Surrogacy Law and Legal Parenthood

Tracy Gilbert Excerpts

Monday 7th September 2026 Westminster Hall

[Tracy Gilbert (Edinburgh North and Leith) (Lab)]

It is a pleasure to serve under your chairship, Mr Pritchard. In the years since the passage of the Surrogacy Arrangements Act, the number of babies born as a result of surrogacy has increased and the nature of surrogacy arrangements has evolved. As I look through Hansard it appears that, in spite of that change, surrogacy has seldom been debated in this place. I therefore welcome this debate; although I do not agree with its framing, I believe it is long overdue.

This debate is critical as there are fundamental human rights at stake. The first are the rights of women: the rights of women as parents to be protected, to have the very best care and to have no outside pressure on decisions relating to their healthcare and their bodies; and the right of women living in poverty, in war zones or in vulnerable situations, here in the UK and across the globe, not to be forced, coerced or trafficked to service the growing demand for surrogates. The second are the rights of children, as set out in the United Nations convention on the rights of the child, to know where they came from, to have a nationality, and to be cared for by their parents, not separated from them, where possible.

Today I will focus on the rights of women. The Law Commission’s previously published proposals recommend tipping the balance of power away from the rights of the birth mother. That is clearly stated in the introduction of its core report:

“Our reforms respect the autonomy of the surrogate—if she withdraws her consent, the courts will make the final decision on parental status.”

If we were to put those proposals on the statute book, a woman who used her own egg as part of a surrogacy agreement, gave birth to a child and then changed her mind would end up in a court battle in which the judge would decide who the parent or parents of the child are. At present, if the surrogate withholds her consent, a parental order cannot be made; she remains the legal parent. However, under the commission’s preferred model, the birth mother’s name would be removed from the birth certificate altogether, and a judge would be forced to consider the living arrangements of the child until the court proceedings concluded.

The commission’s proposals would shift the balance of rights to the intended parents, but it is important that we, as legislators, consider the bigger picture. There is likely to be an economic imbalance between the surrogate mother and the intended—commissioning—parents: by definition, they are commissioning a child. At present, the expenses paid to surrogates far exceed what was anticipated when the 1985 Act was passed. Although the Law Commission’s proposals claim to provide clarity on expenses, they could still result in commissioning parents paying tens of thousands of pounds to a surrogate, including payments for holidays and gifts. That economic power imbalance prompts the question: is it ever a free choice for a surrogate to enter into a surrogacy agreement?

Before concluding, I want to talk about the international impact of surrogacy. Analysis by Stop Surrogacy Now UK suggests that, in most years since 2013, more than 60% of parental order applications in England and Wales related to surrogacy arrangements where the child was born abroad. It is false hope to think that these proposals will stop the demand from the UK for international surrogacy.

[Phil Brickell (Bolton West) (Lab)]

Two of my constituents recently travelled to Mexico, where their children were born by surrogacy. Those births were facilitated by a company called My Surrogacy Journey, which is listed on gov.uk. While in Mexico, they had repeated traumatic experiences with the company relating to issues including insurance for their children, accusations of bullying towards staff and repeated efforts to silence any constructive criticism. I understand that other Members of this House have received similar complaints. Given the severity of these matters, does my hon. Friend agree that the Government should take My Surrogacy Journey down from gov.uk pending a review by the Human Fertilisation and Embryology Authority?

[Tracy Gilbert]

I agree, and I will come to some of those matters shortly.

It is estimated that the international surrogacy industry will be worth more than $200 billion by 2032. The decisions that we take about surrogacy in the UK can help protect vulnerable women and girls in war-torn countries such as Ukraine, as has been mentioned, and low-income countries such as Nigeria from being forced, coerced and trafficked to service the growing demand.

I appreciate the time and consideration that the Law Commission gave to this issue. It heard directly from women who had acted as surrogates, were left displaced and received inadequate medical care. It found that women who had been used as surrogates had not even been told about the genetic parentage make-up of the embryos that had been transferred into their bodies and, as a result, had no information about any inherited conditions that could affect the pregnancy and put them or the baby at risk.

I also welcome the spotlight document published in the last few days by the Independent Anti-Slavery Commissioner, who makes it clear that women in the UK are not only at risk of forced surrogacy but already being identified as such. I have called for a wider debate on surrogacy that would have at its heart women at risk of forced surrogacy and their children.

The Government must fully reject the Law Commission’s proposals. The Scottish Government have already drafted guidance in preparation for the proposals being put on the statute book. Until they are rejected by the UK Government, such preparation will continue.

I hope I have evidenced why we must have a much wider debate on surrogacy. Fifty per cent of responses to the Law Commission’s consultation called for a total ban on surrogacy in the UK. I fully support such a ban, but it should be based on a wider debate that draws on evidence and focuses on reducing harm. In the interim, the Government must immediately recognise the harm and risk that is being inflicted on women and children through international surrogacy and take steps to cut off the UK’s growing demand for it, as that is the only way to play our part in ending the coercion and trafficking of women and children. I understand people’s desire to become parents, but that desire should not take priority over the rights of a child. Surrogacy asks all of us to answer very difficult questions, but answer them we must.

--- Later in debate ---

[Jess Brown-Fuller (Chichester) (LD)]

It is a pleasure to serve under your chairmanship, Mr Pritchard. I pay tribute to the hon. Member for Lichfield (Dave Robertson) for opening the debate and for so thoughtfully laying out both sides, which have been well exercised today.

