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Revista Brasileira de Ginecologia E... Dec 2022Surrogacy is the process in which a woman carries and delivers a baby to other person or couple, known as intended parents. When carriers are paid for surrogacy, this... (Review)
Review
OBJECTIVE
Surrogacy is the process in which a woman carries and delivers a baby to other person or couple, known as intended parents. When carriers are paid for surrogacy, this is known as commercial surrogacy. The objective of the present work is to review the legal, ethical, social, and cultural aspects of commercial surrogacy, as well as the current panorama worldwide.
METHODS
This is a review of the literature published in the 21 century on commercial surrogacy.
RESULTS
A total of 248 articles were included as the core of the present review. The demand for surrogate treatments by women without uterus or with important uterine disorders, single men and same-sex male couples is constantly increasing worldwide. This reproductive treatment has important ethical dilemmas. In addition, legislation defers widely worldwide and is in constant change. Therefore, patients look more and more for treatments abroad, which can lead to important legal problems between countries with different laws. Commercial surrogacy is practiced in several countries, in most of which there is no specific legislation. Some countries have taken restrictive measures against this technique because of reports of exploitation of carriers.
CONCLUSION
Commercial surrogacy is a common practice, despite important ethical and legal dilemmas. As a consequence of diverse national legislations, patients frequently resort to international commercial surrogacy programs. As of today, there is no standard international legal context, and this practice remains largely unregulated.
Topics: Pregnancy; Humans; Female; Male; Surrogate Mothers; Uterus
PubMed: 36580941
DOI: 10.1055/s-0042-1759774 -
Human Reproduction Update 2016Surrogacy is a highly debated method mainly used for treating women with infertility caused by uterine factors. This systematic review summarizes current levels of... (Review)
Review
BACKGROUND
Surrogacy is a highly debated method mainly used for treating women with infertility caused by uterine factors. This systematic review summarizes current levels of knowledge of the obstetric, medical and psychological outcomes for the surrogate mothers, the intended parents and children born as a result of surrogacy.
METHODS
PubMed, Cochrane and Embase databases up to February 2015 were searched. Cohort studies and case series were included. Original studies published in English and the Scandinavian languages were included. In case of double publications, the latest study was included. Abstracts only and case reports were excluded. Studies with a control group and case series (more than three cases) were included. Cohort studies, but not case series, were assessed for methodological quality, in terms of risk of bias. We examined a variety of main outcomes for the surrogate mothers, children and intended mothers, including obstetric outcome, relationship between surrogate mother and intended couple, surrogate's experiences after relinquishing the child, preterm birth, low birthweight, birth defects, perinatal mortality, child psychological development, parent-child relationship, and disclosure to the child.
RESULTS
The search returned 1795 articles of which 55 met the inclusion criteria. The medical outcome for the children was satisfactory and comparable to previous results for children conceived after fresh IVF and oocyte donation. The rate of multiple pregnancies was 2.6-75.0%. Preterm birth rate in singletons varied between 0 and 11.5% and low birthweight occurred in between 0 and 11.1% of cases. At the age of 10 years there were no major psychological differences between children born after surrogacy and children born after other types of assisted reproductive technology (ART) or after natural conception. The obstetric outcomes for the surrogate mothers were mainly reported from case series. Hypertensive disorders in pregnancy were reported in between 3.2 and 10% of cases and placenta praevia/placental abruption in 4.9%. Cases with hysterectomies have also been reported. Most surrogate mothers scored within the normal range on personality tests. Most psychosocial variables were satisfactory, although difficulties related to handing over the child did occur. The psychological well-being of children whose mother had been a surrogate mother between 5 and 15 years earlier was found to be good. No major differences in psychological state were found between intended mothers, mothers who conceived after other types of ART and mothers whose pregnancies were the result of natural conception.
CONCLUSIONS
Most studies reporting on surrogacy have serious methodological limitations. According to these studies, most surrogacy arrangements are successfully implemented and most surrogate mothers are well-motivated and have little difficulty separating from the children born as a result of the arrangement. The perinatal outcome of the children is comparable to standard IVF and oocyte donation and there is no evidence of harm to the children born as a result of surrogacy. However, these conclusions should be interpreted with caution. To date, there are no studies on children born after cross-border surrogacy or growing up with gay fathers.
Topics: Child; Cohort Studies; Family; Female; Humans; Infant, Newborn; Infertility; Oocyte Donation; Parent-Child Relations; Pregnancy; Pregnancy Outcome; Pregnancy, Multiple; Reproductive Techniques, Assisted; Surrogate Mothers
PubMed: 26454266
DOI: 10.1093/humupd/dmv046 -
Fertility and Sterility May 2020Gestational surrogacy can provide an effective family-building method for women whose uterus is absent or dysfunctional and with contraindications to pregnancy, single...
