Fertility and Family Law Trends

There have been significant trends and developments in fertility and modern family law over the last year. We have seen debate and new guidance on the merits of IVF ‘add-ons’. There has been increased focus on fertility preservation, including egg freezing and posthumous conception. There have also been changes and developments in surrogacy law and practice.

IVF ‘add-ons’

There has been growing debate and coverage about the efficacy and merits of IVF ‘add-ons’. As a result, the HFEA has today published a consensus statement together with 10 leading professional and patient fertility groups, on how IVF ‘add-ons’ should be offered ethically to patients undergoing treatment. This follows growing concerns about the benefits and costs of IVF ‘add-ons’ offered to fertility patients. The Chair of the HFEA, Sally Cheshire CBE said:

“It’s crucial that clinics are transparent about the add-on treatments they offer, including the potential costs, to ensure patients know exactly whether they are likely to increase their chance of having a baby.

“That is why we’ve been working with professional groups such as the British Fertility Society to decide how unproven treatments into clinical practice should be correctly and ethically introduced, which is a vital step towards a more transparent approach in fertility services.

“We are now expecting clinics to provide information about treatment add-ons to patients, including what evidence there is of effectiveness.”

This follows the HFEA’s decision to publish ‘traffic light’ rated information about the merits of IVF ‘add-ons’ in May 2018 and its updated guidance today. This system grades various ‘add-on’ treatments. A red rating signifies there is no evidence it is effective and safe. An amber rating signifies there is a small or conflicting body of evidence and further research is needed meaning ‘the technique cannot be recommended for routine use’. A green rating signifies there is more than one good quality trial which shows the procedure is effective and safe. However, currently none of the assessed ‘add-ons’ have been given a green rating and today’s HFEA guidance concludes ‘we don’t think any of these techniques should be used routinely.’

Significant numbers of fertility patients have invested precious time, energy and money in IVF ‘add-ons’ in the hope of having a much wanted child. Given this latest HFEA guidance about ‘add-ons’, it begs further questions about their use and benefit in treatment and the implications for patients and their families.

Fertility preservation

In today’s busy and uncertain times, there is more need than ever to consider fertility preservation and maximisation. Increasing numbers of people are leaving it longer to settle down and have children for a variety of reasons including, education, career building, economic factors and difficulties meeting a suitable partner.

Whilst we often ‘future proof’ other areas of our lives, many people are not taking adequate steps to preserve and maximise their fertility.  This can risk serious problems and heartache for those that go on to grapple with their own or a loved one’s dwindling fertility window, accident, illness or death.

Whilst egg freezing techniques have improved in recent years, there is still only limited data on success rates in practice. In 2016, egg freezing made up only 1.5% of the 68,000 treatment cycles carried out. Egg freezing is not risk free and it does not guarantee a baby.  It also carries a cost of between £7,000 – £8,000 for egg freezing, thawing and transfer.

Illness or death can strike at any time. Last year BBC broadcaster Rachael Bland went to great lengths to highlight her 2-year battle with breast cancer and her fight to preserve her fertility on her blog Big C Little Me. Her story continues to strike a chord with many women and you can read more on my blog and in my article in Female First.

There was also increased focus on posthumous conception last year. This follows a first-of-its-kind legal ruling last summer by The Court of Protection to step in and protect the sperm of a fatally injured man, who had been in the early stages of fertility treatment with his wife. I was part of the wife’s legal team and this ruling is significant because it sends an important message that in appropriate circumstances individual fertility and reproductive legacy is capable of protection. You can read more on my blog and in my comment piece.

Surrogacy law reform and practice

On 3 January 2019 new law came into operation which for the first time enables single people to apply for a parental order for their surrogate born child.  This is welcome news and follows years of calls for law reform by many in the sector including myself.

Single applicants must meet the relevant legal criteria, which includes being their child’s biological parent and applying within six month’s of the birth.  There is also a six month remedial window in which applications can be made for older surrogate born children within six months of the law changing i.e until 2 July 2019.

However, further reform is still needed to make outdated surrogacy law fit for 21st century family building in Britain. I was honoured to give expert evidence on surrogacy law reform to The All Party Parliamentary Group on Surrogacy (APPG on Surrogacy) led by Andrew Percy MP in parliament in November 2018. I was pleased to see lively discussion about the issues and to share my thoughts and suggestions for law reform following my legal work in this area over the last decade.

