Dr. Mary Wingfield:

Communication with the Department of Health is very important. All of my colleagues in all of the fertility clinics throughout the country and in maternity hospitals are willing to engage in any communication and work. We have to say the Covid pandemic and cyber crisis in our health service did not help over the past two years. We did have meaningful discussions prior to that. We are close to having good legislation but we need further dialogue. I hope we can get it completed by the end of this year, which would be great. I do not want it to be delayed too long but I do not think it will be ready before the summer recess.

Regarding an upper age limit we know that pregnancy becomes more complicated as women get older. All medical conditions and complications that can arise in pregnancies, such as high blood pressure, diabetes and bleeding in pregnancy, get more common as women get older. It is not to do with the baby but the mother's health. There are medical international guidelines about surrogacy in the US, Europe and worldwide. They all recommend an upper age limit of somewhere between 40 and 45 for the surrogate. We want to protect the surrogate. We do not want to have somebody who has a medical condition. Pregnancy is getting safer and safer but it is not without risk and we really do want to protect the surrogates. We suggest that she is aged 40 or less and 45 at the very most, that she has previously had healthy and uncomplicated pregnancies and that she does not have any major medical condition. We also suggest that multiple pregnancy is avoided because it is more risky. It is to protect the surrogate. Ultimately these measures would also protect the baby because if the mother develops high blood pressure she may have to be delivered prematurely. This is not good for the baby either. These are all medical safeguards. When somebody is pregnant and carrying their own child they know the pregnancy is risky but at least they will have the joy of having a child at the end of it whereas a surrogate will not have that reward. She is not having the baby. We need to be even more mindful of the surrogate.

Counselling is crucial. I am not sure it is necessary for everybody undergoing IVF but it is crucial where a third party is involved, such as in donor pregnancies or surrogacy.

Counselling is crucial for everyone involved, including the intending parents, the surrogate, and her family, if she has a partner, and sometimes for the surrogate's children, because one of the stipulations is that the surrogate must have had children before. Therefore, her children need to be aware that she is going to be pregnant, but that they are not going to be keeping the baby and it will not be their brother or sister. A great deal of counselling is required in the context of that whole family relationship.

Everybody agrees, including international medical bodies, that the surrogate needs to have autonomy during the pregnancy. She is responsible for any decisions concerning her and her body during the pregnancy. Most of the time, there is not a problem. Situations can arise, however, such as if the intending parents, for example, decide they would like to have prenatal testing to check for genetic abnormalities in early pregnancies. That needs to be discussed in advance with the surrogate to ensure she is happy to have it done. Then, God forbid, if the baby has a problem, there can be situations where the intending parents might want to have a termination of pregnancy, but the surrogate might not want to agree it. All those kinds of scenarios need to be raised beforehand, as far as that is possible. Our experience in doing that is that we can have a very open discussion between the surrogate, and her partner, if she has one and he or she is going to be involved, and the intending parents. With those kinds of things, it is always better to think about them in advance.