Most Australian intended parents via surrogacy consider or use overseas compensated arrangements. Laws banning compensated surrogacy do not appear to deter those seeking surrogacy arrangements.
Cross-border reproductive care (CBRC) is becoming increasingly common. Little is known about the motivations and information and support needs of people who cross borders to access surrogacy. This study aimed to explore: how those considering or undertaking extraterritorial surrogacy reach their decision; what other avenues they have considered and tried to have children; their sources of information and support; and perceptions of how others view their decision. Members of two Australian parenting support forums completed an anonymous online survey. Of the 249 respondents, 51% were gay men, 43% heterosexual women and 7% heterosexual men. Most heterosexual respondents had tried to conceive spontaneously and with assisted reproductive technology before considering surrogacy. Most respondents felt supported in their decision to try extraterritorial surrogacy by close family and friends. Surrogacy-related information was mostly sourced online and from other parents through surrogacy. Few sought information from a local general practitioner or IVF clinic and those who did reported IVF clinic staff were significantly (P < 0.001) more likely than other groups to communicate negative reactions to their decision to seek surrogacy. The apparent negative attitudes to cross-border surrogacy among health professionals warrants further research into health professionals' knowledge, beliefs and attitudes relating to surrogacy.
Since the passage, in November 1995, of the ACT Substitute Parents Agreement Act, The Canberra Fertility Centre has added a true gestational carrier pregnancy programme to its established infertility and IVF services. Embryos generated are transferred as frozen-thawed embryos to the carrier in an average of 2.2 embryos per transfer. Between 1 January 1996 and 31 December 1999 the results of 49 frozen embryo transfers to 25 gestational carriers were compared with 849 frozen embryo transfers on a routine IVF programme. In the carrier group, the embryo implantation rate of 13.8% per embryo transferred is double that of an exactly comparable group of patients undergoing routine frozen-thawed embryo transfer on the same IVF programme and considerably higher than those reported in large series of frozen-thawed embryo transfers. Exclusion from the carrier pregnancy programme of patients with incipient ovarian failure results in an implantation rate of 16.7%, a clinical pregnancy rate of 29.0% and a live birth rate of 19.4% per embryo transfer procedure.
Almost half of the intended parents via surrogacy who completed this survey had undertaken compensated surrogacy overseas; most of these used donor eggs, but few considered Australian donors. A high proportion of surrogates had multiple pregnancies and there was a high rate of premature birth. These adverse outcomes could be avoided if the surrogacy was undertaken in Australia. Removing some of the existing barriers to surrogacy in Australia may reduce the number of surrogacy arrangements carried out overseas.
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