recognition for intended parents
Medicare Reform
bull Medicare rebate for surrogacy-related IVF where there is a medical need
GROWING DOMESTIC
CAPACITY
Well-managed domestic surrogacy so fewer need to go abroad
Evidence-Based Research
Aim
bull Determine what personality traits amp
lifestyle factors best predict a
psychologically healthy surrogacy
arrangement
Outcomes
bull validate the most accurate indicators of
surrogate amp Intended Parent
lsquoappropriatenessrsquo
Rationale
bull Ensure professional counselling practice
supporting by evidence-based research
bull Screen out inappropriate surrogates amp
IPs
Provide understanding of what traits define healthy arrangements
Evidence-Based Research
University partner
bull Ethics Application
bull Funding sought via FSA grant Govt
Design
Retrospective measurement in past Australian
surrogates amp IPs of
bull Personality traits
bull Satisfaction with interpersonal relationships
bull Levels of conflict support
bull Quality of ongoing relationship
Pre-Match Screening
Pilot Project 1
bull Three year project
bull Ethics Approved
bull Provide professional screening of
surrogates and intended parents
BEFORE they meet
Well-managed domestic surrogacy so fewer need to go abroad
Rationale
bull Avoid surrogates amp IPs having to trawl the net
bull Avoid inappropriate matches
bull Screen out surrogates with wrong motives
bull Provide IPs and surrogates with more
confidence about engaging at home
Evaluation
Tracking amongst participants and control group of
bull surrogate amp Intended Parents personality traits
bull surrogacy outcomes amp relationship quality
bull Attract potential surrogates amp IPs via website
amp social media (unpaid)
bull Intended Parents pay membership fee
bull Informed Consent amp Confidentiality
documentation
bull Referred to Psychologist for interview amp
screening
Pre-Match Screening
bull Reports generated amp provided to NFP for
lsquomatchingrsquo
bull Surrogates undergo medical screening
bull Surrogates who pass screening provided
with 2-3 profiles of IPs who are a good
match
bull Surrogate chooses favoured profile and
an introduction is made
Support Post Matching
Pilot Project 2
bull Availability of timely professional support
after surrogacy approval
Rationale
bull Surrogacy a complex emotional and
psychological journey for IPs amp
surrogates
bull Surrogate-run social media support can
only go so far
Some IVF clinics already consideringattempting this
IS POLICY IN LINE WITH
COMMUNITY ATTITUDES
What Do Australians Think of
Surrogacy
bull Which groups should be able to access surrogacy
bull Level of support for financial compensation
bull Concerns with surrogate compensation
bull Support for the use of agencies to recruit screen and place surrogates
Methodology
bull Approach Ethics approved to enable publication
bull Length amp mode 20 item online survey
bull Timing Dec 28th 2015 - Jan 15th 2016
bull Sample size 500 Australians aged 18 - 49 years (reproductive age)
bull Sample make-up Representative age gender and socio-demographic distribution
bull Those with past surrogacy experience ( themselves family member or friend) excluded to
avoid bias
Support for Surrogate Matching in
Australia
Yes should be allowed
50No
17
Donrsquot Know33
References
Harris K Fitzgerald O Paul RC Macaldowie A Lee E amp Chambers GM 2016 Assisted reproductive technology in Australia
and New Zealand 2014 Sydney National Perinatal Epidemiology and Statistics Unit the University of New South Wales
Everingham SG Stafford-Bell MA Hammarberg K Australians Use of surrogacy MJA 2014 201 (5)1-4
Jadva V Blake L Casey P and Golombok S (2012) Surrogacy families 10 years on relationship with the surrogate
decisions over disclosure and childrenrsquos understanding of their surrogacy origins Human Reproduction Vol27 No10 pp
3008ndash3014
Jadva V Imrie S Golombok S (2015) Surrogate mothers 10 years on a longitudinal study of psychological well-being and
relationships with the parents and child Hum Reprod Feb30(2)373-9
Law Reform Required
State-Based
bull Rules on surrogacy-related advertising reviewed in the context of non-profit organisations
bull Expenses to allow for inconvenience payments to surrogates
Law Reform
State-Based Law Reform
bull Rules on surrogacy-related advertising reviewed in the context of non-profit organisations
bull Expenses to allow for inconvenience payments to surrogates
Family Court
bull Remove transfer-of-parentage from the Courts system providing much quicker legal
recognition for intended parents
Policy Reform
State-Based Law Reform
bull Rules on surrogacy-related advertising reviewed in the context of non-profit organisations
bull Expenses to allow for inconvenience payments to surrogates
Family Court Law Reform
bull Remove transfer-of-parentage from the Courts system providing much quicker legal
recognition for intended parents
Medicare Reform
bull Medicare rebate for surrogacy-related IVF where there is a medical need
GROWING DOMESTIC
CAPACITY
Well-managed domestic surrogacy so fewer need to go abroad
Evidence-Based Research
Aim
bull Determine what personality traits amp
lifestyle factors best predict a
psychologically healthy surrogacy
arrangement
Outcomes
bull validate the most accurate indicators of
