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