Introduction 

 

Healthcare professionals (HCPs) should be aware that while they aren't required to be experts in the legal aspects of donor conception and surrogacy, they should have a fundamental understanding of the rights of surrogates, donors, and intended parents (IPs) throughout fertility treatment, pregnancy, birth, and early parenthood. Please refer to the legal section for more information. 

 

LGBTQ+ Parents

 

This systematic review underscores the importance of addressing the specific needs of LGBTQ+ individuals in midwifery care. The study highlights the necessity for culturally competent support and education for midwives to effectively assist LGBTQ+ people contemplating pregnancy, during the antenatal period, and throughout labour. Findings reveal variable experiences among LGBTQ+ individuals accessing midwifery care, emphasising the need for policies and practice guidelines tailored to their distinct needs. Future research should focus on the impact and outcomes of care experiences within midwifery services to further improve support for LGBTQ+ individuals and their families. Visit our page for LGBTQ+ parents here. 

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Key Terminology 

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• Intended Parents (IPs): Individuals or couples seeking parenthood through surrogacy. 

• Surrogate: A woman carrying a child for IPs. 

• Straight or Traditional Surrogacy: Surrogate provides her own eggs. 

• Host or Gestational Surrogacy: Surrogate does not provide her own eggs. 

• Implications Counselling: Counselling offered to all parties involved in surrogacy arrangements. 

 

Key Principles 

 

Surrogacy is a positive family creation option in the UK. The safety and health of the surrogate and child are paramount. Most surrogacy cases are positive experiences. Healthcare staff attitudes significantly impact surrogacy experiences. Surrogates and IPs should be treated with compassion and sensitivity. Surrogates and IPs should receive equitable care. 

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Legal Context and General Guidance 

 

Legal Position: Altruistic surrogacy is legal in the UK; commercial surrogacy is illegal. 

 

Legal Parenthood: Surrogate is legal mother until parental order is issued. 

 

Surrogacy Agreements: Not legally enforceable but guide healthcare provision. 

 

Confidentiality: Information sharing should follow surrogate's consent. Breach of confidentiality only justified in exceptional circumstances. 

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Disputes: Disputes are rare but must be handled respectfully. Surrogate's wishes paramount. Social services involvement if needed. 

 

Mental Capacity: Surrogate's mental capacity essential. IP(s)' mental capacity may be assessed if concerns arise. Child's welfare prioritised.  

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General guidance: Care in surrogacy: Guidance for the care of surrogates and intended parents in surrogate births in England and Wales.  

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Best practice screening guidance for pregnancies resulting from egg or sperm donation 

 

The rise in pregnancies resulting from egg or sperm donation poses challenges for sickle cell and thalassaemia (SCT) screening, with antenatal screening crucial for identifying carriers of haemoglobin disorders. UK NEQAS Haematology is actively raising awareness among laboratory scientists about these challenges, as evidenced by recent surveys highlighting variations in screening practices. Scenario-based assessments have revealed inconsistencies in identifying the need for screening the baby's biological father, underlining the importance of external quality assurance in reinforcing best practices. 

 

• Local screening services should contact fertility clinics for donor haemoglobinopathy results if the mother has a positive screening result. 

• If pregnancy resulted from egg donation or if the mother had a bone marrow transplant, the biological father should be invited for screening immediately. 

• All pregnant women and people, including those using fertility treatment, should be offered haemoglobinopathy testing for optimal maternal care. 

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Understanding the Risks of Fertility Treatment 

 

Main Risks: 

• Multiple Births: The primary risk associated with fertility treatment is the possibility of a multiple pregnancy or birth, which can pose serious health risks for both the mother and babies. Complications such as premature birth, low birth weight, and increased likelihood of miscarriage are common in multiple pregnancies. 

• Ovarian Hyperstimulation Syndrome (OHSS): Some women may experience a severe reaction to fertility drugs, resulting in OHSS. This condition occurs when too many eggs develop in the ovaries, causing them to become enlarged and painful. While mild cases can be managed at home with pain relief, moderate to severe OHSS can be life-threatening and requires immediate medical attention. 

 

Read more about the health risks for egg donors and surrogates here. 

 

Safety Measures: 

• Elective Single Embryo Transfer (eSET): Encourage patients to consider eSET, where only one embryo is transferred to the womb, significantly reducing the risk of multiple births and associated complications. This approach has shown no significant impact on success rates and can be particularly beneficial for older women. 

• Monitoring Symptoms: Educate patients on the symptoms of OHSS, including stomach pain, nausea, shortness of breath, and reduced urine output. Prompt reporting of these symptoms to the clinic is crucial for early intervention and management. 

 

Respectful care 

 

Healthcare professionals should be aware of the importance of creating inclusive environments that respect the identities and experiences of LGBTQ+ individuals and their families. This includes using gender-affirming language, respecting chosen names and pronouns, and recognising diverse family structures. 

 

Signposting 

 

Health professionals seeking guidance on surrogacy in the UK can turn to SurrogacyUK for expert support and resources. SurrogacyUK is dedicated to promoting safer surrogacy practices and offers tailored services for clinics, counsellors, nurses, midwives, and surrogacy coordinators. Their offerings include practical resources, training workshops, guidance on best practices, ongoing support, and insight into proposed surrogacy laws. For more information on how SurrogacyUK can support best practices in surrogacy, professionals can email them directly. 

 

Conclusion

 

Doctors, midwives, and fertility nurses play a crucial role in supporting surrogacy journeys, contributing to the creation of families. By prioritising kindness, respect, and effective communication, we can ensure a positive experience for all involved. Stay informed about your trust's surrogacy policy and consider advocating for further support and education within your practice.