Surrogates' and intended parents' experiences of surrogacy arrangements: a systematic review.

This commentary situates the recently published systematic review of empirical studies of surrogates' and intended parents' experiences of surrogacy by Kneebone, Beilby and Hammarberg within the context of increased international interest in legislative and regulatory reforms to surrogacy. The commentary evaluates the strengths of this systematic review, before turning to a discussion of how jurisdictions could introduce reforms aiming to facilitate domestic surrogacy arrangements, focusing on the UK and the Law Commission's recent proposals.

The future of surrogacy: a review of current global trends and national landscapes.

The practice of surrogacy is frequently the subject of media, scientific, social, regulatory and policy attention. Although it is, for many, an accepted form of assisted reproduction for those who would otherwise not be able to have children, surrogacy often generates strong feeling, particularly where there is any possibility of exploitation. Therefore, there is disagreement about how it should be regulated. In some countries, surrogacy is prohibited in any form, although this does not stop people using it. In others, it is unregulated but still practised. In some nations it is regulated in either a 'commercial' or an 'altruistic' model. This review article considers the possible regulatory future of surrogacy, initially from a UK perspective considering a recent review of the legal framework in a country where surrogacy works well (although some cross borders to access it), and then through an assessment of global trends and other national perspectives. It concludes that the international regulation of surrogacy, although potentially desirable, is unlikely. This being the case, it would be preferable for individual nations to regulate surrogacy so it can be undertaken in ways that are safe, ethical and protective of the best interests of children, surrogates, intended parents and families.

First clinical report of 179 surrogacy cases in the UK: implications for policy and practice.

RESEARCH QUESTION: What implications for policy and practice can be derived from outcomes and trends observed across 8 years of a surrogacy programme in two UK-regulated IVF centres (London, Cardiff)? DESIGN: Retrospective cohort study analysing surrogacy treatments undertaken between 2014 and September 2021. RESULTS: Surrogacy continues to rise in popularity in the UK despite the inability of those supporting safe and professional practice to advertise to recruit surrogates. In two IVF centres regulated by the Human Fertilisation and Embryology Authority (HFEA), both the number of surrogacy treatments and the proportion of those undertaken on behalf of same-sex male intended parents increased year on year in the period studied. From a cohort of 108 surrogates, 71 babies were born to 61 surrogates (with five pregnancies ongoing) by February 2022. No statistically significant difference in live birth rates (LBR) was observed between the heterosexual couples and same-sex male couples. Sample sizes of single and transgender intended parents were too small (n < 5) to compare. The use of vitrified oocytes in surrogacy treatments has increased year on year, while fresh oocyte use has declined since peaking in 2019. There was no significant difference in LBR between fresh and vitrified oocyte usage across the cohort. CONCLUSIONS: The number of surrogacy treatments steadily increased, with clear evidence that the proportion of same-sex male couples accessing surrogacy is a major contributor to this growth. Vitrified/warmed oocyte use now outstrips the use of fresh oocytes in the surrogacy treatment cycles studied here. The results represent a strong basis for supporting the liberalization of regulatory reform expected to be introduced in the UK later in 2022.

A Step Too Far? Whittington Hospital NHS Trust v XX [2020] UKSC 14.

This comment piece explores the decision in Whittington Hospital NHS Trust v XX [2020] UKSC 14. It argues that despite notable shifts in public policy in respect of the acceptability of surrogacy as a means of family formation in the past twenty years, the Supreme Court has taken a step too far in deciding that foreign commercial surrogacy is as widely socially accepted. This impacts on the reasonableness of any claim for damages in negligence for the costs of commercial surrogacy. It is posited that the issue of whether damages for foreign commercial surrogacy are reasonable or not will be the key battleground in future negligence cases of this type.

Fraying at the Edges: UK Surrogacy Law in 2015.

This commentary examines a series of high-profile surrogacy cases decided in 2015. Taken singly or together, these cases serve to illustrate how the UK's law on surrogacy­in particular its provisions regarding eligibility for parental orders­is not only out of date but also becoming nonsensical. These problems culminate in an evident inability of the law to protect the best interests of children born through surrogacy and indicate strongly a need for reform.

Still hazy after all these years: the law regulating surrogacy.

In 1997, Margaret Brazier was asked by the then Government to chair a review of the laws regulating surrogacy. The subsequent Brazier Report made a number of recommendations, including the need for greater regulation and the tightening of 'expenses' payments. Fifteen years on, the limitations in the legal regulation of surrogacy have become increasingly clear. Yet, none of Brazier's recommendations have been adopted, despite the clear opportunity for revisiting the regulation of surrogacy offered during the passage of the Human Fertilisation and Embryology Act (2008). In this paper, we revisit the Brazier Report in the light of subsequent developments and assess to what extent its key findings remain salient. Brazier's recommendations will thus provide a jumping off point for a critical analysis of the current state of the law regarding surrogacy.