I thank members of the committee for the invitation to speak to them today. I am the clinical director of Merrion Fertility Clinic, a not-for-profit fertility clinic affiliated with the National Maternity Hospital. I have been working in infertility for over 30 years. I was a member of the Commission on Assisted Human Reproduction and I have been an expert witness in two High Court cases involving assisted human reproduction, AHR, one of which involved surrogacy. Today, I am speaking in a personal capacity, but I know that my views are also those of the majority of healthcare professionals working in AHR in Ireland. Dr Aoife Campbell, a senior scientist and deputy laboratory manager at Merrion Fertility Clinic, is with me. As a doctor, I will focus on the more medical aspects of surrogacy. I will also address aspects of the AHR Bill of 2022 which are relevant to this discussion.
The common medical indications for surrogacy include women who cannot carry a pregnancy for uterine or general health reasons, single men, transgender women and same-sex male couples. There are also some men whose partner has died and if a man and his partner had frozen embryos, the surviving male may wish to use these via surrogacy. From an in vitro fertilisation, IVF, point of view, the surrogacy procedure is quite simple and the results of treatment are similar to those for other people having IVF and donor egg pregnancies. Studies have shown that 30% to 70% of people will have at least one child, and that child development and health are not affected.
Regarding the practice of surrogacy in Ireland today, Merrion Fertility Clinic, is licensed by the Health Products Regulatory Authority, HPRA, to provide domestic surrogacy. However, because of the lack of legislation, we have extremely strict requirements and, to date, have completed only one case. There are two others in progress. In the last five years we have also shipped embryos overseas for three couples – one to the Ukraine and two to the US. My understanding is that other Irish clinics also ship eggs and embryos abroad for surrogacy, but none is currently offering domestic surrogacy.
If we are to legislate appropriately for surrogacy in Ireland, I make the following comments and suggestions. I believe we must promote and facilitate domestic surrogacy. The vast majority of service users would prefer this to international surrogacy. It is medically safer, especially for intending mothers who have medical conditions and who must undergo egg collection. It is also legally and ethically less complex. To encourage domestic surrogacy we must make at least 15 changes to the draft AHR Bill of 2022. I will discuss some of these and others are contained in the longer briefing document which I have supplied to the committee.
I believe that legal parentage should be assigned to the intending parents at the time of the child's birth, not four to six weeks later. This would be attractive to the intending parents. Importantly, it would also protect the surrogate mother, especially in the case of babies born with medical problems. This is the view of many Irish experts and also of the UK and Scottish law commissions. It was also the view of the Commission on Assisted Human Reproduction 17 years ago. In a survey performed by Merrion Fertility Clinic last year, 84% of 245 Irish healthcare professionals who are obstetrician gynaecologists, general practitioners, GPs, and IVF clinic staff agreed with parental parentage from birth. In discussions with paediatricians, this is also a common view among our paediatric colleagues.
The requirement for one gamete to come from an intending parent should be removed for domestic surrogacy.
This stipulation will preclude some people with fertility issues who cannot provide their own gametes. It is also not consistent with allowing parentage for adoption and for cases of embryo donation or double sperm and egg donation for people who do not have a genetic connection to their child but do not require surrogacy.
Regarding the medical requirements to be a surrogate there should be an upper age limit and the surrogate's previous pregnancies should have been uncomplicated. While advertising should not be allowed, there should be some provision for clinics or maternity hospitals to inform the public that they are willing to consider surrogacy arrangements. Otherwise it would be extremely difficult for anyone in Ireland to access potential surrogates. Men should be allowed to use eggs and embryos posthumously in the case of the death of a partner with whom they had a prior parental project and frozen eggs or embryos, if she had consented prior to death. This would usually require surrogacy. Every effort should be made to avoid multiple pregnancy because it is a greater risk for the surrogate. I have other suggestions included in the written submission.
We must legislate for international surrogacy. It is hard to see how we can avoid it. It is already here and it will continue. There are strong national and international arguments that not to legislate is contrary to children's rights principles. How this legislation would be introduced is a matter for the legal experts but I am impressed by the suggestion of a graded process whereby parentage in a domestic situation would be straightforward and easily obtained and that there would be a more complex and stringent process for international surrogacy cases.
As regards the important rights of children to know their genetic identity, the vast majority of heterosexual couples accessing surrogacy do not require donor gametes. For those who do, identifiable donors are available internationally, such as in the US. It is my experience that the vast majority of intending parents will want to do the right thing and if they cannot find a surrogate in Ireland they will choose clinics most aligned with the Irish regulations. It is also my view that many international clinics will want to comply as far as is possible with our regulations. This has certainly been our experience with international sperm banks which have had to comply with the requirements of the Children and Family Relationships Act.
As assisted human reproduction practitioners we require clarification that under the Bill we will be allowed to continue to help people who need to access surrogacy abroad, including by shipping eggs or embryos overseas for them. We should not rush the legislation. Even though I have been calling for assisted human reproduction legislation for many years I would hate to see it rushed. Assisted human reproduction is extremely complex. There are several non-surrogacy aspects of the Bill that concern me and my colleagues. These still require scrutiny and consideration. There are also several discrepancies between the Children and Family Relationships Act 2015 and the Health (Assisted Human Reproduction) Bill. This will also need to be addressed.
I would like to take this opportunity to challenge the view expressed at last week's meeting that public finding of IVF is dependent on this legislation being in place first. This is one of the arguments being used to hurry up the legislation. I would like it noted that there is absolutely no reference to funding in the assisted human reproduction Bill 2022. Neither is it part of the remit of the assisted human reproduction regulatory authority proposed in the Bill. I also note that for years the State has been funding sperm and egg freezing, which are assisted human reproduction treatments, for cancer patients. The State has also been funding all of the drugs for all IVF treatments done in Ireland. This is despite the fact we do not have legislation. I do not believe that funding should have to wait for the legislation. I also note that the Children and Family Relationships Act was passed in 2015 but the assisted human reproduction aspects were not enacted for a further five years. Fertility patients really do not have this time to wait for funding. A delay of even two years can make the difference between someone having a family or not. I thank the committee for allowing me to present my opinions today. I welcome this important debate and I look forward to further discussion.