In relation to the implementation of our surrogacy code
This code shall be implemented and communicated in accordance with the instructions of GestLife® Management.
Management is committed to monitoring compliance with this code and will settle any consequences that may arise from its violation.
Finally, it will establish timeframes and procedures for monitoring, reviewing and updating the code.
The code of ethics and deontology also controls the professional and ethical standards when performing Assisted Reproductive Technology (ART) and Surrogacy (GS) treatments.
The Code is used as a reference point for all fertility centers we work with in an effort to seek and ensure the highest standard of practice for all personnel involved in clinical activities as well as ethical/moral medical dilemmas.
The Code of Ethics is based on the four main principles that exist in modern medicine:
a. First, do no harm (primum non nocere): the safety and health of patients is the most important value in medicine. Health care professionals must always ensure that no harm is caused to the patients.
b. Beneficence: Health professionals should always act in the best interest of the patient, doing everything in their power to improve the patient's health situation and quality of life. They are expected to choose the most appropriate and beneficial methods of treatment.
c. Autonomy: patients must have the full right to make a free and independent decision when considering medical treatment. Consent to treatment shall be sought only on the basis of clear and balanced information provided by physicians.
d. Fairness: all patients should be treated equally and have similar access to medical advice, diagnosis and treatment.
e. Frequent technological and scientific advances in the field of fertility medicine constantly raise new ethical dilemmas. The Code of Ethics will be a dynamic document that will require continuous development as new issues arise.
Fundamental principles
The Key Principles provide a clear statement of the sound medical standards that underpin the delivery of care within INVESTMEDICAL Fertility Centers. These Key Standards serve as a means of communication for staff, patients, donors, donor-conceived individuals and the public with whom INVESTMEDICAL Fertility Centers engage.
a. We will treat prospective and current patients and donors fairly, and will not unlawfully discriminate against them.
b. We will have due regard for the privacy, confidentiality, dignity, comfort and well-being of patients and donors.
c. We will have due respect for the special status of the embryo when performing clinical and laboratory procedures.
d. We will give due consideration to the welfare of any child born as a result of treatment provided by INVESTMEDICAL clinics.
e. We will provide potential and current patients and donors with sufficient, accessible, and up-to-date information to enable them to make informed decisions.
f. We will ensure that patients and donors have provided all relevant consents prior to carrying out any authorized activity.
g. We will perform all activities with appropriate skill and care and in an appropriate environment, in accordance with good clinical practice, to ensure optimal outcomes and minimal risk to patients, donors and offspring.
h. We will ensure that all facilities, equipment, processes and procedures used in the conduct of authorized activities are safe and fit for purpose.
i. We will ensure that all personnel engaged in the licensed activity are competent and recruited in sufficient numbers to ensure safe clinical and laboratory practice.
j. We will maintain correct and accurate records and information on all clinical and laboratory activities.
k. We will maintain records of all adverse incidents (including serious adverse events and reactions) and investigate all complaints appropriately and share lessons learned throughout the organization.
l. We will ensure that all authorized research conducted meets appropriate ethical standards, and is only conducted when there is clear scientific justification.
m. We will conduct all activities with due consideration of the regulatory frameworks governing gamete or embryo treatment and research within the particular country in which the services are provided.
The following section explores a number of specific situations encountered in the provision of fertility services that raise ethical issues of concern for professional staff and service users. A brief background is provided, key issues are highlighted, and a policy for practice related to the Key Principles (above) is set out.
1. The moral status of the pre-implantation embryo
The pre-implantation embryo is a symbol of human life. This special status of the embryo shall be properly respected when performing Assisted Reproductive Technology treatments, reflecting a responsible attitude towards the child that will be born as a result of these treatments. The preimplantation embryo cannot reach its potential to become a fetus and potentially a child unless it is transferred to the uterus. Therefore, the attitude towards the pre-implantation and post-implantation stages should be classified according to their potential to lead to the development of a human being.
2. The management of cryopreserved embryos and the fate of supernumerary embryos.
After an IVF cycle, 1-2 of the previously created embryos are transferred to the patient's uterus, while the remaining good quality embryos are cryopreserved. In some cases, when patients have not expressed their wishes about the fate of their embryos and cannot be contacted, the surplus cryopreserved embryos are stored, causing problems at the fertility clinic due to high maintenance costs.
Pre-implanted cryopreserved embryos represent the first stage of human life, their main use will be for the original couple, but the option to donate to another couple or for research is also accepted.
a. At all INVESTMEDICAL Fertility centers, an agreement is signed with the intended parents prior to the start of treatment regarding the fate of the supernumerary cryopreserved embryos; this includes a request to keep them for the couple, including the obligation to cover the costs, and consent to donate them to another couple or for research. Within the contract/consent for storage, it is imperative that patients agree to inform the clinic of any changes in contact details. The consent should make reference to the issue of embryo handling if the couples separate.
b. Preimplantation embryos may be offered for donation only after appropriate medical evaluation of the donor couple and after counseling and consent of both couples.
