Education And Debate

Treatment by in vitro fertilisation with surrogacy: experience of one British centreSurrogacy should pay

BMJ 2000; 320 doi: https://doi.org/10.1136/bmj.320.7239.924 (Published 01 April 2000) Cite this as: BMJ 2000;320:924

Treatment by in vitro fertilisation with surrogacy: experience of one British centre

  1. Peter R Brinsden, medical director (brinsdenp@aol.com)a,
  2. Tim C Appleton, counsellorb,
  3. Elizabeth Murray, senior nursing sistera,
  4. Mohammed Hussein, research fellowa,
  5. Fidelis Akagbosu, consultant gynaecologista,
  6. Samuel F Marcus, consultant gynaecologista
  1. a Bourn Hall Clinic, Bourn, Cambridge CB3 7TR
  2. b 44 Eversden Road, Harlton, Cambridge CB3 7ET
  3. Childlessness Overcome Through Surrogacy, Loandhu Cottage, Gruids, Lairg, Sutherland IV27 4EF
  1. Correspondence to: P R Brinsden
  • Accepted 11 November 1999

Surrogacy has been an accepted form of treatment for certain forms of childlessness for centuries.1 Until recently, “natural surrogacy” was the only means of helping certain women to have babies. In vitro fertilisation surrogacy is now accepted in the United Kingdom as a treatment option for infertile women with certain clearly defined medical problems (box).

Indications for treatment by in vitro fertilisation surrogacy

  • After hysterectomy for cancer

  • Congenital absence of the uterus

  • Hysterectomy for postpartum haemorrhage

  • Repeated failure of in vitro fertilisation treatment

  • Recurrent abortion

  • Hysterectomy for menorrhagia

  • Severe medical conditions incompatible with pregnancy

In 1985, despite opposition from the BMA, Mr Patrick Steptoe and Professor Robert Edwards, the pioneers of in vitro fertilisation, first proposed treating a patient by in vitro fertilisation surrogacy at Bourn Hall Clinic. After extensive discussions with the independent ethics committee they treated the first couple in the United Kingdom, and the child was born in 1989. In 1989, the clinic's ethics committee drew up guidelines for the treatment of women by in vitro fertilisation surrogacy, and the full programme was formalised in 1990 (table 1). Since then 49 “genetic couples” have received treatment. This review describes our experience of in vitro fertilisation surrogacy since 1989 and discusses some ethical and legal issues.

Summary points

Treatment by in vitro fertilisation surrogacy is accepted in the United Kingdom for appropriate indications

In depth counselling is essential for the preparation of couples for treatment

Treatment of the commissioning couple and the host is straightforward, but must be done in clinics licensed by the Human Fertilisation and Embryology Authority

Complications of treatment are minimal with appropriate selection and counselling of couples

Review of each surrogacy arrangement by an independent ethics committee is strongly recommended

Patients and methods

In this review we have defined the couple who provide both sets of gametes as the genetic couple; they may also be known …

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