Surrogacy: all the features of a relationship that could go wrong?
by Helen Szoke
AUSTRALIAN EXPERIENCE OF THE REGULATION OF SURROGACY
The first IVF baby was born in Australia in 1980. However, before IVF technology became common practice, donor insemination had been used as a means of addressing male infertility. Although its use dates back to the 1950’s within hospital settings, it was not until 1987 that the Fatally Law Act (Cth) 1975 was amended to recognise the social parent in donor procedures as the legal parent, thus severing the legal relationship between the biological parent and the child. State governments reflected this change in their own legislation (2). Ironically these changes had the effect of further exacerbating the issues associated with the legal status of the child in surrogacy arrangements. The birth mother became the legal mother, irrespective of the genetic link.
As the use of IVF became more widespread, various federal and state reviews were instituted, with a view to identifying the public policy considerations associated with the use of reproductive technology (3). In 1988, IVF was applied to a totally different procedure which challenged all previous understandings of motherhood and family. The Kirkman sisters were involved in a very public surrogacy arrangement in Victoria, the first reported case of IVF surrogacy. Alice Kirkman was born in May that year, from an egg taken from her mother Maggie, and donor sperm. The resultant embryo was transferred to Maggie’s sister Linda, who safely carried the baby to term. The baby was handed over to Maggie and her husband, and subsequently an adoption order was made in accordance with state legislation. (Kirkman & Kirkman, 1988)
There are many features of that arrangement which suggest that there was not a high level of support for this form of altruistic surrogacy. The ethics committee of the hospital where the Kirkman’s doctor was a member of the IVF team found the proposed arrangement unethical, resulting in the transfer of the procedure to another hospital where there was no institutional ethics committee. (Waller, 1993) Victoria’s legislative provisions which were not in full force at that time clearly intended to allow altruistic surrogacy applications in only a small number of special circumstances. (Waller, 1993) However, the Kirkman episode did have the effect of placing altruistic surrogacy on the policy agenda. In 1988, the Australian Health Ministers’ Conference formed the National Bioethics Consultative Committee (NBCC) to report on a range of matters related to assisted reproductive technology. These included record keeping and access to information, birth certificates and birth records, counselling and access to reproductive technology. (National Binethics Consultative Committee, 1989) During the deliberations of the Committee, surrogacy was added as a further reference from the Council of Social Welfare Ministers, and an extensive discussion paper and report resulted. (National Bioethics Consultative Committee, 1990) The Consultative Committee reports did not hasten the move to national legislation. In fact, the recommendations supporting the regulation of altruistic surrogacy were not accepted by a joint meeting of the Australian Health and Welfare Ministers. Further, this meeting decided that the responsibility for advice to them on bioethical issues should be transferred to the NHMRC. This resulted in the formation of the Australian Health Ethics Committee (AHEC) and the ultimate demise of the NBCC. (Waller, 1993)
Commercial surrogacy has no basis in any Australian jurisdiction, and most of the Australian states have legislative provisions which make any contract in relation to a surrogacy agreement unenforceable, and any payment for the soliciting of a surrogacy arrangement illegal. The ACT is the only jurisdiction where altruistic IVF surrogacy is facilitated by statute. The Substitute Parents Agreement Act 1994 makes surrogacy agreements void and unenforceable and prohibits commercial arrangements, advertising and procuring a person to participate. However, provided these conditions are met and the interests of the child are considered paramount, altruistic or voluntary arrangements can be put into effect. This was clarified through the passage of the Substitute Parent Agreements (Consequential Amendments) Act 1994. (Wallace, 1995) The practice occurs in NSW, but without any statutory provisions directly regulating surrogacy, and it is allegedly also practised in WA. The variations between states mean that some people will pursue treatment in a state that allows the procedure. Such reproductive tourism is not new. Of greater concern, however, is the lack of any statutory provision that clarifies the status of the child born as a result of a surrogate arrangement. The very provisions that defined the legal status of a child born to a woman following a donor treatment procedure, confuse the issue in surrogacy. These provisions say that for all intents and purpose the woman who gives birth is the mother. This is not the desired outcome where the woman who gives birth is the surrogate. Only the ACT has addressed this requirement through legislation, where application may be made by the genetic parents of a child who is born as a result of surrogacy agreement to the Supreme Court to have the child’s birth certificate re-registered in their names. The child then has the same status and legal rights as a child who is adopted. In the case of a surrogacy arrangement that is not organised within a family, the adoption process becomes difficult, and legal custody must be sought through the Family Court. The Commonwealth Government lacks clear constitutional power to legislate on the issue of surrogacy. (Janu, 1996)
