World’s IVF clinics: protecting human rights is front and centre for all IVF

Yesterday, 29 April, Fertility Societies of the world agreed that valuing human rights was central to the practice of assisted reproductive technology around the world.

They did so at the International Federation of Fertility Societies meeting in Tokyo. The agreement is called the Tokyo Declaration. While other human rights are impacted by the journey to parenthood through ART, the Tokyo Declaration is a milestone for putting the protection of human rights at the front and centre of the practice of ART throughout the world.

Dr Petra Wale, President of the Fertility Society of Australia and New Zealand, was one of the signatories.

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TOKYO DECLARATION

Reproductive Health and Human Rights.

PREAMBLE

Recognizing the family as the fundamental unit of society, and in view of the current evidence of the global decline in fertility rates, the Tokyo Declaration sets out universal and fundamental principles to ensure and support the health and human rights of all parties needing access to fertility resources including, education, clinical assessment, diagnosis, and/or treatment (and associated practices), and the children born as a result of such treatments.

Signatories to the Tokyo Declaration call on governments worldwide to provide oversight to support the ethical practice of reproductive care and the clinical assessment, diagnosis, and treatment of human fertility and reproduction issues within a human rights framework; to recognize such services as deserving of the same level of funding and service provision as other medical conditions; and to support the training of doctors, nurses, and scientists to deliver services for the infertile globally.

Signatories also call on public and private entities and corporations to recognize human reproduction as deserving of both antenatal and postnatal support and throughout pregnancy, including but not limited to appropriate parental leave and provision of insurance coverage for fertility care, as required.

Signatories to the Tokyo Declaration undertake to uphold and advocate for the principles herein to ensure the health and human rights of those people who access reproductive care, clinical assessment, diagnosis, and or treatment (and associated practices); donors of gametes; surrogates; their partners, if any; and the people born as a result of treatment.

Signatories note that all practices must fall within the laws and regulations of the respective jurisdictions where assisted reproductive care and associated practices occur, and that the Tokyo Declaration does not aim to change national laws.

TOKYO DECLARATION PRINCIPLES

1. Access to Fertility Education, Clinical Assessment, Diagnosis, and Treatment

Access to fertility education, reproductive care, clinical assessment, diagnosis, and/or treatment (and associated practices) should be available to everyone who wishes to form a family that includes children. This includes but is not limited to general education about human fertility, as well as when a person and their partner (if any) are having difficulty conceiving or carrying a pregnancy, or other reproductive health issues, or are unlikely to become pregnant without assisted reproductive treatment, or if the risk of a serious genetic abnormality in a child could be significantly reduced by utilizing assisted reproductive technology.

2. Universal Health Coverage

Universal health coverage should be available to support people who need to access reproductive care, clinical assessment, diagnosis, and/or treatment (and associated practices) aimed at helping people address their fertility issues, conceive, carry a pregnancy, and or give birth to a child.

3. Equality and Freedom from Discrimination

Access to reproductive care, clinical assessment, diagnosis, and/or treatment (and associated practices) should uphold the right to equality of all people and be free from discrimination based on such things as race, color, sex, gender, language, religion, political or other opinion, national or social origin, property, birth, or other status.

4. Prohibition of Exploitation and Human Trafficking

Access to reproductive care, clinical assessment, diagnosis, and/or treatment (and associated practices) should never involve exploitation or human trafficking of the parties involved. This includes prohibiting exploiting and/or trafficking potential parent(s), surrogates, gamete donors, and/or the people born as a result of such practices and requires protection of vulnerable people and/or populations.

5. Free and Informed Consent

All parties involved in or receiving reproductive care, clinical assessment, diagnosis, and/or treatment (and associated practices), and their partners (if any), must give free and informed consent to such treatment and any processes involved. This includes any person accessing reproductive clinical assessment, diagnosis, assisted reproductive treatment, donating gametes or embryos (or other genetic material), and or acting as a surrogate. No undue influence or coercion should occur.

6. Independent legal advice, counselling, and the provision of information

Recognizing, respecting and supporting that most countries choose to prohibit surrogacy or limit its practice (for example, to altruistic arrangements, prohibition of commercial surrogacy, and or limiting practices to people domiciled within a particular jurisdiction); when surrogacy is practised, appropriate screening of intended parents and independent legal advice and counselling should be required and available for each party independently of each other, from the antenatal interval through the postnatal period, in a language that each of the parties understands, at a level the parties comprehend, and independent of clinics or agents. A freely chosen support person, for each party, should be permitted at any time.