Being able to start a family is one of life’s greatest privileges. However, for those in many families, whether they are struggling with infertility, are in same-sex relationships or have health issues that would prevent them from having a safe pregnancy, surrogacy has become an option that would allow them to start a family.

The landscape of surrogacy has changed in the years since the first known surrogate baby was born in 1984. Surrogacy is now being widely recognised as a pathway to parenthood, with 67 parental order applications received by the family courts in 2008, rising to 514 in 2025, although I recognise that many different numbers have been suggested today.

[Tracy Gilbert]

I want to pick up on the hon. Lady’s point about healthcare and situations in which women cannot carry a pregnancy. Is she aware of the health risks posed by women carrying embryos that are not their own, and the additional risks to surrogate mothers from being a surrogate?

[Jess Brown-Fuller]

I do not think any woman enters into any pregnancy lightly, whether it is their own pregnancy or a surrogate pregnancy. I would assume that any surrogate mother is well informed of the risks they are taking in growing a life over nine months, which is no mean feat.

Since 2018, there have been 350 parental order applications from couples in a same-sex relationship, according to Brilliant Beginnings. Adam and Jamie, who brought this petition to the House today, chose to go abroad to the US because they would be recognised as Leven’s parents from day one. I am sure it would have come as a shock to them to discover, before Leven was born, that their home—the UK—does not recognise them as Leven’s legal parents under UK law until the parental order is completed, which can take anywhere between six and 12 months.

Infants, Parents and Carers Bill

Tracy Gilbert Excerpts

2nd reading
Friday 4th September 2026 Commons Chamber

[Tracy Gilbert (Edinburgh North and Leith) (Lab)]

I congratulate the right hon. Member for New Forest West (Sir Desmond Swayne) on coming first in the private Member’s Bill ballot and on promoting this Bill. In the previous Session, my private Member’s Bill was the first to pass through this place and the other place, so I wish the right hon. Gentleman similar success with his very important Bill. Having taken through a private Member’s Bill, I know full well the hard work that he and his team will be putting into the proposals, and I want to put on record my thanks to them for doing so.

I welcome the opportunity to speak on the Floor of the House about the importance of a baby’s first 1,000 days of life. We all know of the love, care and attention that new-born babies need to thrive. By the time they reach 1,001 days old, they will already have progressed to having some form of independence in eating and communicating. The devastating fact, however, is that in the same timeframe, the impact of financial and health inequalities will already be visible. The gap between the most affluent and the most deprived areas will already be evident in toddlers’ groups and nurseries across our communities. For Labour Members, tackling these inequalities is a fundamental goal. We wanted to be elected to eradicate this unfairness. I am therefore keen to hear from the Minister how this Bill could further the Government’s ambitious tackling child poverty strategy.

I want to speak about the growing number of babies across the UK who are born as the result of a surrogacy arrangement either here in the UK or abroad. We cannot be absolutely sure how many babies have been born through a surrogacy arrangement, but what we do know is that the number of parental orders granted by the courts, in line with the Human Fertilisation and Embryology Act 2008, increased from 132 in 2011 to 450 in 2021. The number of babies being born as the result of surrogacy is far more than the handful of cases that the Surrogacy Arrangements Act 1985 had intended to cover. The growing number of babies being born as the result of surrogacy arrangements poses a serious issue that we as legislators must address.

I do not intend to cover all the points today, but I want to cover two areas in particular. The number of UK nationals using commercial surrogacy arrangements abroad is on the rise. The explosion in international surrogacy is estimated to be worth a $200 billion industry by 2032. Too many babies in their first 1,001 days are being left in legal limbo, because the Surrogacy Arrangements Act did not legislate for overseas commercial surrogacy arrangements, and, as far as I am aware, this place has not taken a view or held a debate on this issue. My position is clear. We should follow our EU partners in Spain, France and Germany in banning surrogacy and, at the very least, we should work in this place to prevent the harms caused by international surrogacy.

The failure of this House to have debated the increasing use of international surrogacy arrangements has resulted in different rules applying between adoption and surrogacy. For instance, the Children and Adoption Act 2006 places a duty on the Secretary of State to maintain and publish a list of countries where restrictions on inter-country adoption apply, yet a similar process does not exist for surrogacy. In 2021, the then Secretary of State used his power to place Nigeria on the list of restricted countries, therefore preventing all adoptions between the UK and Nigeria. The reasons given for this decision, which is still in place today, include unreliable documentation, corruption and evidence of child trafficking.

Those harmful and illegal practices, however, are not isolated to adoption. For example, earlier this year, a Nigerian police force made five arrests exposing child trafficking and an illegal surrogacy syndicate under the guise of an orphanage. There is no law currently preventing a child born in such circumstances from being brought to the UK. This void in legislation creates a vacuum where children’s welfare and children’s rights are left unprotected while fuelling the international surrogacy syndicates that put women and girls in developing countries at further risk.

My second point is that the procedures and guidance about surrogacy that are available to midwives, doctors, nurses and health teams on maternity wards are often out of date and very patchy. In some parts of the country, midwives may experience a number of births involving a surrogate; others may see very few or none at all. It is therefore even more important that up-to-date guidance is available with the very best information, so that the care of the mother and child, both pre and post birth, is the very best it can be.