Although the demand for IVF surrogacy is not great, the primary consideration must be whether there is sufficient protection for the interests of the child who is born. The much publicised surrogacy arrangement by the Kirkman sisters spurred on the regulatory moves by respective state governments. Since then, Australia has experienced the first legally arbitrated tragedy of a custody battle in the Baby Evelyn case. (“Re Evelyn”, 1998) This case involved the use of traditional surrogacy, where the surrogate mother was inseminated with the commissioning father’s sperm. This case highlights how irreparably wrong such arrangements can go. This case was a de facto arrangement between the couples concerned and highlights the risks that are taken in the absence of selection, counselling, screening and competent medical management. ‘Evelyn’ was born to a woman who rived in South Australia, and who agreed to carry the child for a Queensland couple. The woman who gave birth was in fact the child’s natural mother, and she found she could not relinquish ‘Evelyn’ to her natural father and his wife. After family court proceedings the child was returned to her natural mother in South Australia with court orders specifying the type and frequency of contact between the child and her natural father and his wife. Professor Leeton estimates that of the 12,000 surrogate births in the United States over the last 20 years, approximately 0.6% resulted in legal disputes, and most of these were cases where traditional surrogacy was used. (Leeton, 1999) Notwithstanding the volume of the cases that lead to court proceedings, the gravity of placing a child in such circumstances through the intervention of assisted reproductive techniques cannot be underestimated.
Little can be done to monitor the private arrangements made between couples organising their own surrogacy arrangements. They do not become evident until a child is born and the legal status of the child has to be clarified. Arguably, such arrangements should be discouraged in law, as the complexity of surrogacy is exacerbated by the requirement that the surrogate mother relinquish her own biological child. Where reproductive technology is used, however, it is possible to monitor and regulate practice, providing checks and balances to ensure as far as possible the interest of all parties, and most importantly of the child, are protected. Much more public debate is required to progress this issue.
THE REGULATION OF PRIVATE BEHAVIOUR
The most contentious application of social regulatory regimes relates to those which impinge on private behaviour. In this regard, where governments choose to regulate surrogacy practices, an added complexity arises because surrogacy raises a cluster of issues which are different from each other. The rationale for such intervention by government must thus be clearly defined, and the identification of the public interest clearly stated. In the justification for regulatory intervention, risk management is a major focus. Risk management used to be about war and famine. Increasingly it is about the risks of new technology. (Douglas, 1985) The management of risk may relate to ensuring consumers are able to make a free and informed choice, balancing private interests and public good, and balancing the contentious aspects of rights versus choice. A consumer may be protected from his or her own bad decision making through the imposition of a regulatory framework. “Governments have always, and must continue to be, in the business of regulating behaviour.” (Thomson, 1983) The question is, what behaviour is to be regulated?
In the case of surrogacy arrangements the question may be whether government should intervene to prohibit, intervene and provide checks and balances, or leave these arrangements to the province of the common law. All of these options are reflected in the different arrangements which have been instituted by different state governments. The policy maker may feel that free and informed choice is not possible. (Francis, 1993) Some commentators question the moral concerns about government intervention and ask if risks are better balanced if they are anticipated, or if one tries to mitigate their effects. (Wildavsky, 1983) Other commentators argue that both regulatory and non-regulatory frameworks must be looked at. Alternatives to regulation include common law suits, used to deal with injuries arising from defective products, or product liability, where a person may recover from the manufacturers following personal injury and the laws of nuisance and trespass. (Baram & McAllister, 1982) Each, however, has its limitations, as it addresses problems after the event and only on a case by case basis. They are also very expensive avenues for dealing with resolution of such problems. In those cases such as surrogacy arrangements where a child’s legal standing and protection is involved the parties may find the common law too imprecise and too tardy an instrument. Many state laws render surrogacy agreements or contracts void, overriding the potential common law avenues to enforce an agreement.