Similarly, where gamete or embryo donation occurs, all donors, recipients, and their partners, if any, should undergo any relevant assessments (for example, medical assessment and history), and should be provided with counselling and advice about the implications of donor conception.

7. Freedom of movement, personal autonomy, control

At all times, a person undergoing reproductive care, clinical assessment, diagnosis, and/or treatment (such as assisted reproductive treatment, gamete donation, surrogacy, or other practices) should maintain their right to self-determination. This includes but is not limited to decisions about pregnancy, self-care, and the medical procedures and treatments they will or won’t accept. Freedom of movement is essential; such persons should not be limited in their movements nor held or detained against their will.

8. Quality of Care

Quality antenatal and postnatal care, as well as throughout pregnancy, is essential for all people who are undergoing clinical assessment, trying to conceive, who are pregnant, who have experienced miscarriage/termination of a pregnancy, or where a person has given birth (whether a live birth or otherwise). This includes but is not limited to all those who are receiving fertility care and treatment (such as assisted reproductive treatment, gamete donation, surrogacy, or other practices). Assuring quality of care in these circumstances aligns with human rights values.

9. Welfare, health and well-being of children born as a result of Assisted Reproductive Treatment

The welfare, health, and well-being of a child(ren) born as a result of assisted reproductive treatment and/or associated practices must be recognized as paramount. This should include but is not limited to, ensuring best medical practices, recognition of legal parentage, and access to information about medical history, identity, and gestational/genetic heritage (see Principle 10). It may also include screening of donors, surrogates, and recipients for risk(s) that may impact a child’s welfare, physical or mental health, and/or well-being.

10. Right to information

All people should have a right to information and education about their fertility and reproductive care.

Where donor conception and/or surrogacy are utilized, record keeping regarding all parties involved must be thorough, including, at a minimum, identifying information and medical history regarding the gamete or embryo donors, surrogate and siblings (if any). Such records should be kept in perpetuity to allow access to information by the individuals born as a result of such practices and their descendants when possible. Access should be available to information from birth, subject to the laws of the respective jurisdiction.

Surrogates and donors of gametes or embryos should also be entitled to receive information about any offspring born as a result of assisted reproductive treatment (including but not limited to the number of children born, gender, and other information), subject to the laws of the respective jurisdiction.

Explanatory Note:

The International Federation of Fertility Societies’ (IFFS) worldwide mission is to stimulate research, disseminate educational information, and promote superior clinical care in all aspects of reproductive and fertility medicine. Its aim is to ensure everyone has access to quality fertility and reproductive health care. The IFFS is a non-state actor (NSA) with the World Health Organization (WHO), a global organization that recognizes infertility as a disease.

The International Federation of Fertility Societies (IFFS) Board and the IFFS Special Interest Jurist Group drafted the Tokyo Declaration to coincide with the IFFS World Congress held in Tokyo in April 2025, the launch of the IFFS 2025 Triennial Report (which surveys laws and practices regarding assisted reproduction and associated practices around the globe), and the IFFS ‘More Joy’ campaign.

The Tokyo Declaration is underpinned by recognition of the Declaration of Geneva, which is a statement of ethical principles for physicians worldwide emphasizing the duty of doctors to uphold human rights and respect the dignity of all patients. It also upholds Article 2 of the International Covenant on Civil and Political Rights (ICCPR), which creates an obligation to respect and ensure the rights recognized in the Covenant. The table below sets out further human rights principles underpinning the Tokyo Declaration.

 