Through freedom of information requests to all Scottish NHS boards, I have discovered that only NHS Ayrshire and Arran and NHS Fife have active guidance in place for midwives and clinician teams on the care and treatment of surrogate mothers and babies to ensure that the law is followed and to set out where they can access support. Of the other Scottish NHS boards, five have no policy at all, one has a draft policy, four have a policy on which a review is overdue, and one refers to the Department of Health and Social Care guidance. Midwives across Scotland are being left to their own devices in ensuring that babies born under a surrogacy arrangement receive uninterrupted care and treatment. I encourage the Department of Health and Social Care to ensure that maternity wards and midwives across England are not left in the same position.

[Torcuil Crichton (Na h-Eileanan an Iar) (Lab)]

My hon. Friend is making a passionate speech on international surrogacy, as she has done previously on adoption. I commend the efforts of the right hon. Member for New Forest West (Sir Desmond Swayne) to bring in this new law. Does my hon. Friend agree with my hon. Friend the Member for Glasgow East (John Grady) that the Scottish Government should closely follow what is happening in this House today and consider similar laws on the rights of babies and on surrogacy?

[Tracy Gilbert]

I absolutely agree that the Scottish Government must take some action on this matter.

In conclusion, I would be keen to see if there are areas where I can work with the right hon. Member for New Forest West to look at changing the law to ensure that babies born through a surrogacy arrangement and the women giving birth to them are no longer forgotten.

Type 1 Diabetes: Infant Testing

Tracy Gilbert Excerpts

Monday 9th March 2026 Westminster Hall

[Tracy Gilbert (Edinburgh North and Leith) (Lab)]

It is a pleasure to serve under your chairship, Sir Alec. I thank my hon. Friend the Member for North Ayrshire and Arran (Irene Campbell) for opening this important debate on behalf of the Petitions Committee, and I thank Lyla’s family for their courage.

Some 95 of my Edinburgh North and Leith constituents signed this important petition, and I thank them for sharing their experiences. In particular, I want to share the story of one mum who told me about the devastating consequences that diabetes had for her family. She told me about her son Nick, who sadly died of this terrible disease aged 28. Nick’s initial diagnosis at 16 was dismissed by the doctor he went to see. It was only the family’s knowledge of what was happening that ensured Nick got to see the specialist he needed. Nick’s mum told me that, in his 12 years as a diabetic, he carried his type 1 diagnosis as lightly as possible, despite having to give himself more than 25,000 injections in that time.

Families such as Nick’s hope that by supporting the petition, our Government will take these vital steps towards making sure that life is made safer for children and adults living with type 1 diabetes. I share that view, and hope that the Government pay close attention to the experience of families across the country. I also urge the Scottish Medicines Consortium to consider similar changes for Scotland, and hope that the Scottish Government ensure that improvements are made for type 1 diagnosis and care.

Oral Answers to Questions

Tracy Gilbert Excerpts

Tuesday 13th January 2026 Commons Chamber

[Wes Streeting]

I am grateful to the hon. Member for her question. Although of course we are considering prevalence and what is driving the apparent increase in conditions such as autism and ADHD, we are really driving at ensuring that we meet everyone’s needs. I do not want for this country a future in which those who can afford it pay to go private and those who cannot are left behind. Nor do I want to see a situation in which people who have a diagnosis do not receive the care they need. We are looking at those issues with urgency.

[Tracy Gilbert (Edinburgh North and Leith) (Lab)]

I and a number of colleagues have concerns about the upcoming PATHWAYS trial. The Secretary of State has powers to use existing medical records for research purposes. Will he therefore consider using those powers to increase the evidence base and prevent the PATHWAYS trial from proceeding?

[Karin Smyth]

I thank my hon. Friend for her constructive approach to this difficult issue. She is right to challenge; we must have open and transparent debate. To be very clear—and to refer to my previous answer—the Secretary of State will use that power. We will have a retrospective data linkage study to identify the associations informing patient experience and outcomes, through the analysis of available digital information in health records and other nationally held databases. It will not establish causation but will be an important contribution to the evidence base.

IVF Egg Donation: Young Women

Tracy Gilbert Excerpts

Thursday 26th June 2025 Westminster Hall

[Jim Shannon (Strangford) (DUP) [R]]

I beg to move,

That this House has considered IVF egg donation in young women.

I thank the Backbench Business Committee for granting this debate on adverts targeting young women for their eggs and attendant consequences. I know that another debate was supposed to be happening here, but unfortunately for the hon. Member who secured that debate, it was not able to take place. That was fortunate for myself and others who have come along today, so I thank the Committee for having offered this slot to us on Tuesday.

It is a pleasure to see the Minister in her place. She always seems to come along to answer questions on health issues, and I thank her for that. It is also a pleasure to see the shadow Minister, the hon. Member for Sleaford and North Hykeham (Dr Johnson) and the Liberal Democrat spokesperson, the hon. Member for Chichester (Jess Brown-Fuller), as well as others who have come along to participate.

The issue of adverts for IVF egg donation has been brought to my attention, and we have some people in the Gallery today who have enabled me to prepare this speech—as well as the questions I wish to ask the Minister —in order to highlight this issue and raise awareness. I thank hon. Members for participating in this debate, which could not be more timely, and the Minister for joining us today. I look forward to her response.