surrogate amp Intended Parent
lsquoappropriatenessrsquo
Rationale
bull Ensure professional counselling practice
supporting by evidence-based research
bull Screen out inappropriate surrogates amp
IPs
Provide understanding of what traits define healthy arrangements
Evidence-Based Research
University partner
bull Ethics Application
bull Funding sought via FSA grant Govt
Design
Retrospective measurement in past Australian
surrogates amp IPs of
bull Personality traits
bull Satisfaction with interpersonal relationships
bull Levels of conflict support
bull Quality of ongoing relationship
Pre-Match Screening
Pilot Project 1
bull Three year project
bull Ethics Approved
bull Provide professional screening of
surrogates and intended parents
BEFORE they meet
Well-managed domestic surrogacy so fewer need to go abroad
Rationale
bull Avoid surrogates amp IPs having to trawl the net
bull Avoid inappropriate matches
bull Screen out surrogates with wrong motives
bull Provide IPs and surrogates with more
confidence about engaging at home
Evaluation
Tracking amongst participants and control group of
bull surrogate amp Intended Parents personality traits
bull surrogacy outcomes amp relationship quality
bull Attract potential surrogates amp IPs via website
amp social media (unpaid)
bull Intended Parents pay membership fee
bull Informed Consent amp Confidentiality
documentation
bull Referred to Psychologist for interview amp
screening
Pre-Match Screening
bull Reports generated amp provided to NFP for
lsquomatchingrsquo
bull Surrogates undergo medical screening
bull Surrogates who pass screening provided
with 2-3 profiles of IPs who are a good
match
bull Surrogate chooses favoured profile and
an introduction is made
Support Post Matching
Pilot Project 2
bull Availability of timely professional support
after surrogacy approval
Rationale
bull Surrogacy a complex emotional and
psychological journey for IPs amp
surrogates
bull Surrogate-run social media support can
only go so far
Some IVF clinics already consideringattempting this
IS POLICY IN LINE WITH
COMMUNITY ATTITUDES
What Do Australians Think of
Surrogacy
bull Which groups should be able to access surrogacy
bull Level of support for financial compensation
bull Concerns with surrogate compensation
bull Support for the use of agencies to recruit screen and place surrogates
Methodology
bull Approach Ethics approved to enable publication
bull Length amp mode 20 item online survey
bull Timing Dec 28th 2015 - Jan 15th 2016
bull Sample size 500 Australians aged 18 - 49 years (reproductive age)
bull Sample make-up Representative age gender and socio-demographic distribution
bull Those with past surrogacy experience ( themselves family member or friend) excluded to
avoid bias
Support for Surrogate Matching in
Australia
Yes should be allowed
50No
17
Donrsquot Know33
References
Harris K Fitzgerald O Paul RC Macaldowie A Lee E amp Chambers GM 2016 Assisted reproductive technology in Australia
and New Zealand 2014 Sydney National Perinatal Epidemiology and Statistics Unit the University of New South Wales
Everingham SG Stafford-Bell MA Hammarberg K Australians Use of surrogacy MJA 2014 201 (5)1-4
Jadva V Blake L Casey P and Golombok S (2012) Surrogacy families 10 years on relationship with the surrogate
decisions over disclosure and childrenrsquos understanding of their surrogacy origins Human Reproduction Vol27 No10 pp
3008ndash3014
Jadva V Imrie S Golombok S (2015) Surrogate mothers 10 years on a longitudinal study of psychological well-being and
relationships with the parents and child Hum Reprod Feb30(2)373-9
Law Reform
State-Based Law Reform
bull Rules on surrogacy-related advertising reviewed in the context of non-profit organisations
bull Expenses to allow for inconvenience payments to surrogates
Family Court
bull Remove transfer-of-parentage from the Courts system providing much quicker legal
recognition for intended parents
Policy Reform
State-Based Law Reform
bull Rules on surrogacy-related advertising reviewed in the context of non-profit organisations
bull Expenses to allow for inconvenience payments to surrogates
Family Court Law Reform
bull Remove transfer-of-parentage from the Courts system providing much quicker legal
recognition for intended parents
Medicare Reform
bull Medicare rebate for surrogacy-related IVF where there is a medical need
GROWING DOMESTIC
CAPACITY
Well-managed domestic surrogacy so fewer need to go abroad
Evidence-Based Research
Aim
bull Determine what personality traits amp
lifestyle factors best predict a
psychologically healthy surrogacy
arrangement
Outcomes
bull validate the most accurate indicators of
surrogate amp Intended Parent
lsquoappropriatenessrsquo
Rationale
bull Ensure professional counselling practice
supporting by evidence-based research
bull Screen out inappropriate surrogates amp
IPs
Provide understanding of what traits define healthy arrangements
Evidence-Based Research
University partner
bull Ethics Application
bull Funding sought via FSA grant Govt
Design
Retrospective measurement in past Australian
surrogates amp IPs of
bull Personality traits
bull Satisfaction with interpersonal relationships
bull Levels of conflict support
bull Quality of ongoing relationship
Pre-Match Screening