Tokyo Declaration: Underlying Human Rights Principles Access to assisted reproductive treatments: International Covenant on Civil and Political Rights (ICCPR) Article 26 – All persons are equal before the law and are entitled without any discrimination to the equal protection of the law. In this respect, the law shall prohibit any discrimination and guarantee to all persons equal and effective protection against discrimination on any ground such as race, colour, sex, language, religion, political or other opinion, national or social origin, property, birth or other status. International Covenant on Economic, Social and Cultural Rights (ICESCR), Article 10 – The widest possible protection and assistance should be accorded to the family, which is the natural and fundamental group unit of society, particularly for its establishment and while it is responsible for the care and education of dependent children. Universal health coverage: International Covenant on Economic, Social and Cultural Rights (ICESCR) Article 12 – [Everyone has the] right to the highest attainable standard of physical and mental health. Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW) Article 12 – States Parties shall take all appropriate measures to eliminate discrimination against women in the field of health care in order to ensure, on the basis of equality of men and women, access to health care services, including those related to family planning. Freedom from discrimination: The Universal Declaration of Human Rights UDHR   Article 7 – All are equal before the law and are entitled without distinction to equal protection of the law. Everyone has the right to equal protection against any discrimination that violates this Declaration and against any incitement to such discrimination. International Covenant on Civil and Political Rights (ICCPR) Article 2 – Each State Party undertakes to respect and to ensure to all individuals within its territory and subject to its jurisdiction the rights recognized in the present Covenant, without distinction of any kind, such as race, colour, sex, language, religion, political or other opinion, national or social origin, property, birth or other status. Article 26 – All persons are equal before the law and are entitled without any discrimination to the equal protection of the law. In this respect, the law shall prohibit any discrimination and guarantee to all persons equal and effective protection against discrimination on any ground such as race, colour, sex, language, religion, political or other opinion, national or social origin, property, birth or other status. Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW) Article 2 – States Parties condemn discrimination against women in all its forms, agree to pursue by all appropriate means and without delay a policy of eliminating discrimination against women… Article 16 – Elimination of discrimination against women in all matters relating to marriage and family relations. … [including but not limited to] the same rights and responsibilities as parents, irrespective of their marital status, in matters relating to their children; in all cases the interests of the children shall be paramount; …The same rights to decide freely and responsibly on the number and spacing of their children and to have access to the information, education and means to enable them to exercise these rights… American Convention on Human Rights (ACHR) Article 24 – Equality before the law. All people are equal before the law. Consequently, they are entitled, without discrimination, to equal protection of the law. Prohibition of exploitation or human trafficking: International Covenant on Civil and Political Rights (ICCPR), Article 8 – No one shall be held in slavery; slavery and the slave-trade in all their forms shall be prohibited. …No one shall be held in servitude. United Nations Convention against Transnational Organized Crime Protocol to Prevent, Suppress and Punish Trafficking in Persons, Especially Women and Children. State parties shall take steps to prevent and combat trafficking in persons; and protect victims of trafficking in persons, especially women and children, from revictimization. Free and informed consent: International Covenant on Civil and Political Rights (ICCPR) Article 7 – [N]o one shall be subjected without his free consent to medical or scientific experimentation. The Universal Declaration on Bioethics and Human Rights (UDBHR): Any preventive, diagnostic and therapeutic medical intervention is only to be carried out with the prior, free and informed consent of the person concerned, based on adequate information. The consent should, where appropriate, be express, and may be withdrawn by the person concerned at any time and for any reason without disadvantage or prejudice. Independent legal advice and counselling: International Covenant on Civil and Political Rights (ICCPR) Article 7 – [N]o one shall be subjected without his free consent to medical or scientific experimentation. The Universal Declaration on Bioethics and Human Rights (UDBHR): Any preventive, diagnostic and therapeutic medical intervention is only to be carried out with the prior, free and informed consent of the person concerned, based on adequate information. The consent should, where appropriate, be express, and may be withdrawn by the person concerned at any time and for any reason without disadvantage or prejudice. Freedom of movement, personal autonomy, control: International Covenant on Civil and Political Rights (ICCPR) Article 17 – 1. No one shall be subjected to arbitrary or unlawful interference with his privacy, family, home or correspondence, nor to unlawful attacks on his honour and reputation. 2. Everyone has the right to the protection of the law against such interference or attacks. The Universal Declaration on Bioethics and Human Rights (UDBHR): Any preventive, diagnostic and therapeutic medical intervention is only to be carried out with the prior, free and informed consent of the person concerned, based on adequate information. The consent should, where appropriate, be express, and may be withdrawn by the person concerned at any time and for any reason without disadvantage or prejudice. Quality of Care: International Covenant on Economic, Social and Cultural Rights (ICESCR) Article 10 – The widest possible protection and assistance should be accorded to the family, which is the natural and fundamental group unit of society, particularly for its establishment and while it is responsible for the care and education of dependent children… Special protection should be accorded to mothers during a reasonable period before and after childbirth. Article 12 – [Everyone has the] right to the highest attainable standard of physical and mental health. Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW) Article 12 – …States Parties shall ensure to women appropriate services in connection with pregnancy, confinement and the post-natal period, granting free services where necessary, as well as adequate nutrition during pregnancy and lactation. Welfare, health, and well-being of people born as a result of ART: Convention on the Rights of the Child (CRC) Article 3 – In all actions concerning children, whether undertaken by public or private social welfare institutions, courts of law, administrative authorities or legislative bodies, the best interests of the child shall be a primary consideration. Article 24 – States Parties recognize the right of the child to the enjoyment of the highest attainable standard of health and to facilities for the treatment of illness and rehabilitation of health. States Parties shall strive to ensure that no child is deprived of his or her right of access to such health care services. International Covenant on Economic, Social and Cultural Rights (ICESCR) Special measures of protection and assistance should be taken on behalf of all children and young persons without any discrimination for reasons of parentage or other conditions. Children and young persons should be protected from economic and social exploitation. Right to Information Universal Declaration of Human Rights Article 18: Everyone has the right to recognition everywhere, as a person before the law. Convention on the Rights of the Child (CRC) Article 7 – The child shall be registered immediately after birth and shall have the right from birth to a name, the right to acquire a nationality and, as far as possible, the right to know and be cared for by his or her parents. Article 8 – States Parties undertake to respect the right of the child to preserve his or her identity, including nationality, name and family relations as recognized by law without unlawful interference.