Fertility and family law for modern families continues to rapidly evolve. This makes it important for people to take time to understand the complex legal landscape and take proactive measures to preserve their fertility and protect their much wanted children and families.

NICE issues new IVF and fertility guidance

The National Institute for Health and Clinical Excellence (NICE) has today issued new draft guidance concerning the provision of fertility treatment and IVF on the NHS.  The new proposals recommend that the age limit for women undergoing IVF treatment on the NHS should be increased from 39 to 42 years.  The proposals also recommend for the first time that same-sex couples should qualify for fertility treatment if they have undergone six cycles of artificial insemination at a private fertility clinic. Furthermore, the proposals recommend that women should be offered fertility treatment on the NHS after two rather than three years of unsuccessful trying for a baby.

NICE guidance on the provision of IVF treatment on the NHS hasn’t been updated since 2004. It is high time this is achieved to reflect better treatment success rates, equality legislation and greater demand for IVF by women aged 35 upwards.  However, NICE guidance is not mandatory and it remains to be seen whether these new proposals will bring about greater recognition of IVF as a legitimate clinical need or greater fairness in terms of access to fertility treatment on the NHS across the country.  In the meantime, fertility patients continue to battle with the reality of the postcode lottery and varying restrictions imposed by PCT’s who continue to flout the guidance.

Infertility affects one in six couples across the UK from all  walks of life.  The IVF postcode lottery causes great distress for people when faced with the reality that they will not be offered the recommended number of free IVF cycles on the NHS or worse none at all. This can lead to relationship breakdown and depression which can blight people’s lives and cause long term misery and hardship. Private fertility treatment can cost thousands of pounds which is too often beyond the reach of couples, particularly in the current economic climate.  With an increasingly ageing population, we need to do all we can to increase the birth rate in the UK to mitigate the increasing economic burden placed upon younger generations of society.

Surrogacy and donor conception: the question of parenthood

Advances in fertility treatment have outstripped the law and this increasingly challenges traditional concepts of parenthood.  For those who have struggled for years with infertility or never thought they could have a child, they can now conceive using a sperm donor, an egg donor, a surrogate (or a combination of these).  This creates a key question: who is a parent?

Traditionally, parenthood followed biology.  The woman who gave birth to the child was legal mother and her husband was the presumed legal father.  However, it is now a far more complex question in assisted conception cases.  As growing numbers of people embrace fertility treatment, cross borders, engage foreign surrogacy organizations and conceive with donor eggs and sperm the concept of parenthood can seem confusing and unclear. This challenges existing law and policy and has resulted in a a legal jigsaw puzzle that many struggle to make sense of.

Assisted reproduction and modern family structures challenge traditional notions of family.  Increasing numbers of people are creating families through surrogacy, using a known donor who may have ongoing involvement with the family, through co-parenting arrangements or embracing family life as a solo parent.  This raises questions about the legal status and role of the individuals involved and whether parenthood should be based on biology, intent, pregnancy and birth or social parenting.

The structures of modern families are changing and assisted reproductive technology is developing at a fast pace.  The law has not kept pace with these developments and there needs to be greater understanding of the different pieces of the jigsaw that make up family building through assisted conception, sperm and egg donation and surrogacy.  Only then, can we effectively tackle the question of parenthood and put effective law and policy in place.

If you would like to discuss your personal situation in more detail or you would like more information please email me lghevaert@vardags.com.

The impact of infertility

Infertility fears are increasingly common as more and more people think about their fertility and worry about starting a family. Infertility is a difficult issue and a diagnosis of infertility can affect you deeply.

Whilst some will take a proactive approach following a diagnosis of infertility, others will struggle to come to terms with this.  Recent research shows that involuntary infertility has a big impact on self-esteem and emotional well-being in both men and women. Our sense of identity, our masculinity and femininity are linked to our fertility.  People can find it difficult to discuss the problems they might have (or fear they might have) and it can put strain on relationships and affect performance at work.