Pilot Project 1
bull Three year project
bull Ethics Approved
bull Provide professional screening of
surrogates and intended parents
BEFORE they meet
Well-managed domestic surrogacy so fewer need to go abroad
Rationale
bull Avoid surrogates amp IPs having to trawl the net
bull Avoid inappropriate matches
bull Screen out surrogates with wrong motives
bull Provide IPs and surrogates with more
confidence about engaging at home
Evaluation
Tracking amongst participants and control group of
bull surrogate amp Intended Parents personality traits
bull surrogacy outcomes amp relationship quality
bull Attract potential surrogates amp IPs via website
amp social media (unpaid)
bull Intended Parents pay membership fee
bull Informed Consent amp Confidentiality
documentation
bull Referred to Psychologist for interview amp
screening
Pre-Match Screening
bull Reports generated amp provided to NFP for
lsquomatchingrsquo
bull Surrogates undergo medical screening
bull Surrogates who pass screening provided
with 2-3 profiles of IPs who are a good
match
bull Surrogate chooses favoured profile and
an introduction is made
Support Post Matching
Pilot Project 2
bull Availability of timely professional support
after surrogacy approval
Rationale
bull Surrogacy a complex emotional and
psychological journey for IPs amp
surrogates
bull Surrogate-run social media support can
only go so far
Some IVF clinics already consideringattempting this
IS POLICY IN LINE WITH
COMMUNITY ATTITUDES
What Do Australians Think of
Surrogacy
bull Which groups should be able to access surrogacy
bull Level of support for financial compensation
bull Concerns with surrogate compensation
bull Support for the use of agencies to recruit screen and place surrogates
Methodology
bull Approach Ethics approved to enable publication
bull Length amp mode 20 item online survey
bull Timing Dec 28th 2015 - Jan 15th 2016
bull Sample size 500 Australians aged 18 - 49 years (reproductive age)
bull Sample make-up Representative age gender and socio-demographic distribution
bull Those with past surrogacy experience ( themselves family member or friend) excluded to
avoid bias
Support for Surrogate Matching in
Australia
Yes should be allowed
50No
17
Donrsquot Know33
References
Harris K Fitzgerald O Paul RC Macaldowie A Lee E amp Chambers GM 2016 Assisted reproductive technology in Australia
and New Zealand 2014 Sydney National Perinatal Epidemiology and Statistics Unit the University of New South Wales
Everingham SG Stafford-Bell MA Hammarberg K Australians Use of surrogacy MJA 2014 201 (5)1-4
Jadva V Blake L Casey P and Golombok S (2012) Surrogacy families 10 years on relationship with the surrogate
decisions over disclosure and childrenrsquos understanding of their surrogacy origins Human Reproduction Vol27 No10 pp
3008ndash3014
Jadva V Imrie S Golombok S (2015) Surrogate mothers 10 years on a longitudinal study of psychological well-being and
relationships with the parents and child Hum Reprod Feb30(2)373-9
Policy Reform
State-Based Law Reform
bull Rules on surrogacy-related advertising reviewed in the context of non-profit organisations
bull Expenses to allow for inconvenience payments to surrogates
Family Court Law Reform
bull Remove transfer-of-parentage from the Courts system providing much quicker legal
recognition for intended parents
Medicare Reform
bull Medicare rebate for surrogacy-related IVF where there is a medical need
GROWING DOMESTIC
CAPACITY
Well-managed domestic surrogacy so fewer need to go abroad
Evidence-Based Research
Aim
bull Determine what personality traits amp
lifestyle factors best predict a
psychologically healthy surrogacy
arrangement
Outcomes
bull validate the most accurate indicators of
surrogate amp Intended Parent
lsquoappropriatenessrsquo
Rationale
bull Ensure professional counselling practice
supporting by evidence-based research
bull Screen out inappropriate surrogates amp
IPs
Provide understanding of what traits define healthy arrangements
Evidence-Based Research
University partner
bull Ethics Application
bull Funding sought via FSA grant Govt
Design
Retrospective measurement in past Australian
surrogates amp IPs of
bull Personality traits
bull Satisfaction with interpersonal relationships
bull Levels of conflict support
bull Quality of ongoing relationship
Pre-Match Screening
Pilot Project 1
bull Three year project
bull Ethics Approved
bull Provide professional screening of
surrogates and intended parents
BEFORE they meet
Well-managed domestic surrogacy so fewer need to go abroad
Rationale
bull Avoid surrogates amp IPs having to trawl the net
bull Avoid inappropriate matches
bull Screen out surrogates with wrong motives
bull Provide IPs and surrogates with more
confidence about engaging at home
Evaluation
Tracking amongst participants and control group of
bull surrogate amp Intended Parents personality traits
bull surrogacy outcomes amp relationship quality
bull Attract potential surrogates amp IPs via website
amp social media (unpaid)
bull Intended Parents pay membership fee
bull Informed Consent amp Confidentiality
documentation
bull Referred to Psychologist for interview amp
screening
Pre-Match Screening
bull Reports generated amp provided to NFP for
lsquomatchingrsquo
bull Surrogates undergo medical screening