Oocyte Donation
When a woman cannot use her own eggs for IVF, donor eggs can be used instead. Young, fertile women are willing to donate their eggs. Donors are usually given compensation to cover their efforts. Short-term medical risks (due to the hormones used for ovarian hyperstimulation, anesthesia and the surgical procedure) and unknown potential long-term health outcomes may be associated with the egg donation process.
a. All egg donors and recipients will be informed about possible legal, medical and emotional issues involved in egg donation.
b. An egg donor may receive compensation to reasonably cover any financial loss incurred in connection with the donation.
c. Donors should be offered the option of entering the egg donation program as an identifiable or anonymous donor, but are encouraged to remain identifiable in the interest of the resulting child or children.
d. Donors will be informed that they no longer have dispositional control over their oocytes once they have been retrieved, and that they have no legal rights or duties to raise the resulting children.
e. Donors will be informed that they will be screened for infectious diseases and other health-related risk factors, which will be provided with the test results, and referred to further counseling or medical care if necessary after screening.
6. INVESMEDICAL has a duty to provide written information on the manner and timing of conception to both the recipient and other health professionals involved in your care upon request.
4. Preconception gender selection for medical reasons.
After natural conception, the probability that a child will be of a particular gender is about 50%. Individuals may wish to choose the sex of their baby for medical or non-medical reasons:
• Medical reasons: to avoid or reduce the risk of inheriting genetic diseases known to affect children of a specific sex or diseases that show an unequal sexual incidence.
• Non-medical reasons: social or economic reasons for preferring a child of a specific sex over the other, "sex balance" when there are already only children or predominantly of one sex.
a. Sex selection should be allowed if it is intended to avoid risks to the health of offspring, including reducing the chances of a child being affected by a disorder with unequal sexual incidence.
b. Gender selection for non-medical reasons is not accepted in some countries. It is also not accepted when it can be applied as an additional selection in the context of medically indicated PGD / PGS Preimplantation Genetic Diagnosis procedures. However, in some countries, gender selection is allowed.
5. Fertility treatments when the prognosis is futile or very poor.
Patients may reach a point where their chances of achieving a live birth are very low or non-existent. Some of these patients have difficulty discontinuing treatment. These situations can create conflicts of interest between physicians and their patients. While patients will try anything to have a child and may wish to make autonomous decisions regarding medical treatments, physicians have professional interests in minimizing harm and avoiding the frustration (and cost) of providing virtually useless treatments.
6. Child welfare in medically assisted reproduction.
Fertility treatments treat or prevent medical problems that may be interfering with the ability to have children. Fertility specialists usually focus on the medical aspects of the situation, but sometimes they are faced with patients who do not seem well suited to provide safe and appropriate care for children. Concerns about parenting ability and the possibility of causing significant harm to a future child are legitimate.
a. Those seeking treatment have the right to a fair assessment. The wishes of all involved will be taken into account and the assessment will be conducted in a nondiscriminatory manner.
b. Services may be withheld based on informed judgments of the patient's inability to provide minimally adequate or safe care for the offspring. The assessment of the patient's inability to care for a child or the potential for harm to a child should be made jointly among the various professionals on the team, always including an independent opinion. The psychological assessment should be complemented in some cases by social work professionals.
c. Persons with disabilities should not be denied fertility services solely because of their disability.
7. Medically assisted reproduction in single, lesbian and gay couples and transsexuals.
Medically assisted reproduction is primarily offered to heterosexual couples (whether married or in a stable relationship). However, there are increasing numbers of requests from single people and people with other sexual identities, including gay female couples (lesbians), gay male couples (homosexuals), and, more recently, transgender men and women.
Reproduction is a basic element of people's autonomy regardless of their sexual orientation. Medically assisted reproduction in the situations described above is morally good in many cases. There is no good reason to rule out a priori access in these situations.
Health is not only defined by medical facts but also by social conventions and justifications. Medically assisted reproduction in these cases can be viewed in this broader sense.
a. INVESTMEDICAL's fertility clinics will always take into account the legal frameworks in the countries where they operate, while fulfilling their mission to help those who wish to procreate and create a family.
b. If there are concerns about the implications of assisted reproduction on the welfare of any of the persons involved, including the prospective child, a surrogate mother, or the applicants themselves, these concerns should be carefully considered in light of the available evidence.
8. Subrogation
A gestational carrier (gestational carrier) is a woman who carries a child that has no genetic relationship to herself, for a person or couple who intends to be the legal parent of that child. Initially, gestational surrogacy was applied to cases of intended opposite-sex parents who had fertility or medical problems that prevented the female partner from carrying the pregnancy. Today, the process is also used for individuals and same-sex couples who wish to become parents.
a. Surrogacy can be facilitated through assisted reproductive technology, but only if permitted by legislation within the country where the center operates.
b. There must be legal agreements in place to spell out and then protect the roles and responsibilities of each participant.
c. The pregnant woman must be at least 21 years of age, healthy, have a stable social environment and have had at least one pregnancy that resulted in the delivery of a child.
d. It is the duty of the treating physician to inform all parties of the medical, social, psychological, emotional, moral and legal issues related to surrogacy.
e. Where local laws and regulations permit, pregnant women should receive fair and reasonable financial compensation.
f. Pregnant women have the right to receive adequate medical care during treatment and throughout pregnancy.
g. Pregnant women will be evaluated and receive appropriate counseling to consider the potential impact of surrogacy on their own families.
h. The same precautions should be implemented as for gamete donation, including screening for infectious diseases (HIV, hepatitis B and hepatitis C) and those that the physician deems appropriate.
i. Only one or two embryos of good quality will be transferred as a general rule, and in no case more than 3 embryos will be transferred.