The acceptability of risks involves freedom as well as justice. The assessment of risk is thus objective, through an understanding of the institutional context, and subjective, through the perception of the individual. Social organizations impinge on private attitudes to risk. (Douglas, 1985) Regulatory intervention is thus more likely in those circumstances where the policy makers feel that free and informed choice is not possible, and the consumer must be protected. (Francis, 1993) In the case of altruistic surrogacy, however the question of protection is complex. Is it the child who is protected, or the commissioning parents or the surrogate mother? Or is it the general community, and the public interests which should be protected by prohibiting such arrangements? There may be confusion in areas of social regulation about assigning responsibility. Douglas argues that people regularly underestimate risk and will pay great attention to media coverage about air crashes, but don’t seem to notice the number of deaths associated with asthma. (Douglas, 1985) Similarly, Gertson et al identify the trend in consumer polling which consistently shows a preference by consumers for disclosure rather than regulation. However, in practice, consumers will not take into account advice given through educative campaigns and will more often listen to the advice of families and friends. (Gertson et al., 1988) In practice, this assessment and the government response will depend on contextual factors and community acceptance.
The assessment of risk becomes increasingly difficult in areas where the interests of the private individual overlap with the public interest.
“The polarisation of the ethical debate concerning IVF demonstrates
that one person’s instinct can foster reasoning and conclusions that
are quite different from those of another. Whether the diversity of
moral opinion concerning the effect of IVF on marriage, the family
and the nature of human parenthood should preclude regulation of the
area is a complex issue …” (McCartan, 1986)
Certainly for some commentators the development of reproductive technology is seen as providing government with “another reason to interfere with human reproduction in the guise of protection.” (Spallone, 1989) However, reproductive technologies are not just about treatment, hut also about the creation of new life under unusual circumstances. This has an impact not just on the individual involved but also on society more generally. Where surrogacy arrangements are put in place, this myriad of relationships is made more complex. Unlike donation, where the uncommitted sperm or egg is donated without further involvement or interaction, surrogacy involves a continuous and arguably intimate relationship over the period of a year or more. A pregnancy must be achieved, a baby gestated, medical checks undertaken, a baby delivered and then handed over. The wellbeing of the surrogate after the birth may be a consideration. The ability to confidently relinquish a child may be difficult, as was evident in the
Baby Evelyn case.
“Some friction developed between Mrs S (Surrogate) and the Q’s while
the Q’s were in South Australia relating to Mrs Q’s unwillingness to
persist with her efforts to breastfeed the child and because of
concerns Mrs S developed about the capacity of Mrs Q to properly
nurture the child and keep Mrs S informed.” (“Re Evelyn”, 1998)
There are many opportunities for changes of mind, changes in circumstances or real harm to the developing child along the way. Any pregnancy is a matter of uncontrollable features such as possible harm to the child, harm to the woman carrying the child, or changes in the familial circumstances. Surrogacy adds further dimensions to this. The intervention of the state into private activity is not a recent phenomenon. The nature of marriage and as a consequence the status of children born to that marriage has long been governed by legal requirements, albeit ones that have changed significantly in the last three decades. (Hale, 1996) The intervention may not be uniform. The legislative response to surrogacy in Australia has not been uniform. Surrogacy is distinguishable from other forms of reproductive technologies because it transfers the burden of gestation away from the whom wants the child. It also disrupts traditional notions of child rearing because it introduces an identifiable third party into an arrangement (Stuhmcke, 1994) as opposed to anonymous donation of gametes where the third party is often not identified to the corn missioning woman or couple. It is claimed that legislative response to surrogacy in Australia is perceived to be the prevailing moral view of the issue, yet there is a lack of empirical data about the incidence and the outcome of surrogacy arrangements. Opponents of surrogacy are very vocal. Those seeking surrogacy as a response to their particular circumstances are a small number, and naturally tend to remain silent because of their unusual and controversial problem
There are a number of responses which governments may institute for the regulation of altruistic surrogacy, which are variously applied in different states, or which could be explored in the future. Governments may utilise the common law to regulate practice, such as occurs in NSW. (Szoke, 1999) They may prohibit all forms of surrogacy contracts or make agreements unenforceable, such as occurs in all states where surrogacy legislation exists (4). Finally, certain forms of surrogacy may be regulated by state law, such as the Substitute Parents Act 1994 (ACT). In all states, the legal status of the child is regulated by legislation and affected by adoption laws. This is unfortunate as the basics motivation between surrogacy arrangements on the one hand and adoption procedures on the other are diametrically opposed as they represent a planned and wanted child against one that is neither. In the case of traditional or IVF surrogacy, the child is legally the child of the woman who gave birth. The process of the commissioning mother becoming the legal parent may be affected by state adoption laws, where private trade in children is prohibited, or Family Law, where custodial orders are given.