bull Surrogates who pass screening provided
with 2-3 profiles of IPs who are a good
match
bull Surrogate chooses favoured profile and
an introduction is made
Support Post Matching
Pilot Project 2
bull Availability of timely professional support
after surrogacy approval
Rationale
bull Surrogacy a complex emotional and
psychological journey for IPs amp
surrogates
bull Surrogate-run social media support can
only go so far
Some IVF clinics already consideringattempting this
IS POLICY IN LINE WITH
COMMUNITY ATTITUDES
What Do Australians Think of
Surrogacy
bull Which groups should be able to access surrogacy
bull Level of support for financial compensation
bull Concerns with surrogate compensation
bull Support for the use of agencies to recruit screen and place surrogates
Methodology
bull Approach Ethics approved to enable publication
bull Length amp mode 20 item online survey
bull Timing Dec 28th 2015 - Jan 15th 2016
bull Sample size 500 Australians aged 18 - 49 years (reproductive age)
bull Sample make-up Representative age gender and socio-demographic distribution
bull Those with past surrogacy experience ( themselves family member or friend) excluded to
avoid bias
Support for Surrogate Matching in
Australia
Yes should be allowed
50No
17
Donrsquot Know33
References
Harris K Fitzgerald O Paul RC Macaldowie A Lee E amp Chambers GM 2016 Assisted reproductive technology in Australia
and New Zealand 2014 Sydney National Perinatal Epidemiology and Statistics Unit the University of New South Wales
Everingham SG Stafford-Bell MA Hammarberg K Australians Use of surrogacy MJA 2014 201 (5)1-4
Jadva V Blake L Casey P and Golombok S (2012) Surrogacy families 10 years on relationship with the surrogate
decisions over disclosure and childrenrsquos understanding of their surrogacy origins Human Reproduction Vol27 No10 pp
3008ndash3014
Jadva V Imrie S Golombok S (2015) Surrogate mothers 10 years on a longitudinal study of psychological well-being and
relationships with the parents and child Hum Reprod Feb30(2)373-9
GROWING DOMESTIC
CAPACITY
Well-managed domestic surrogacy so fewer need to go abroad
Evidence-Based Research
Aim
bull Determine what personality traits amp
lifestyle factors best predict a
psychologically healthy surrogacy
arrangement
Outcomes
bull validate the most accurate indicators of
surrogate amp Intended Parent
lsquoappropriatenessrsquo
Rationale
bull Ensure professional counselling practice
supporting by evidence-based research
bull Screen out inappropriate surrogates amp
IPs
Provide understanding of what traits define healthy arrangements
Evidence-Based Research
University partner
bull Ethics Application
bull Funding sought via FSA grant Govt
Design
Retrospective measurement in past Australian
surrogates amp IPs of
bull Personality traits
bull Satisfaction with interpersonal relationships
bull Levels of conflict support
bull Quality of ongoing relationship
Pre-Match Screening
Pilot Project 1
bull Three year project
bull Ethics Approved
bull Provide professional screening of
surrogates and intended parents
BEFORE they meet
Well-managed domestic surrogacy so fewer need to go abroad
Rationale
bull Avoid surrogates amp IPs having to trawl the net
bull Avoid inappropriate matches
bull Screen out surrogates with wrong motives
bull Provide IPs and surrogates with more
confidence about engaging at home
Evaluation
Tracking amongst participants and control group of
bull surrogate amp Intended Parents personality traits
bull surrogacy outcomes amp relationship quality
bull Attract potential surrogates amp IPs via website
amp social media (unpaid)
bull Intended Parents pay membership fee
bull Informed Consent amp Confidentiality
documentation
bull Referred to Psychologist for interview amp
screening
Pre-Match Screening
bull Reports generated amp provided to NFP for
lsquomatchingrsquo
bull Surrogates undergo medical screening
bull Surrogates who pass screening provided
with 2-3 profiles of IPs who are a good
match
bull Surrogate chooses favoured profile and
an introduction is made
Support Post Matching
Pilot Project 2
bull Availability of timely professional support
after surrogacy approval
Rationale
bull Surrogacy a complex emotional and
psychological journey for IPs amp
surrogates
bull Surrogate-run social media support can
only go so far
Some IVF clinics already consideringattempting this
IS POLICY IN LINE WITH
COMMUNITY ATTITUDES
What Do Australians Think of
Surrogacy
bull Which groups should be able to access surrogacy
bull Level of support for financial compensation
bull Concerns with surrogate compensation
bull Support for the use of agencies to recruit screen and place surrogates
Methodology
bull Approach Ethics approved to enable publication
bull Length amp mode 20 item online survey
bull Timing Dec 28th 2015 - Jan 15th 2016
bull Sample size 500 Australians aged 18 - 49 years (reproductive age)
bull Sample make-up Representative age gender and socio-demographic distribution
bull Those with past surrogacy experience ( themselves family member or friend) excluded to
avoid bias
Support for Surrogate Matching in
Australia
Yes should be allowed
50No
17
Donrsquot Know33
References
Harris K Fitzgerald O Paul RC Macaldowie A Lee E amp Chambers GM 2016 Assisted reproductive technology in Australia