This issue is not as widely understood in this House as perhaps it ought to be. When I made representations to the Backbench Business Committee, I was asked what I was trying to achieve. I explained that, and the Committee very kindly offered me the opportunity to have this debate. This issue must be debated. Adverts in public places asking women to donate their eggs for use by others have hugely increased in recent years. They are seen at bus stops, at stalls in university student unions, in shopping centres and on social media sites. It needs to be regularised and there needs to be departmental input into how it happens. There needs to be rules on how it takes place. I hope that my speech will illustrate the clear issues and why they are so important.

All my contributions in this House start in my constituency of Strangford. My constituents have asked me to bring forward this issue, and it has been very kindly supported by others across this United Kingdom of Great Britain and Northern Ireland.

Adverts are not legally required to state the health risks up front, but they should be. This is despite the process for retrieving eggs from a young woman requiring her to be put through the early stages of IVF and an invasive and often painful surgical procedure to remove them. IVF is so important. I read in the paper today about the number of IVF successes, and I welcome that. This is not about stopping IVF treatment. It is not about ensuring that people cannot have babies. Nothing makes our relationships strong like having children. I always think of those who perhaps cannot and who wish they could. IVF gives them an opportunity to do that.

In 2011, the amount a young woman could be compensated for her eggs rose to £750 per cycle. Thirteen years later, in October 2024, following advice from the Human Fertilisation and Embryology Authority, it rose again, this time to £985, with additional expenses payments able to be made in some cases. That shows that there is a cost factor, and payments should be along the lines of cost.

Women as young as 18 can donate their eggs for use by others—either for IVF for older people or for surrogacy —and demand is soaring. According to the HFEA, women can undergo as many as 10 donation rounds—a huge toll on any lady’s body. Later, I will give the price at which fertility clinics sell the eggs on, so hon. Members will see the difference between that and the figure that ladies are given for a cycle of eggs.

In 2024, the Department of Health and Social Care confirmed to me in a letter that it did not undertake an impact assessment before allowing the payments to women for their eggs to rise, nor has it undertaken a long-term study on the effects of egg retrieval on women’s bodies, but I believe it must do so. Clinics do not undertake long-term follow-up checks on donors’ health. Again, I would have thought that that happens, and I am really surprised that it does not. There seems to be no accountability in the process.

Concerningly, between 2021 and 2023, the Scottish Government also targeted women with open adverts for their eggs, and four NHS health boards in Scotland continue to do so as a result of surging demand.

[Tracy Gilbert (Edinburgh North and Leith) (Lab)]

I congratulate the hon. Member on securing this debate. Is he aware that the adverts that the Scottish Government and NHS fertility centres put out do not convey the associated risks, and that some have used disingenuous language? Does he share my concern about those advertising campaigns, and does he believe that they should be immediately stopped?

[Jim Shannon]

I thank the hon. Lady very much for that point. That is the central thrust of this important debate. There do not seem to be any controls, and donation is almost glamourised, so for those in financial need—I will talk about them shortly—it may look too good to be true. It certainly does need regulating, and I thank the hon. Lady for coming along and making that pertinent point. I very much look forward to the Minister’s response on how the Government can regulate things in a constructive, helpful and safe way.

I do not know of any other Government in the world who ask women to donate their eggs for use by others, so why are we doing it here in a way that can undermine women’s health? It does not seem to be regulated in any way, and there do not seem to be any rules. That needs to be changed.

Research from Surrogacy Concern cited HFEA data showing that between 1991 and 2000, there were 736 egg donors aged between 18 and 25. Further research has shown that between 2000 and 2022, there were at least 78 women across the UK aged just 18 who registered to donate their eggs, 283 aged 19, and 468 aged just 20. That gives an indication of the age that this starts, and I will outline some of the reasons why this can have an impact later down the line.

Between 2000 and 2022, the HFEA registered 5,158 new donors across the UK aged 18 to 25 for egg donation. I say all those things because I believe that this is such an important issue, and that we are on the cusp of uncovering a major public scandal in the way egg donation is advertised.

The issue gets worse when we look at the socioeconomic background of the donors. In 2024, the Government confirmed to me that between 2011 and 2020, 4,147 donors came from the three most deprived deciles of the index of multiple deprivation. In stark contrast, there were 3,007 donors from the least deprived deciles. Again, as I will explain, those who may feel pressurised may see donation as a method of income without understanding all the potential side effects. Between 1991 and 2022, 23,522 new British egg donors were registered across the UK by the HFEA—21,020 from England, 1,315 from Scotland, 954 from Wales and 245 from Northern Ireland. In 2022 alone, 1,645 new British donors were registered in the UK.

Campaigners are concerned about the developing societal entitlement to women’s eggs, and that eggs are becoming a tradable commodity. They should not be, but that is the perception—indeed, that is the reality. Eggs for donation need to be of high quality, so only women aged 18 to 35 are targeted by fertility clinics. I believe that a power imbalance is developing between young and old, between poor and rich, and, in many cases, between female and male. The majority of egg donors are also not mothers, raising concerns about the psychological impact of a woman’s own genetic offspring being raised by others, which may only be realised years after donation. There is also a concerning development whereby young women’s bodies seem to be commodified resources to be assessed for the benefit of others. That concerns me greatly.