Matters to do with rights and choice are inevitably blurred. Democracies may vary in their emphasis on rights, with some placing a great emphasis on human rights and others emphasising human good. (Blank, 1984) Biomedical technologies have further focussed the role of rights, because they act on humans and directly deal with issues of life and death. (Blank, 1984) Positive rights impose obligations on others. McNeil identifies the difficulty of using individual rights as a measure of intervention, in that it emphasises individualism, and inevitably places issues into a consumer context. (McNeil, 1990) Within the context of a rights/responsibility understanding, it can be argued that no one person has an inalienable right to form a family through assisted means. A consideration of responsibility helps to place rights in a social context, and to prioritise competing rights. “Responsibility of society towards these individuals or groups must be gauged and their freedom of expressions and choice must be balanced against some broader responsibility for society.” (Blank, 1984) Democracies have a role in defining boundaries to be applied to these technologies.
One would expect that Australian state governments would continue the prohibition on commercial surrogacy and the unenforceability of a contract for a surrogacy arrangement. However, in the case of altruistic surrogacy, regulation rather than prohibition may provide a strategy that recognises diversity. “The creation of regulatory regimes bespeaks compromise–of limits, such as when another woman’s womb may be used or organs transplanted–unlike prohibitions of practice.”(Francis, 1993) This means that there must be a political will to develop facilitative regulatory mechanism and a commitment to ensuring that the public is informed about how the technology will be used.
For those who wish to argue that social regulatory regimes should be applied in a facilitative manner, then the regulation of medically indicated, altruistic IVF surrogacy arrangements is provides a means to protect interests, minimize risks and provide checks and balances which ensure that the parties to the arrangement are informed. In such circumstances, conditions may be imposed. It may be required that the provision an surrogacy treatment is only where there are medically indicated conditions, and where it is possible for there to be no biological link between the surrogate and the commissioning parents. The matter of rights in relation to relinquishing the child is also vexed, and the final decision must reside with the birth mother. There should be a prohibition on provision of” services by intermediary agencies, to ensure that there are no opportunities for exploitation of women who are willing to be surrogates, or the commissioning couple. Finally, it may be appropriate for the surrogate and the commissioning mother to have separate clinical supervision to allow the respective treating doctor to avoid a conflict of interest in treating the surrogate and the commissioning mother. This may address the conflict of interest, which arises when a doctor attempts to act in the best interest of” the surrogate and the commissioning couple, when they are both the mother of the same baby: (Rothenberg, 1990) Precedents already exist for the issuing of parental orders to enable the legal status of the child born to be clarified (5).
However, were such provisions to be put in place, the respective costs and benefits would have to be assessed. The Australian Health Ministers Council, in rejecting the recommendations of the National Bioethics Consultative Committee in 1990, were concerned that regulation of surrogacy in a facilitative way would institutionalise the practice as a means of family formation. In a similar vein, the medicalisation of surrogacy could be seen to legitimise the practice. (Rothenberg, 1990) Surrogacy arrangements are such that many aspects of the process could go wrong. The costs are high, because the child is the ultimate expression of that relationship. There is a high level of need or desire on the part of the commissioning parents, a necessity to involve a third party for at least the period of treatment and gestation, the involvement in a medical intervention where the outcomes which can be predicted are limited, and where there is a low level of community acceptance and understanding. Finally the issues of the legal status of the child remain unresolved. Legislation would then have to be changed to ensure that the legal status of the child could be clarified other than through a Family Court order. Such clarification would be in the interests of the child.
Proponents of regulation of surrogacy through statute argue that such concerns are the reason why such arrangements would be better managed through a regulatory process, rather than left to the free market to sort out. For example, it is legal to donate embryos, where the biological link is completely disaggregated from the social link. Why then could not this gift relationship be extended to gestation of a child, who is returned to their biological parent? Where there is monitoring and regulation of practice in such a volatile area, it is possible to afford proper medical, psychological and legal protections to the parties to the agreement. The concern is that where such a regulation does not occur, then people are forced into an unregulated market, which may exploit them financially and emotionally. (Dunn, 2001) Finally the complexities of these arrangements, it is argued, means that it is better to institute a risk management structure to ensure that only those appropriate cases are facilitated, and the parties enter into the arrangement fully informed and aware of the possible pitfalls in their decisions.