and New Zealand 2014 Sydney National Perinatal Epidemiology and Statistics Unit the University of New South Wales
Everingham SG Stafford-Bell MA Hammarberg K Australians Use of surrogacy MJA 2014 201 (5)1-4
Jadva V Blake L Casey P and Golombok S (2012) Surrogacy families 10 years on relationship with the surrogate
decisions over disclosure and childrenrsquos understanding of their surrogacy origins Human Reproduction Vol27 No10 pp
3008ndash3014
Jadva V Imrie S Golombok S (2015) Surrogate mothers 10 years on a longitudinal study of psychological well-being and
relationships with the parents and child Hum Reprod Feb30(2)373-9
Evidence-Based Research
Aim
bull Determine what personality traits amp
lifestyle factors best predict a
psychologically healthy surrogacy
arrangement
Outcomes
bull validate the most accurate indicators of
surrogate amp Intended Parent
lsquoappropriatenessrsquo
Rationale
bull Ensure professional counselling practice
supporting by evidence-based research
bull Screen out inappropriate surrogates amp
IPs
Provide understanding of what traits define healthy arrangements
Evidence-Based Research
University partner
bull Ethics Application
bull Funding sought via FSA grant Govt
Design
Retrospective measurement in past Australian
surrogates amp IPs of
bull Personality traits
bull Satisfaction with interpersonal relationships
bull Levels of conflict support
bull Quality of ongoing relationship
Pre-Match Screening
Pilot Project 1
bull Three year project
bull Ethics Approved
bull Provide professional screening of
surrogates and intended parents
BEFORE they meet
Well-managed domestic surrogacy so fewer need to go abroad
Rationale
bull Avoid surrogates amp IPs having to trawl the net
bull Avoid inappropriate matches
bull Screen out surrogates with wrong motives
bull Provide IPs and surrogates with more
confidence about engaging at home
Evaluation
Tracking amongst participants and control group of
bull surrogate amp Intended Parents personality traits
bull surrogacy outcomes amp relationship quality
bull Attract potential surrogates amp IPs via website
amp social media (unpaid)
bull Intended Parents pay membership fee
bull Informed Consent amp Confidentiality
documentation
bull Referred to Psychologist for interview amp
screening
Pre-Match Screening
bull Reports generated amp provided to NFP for
lsquomatchingrsquo
bull Surrogates undergo medical screening
bull Surrogates who pass screening provided
with 2-3 profiles of IPs who are a good
match
bull Surrogate chooses favoured profile and
an introduction is made
Support Post Matching
Pilot Project 2
bull Availability of timely professional support
after surrogacy approval
Rationale
bull Surrogacy a complex emotional and
psychological journey for IPs amp
surrogates
bull Surrogate-run social media support can
only go so far
Some IVF clinics already consideringattempting this
IS POLICY IN LINE WITH
COMMUNITY ATTITUDES
What Do Australians Think of
Surrogacy
bull Which groups should be able to access surrogacy
bull Level of support for financial compensation
bull Concerns with surrogate compensation
bull Support for the use of agencies to recruit screen and place surrogates
Methodology
bull Approach Ethics approved to enable publication
bull Length amp mode 20 item online survey
bull Timing Dec 28th 2015 - Jan 15th 2016
bull Sample size 500 Australians aged 18 - 49 years (reproductive age)
bull Sample make-up Representative age gender and socio-demographic distribution
bull Those with past surrogacy experience ( themselves family member or friend) excluded to
avoid bias
Support for Surrogate Matching in
Australia
Yes should be allowed
50No
17
Donrsquot Know33
References
Harris K Fitzgerald O Paul RC Macaldowie A Lee E amp Chambers GM 2016 Assisted reproductive technology in Australia
and New Zealand 2014 Sydney National Perinatal Epidemiology and Statistics Unit the University of New South Wales
Everingham SG Stafford-Bell MA Hammarberg K Australians Use of surrogacy MJA 2014 201 (5)1-4
Jadva V Blake L Casey P and Golombok S (2012) Surrogacy families 10 years on relationship with the surrogate
decisions over disclosure and childrenrsquos understanding of their surrogacy origins Human Reproduction Vol27 No10 pp
3008ndash3014
Jadva V Imrie S Golombok S (2015) Surrogate mothers 10 years on a longitudinal study of psychological well-being and
relationships with the parents and child Hum Reprod Feb30(2)373-9
Evidence-Based Research
University partner
bull Ethics Application
bull Funding sought via FSA grant Govt
Design
Retrospective measurement in past Australian
surrogates amp IPs of
bull Personality traits
bull Satisfaction with interpersonal relationships
bull Levels of conflict support
bull Quality of ongoing relationship
Pre-Match Screening
Pilot Project 1
bull Three year project
bull Ethics Approved
bull Provide professional screening of
surrogates and intended parents
BEFORE they meet
Well-managed domestic surrogacy so fewer need to go abroad
Rationale
bull Avoid surrogates amp IPs having to trawl the net
bull Avoid inappropriate matches
bull Screen out surrogates with wrong motives
bull Provide IPs and surrogates with more
confidence about engaging at home