One London egg centre has an online catalogue—my goodness me—where donors can be searched for by their ethnic background, their hair colour, the colour of their eyes, their height, their skin tone and their educational attainment, raising further concerns about the development of designer babies. In other words, people think, “We’ll pick through this catalogue, and we’ll see which one we’d like to have.” It should never be that way.

Despite women supposedly not being paid for their eggs, donors have reported receiving payment, which the industry terms “compensation”. Originally £750 but now £985, it is paid into their bank accounts directly after egg retrieval, with no expenses claims or receipts needed to be submitted to the clinic. There are no rules. There are no guidelines. There is nothing to follow. Meanwhile, campaigners have seen plenty of examples of payments quoted up front and adverts directly incentivising young women to undergo the procedure for money, raising the likelihood of exploitation; the hon. Member for Edinburgh North and Leith (Tracy Gilbert) made that point very clearly. There is a significant risk to low-income, working-class women and to students. It also stands in stark contrast to expenses payments for British kidney donors, which must be strictly itemised with receipts provided. If that is the way to do it for kidney donors, it is the way to do it for egg donors.

The HFEA claims that egg donors largely state they are undergoing the procedure for altruistic reasons, but we must acknowledge the risk that some young women’s desire to help others, often at a cost to themselves, is being used against them. Eggs are sold in packages for thousands of pounds by egg banks and fertility clinics. The London Egg Bank offers six frozen eggs for sale at £5,500, and the Manchester Fertility clinic offers a package of eight frozen eggs starting from £11,000. That £985 against those prices gives an indication of where the real money is. The majority of British fertility clinics are now owned by private equity firms—again, there is little or no regulation, no rules and no safety measures. Something needs to be in place.

The process of egg donation is gruelling, which is sometimes overlooked. Women must inject hormones in a process known as downregulation, which switches off the pituitary gland in order to stop the ovaries working temporarily and allow the lady’s cycle, in its totality, to be controlled by the clinic. In cases of fresh egg donation to another woman, the donor’s cycle is synchronised with that of the recipient.

The donor then takes follicle-stimulating hormones to overstimulate the ovaries into producing an artificially high number of eggs at the same time. The clinic wants extra eggs, wants the donation to be larger than the lady would normally produce, and the woman then injects human chorionic gonadotropin, or HCG, which helps eggs to mature, ready for retrieval. This maturation mimics the natural process that normally triggers ovulation.

Finally, eggs are collected from the woman using a needle that punctures the vaginal wall and perforates the ovary, gathering fluid from each follicle—the fluid containing the eggs. Donors in the UK have reported that dozens of eggs, and often even more, have been retrieved in just one donation round. One British donor reported 42 eggs being retrieved in one cycle; another reported 46 eggs being retrieved in the next cycle. That stands in stark contrast to the one egg a month that the female body naturally ovulates. I hope that those who are here today will understand that if a lady’s natural ovulation rate is one egg a month, but 42 or 46 eggs are produced and farmed, that is very much going against what the body does naturally, which has a detrimental effect on some people.

Nobody fails to have sympathy for those who struggle to have a child and who therefore embark on fertility treatment. I know quite a number of ladies who have embarked on such treatment, and their joy at having their wee baby is something that words cannot describe. The look of happiness on the faces of the mum and dad is great, as is the fact that the wee child has been born. However, the use of donor eggs has real societal consequences and potentially there can be a very negative long-term physical and psychological impact on young women who donate their eggs.

We must rebalance this conversation to take into account the impact on the young women who undergo these procedures. We need to have regulation; we need to have rules in place. The process needs to be controlled, rather than the matter just being seen from the point of view of those who want access to donor eggs.

We know from the experience of women who underwent forced adoption in mother and baby homes in the 20th century that often it takes years for women to come forward and report harm done to them in the past. Some donors have reported needing hysterectomies as a result of the damage they sustained during egg retrieval. Other donors have said that when they discovered they had genetic diseases, the clinics refused to take further action and put the onus back on the donor themselves to report to the HFEA. Those checks should have been done before donation, not afterwards.

Similarly, donors are not required to undergo enhanced carrier screening, leading to a risk that some genetic diseases might be unknowingly passed on in the donor eggs and ultimately on to the wee baby who will be born. Another donor has reported donating eggs in her early 20s, only to find when she tried to start her own family in her early 30s that she was unable to do so. Other donors report endometriosis and adenomyosis developing after donation. Quite simply, the long-term risks to women’s health from egg donation are unknown and largely unstudied. Today, I am hopefully outlining where the problems are, why regulation is needed and why I believe that the Government need to step in.

Women who have undergone egg retrieval for their own IVF have reported complications and side effects, including sepsis, abscesses, perforated bowels, severe pain during or after retrieval, and even slipping into a coma as a result of developing ovarian hyperstimulation syndrome.

All this risk is borne by young people so that older people can purchase eggs from fertility clinics and egg banks. According to the HFEA, between 1991 and 2022 —some 31 years—44,760 IVF cycles involving donor eggs were made for people aged 40 or over.

Young donors are at higher risk of ovarian hyper- stimulation syndrome because of the higher number of eggs that they have compared with older women. The Royal College of Obstetricians and Gynaecologists has said that as many as 30% of women aged under 30 who undergo egg retrieval may develop ovarian hyperstimulation syndrome. Complications arising from OHSS can kill. That is why there needs to be regulation and consideration of safety as part of the process.