The options for the treatment of altruistic surrogacy remain diverse in Australia. The issue is not easily managed within the context of the public policy process, as it engenders real concerns about the challenge to commonly understood notions of gestation, motherhood and the family. In Victoria, surrogacy was a contentious issue in the revision of the legislation that led to the Infertility Treatment Act 1995. The Government and the Opposition both reached bi-partisan and bicameral agreement that altruistic surrogacy would not be encouraged in that State. At the end of the day, risk management and instituting checks and balances through statutory regulation can only be achieved where community acceptance exists.
(1) The commissioning couple is the couple who is unable or unwilling to have a child through normal gestation.
(2) Status of Children Act 1974 (Tas); Family Relationship Act 1984 (SA); Family Relationship Amendment Act 1984 (ACT); Status of Children Act 1984 (Vic); Artificial Conception Act 1984 (NSW); Artificial Conception Act 1985 (WA); Artificial Conception Act 1985 (Qld).
(3) Each state reported as follows:
Chalmers, D. “Committee to Investigate Artificial Conception and Related Matters.” Hobart: Tas Government 1985.
Justice Denack. “Report of the Special Committee appointment by the Queensland Government to enquire into the laws relating to artificial insemination, in-vitro ferzilisation and other related matters.” Brisbane: Qld Parliament 1984.
New South Wales Law Reform Commission “Report: Artificial Conception–Human Artificial Insemination 1986”; “Report: Artificial Conception–Surrogate Motherhood” 1988; “Report: Artificial Conception–In-Vitro Fertilisation” 1988.
Select Committee of the Legislative Council. “Artificial Insemination by Donor, In-Vitro Fertilisation and Embryo Transfer Procedures and Related Matters in South Australia.” Adelaide 1987.
W.A. Parliamentary Committee. “Report of the Committee Appointed by the Western Australian Government to Enquire into the Social, Legal and Ethical Issues Relating to in-Vitro Fertilisation.” Perry 1986.
Waller, L “Consolidated Reports of the Victorian Inquiry into IVF and Related Issues.” Melbourne 1990.
(4) See for example: Surrogate Parenthood Act 1988 (Qld); Substitute Parents Act 1994 (ACT); Surrogacy Contracts Act 1993 (Tas).
(5) See for example: Substitute Parents Act 1994 (ACT) and Human Fertilisation & Embryology Act 1990 (UK).
Acts of Parliament
Status of Children Act 1974 (Tas)
Family Relationships Amendment Act 1984 (ACT)
Family Relationships Amendment Act 1984 (Cth)
Status of Children Act 1984 (Vic)
Artificial Conception Act 1984 (WA)
Artificial Conception Act 1984 (NSW)
Surrogate Parenthood Act 1988 (Qld)
Surrogate Contracts Act 1993 (Tas)
Substitute Parent Agreement Act 1994 (ACT)
“Re Evelyn” (1998) FamCA 55 BR7321 of 1997
Baram, M.S. & McAllister, K. (1982) Alternatives to Regulation (Lexington, Lexington Books).
Blank, R.H. (1984) Redefining Human Life: Reproductive Technologies and Social Policy (Boulder, Colorado, Westview Press).
Chalmers, D. Committee to Investigate Artificial Conception and Related Matters. Hobart: Tas Government 1985.
Justice Denack. Report of the Special Committee appointment by the Queensland Government to enquire into the laws relating to artificial insemination, in-vitro fertilisation and other related matters. Brisbane: Qld Parliament 1984.
Douglas, M. (1985) Risk Acceptability according to the social sciences (London, Routledge & Kegan Paul).
Dunn, M. (2001) ‘Outlawed surrogacy thriving’ Herald Sun, 21 April 2001, page 5.
Ferrari, J. (1997) ‘Infertile couples turn to US surrogate mums’ The Australian, 10 September 2001, page 5.
Francis, J. (1993) The Politics of Regulation (Mass, Blackwell).
Gertson, L.N., Fraleigh, C. & Schwab, R. (1988) The Deregulated Society (Pacific Grove, California, Brooks/Cole Publishing Company).
Hale, B. (1996) From the Test Tube to the Coffin. Choice and Regulation of Private Life (London, Stevens & Sons/Sweet & Maxwell).