For those people whose fertility levels do not improve through lifestyle changes, it may mean they will need to turn to assisted conception.  Assisted conception can take many different forms, including IVF, ICSI, egg and sperm donation and surrogacy.  The range of choice can seem overwhelming and it can be difficult to know where to start, or perhaps to reassess the situation if fertility treatment is unsuccessful.

If you are planning a family through fertility treatment or surrogacy it is equally important to get to grips with the legal issues so that you can ensure you properly protect your parental status and you can legally secure your family unit.  Assisted conception, complex personal circumstances, an international dimension, donor conception, solo-parents, co-parents, same-sex parenting and known donation can all raise complex legal issues.

Surrogacy: what motivates its practice?

There are number of factors that motivate the practice of surrogacy around the world, including altruism, infertility, commercialism and in some cases grief.  Different jurisdictions take different approaches to surrogacy law and practice in what remains an evolving area fraught with many difficulties and challenges.

Sometimes, people are motivated to turn to surrogacy through tragedy as in the recently publicised Indian case of KP Ravikumar and his wife Karthyayani.  Their only son died unexpectedly of testicular cancer in January 2011, leaving behind a semen sample in case his cancer treatment left him infertile.  Ravikumar and his wife recently won a court order for the release of their son’s semen which they plan to use to conceive a child through surrogacy.  Their case has made headlines and brought surrogacy once again into the media spotlight.

Ravikumar, aged 59, and his wife Karthayani, aged 58, first wanted to adopt a child following the death of their son but found they were disqualified by their combined age.  Motivated by their grief and sense of loss, they turned to surrogacy.  They found a relative of Ravikumar who was willing to become a surrogate mother for them and they planned to sell some of their land to raise enough money to cover the costs of the surrogacy arrangement.  However, their surrogate subsequently backed out following intense media publicity.

Much of the publicity surrounding this case focused on the ages of Ravikumar and his wife and their desire to have their dead son’s child.  India has no formal surrogacy laws as the Assisted Reproductive Technology (ART) Regulation Bill 2010 has not yet been approved.  As a result, there is no formal age bar or other legal restrictions preventing them from entering into a surrogacy arrangement.

Whilst the story is compelling in its grief and tragedy, it raises a number of complex legal issues associated with ownership of their son’s semen, parenting in later life, the best interests of the surrogate born child and the regulation of surrogacy law and practice. The lack of legal uniformity of surrogacy around the world, combined with growing demand for surrogacy and assisted conception creates a number of challenges for law and policy makers.  This case aptly demonstrates the overwhelming desire that can motivate some to become parents through surrogacy when all else has failed and the complex issues it can create.  Assisted reproductive technology is here to stay and this makes family building possible in ways that simply was not a reality twenty or thirty years ago.

Couple win IVF postcode lottery battle against PCT

A married couple from Portsmouth have won a  rare IVF funding victory against their local PCT following a hard-fought legal battle.  The couple have tried unsuccessfully for a baby for over three years and, despite numerous appeals, were refused funding for IVF treatment on the NHS by Portsmouth City PCT, under the umbrella of South Central, due to the husband’s child from his previous marriage. Following an unsuccessful appeal through their GP, they contacted their local MP, Ms Penny Mordaunt for help, who put the couple in touch with me as a leading expert in fertility law.

Whilst this victory is very welcome, it still leaves many people facing uphill funding battles with their PCTs, which is why I have written to the Secretary of State for Health on this matter.

There needs to be routine implementation of the NICE guidance across the board. There also needs to be greater recognition and understanding of infertility, which blights too many people’s lives and better support for people struggling to have a family and those needing to undergo IVF.

It is unfair to deny a childless woman access to IVF on the NHS if her partner has a child from a previous relationship.  This actively discriminates against women and denies them the opportunity to bear their own children and become mothers.

By introducing such stringent age restrictions, it denies younger women access to treatment who have three years of proven infertility when they will have a better chance of conceiving at a younger age.  Equally it restricts access to treatment  by women who do not actively try for a baby until later in life and who struggle to achieve three years of proven infertility.

