Dr. Mary Wingfield:

I cannot answer the question on whether we funded international surrogacy. The Department of Health might be able to answer that. A couple of years ago there was one particular group of women with medical issues such that they may have required surrogacy and there may have been some funding allocated to this very small group, but I do not have any detail on that. That might be something the Department of Health could answer.

On the multiple pregnancy question, IVF was introduced in the late 1980s. One of the major adverse effects of it was that it led to an increase in multiple pregnancy. Multiple pregnancy is twins, triplets, and quadruplets. The more babies there are, the more complicated the pregnancy is. There has been a big push over the past 20 years to reduce the number of twins and triplets born via IVF. We cannot exclude it completely. In our clinic, we have a very low rate of multiple pregnancy. Our rate of twins has been less than 5% for the last couple of years.

Coming back to the surrogate, it is even more important because a twin pregnancy is a more complicated pregnancy for the mother and for the babies. In the surrogacy situation in particular, you just want to give extra protection to the surrogate mother.

In regard to regulating clinics, Dr. Campbell might have some things to say here. As doctors or people working in the area and talking to people internationally and to patients or service users, we pick up very quickly whether a clinic is practising good principles or not. I think most people can see that. We worry about trafficking and sale of children. That is so rare. I would hope that most people would pick up straight away if there were dodgy things going on in a clinic. We have had requests over the years for patients of ours who wanted to attend another clinic and do treatments that we were not happy with, and we just said no. You can see good practice where there is good practice and patients will pick up on that. Word of mouth is very important in terms of fertility care and choosing a clinic, an agency and a service. There are support groups for people having surrogacy. They will know who is providing a good service or not, and an ethical service or not. When Ireland introduced the Child and Family Relationships Act, we could no longer use anonymous sperm in Ireland and the international sperm banks co-operated with that. Dr. Campbell will discuss that more.