Surrogacy is sometimes the only way for couples to fulfil the desire to have children of their own. However, in many countries there is still no legal framework to support it. Greece is one of the exceptions – surrogacy has been legal there since 2004. In this webinar, Dr. Danny Daphnis, Scientific Director at Mediterranean Fertility Institute (Chania), and Katerina Dimotaki (Director of the Surrogacy Programme) are talking about surrogacy options in Greece – legal framework, the process and outcomes.
Surrogacy is defined as “the practice by which a woman (called a surrogate mother) becomes pregnant and gives birth to a baby in order to give it to someone who cannot have children.” It is a part of the Assisted Reproduction Techniques (ART) – which means it cannot be performed without IVF.
There are two types of surrogacy: traditional surrogacy and gestational surrogacy. The former describes the situation when the surrogate’s eggs are inseminated, making her the biological mother of the child she carries. Therefore, she does not only carry the child but her DNA also constitutes half of the child’s DNA. Dr Daphnis stresses that traditional surrogacy is prohibited in Greece. Gestational surrogacy, on the other hand, is allowed by the Greek law and it refers to the procedure in which the oocytes of the intended mother or from an anonymous egg donor are fertilised by the sperm of the intended father (or an anonymous egg donor). The embryos that are created are then transferred into the uterus of the surrogate mother. In such a way, the surrogate has no genetic relation to the baby.
Dr Daphnis admits that the idea of a surrogate mother has changed and expanded over the last 10-15 years and more countries have been introducing it into the scope of the ART techniques they are using. However, a lot of countries have banned it as well, due to the abuse and misuse of surrogacy happening in some parts of the world. Fortunately, one can now observe growing awareness and acceptance of this technique by global societies. As there has been an increased demand for these programmes over the last years, neither religion nor laws become obstacles in accepting it anymore.
According to Dr Daphnis, the main clinical objective in gestational surrogacy is to acquire the right number of oocytes from the surrogate mother or an anonymous egg donor. Then, it is expected to transfer one or two embryos into the uterus of the surrogate mother and have the rest of the embryos frozen. In order to achieve the goals, IVF laboratories have to maintain high quality standards, which – combined with the best techniques and all the accreditations available – will help to achieve good embryos resulting in good pregnancy results.
It is important to mention that surrogacy only applies to women who cannot become pregnant due to medical problems. The latter include congenital absence or abnormalities of the uterus, medical conditions that make pregnancy dangerous for a woman’s life (such as e.g. congenital heart disease), cases of multiple miscarriages and selected cases of multiple failures in previous IVF efforts.
At the moment, the surrogate motherhood program in Greece is allowed only for married heterosexual couples, cohabiting couples and single women. Dr Daphnis goes on to explaining the steps of the program at his clinic. Everything starts with an email or a phone call from interested patients, which is followed by an initial consultation with a doctor (either in person or via Skype). If patients are able to show themselves at the clinic, some initial diagnostic examination is performed – however, if they are far away, they are asked to perform all the necessary tests back home. Gathering all patients’ medical issues and fertility problems together is necessary in order to understand the reason why the intended mother cannot carry a pregnancy to term. Once it is determined, doctors proceed with choosing the appropriate treatment plan based on patients’ personal needs. Dr Daphnis says that at that moment, they ask patients to come over to Chania to meet the team and see where everything is carried out – and to start the paperwork.
When the first medical part of the program is completed, the organisation of the legal process starts. According to Dr Danny Daphnis, the good thing about the Greek law is the fact that surrogacy is highly regulated. It means that there always has to be a court hearing and it is the judge who passes on the judgement, deciding whether the surrogacy program can go ahead or not. Once the court’s positive decision is out, the clinic starts the IVF treatment plan that was decided beforehand.
For the surrogate motherhood programme to be successful, there are two processes of the highest importance: the selection of the right egg donor and the right surrogate mother. In case of the former, the donors have to be between 18 and 30 years old. They have to be in overall good health – for that reason, they are tested for 27 genetic diseases, including karyotype, cystic fibrosis and fragile X syndrome. They have to have good ovarian reserve and undergo a thorough examination for infectious diseases, such as HIV, AIDS, Hepatitis, etc. Apart from the clear medical report, they also have to be aware of what they’re doing and conscious of all possible consequences of their actions.
Choosing the right surrogate is equally important. Dr Daphnis admits that it is a good solution when the intended parents have their own surrogate chosen beforehand. If not, the surrogate needs to be selected in medical terms first of all. It means she needs to have an anatomically normal uterus (with no significant polyps or fibroids) and she has to be healthy in both physical and emotional sense. In order to determine her psychological profile, she goes through a detailed evaluation that includes checking her stable character, moral values and a positive attitude towards the surrogacy program. It is also highly important that the chosen surrogate mother is willing to end the program successfully – regardless of the number of IVF attempts required to achieve the desired final result.
In Greece, all aspects of surrogacy are clearly defined by the law. First of all, the Greek legislation allows intended parents to be foreign – and this is surely important information for patients traveling for fertility treatment abroad. Secondly, the court decision is required to state clearly that the baby resulting from the surrogacy program is the intended parents’ – and not the surrogate’s. According to the Court Order, on the day of baby’s birth, the clinic registers him or her into the intended parents’ family names and on the basis of that, the Registration Office provides the baby’s birth certificate. The Court Order also says that the surrogate mother has no legal rights to the intended parents’ baby. Dr Daphnis thinks that knowing this fact may help many patients ease their anxiety regarding the relationship between the surrogate mother and their offspring. It clearly proves that the baby, which is born through the surrogate motherhood program, is the intended parents’ child – and nobody else’s.
Once the court decision is in the clinic’s possession, the medical procedure of the program may be initiated. If needed, an anonymous egg or sperm donor is selected and afterwards – depending on the treatment plan – either the mother’s or the donor’s eggs are collected. Afterwards, laboratory fertilisation of eggs with sperm (either partner’s or donor’s) takes place. Dr Daphnis says that, if required, the fertilised eggs (embryos) may undergo pre-implantation genetic diagnosis to exclude any potential chromosomal abnormalities. Finally, the process is completed by transferring one or two embryos to the uterus of the surrogate mother. If there is a positive result, the embryo transfer is followed by pregnancy and birth.
According to Dr Daphnis, the surrogate motherhood program at his clinic ensures that all surrogate mothers have the best possible conditions to achieve a successful birth of a healthy baby. During pregnancy, a surrogate mother is monitored every 2 weeks. She is tested via ultrasounds, hormone tests and general blood tests, with one or two gynaecologists being responsible for her. She also has a specialised fetal medicine gynaecologist monitoring her three times during her gestation (at 12, 20 and 32 weeks). According to Dr Daphnis, their clinic also performs non-invasive prenatal testing at 12 weeks of gestation (e.g. Harmony or NATIVA tests). Both the pregnancy and the delivery is supervised by a very experienced obstetrician in order to bring a fully term healthy baby into life and maintain the health of the surrogate mother. Once the baby is born, the intended parents can make their dream come true and take the desired child home with them.
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