Two women died in England from such complications in 2005-06. In 2023 there were 53 severe or critical cases of OHSS reported to the HFEA. Yet nowhere in the adverts, online or anywhere else are the risks stated, and they should be. Those donating eggs should be aware of the risks. Donors have reported that clinics mention the risks and likely side effects only briefly and not in depth. They should be stated in depth, but they are not. Counselling for donors is offered, but is not mandatory.

We must look at international comparators. I always like to see what has been happening elsewhere. In Germany there is no egg donation at all. German legislation specifically prohibits the “splintering”—that is the word used—of motherhood that egg donation and surrogacy create. In Italy, donors cannot be compensated at all so that women are not incentivised to undergo the procedure because of financial need.

We must also consider the donor-conceived child. Egg and sperm donations are not meant to create more than 10 families. How many times have I read in the press about men who have fathered, through their sperm, perhaps as many as 100-plus children in the United Kingdom and across the world? One day a young boy and girl could meet, marry, and actually be brother and sister. There needs to be a limit, which is 10, but it is clear that some clinics do not have the control that perhaps they should have.

As gamete donation and use rapidly increases, the likelihood of genetic half-siblings across multiple households, often in close geographical proximity to one another, increases. That is what I fear no controls means. Although British clinics must ensure that donor identities can be revealed to children at 18 years of age, many people resident in the UK still travel abroad for IVF, including to jurisdictions where anonymous gametes and sex selection of embryos are legal. That means hundreds, if not thousands, of children are growing up in the United Kingdom of Great Britain and Northern Ireland unable ever to trace their genetic parents.

The evidence is strong enough to call on the Government to raise the minimum age for egg donors to 25, because of the effect it has on those under that age who donate eggs. Secondly, we should ban adverts asking for women to donate eggs—the very thing that the hon. Member for Edinburgh North and Leith referred to and which we are all very aware of. Advertising for surrogate mothers is already banned, so why not ban adverts asking for women to donate eggs? Thirdly, we should end payments to donors to ensure they are not donating because of financial need. In other words, their financial circumstances could put them in a quandary when it comes to doing what they are doing. At a minimum, adverts must state the health risks up front and the minimum donor age must rise. I sincerely hope that the Minister will take the issue back to the Department and that the Government will act quickly to protect and prioritise young women and their health.

Gender Incongruence: Puberty Suppressing Hormones

Tracy Gilbert Excerpts

Wednesday 30th April 2025 Westminster Hall

[Helen Morgan (North Shropshire) (LD)]

It is a pleasure to serve under your chairmanship, Ms Lewell. For too long, children and young people who are struggling with their gender identity have been badly let down by low standards of care, exceptionally long waiting lists and an unacceptably toxic public debate. That is why Liberal Democrats have been arguing for much better specialist healthcare services for children and young people who find themselves in this distressing situation. The old system, a single clinic, with a shockingly long waiting list and rated “inadequate” by the Care Quality Commission, was clearly failing vulnerable young people at the most difficult time in their lives. Before GIDS closed, more than 5,000 young people were stuck on the list and left waiting for an average of almost three years for a first appointment. For vulnerable teenagers and pre-teens, going through what are often incredibly difficult experiences, those three years must have felt like an eternity.

Liberal Democrats have consistently campaigned for action to tackle appallingly long wait times across the NHS, whether for cancer treatment or mental health, and it is right that we do so for gender identity services as well. It is clear that change is needed. That is why we have long been pressing the Government to establish new specialist services and recruit and train more specialist clinicians, so that children and young people can access the appropriate, high-quality healthcare that they need. The move to create multiple new regional centres is, therefore, a very welcome one, but only two are open now—in London and the North West—leaving those who have already been stuck on waiting lists for years to wait even longer. There is no sign yet of when the other centres will open. Would the Minister be able to give us an indication of when they might?

Unless the Government show far more urgency in getting these centres up and running properly, more and more children will be denied the care they need as they languish on those long waiting lists. While it is right that treatment is largely based on talking therapies for both the child and their parents to give all gender-questioning young people the time and space to make clear and informed decisions about their future, that has got to mean that people starting their talking therapy when they need it, not after years of delay.

Following the Cass review, the Secretary of State announced that the NHS would be conducting clinical trials on the impact of puberty blockers. That is due to begin very soon. I would appreciate clarification from the Minister about the current status of the trials and the terms of reference under which they will be conducted. The announcement of the trial came alongside an indefinite ban on the prescription of puberty blockers as a treatment for young people with gender incongruence or dysphoria, unless they are part of that trial. Numerous organisations, including the Council of Europe, have raised concerns about the potential ethical implications of only offering a treatment to a small group of patients taking part in a clinical trial. I believe that the Secretary of State confirmed at the Dispatch Box that the trial would be uncapped when he gave a statement on puberty blockers to the House in December 2024. Would the Minister confirm whether that is the case?

The ban has caused fear and anxiety for some young trans people and their families, who have been so badly let down for so many years. I have met with families in my own constituency who have highlighted the severe mental health impacts that uncertainty over treatment can have. It is crucial that any clinical decisions are made by expert clinicians based on the best possible evidence, not politicians with a point to make.