Where conflict arises regarding the application of the principles set out in the Tokyo Declaration and or the health and human rights of the parties involved or born as a result of assisted reproductive treatment, such conflict should be resolved according to the relevant laws and guidelines of the jurisdiction in which the conflict takes place; considering at all times the fundamental human rights principles upon which this document is based.

The Tokyo Declaration opened for signature at the IFFS World Congress, which was held in Tokyo, Japan, in April 2025.

SIGNATORIES

International Federation of Fertility Societies (IFFS)

Professor Edgar V. Mocanu MD, FRCOG, FRCPI

IFFS President

Honorary Clinical Associate Professor of Reproductive Medicine and Surgery,

Royal College of Surgeons in Ireland and Rotunda Hospital, Dublin, Ireland

 

Dr. Marcos Horton

President-Elect IFFS

Pregna Medicina Reproductiva, Buenos Aires, Argentina

 

Professor Steven Ory M.D.

Editor-in-Chief, IFFS Triennial Report
Voluntary Associate Professor of Obstetrics, Gynecology & Reproductive Sciences University of Miami, Florida International University, Miami, Florida, USA

…

International Federation of Fertility Societies Special Interest Jurist Group

Professor Sonia Allan OAM (Chair), School of Law, University of New England, Australia; Assistant Editor, IFFS Triennial Report

Professor Susannah Barruch, Harvard Law School, Harvard University, Boston, United States

Susan L. Crockin, Georgetown University, Healy Hall, Washington D.C., United States

Professor Itziar Alkorta Idiakez, Law Faculty, University of the Basque Country, Spain

Professor Tetsuya Ishii, Office of Health and Safety, Hokkaido University, Japan

Mariana Rodríguez Iturburu, Specialist in Family Law, Childhood and Adolescence, Argentina

Professor Bartha Knoppers OC QC, School of BioMedical Sciences, McGill University, Canada

Assistant Professor Rafal Lukasiewicz, Faculty of Law and Administration, the University of Rzeszów, Poland

Assistant Professor Uchechukwu Ngwaba, Lincoln Alexander School of Law, Toronto, Canada

 

All other signatories

[Title; Name; Affiliation; Country]

 

TOKYO DECLARATION

RESERVATIONS BY SIGNATORIES TO THE TOKYO DECLARATION

It is open to Signatories to place reservations where they may have specific human rights concerns.

 

COMMERCIAL AND INTERNATIONAL CROSS-BORDER SURROGACY

The undersigned signatories expressly indicate their reservations towards commercial and international cross-border surrogacy and the significant human rights concerns such practices raise:

Professor Sonia Allan Allan OAM (Chair), School of Law, University of New England, Australia

Professor Itziar Alkorta Idiakez, Law Faculty, University of the Basque Country, Spain

Assistant Professor Uchechukwu Ngwaba, Lincoln Alexander School of Law, Toronto, Canada

Assistant Professor Rafal Lukasiewicz, Faculty of Law and Administration, the University of Rzeszów, Poland