Janu, P.W. (1996) The case for the discouragement of surrogacy arrangements, Journal of Law and Medicine, 4(1), pp. 72-81.
Kirkman, M. & Kirkman, L. (1988) My Sister’s Child (Melb, Penguin).
Leeton, J. (1991) Surrogacy, Aust N Z J Obstet Gynaecol, 3(3), pp. 260.
Leeton, J. (1999) Letter to the Editor, ANZJOG, (April).
McCartan, M.K. (1986) A Survey of the Legal, Ethical, and Public Policy Considerations of in vitro Fertilisation, Notre Dame Journal of Law, Ethics and Public Policy, 2, pp. 695-731.
McNeil, M. (1990) Reproductive Technologies: A New Terrain for the Sociology of Technology, in: M. McNeil, Varcoe, I, Yardley S. (EA) The New Reproductive Technologies (London, Macmillan).
National Bioethics Consultative Committee (1989) Reproductive Technology. Record keeping and Access to Information. Birth Certificates and Birth Records of Offspring Born as a Result of Gamete Donation.(Canberra, ACT, NBCC).
National Bioethics Consultative Committee (1990) Surrogacy. Reports 1 and 2. (Canberra, ACT, NBCC).
New South Wales Law Reform Commission. Report: Artificial Conception–Human Artificial Insemination 1986; Report: Artificial Conception–Surrogate Motherhood 1988; Report: Artificial Conception–In-Vitro Fertilisation 1988.
Rothenberg, K.H. (1990) Gestational Surrogacy and the Health Care Provider: Put Part of the IVF Genie back into the Bottle, Law, Medicine and Health Care, 18(4), pp. 345-352. Select Committee of the Legislative Council (as per back page 4).
Spallone, P. (1989) Beyond Conception. The New Politics of Reproduction. (Houndsmill, Macmillan).
Stuhmcke, A. (1994) Surrogate Motherhood: The Legal Position ha Australia, Journal of Law and Medicine, 2(2), pp. 116-124.
Szoke, H. (1999) Regulation of Assisted Reproductive Technology: the State of Play ha Australia, in: I. Freckleton & K. Petersen (Eds) Controversies in Health Law (Annandale, The Federation Press).
The Daily Telegraph ‘Writer to have baby for gay couple’ The Daily Telegraph, 24 March 2001, page 24.
Thomson, J.J. (1983) Some Questions About government Regulation of Behaviour, ha: T.R. Machan & M.B. Johnson (Eds) Rights and Regulation. Ethical, Political and Economic Issues (Cambridge, Mass, Ballinger Publishing Company).
W.A. Parliamentary Committee. Report of the Committee Appointed by the Western Australian Government to Enquire into the Social, Legal and Ethical Issues Relating to In-Vitro Ferlilisation. Perty, 1986.
Wallace, M. (1995) Health Care and the Law (North Ryde, Law Books Co Ltd).
Waller, L. (1990) Consolidated Reports of the Victorian Inquiry into IVF and Related Issues. 2nd Reprint (Melbourne, Vic, Committee to Consider the Social, Ethical and Legal issues arising from in-vitro fertilisation).
Waller, L. (1993) Surrogate Parenting First Worm Congress on Family Law and Children’s Rights (Sydney, NSW).
Wildavsky, A. (1983) Foreword, in: T.R. Machan & M.B. Johnson (Eds) Rights and Regulation. Ethical, Political and Economic Issues. (Cambridge Mass, Ballinger Publishing Company).
THE UNIVERSITY OF MELBOURNE
Helen Szoke is currently undertaking a PhD at the University of Melbourne, within the Political Science Department, looking at the public policy issues associated with the regulation of reproductive technologies. She has published a chapter entitled Regulation of Reproductive Technology in Australia. The State of Play. in CONTROVERSIES IN HEALTH LAW–Ian Freckleton and K Petersen (eds). Federation Press:Syd. 1999, and is currently awaiting the publication of “The State of ART Regulation’ which she has co-edited with Dr Jennifer Gunning. Helen has been the Chief Executive Officer of the Infertility Treatment Authority, in Melbourne, Victoria, Australia, since 1996. The Infertility Treatment Authority is a government statutory authority with responsibility for the implementation of statutory provisions outlined in the Infertility Treatment Act 1995.