[Tracy Gilbert (Edinburgh North and Leith) (Lab)]

Are the Liberal Democrats supportive of the views in the Cass review? I do not think that that has been stated on the public record as yet.

[Helen Morgan]

I have met with Dr Cass. We have considered the Cass review, and we are in support of the clinical trial that she has recommended. That is why I am asking the Minister to clarify some of the points that have been made as that trial progresses.

When that decision was made to indefinitely ban puberty blockers, it obviously caused some concern and uncertainty for the families that are affected. Would the Minister commit to publishing the supporting evidence, including the results of the consultation, to give those families confidence in the decision to ban their prescription?

With any medical treatment, especially for children and young people, it is most important that the clinical professionals follow the evidence on safety and effectiveness. I welcome the Government’s support for the research to improve evidence on the safety and efficacy of potential treatments; that research must take into account the direct personal experiences of those who have used those services in the past. More broadly, Liberal Democrats believe that all trans and non-binary people should have access to the high-quality healthcare that they deserve, and that Government should prioritise tackling unacceptable waiting times by expanding the provision of appropriate and timely specialist healthcare through NHS child and adult services for trans and non-binary people, ensuring that trans people have access to high-quality healthcare on the same basis as we would expect for all patients, with medical decisions made by patients and doctors together, informed by the best possible evidence, and supporting research using international best practice to improve evidence on the safety and efficacy of potential treatments.

For puberty blockers specifically, it is for expert clinicians to build the evidence base and determine whether they are safe and effective. I do not think any politician, such as me, who does not have that clinical experience or evidence to hand should be making pronouncements on whether or not they are. We need the NHS to act on building up that evidence base, and for the Government to provide certainty that they will follow the evidence and expert advice when that is available.

Children and young people with gender incongruence are uniquely vulnerable, potentially facing an identity crisis, difficult relationships at home and social isolation at a very young age. It is extremely important that they are treated respectfully, safely, quickly and in the way that is best for their long-term health and personal development. It is unlikely that the same treatment will be appropriate for every individual in that situation, but when it comes to any individual medical interventions, Liberal Democrats believe it is right that those decisions are made by clinicians and patients together, informed by the best possible evidence, as is the case in all areas of healthcare.

--- Later in debate ---

[The Minister for Secondary Care (Karin Smyth)]

It is a pleasure to serve under your chairmanship, Ms Lewell. I congratulate the hon. Member for Reigate (Rebecca Paul) on securing this debate, on the constructive tone in which she has engaged with me and my Department, and on the way that she opened the debate.

The Government’s approach is governed by three principles. First, the health and wellbeing of children and young people is our primary concern—a point made by the hon. Member for Strangford (Jim Shannon). Secondly, evidence-led, effective, ethical and safe healthcare must be provided to all who need it, when they need it—a point well made by my hon. Friend the Member for Macclesfield (Tim Roca). Thirdly, this Government believe in the dignity and equality of every single one of His Majesty’s citizens.

Since the election, we have been calmly and cautiously guided by the evidence. We take children’s healthcare extremely seriously. That is why we remain committed to implementing the Cass review, and ensuring that children and young people who are looking for support in relation to their gender receive the highest quality of care, as one would expect of any other child health service in the NHS.

[Tracy Gilbert]

Dr Cass was clear in her review that the model of care for people with gender incongruence, and particularly for children and young people, needs to be changed to take into account their holistic care needs. Will the Minister update us on her Department’s progress in implementing those findings?

[Karin Smyth]

I thank my hon. Friend for that intervention; I hope to get on to that subject in my speech. It is important that people are aware of that progress.

I know that many people are concerned about the ethics of this research, as the hon. Member for Reigate and the right hon. Member for South Holland and The Deepings (Sir John Hayes) both noted. I assure hon. Members that the UK has, as we know, extremely rigorous and robust ethical approval pathways, and that no clinical trial can proceed without the necessary independent scientific approvals.

We already regularly use those processes to consider clinical trials in children so that we can evaluate new treatments for a whole range of conditions, including cancer, depression, respiratory infections, or any illness. Many aspects of the methodology of this trial are still being looked at, such as how long it will follow children, how many children will be on the trial and how the demographics of the trial will be constructed. That is all still to be confirmed and approved; many hon. Members asked about those points today. All participants in the trial will also be part of the ongoing observational study.

Following the decision by the Secretary of State for Health and Social Care about puberty blockers, which was based on the evidence, we needed to make sure that we got on with helping scientists, researchers and clinicians to do their jobs. Some people have called for the Government to stop those experts from pursuing this line of inquiry, and we have heard such calls again in this debate. They have argued that the decision to halt the sale and supply of puberty blockers should be the end of the matter, and that young people should not have access to this medication, come what may. That would be to ignore the distress and real experiences of young people, and the Government have no doubt that it would drive people towards possible illegal and underground routes, shutting off young people’s access to conversations with professionals and the opportunity to pause and consider other options.

Instead, as Dr Cass suggests, we can set out a proper path to treatment that involves young people, their parents, clinicians and mental health professionals. Knowing that they are on a path will reassure young people that they are being taken seriously. The cautious process that they will have to work through before joining a trial means that young people will have access to support and counselling, which may result in them deciding against joining the trial and pursuing a medical route. That is an approach entirely missing over recent years.