Infertility affects one in seven couples in the UK (approx 3.5 million people). The current IVF postcode lottery, coupled with conflicting IVF funding policies between PCTs causes immeasurable heartache and distress for people when faced with the stark reality that they will not be offered the recommended number of free IVF cycles on the NHS or worse none at all.  Private fertility treatment can cost thousands of pounds which is too often beyond the reach of the average couple, particularly in the current economic climate.

Fertility treatment is on the rise in the UK

The latest figures released by the Human Fertilisation and Embryology Authority (HFEA) show a six percent increase in the number of fertility treatments undergone in the UK  last year.

According to the HFEA’s annual report, approximately 45,200 women underwent fertility treatment in the UK in 2010, up from approximately 42,500 in 2009. The HFEA’s report also indicates that the number of fertility treatment cycles using donor eggs and donor sperm increased. The majority of women who underwent IVF treatment in the UK in 2010 were aged 37 years or under. The average age of women undergoing IVF was 35.

International Surrogacy: British couple allowed to keep children born to two Indian surrogate mothers

Sir Nicholas Wall, President of the Family Division gave judgment earlier this week awarding parental orders to a married British couple to secure the legal status of  their two children in their care following an international surrogacy arrangement in India.  The two children were conceived with two different Indian surrogate mothers using an anonymous egg donor and the intended father’s sperm.

The couple paid approximately £27,400 in medical and care costs, including sums of approximately £3,000 to each of the Indian surrogate mothers. The baby boy and girl were born within days of each other and are now just over a year old. Sir Nicholas ruled that the couple had acted in good faith and the amount paid to each surrogate mother was not so disproportionate that the grant of parental orders “would be an affront to public policy”. He authorised the payments made to the two Indian surrogate mothers, notwithstanding the public policy restriction against commercial surrogacy in the UK on the basis that it was in the children’s best interests to be brought up by their intended parents.

This legal judgment is the second to be published by the English court this year involving British couples who have entered into an international surrogacy arrangement in India. It follows a handful of other published cases  involving British couples who have entered into international surrogacy arrangements in certain US surrogacy friendly states and the Ukraine and who successfully secured parental orders for their surrogate born children.

Surrogacy lawyer in US international baby-selling ring sentenced

The first of three women who pleaded guilty to her role in an international baby-selling ring has been sentenced to one year in custody by a US federal judge according to a news report in Signon San Diego.  The judge admonished her for preying on people’s desire to have children and said she had brought the legal profession into disrepute.

Former Maryland lawyer, Hilary Neiman, was also ordered by US District Judge Anthony Battaglia to forfeit $133,000 being the known profits that prosecutors said she made for her part in the fraud.

The sentence was more severe than the nine months home confinement both sides had agreed.  The judge disagreed and sentenced her to five months in prison and a further seven months in home confinement following her guilty plea in April to conspiracy to commit wire fraud. The judge said he was not convinced that she fully appreciated the seriousness of her involvement in the fraud.

Hilary Neiman was charged alongside a former prominent US surrogacy lawyer from Poway and a woman from Las Vegas for the fraud which profited from surrogacy laws in California. They recruited US surrogate mothers to travel to the Ukraine for IVF treatment and then found parents to “assume” fake surrogacy agreements for sums reported to cost around $100,000. The other two women are due to be sentenced in January 2012.

The fraud has sent shock waves through the international surrogacy and fertility law community and graphically demonstrates the need for anyone contemplating an international surrogacy arrangement to take great care and to obtain reputable expert legal help.

International surrogacy law: Bulgaria moves to legalize surrogacy

As the global surrogacy and fertility sector continues to expand, Bulgaria’s Parliament has approved a first reading of an amending and supplementary bill to the Family Code to legalize surrogacy according to a recent report by FOCUS News Agency.

Surrogacy is reported to have existed unlawfully in Bulgaria in the past according to Kalina Krumova, an MP from the Ataka party who moved the bill. Ms Krumova added that those Bulgarians who needed surrogacy would travel to other countries like the Ukraine where surrogacy is legal and that more than 270,000 Bulgarian families have reproductive problems.

Whilst Bulgaria looks to change its  law and policy surrounding surrogacy, many other countries continue to ban surrogacy or limit its practice.  This lack of legal harmonization raises complex issues and problems in law and practice for increasing numbers of people looking to build their family through surrogacy and particularly those that enter into international surrogacy arrangements.