Evaluation
Tracking amongst participants and control group of
bull surrogate amp Intended Parents personality traits
bull surrogacy outcomes amp relationship quality
bull Attract potential surrogates amp IPs via website
amp social media (unpaid)
bull Intended Parents pay membership fee
bull Informed Consent amp Confidentiality
documentation
bull Referred to Psychologist for interview amp
screening
Pre-Match Screening
bull Reports generated amp provided to NFP for
lsquomatchingrsquo
bull Surrogates undergo medical screening
bull Surrogates who pass screening provided
with 2-3 profiles of IPs who are a good
match
bull Surrogate chooses favoured profile and
an introduction is made
Support Post Matching
Pilot Project 2
bull Availability of timely professional support
after surrogacy approval
Rationale
bull Surrogacy a complex emotional and
psychological journey for IPs amp
surrogates
bull Surrogate-run social media support can
only go so far
Some IVF clinics already consideringattempting this
IS POLICY IN LINE WITH
COMMUNITY ATTITUDES
What Do Australians Think of
Surrogacy
bull Which groups should be able to access surrogacy
bull Level of support for financial compensation
bull Concerns with surrogate compensation
bull Support for the use of agencies to recruit screen and place surrogates
Methodology
bull Approach Ethics approved to enable publication
bull Length amp mode 20 item online survey
bull Timing Dec 28th 2015 - Jan 15th 2016
bull Sample size 500 Australians aged 18 - 49 years (reproductive age)
bull Sample make-up Representative age gender and socio-demographic distribution
bull Those with past surrogacy experience ( themselves family member or friend) excluded to
avoid bias
Support for Surrogate Matching in
Australia
Yes should be allowed
50No
17
Donrsquot Know33
References
Harris K Fitzgerald O Paul RC Macaldowie A Lee E amp Chambers GM 2016 Assisted reproductive technology in Australia
and New Zealand 2014 Sydney National Perinatal Epidemiology and Statistics Unit the University of New South Wales
Everingham SG Stafford-Bell MA Hammarberg K Australians Use of surrogacy MJA 2014 201 (5)1-4
Jadva V Blake L Casey P and Golombok S (2012) Surrogacy families 10 years on relationship with the surrogate
decisions over disclosure and childrenrsquos understanding of their surrogacy origins Human Reproduction Vol27 No10 pp
3008ndash3014
Jadva V Imrie S Golombok S (2015) Surrogate mothers 10 years on a longitudinal study of psychological well-being and
relationships with the parents and child Hum Reprod Feb30(2)373-9
Pre-Match Screening
Pilot Project 1
bull Three year project
bull Ethics Approved
bull Provide professional screening of
surrogates and intended parents
BEFORE they meet
Well-managed domestic surrogacy so fewer need to go abroad
Rationale
bull Avoid surrogates amp IPs having to trawl the net
bull Avoid inappropriate matches
bull Screen out surrogates with wrong motives
bull Provide IPs and surrogates with more
confidence about engaging at home
Evaluation
Tracking amongst participants and control group of
bull surrogate amp Intended Parents personality traits
bull surrogacy outcomes amp relationship quality
bull Attract potential surrogates amp IPs via website
amp social media (unpaid)
bull Intended Parents pay membership fee
bull Informed Consent amp Confidentiality
documentation
bull Referred to Psychologist for interview amp
screening
Pre-Match Screening
bull Reports generated amp provided to NFP for
lsquomatchingrsquo
bull Surrogates undergo medical screening
bull Surrogates who pass screening provided
with 2-3 profiles of IPs who are a good
match
bull Surrogate chooses favoured profile and
an introduction is made
Support Post Matching
Pilot Project 2
bull Availability of timely professional support
after surrogacy approval
Rationale
bull Surrogacy a complex emotional and
psychological journey for IPs amp
surrogates
bull Surrogate-run social media support can
only go so far
Some IVF clinics already consideringattempting this
IS POLICY IN LINE WITH
COMMUNITY ATTITUDES
What Do Australians Think of
Surrogacy
bull Which groups should be able to access surrogacy
bull Level of support for financial compensation
bull Concerns with surrogate compensation
bull Support for the use of agencies to recruit screen and place surrogates
Methodology
bull Approach Ethics approved to enable publication
bull Length amp mode 20 item online survey
bull Timing Dec 28th 2015 - Jan 15th 2016
bull Sample size 500 Australians aged 18 - 49 years (reproductive age)
bull Sample make-up Representative age gender and socio-demographic distribution
bull Those with past surrogacy experience ( themselves family member or friend) excluded to
avoid bias
Support for Surrogate Matching in
Australia
Yes should be allowed
50No
17
Donrsquot Know33
References
Harris K Fitzgerald O Paul RC Macaldowie A Lee E amp Chambers GM 2016 Assisted reproductive technology in Australia
and New Zealand 2014 Sydney National Perinatal Epidemiology and Statistics Unit the University of New South Wales
Everingham SG Stafford-Bell MA Hammarberg K Australians Use of surrogacy MJA 2014 201 (5)1-4
Jadva V Blake L Casey P and Golombok S (2012) Surrogacy families 10 years on relationship with the surrogate
