Assisted reproduction – insemination and in vitro fertilization • First IVF-baby born in 1978 • IVF is nowadays a routine treatment procedure for all indications of infertility • Tubal • Endometriosis • Poor sperm quality • Unexplained • Worldwide about 5 million IVF babies born • In 2015 in Finland 2568 children born after ART treatment (5.6 % of all children born) 1
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Worldwide about 5 million IVF babies borngyllenbergs.fi/uploads/general/Viveca_Soderstrom-Anttila.pdf · •IVF is nowadays a routine treatment procedure for all indications of infertility
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Assisted reproduction – insemination and in vitro fertilization
• First IVF-baby born in 1978
• IVF is nowadays a routine treatment procedure
for all indications of infertility
• Tubal
• Endometriosis
• Poor sperm quality
• Unexplained
• Worldwide about 5 million IVF babies born
• In 2015 in Finland 2568 children born after ART
treatment (5.6 % of all children born)
1
ART treatments 1992–2016
Lähde: THL, Hedelmöityshoitotilastot
* Ennakkotieto
Sperman- ja alkionluovutukset 2001 alkaen, inseminaatiot 2006 alkaen
0
2 000
4 000
6 000
8 000
10 000
12 000
14 000
16 000
1992 1995 2000 2005 2010 2016*
Ho
ito
jen
lu
ku
mä
ärä
IVF ICSI FET Koeputki, luovutushoidot IUI IUI, luovutushoidot
19.3% of all treatments with
donated gametes 2015
Docent Viveca Söderström-Anttila
Felicitas Mehiläinen
Helsinki, Finland
Gyllenberg symposium
Helsinki
September 23rd 2017
Surrogacy:
outcomes for surrogate mothers,
children and the resulting parents
Disclosure
▪ Docent, specialist in gynecology, obstetrics and reproductive endocrinology
▪ Main occupation
▪ Felicitas Mehiläinen, Helsinki
▪ Other engagements
▪ Board member of Signe and Ane Gyllenberg Foundation
▪ Member of NFS expert group (unconditional support by Finox)
▪ Conference presentations (Ferring, Merck, MSD)
• Definitions
• Surrogacy legislation in Europe
• Indications for surrogacy treatment
• Experience of gestational surrogacy in Finland
• Concerns related to gestational surrogacy
• Outcomes of surrogate mothers, children and intended parents
Introduction and definitions
Gestational or in vitro fertilization surrogacy (host or full surrogacy)
• an embryo from the intended parents, or from a donated oocyte or sperm, is transferred to the surrogate´s uterus.
• the woman who carries the child has no genetic connection to the child.
• First reported in 1985
Traditional (genetic or partial) surrogacy
• is the result of artificial insemination of the surrogate mother with the intended father´s sperm.
• The surrogate mother´s eggs are used, making her a genetic parent together with the intended father.
6
Surrogacy – carrying the pregnancy for intended parents:
Denmark Finland Iceland Norway Sweden
Gestational
surrogacy
Prohibited
since 1997
Prohibited
since 2007
Prohibited
since 1996
Prohibited
since 1987
Prohibited
since 1988
Traditional
surrogacy
Prohibits
assisting
contact
Unregulated Unregulated Contract not
binding
Unregulated
Surrogacy legislation in different countries
• In Europe, surrogacy is prohibited in the Nordic countries and in Austria, Bulgaria, France, Germany, Italy, Malta, and Spain.
• Altruistic, but not commercial, surrogacy is allowed in Belgium, Greece, the Netherlands, Portugal (since 2016 in certain specific situations) and the United Kingdom.
• Poland and the Czech Republic have no laws regulating surrogacy.
• Commercial surrogacy is legal in Georgia, Israel, Ukraine, Russia, India and California
• Only altruistic surrogacy allowed in many US states, Australia, Canada, and New Zealand.
8
Brunet L, et al A Comparative Study on the Regime of Surrogacy in EU
Member States. 2013. http://www.europarl.europa.eu/studies,
Indications for treatment with gestational surrogacy
1. Congenital absence of uterus; (MRKH) syndrome
2. After hysterectomy for obstetric complications
3. After hysterectomy for cancer or other uterine diseases
4. Uterus anomaly
5. Medical conditions incompatible with pregnancy
6. Biologic inability to conceive or bear a child, such as
same sex male couples or single men
Recommendations regarding gestational carriers
• A gestational carrier should be 21-45 years of age and she should have at least one child.
• Her previous pregnancies should be full-term and uncomplicated
• The carrier should not have had more than a total of five previous deliveries and three deliveries via CS
• General requirements as to the screening and the recommendations related to psychosocial consultations have been summarized by the expert groups from ESHRE and ASRM
• Surrogacy arrangements should not be commercial
10ESHRE Task Force on Ethics and Law, 2005; FIGO Committee Report, 2008; Practice
committee of ASRM, 2015)
Gestational surrogacy treatments performed in Finland
1992-2001
• 12 couples at Väestöliitto• 3 at Felicitas Clinic• 2 at Eira Hospital• 1 at Kuopio University Hospital
• Two Swedish couples, one Norwegian and one Danish couple