We all agree that treatment should be offered based on the best available evidence, and clinical trials in the UK are considered to be the gold standard for evaluating healthcare interventions. The Cass review found:

“The evidence base underpinning medical and non-medical interventions in this clinical area must be improved.”

That is why we have commissioned the PATHWAYS programme of research, one aspect of which includes the world’s first clinical trial designed to help us to better understand the relative benefits and potential wider effects of the use of puberty blockers in affected children.

We must look at the most appropriate medical and non-medical approaches to support physical, emotional and psychosocial health. That is why the trial forms just one component of a wider study and a growing portfolio of research, jointly hosted by NHS England. That includes looking at the experiences of the 9,000 adults who, as children, were cared for under a previous model of NHS care, which I know the hon. Member for Reigate has described as a “medical scandal”. Dr Cass was clear in her review that both a clinical trial on puberty blockers and a data linkage study, which many hon. Members have raised today, are important to improving the evidence base on gender incongruence in children and young people.

Regardless of individuals’ views on the practices of the Tavistock, I hope we can all agree that learning from the experiences of those thousands of people who have accessed puberty blockers is important; it will provide different and separately valuable information from the clinical trial. That data alone, however, will not provide the answer as to whether we should—or should not—consider routinely prescribing these drugs in the future, or continue the ban indefinitely.

The adult gender services have now committed to sharing their data, a point also raised by hon. Members. I acknowledge that we need to move quickly, and I expect to be making progress on this soon. We will consider all data that is relevant to puberty blockers, including from the adult gender clinics.

As with all clinical research, the team leading the trial must ensure that approval is obtained from the regulatory authorities, including one of the Health Research Authority’s independent ethics committees and the Medicines and Healthcare products Regulatory Agency. Those are all standard steps where the research receives full scrutiny. Once approvals are granted, the study protocol will be finalised and published, and only then can the trial commence. I am not able to comment on the finer details of that today, but we will issue further updates when they are available, and I commit to keeping Members updated.

I assure hon. Members that entry into the trial will be guided by strict eligibility criteria. It will involve only young people under the care of the NHS children’s gender services who have received a full assessment, where other appropriate forms of support have been offered and where their clinician supports a referral to the trial. Under the law, if a child is under 16, a parent will have to consent to their participation, and the child also needs to agree.

I am repeating myself slightly, but that level of caution was entirely missing over recent years. This is a more considered and evidence-based approach. In the past, puberty blockers were presented as the magic pill that young people needed to access; this trial will give children and young people the support they need to make these major decisions.

As we have heard today, we are currently in a situation where some people think it is unethical not to provide these treatments, and some think it is unethical to provide them. The reality is that we do not have definitive evidence. When that happens, we routinely ask for the study to be checked by an independent ethics committee. We spell out the uncertainty to young people and their parents, so that they can balance any such risk against their desire to join the trial before deciding whether they wish to participate.

Rare Cancers Bill

Tracy Gilbert Excerpts

2nd reading
Friday 14th March 2025 Commons Chamber

[Tracy Gilbert (Edinburgh North and Leith) (Lab)]

I thank all hon. Members for their moving, passionate and powerful speeches. I congratulate my hon. Friend the Member for Edinburgh South West (Dr Arthur) on bringing forward the Bill and on the work he has done with so many stakeholders. I commend him on sharing the story of his father-in-law, who will be sadly missed by him and his family.

The story of my hon. Friend’s father-in-law has prompted a significant number of my constituents in Edinburgh North and Leith who are advocates for the Bill to share their stories. A constituent told me about their friend, who passed away aged 45 in November 2023. They were diagnosed with two rare cancers. On each occasion, they were informed by their doctor that it was a cancer that they did not know how to treat. My constituent’s friend tragically died unable to understand why more was not known about those rare cancers, despite the large amount of money that has been put into research and the wins achieved in cancer care and treatment by scientists and medics over the past few decades.

In Edinburgh, many cancer patients are treated at the Edinburgh Cancer Research Centre at the Western general hospital, which borders my Edinburgh North and Leith constituency. Established in 2022, the Cancer Research UK Scotland centre brings together the very best in cancer research from Edinburgh and Glasgow, working with over 80 teams. The centre has established processes, and has access to two of the largest cancer treatment centres in Scotland, making trials and research more efficient. One of the centre’s six research themes is mesothelioma, a rare cancer that affects the lining of the lungs, abdomen or heart. I am keen to hear from my hon. Friend the Member for Edinburgh South West about his engagement with the University of Edinburgh and the Edinburgh Cancer Research Centre on the Bill.

The Bill crosses devolved and reserved areas. I believe in pooling and sharing resources. Just as profit should not be a barrier to research, neither should the border at Gretna. I am keen to hear from my hon. Friend or the Minister about any discussions that have taken place with the Scottish Government and other devolved Administrations to ensure that we work across the UK, and use the research talent of the University of Edinburgh and others across the UK. We need a joined-up approach to make breakthroughs on the treatment and care of those with rare cancers. Has there been dialogue with Ministers in Scotland and other devolved Ministers on clauses 2 and 3? Have devolved Ministers given any undertakings to replicate the proposals?

In conclusion, the Bill will make a difference to our constituents, and I am delighted to speak in support of it. My mum Violet died two decades ago within six weeks of her cancer being diagnosed. I hope that the Bill will give hope and time to every family impacted by a cancer diagnosis.