decisions over disclosure and childrenrsquos understanding of their surrogacy origins Human Reproduction Vol27 No10 pp
3008ndash3014
Jadva V Imrie S Golombok S (2015) Surrogate mothers 10 years on a longitudinal study of psychological well-being and
relationships with the parents and child Hum Reprod Feb30(2)373-9
bull Attract potential surrogates amp IPs via website
amp social media (unpaid)
bull Intended Parents pay membership fee
bull Informed Consent amp Confidentiality
documentation
bull Referred to Psychologist for interview amp
screening
Pre-Match Screening
bull Reports generated amp provided to NFP for
lsquomatchingrsquo
bull Surrogates undergo medical screening
bull Surrogates who pass screening provided
with 2-3 profiles of IPs who are a good
match
bull Surrogate chooses favoured profile and
an introduction is made
Support Post Matching
Pilot Project 2
bull Availability of timely professional support
after surrogacy approval
Rationale
bull Surrogacy a complex emotional and
psychological journey for IPs amp
surrogates
bull Surrogate-run social media support can
only go so far
Some IVF clinics already consideringattempting this
IS POLICY IN LINE WITH
COMMUNITY ATTITUDES
What Do Australians Think of
Surrogacy
bull Which groups should be able to access surrogacy
bull Level of support for financial compensation
bull Concerns with surrogate compensation
bull Support for the use of agencies to recruit screen and place surrogates
Methodology
bull Approach Ethics approved to enable publication
bull Length amp mode 20 item online survey
bull Timing Dec 28th 2015 - Jan 15th 2016
bull Sample size 500 Australians aged 18 - 49 years (reproductive age)
bull Sample make-up Representative age gender and socio-demographic distribution
bull Those with past surrogacy experience ( themselves family member or friend) excluded to
avoid bias
Support for Surrogate Matching in
Australia
Yes should be allowed
50No
17
Donrsquot Know33
References
Harris K Fitzgerald O Paul RC Macaldowie A Lee E amp Chambers GM 2016 Assisted reproductive technology in Australia
and New Zealand 2014 Sydney National Perinatal Epidemiology and Statistics Unit the University of New South Wales
Everingham SG Stafford-Bell MA Hammarberg K Australians Use of surrogacy MJA 2014 201 (5)1-4
Jadva V Blake L Casey P and Golombok S (2012) Surrogacy families 10 years on relationship with the surrogate
decisions over disclosure and childrenrsquos understanding of their surrogacy origins Human Reproduction Vol27 No10 pp
3008ndash3014
Jadva V Imrie S Golombok S (2015) Surrogate mothers 10 years on a longitudinal study of psychological well-being and
relationships with the parents and child Hum Reprod Feb30(2)373-9
Support Post Matching
Pilot Project 2
bull Availability of timely professional support
after surrogacy approval
Rationale
bull Surrogacy a complex emotional and
psychological journey for IPs amp
surrogates
bull Surrogate-run social media support can
only go so far
Some IVF clinics already consideringattempting this
IS POLICY IN LINE WITH
COMMUNITY ATTITUDES
What Do Australians Think of
Surrogacy
bull Which groups should be able to access surrogacy
bull Level of support for financial compensation
bull Concerns with surrogate compensation
bull Support for the use of agencies to recruit screen and place surrogates
Methodology
bull Approach Ethics approved to enable publication
bull Length amp mode 20 item online survey
bull Timing Dec 28th 2015 - Jan 15th 2016
bull Sample size 500 Australians aged 18 - 49 years (reproductive age)
bull Sample make-up Representative age gender and socio-demographic distribution
bull Those with past surrogacy experience ( themselves family member or friend) excluded to
avoid bias
Support for Surrogate Matching in
Australia
Yes should be allowed
50No
17
Donrsquot Know33
References
Harris K Fitzgerald O Paul RC Macaldowie A Lee E amp Chambers GM 2016 Assisted reproductive technology in Australia
and New Zealand 2014 Sydney National Perinatal Epidemiology and Statistics Unit the University of New South Wales
Everingham SG Stafford-Bell MA Hammarberg K Australians Use of surrogacy MJA 2014 201 (5)1-4
Jadva V Blake L Casey P and Golombok S (2012) Surrogacy families 10 years on relationship with the surrogate
decisions over disclosure and childrenrsquos understanding of their surrogacy origins Human Reproduction Vol27 No10 pp
3008ndash3014
Jadva V Imrie S Golombok S (2015) Surrogate mothers 10 years on a longitudinal study of psychological well-being and
relationships with the parents and child Hum Reprod Feb30(2)373-9
IS POLICY IN LINE WITH
COMMUNITY ATTITUDES
What Do Australians Think of
Surrogacy
bull Which groups should be able to access surrogacy
bull Level of support for financial compensation
bull Concerns with surrogate compensation
bull Support for the use of agencies to recruit screen and place surrogates
Methodology
bull Approach Ethics approved to enable publication
bull Length amp mode 20 item online survey
bull Timing Dec 28th 2015 - Jan 15th 2016
bull Sample size 500 Australians aged 18 - 49 years (reproductive age)
bull Sample make-up Representative age gender and socio-demographic distribution
bull Those with past surrogacy experience ( themselves family member or friend) excluded to
avoid bias
Support for Surrogate Matching in
Australia
Yes should be allowed
50No
17
Donrsquot Know33
References
Harris K Fitzgerald O Paul RC Macaldowie A Lee E amp Chambers GM 2016 Assisted reproductive technology in Australia
and New Zealand 2014 Sydney National Perinatal Epidemiology and Statistics Unit the University of New South Wales
Everingham SG Stafford-Bell MA Hammarberg K Australians Use of surrogacy MJA 2014 201 (5)1-4
Jadva V Blake L Casey P and Golombok S (2012) Surrogacy families 10 years on relationship with the surrogate
decisions over disclosure and childrenrsquos understanding of their surrogacy origins Human Reproduction Vol27 No10 pp
3008ndash3014
Jadva V Imrie S Golombok S (2015) Surrogate mothers 10 years on a longitudinal study of psychological well-being and
relationships with the parents and child Hum Reprod Feb30(2)373-9
What Do Australians Think of
Surrogacy
bull Which groups should be able to access surrogacy
bull Level of support for financial compensation
bull Concerns with surrogate compensation
bull Support for the use of agencies to recruit screen and place surrogates
Methodology
bull Approach Ethics approved to enable publication
bull Length amp mode 20 item online survey
bull Timing Dec 28th 2015 - Jan 15th 2016
bull Sample size 500 Australians aged 18 - 49 years (reproductive age)
bull Sample make-up Representative age gender and socio-demographic distribution
bull Those with past surrogacy experience ( themselves family member or friend) excluded to
avoid bias
Support for Surrogate Matching in
Australia
Yes should be allowed
50No
17
Donrsquot Know33
References
Harris K Fitzgerald O Paul RC Macaldowie A Lee E amp Chambers GM 2016 Assisted reproductive technology in Australia
and New Zealand 2014 Sydney National Perinatal Epidemiology and Statistics Unit the University of New South Wales
Everingham SG Stafford-Bell MA Hammarberg K Australians Use of surrogacy MJA 2014 201 (5)1-4
Jadva V Blake L Casey P and Golombok S (2012) Surrogacy families 10 years on relationship with the surrogate
decisions over disclosure and childrenrsquos understanding of their surrogacy origins Human Reproduction Vol27 No10 pp
3008ndash3014
Jadva V Imrie S Golombok S (2015) Surrogate mothers 10 years on a longitudinal study of psychological well-being and
relationships with the parents and child Hum Reprod Feb30(2)373-9
Methodology
bull Approach Ethics approved to enable publication
bull Length amp mode 20 item online survey
bull Timing Dec 28th 2015 - Jan 15th 2016
bull Sample size 500 Australians aged 18 - 49 years (reproductive age)
bull Sample make-up Representative age gender and socio-demographic distribution
bull Those with past surrogacy experience ( themselves family member or friend) excluded to
avoid bias
Support for Surrogate Matching in
Australia
Yes should be allowed
50No
17
Donrsquot Know33
References
Harris K Fitzgerald O Paul RC Macaldowie A Lee E amp Chambers GM 2016 Assisted reproductive technology in Australia
and New Zealand 2014 Sydney National Perinatal Epidemiology and Statistics Unit the University of New South Wales
Everingham SG Stafford-Bell MA Hammarberg K Australians Use of surrogacy MJA 2014 201 (5)1-4
Jadva V Blake L Casey P and Golombok S (2012) Surrogacy families 10 years on relationship with the surrogate
decisions over disclosure and childrenrsquos understanding of their surrogacy origins Human Reproduction Vol27 No10 pp
3008ndash3014
Jadva V Imrie S Golombok S (2015) Surrogate mothers 10 years on a longitudinal study of psychological well-being and
relationships with the parents and child Hum Reprod Feb30(2)373-9
Support for Surrogate Matching in
Australia
Yes should be allowed
50No
17
Donrsquot Know33
References
Harris K Fitzgerald O Paul RC Macaldowie A Lee E amp Chambers GM 2016 Assisted reproductive technology in Australia
and New Zealand 2014 Sydney National Perinatal Epidemiology and Statistics Unit the University of New South Wales
Everingham SG Stafford-Bell MA Hammarberg K Australians Use of surrogacy MJA 2014 201 (5)1-4
Jadva V Blake L Casey P and Golombok S (2012) Surrogacy families 10 years on relationship with the surrogate
decisions over disclosure and childrenrsquos understanding of their surrogacy origins Human Reproduction Vol27 No10 pp
3008ndash3014
Jadva V Imrie S Golombok S (2015) Surrogate mothers 10 years on a longitudinal study of psychological well-being and
relationships with the parents and child Hum Reprod Feb30(2)373-9
References
Harris K Fitzgerald O Paul RC Macaldowie A Lee E amp Chambers GM 2016 Assisted reproductive technology in Australia
and New Zealand 2014 Sydney National Perinatal Epidemiology and Statistics Unit the University of New South Wales
Everingham SG Stafford-Bell MA Hammarberg K Australians Use of surrogacy MJA 2014 201 (5)1-4
Jadva V Blake L Casey P and Golombok S (2012) Surrogacy families 10 years on relationship with the surrogate
decisions over disclosure and childrenrsquos understanding of their surrogacy origins Human Reproduction Vol27 No10 pp
3008ndash3014
Jadva V Imrie S Golombok S (2015) Surrogate mothers 10 years on a longitudinal study of psychological well-being and
relationships with the parents and child Hum Reprod Feb30(2)373-9