Gestational surrogacy can provide an effective family-building method for women whose uterus is absent or dysfunctional and with contraindications to pregnancy, single men, and same-sex male couples. Over the past 30 years, gestational surrogacy cases have represented a growing percentage of third-party reproduction cases, both in the United States and internationally. The following series of articles provides a summary of current topics in optimizing GS arrangements. They focus on medical and psychological screening; psychosocial adjustment of carriers, children, and their families; legal considerations with precedent-setting cases that every clinician should know; and an international overview of cross-border surrogacy.
Topics: Female; Humans; Policy Making; Pregnancy; Reproductive Medicine; Reproductive Techniques, Assisted; Surrogate Mothers
PubMed: 32312561
DOI: 10.1016/j.fertnstert.2020.03.016 -
Obstetrical & Gynecological Survey Sep 2019Surrogacy allows for parenthood when it is otherwise impossible or exceedingly difficult; however, the risks of surrogate pregnancy for the gestational surrogate and the... (Review)
Review
IMPORTANCE
Surrogacy allows for parenthood when it is otherwise impossible or exceedingly difficult; however, the risks of surrogate pregnancy for the gestational surrogate and the fetus are not well defined.
OBJECTIVE
The aim of this study was to review the literature to examine the prevalence and requirements of surrogate pregnancy and maternal and perinatal outcomes.
EVIDENCE ACQUISITION
A CINAHL and 2 PubMed searches were undertaken using the terms "surrogate mothers" OR "(surrogate or surrogacy)" AND "(mothers OR pregnancy OR pregnant)." The second search used these terms and pregnancy outcomes. The search was limited to the English language, but the years searched were unlimited.
RESULTS
The search identified 153 articles, 36 of which are the basis for this review. The number of surrogate pregnancies is increasing in the United States. Fetal risks associated with surrogacy include low birth weight, increased risk of multiple gestation, and preterm birth. Maternal complications associated with surrogate pregnancy include hypertensive disorders of pregnancy, postpartum hemorrhage, and gestational diabetes.
CONCLUSIONS AND RELEVANCE
Surrogacy is a route to parenting that is not without risk to the surrogate or the fetus, and surrogate pregnancy is increasing in frequency in the United States.
Topics: Embryo Transfer; Female; Humans; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Risk Assessment; Surrogate Mothers
PubMed: 31830299
DOI: 10.1097/OGX.0000000000000703 -
Medicina (Kaunas, Lithuania) Jan 2021: To explore the ethical and legal complexities arising from the controversial issue of surrogacy, particularly in terms of how they affect fundamental rights of... (Review)
Review
: To explore the ethical and legal complexities arising from the controversial issue of surrogacy, particularly in terms of how they affect fundamental rights of children and parents. Surrogacy is a form of medically-assisted procreation (MAP) in which a woman "lends" her uterus to carry out a pregnancy on behalf of a third party. There are pathological conditions, such as uterine agenesis or hysterectomy outcomes, that may prevent prospective mothers from becoming pregnant or carry a pregnancy to term; such patients may consider finding a surrogate mother. Many issues relating to surrogacy remain unresolved, with significant disagreements and controversy within the scientific community and public opinion. There are several factors called into play and multiple parties and stakeholders whose objectives and interests need to somehow be reconciled. First and foremost, the authors contend, it is essential to prioritize and uphold the rights of children born through surrogacy and heterologous MAP. : To draw a parallel between Italy and the rest of the world, the legislation in force in twelve European countries was analyzed, eleven of which are part of the European Union (France, Germany, Italy, Spain, Greece, Netherlands, Belgium, Denmark, Lithuania, Czech Republic and Portugal) and three non-members of the same (United Kingdom, Ukraine and Russia), as well as that of twelve non-European countries considered exemplary (United States, Canada, Australia, India, China, Thailand, Israel, Nigeria and South Africa); in particular, legislative sources and legal databases were drawn upon, in order to draw a comparison with the Italian legislation currently in force and map out the evolution of the Italian case law on the basis of the judgments issued by Italian courts, including the Constitutional and Supreme Courts and the European Court of Human Rights (ECHR); search engines such as PubMed and Google Scholar were also used, by entering the keywords "surrogacy" and "surrogate motherhood", to find scientific articles concerning assisted reproduction techniques with a close focus on surrogacy. : SM is a prohibited and sanctioned practice in Italy; on the other hand, it is allowed in other countries of the world, which leads Italian couples, or couples from other countries where it is banned, to often contact foreign centers in order to undertake a MAP pathway which includes surrogacy; in addition, challenges may arise from the legal status of children born through surrogacy abroad: to date, in most countries, there is no specific legislation aimed at regulating their legal registration and parental status. : With reference to the Italian context, despite the scientific and legal evolution on the subject, a legislative intervention aimed at filling the regulatory gaps in terms of heterologous MAP and surrogacy has not yet come to fruition. Considering the possibility of "fertility tourism", i.e., traveling to countries where the practice is legal, as indeed already happens in a relatively significant number of cases, the current legislation, although integrated by the legal interpretation, does not appear to be effective in avoiding the phenomenon of procreative tourism. Moreover, to overcome some contradictions currently present between law 40 and law 194, it would be appropriate to outline an organic and exhaustive framework of rules, which should take into account the multiplicity of interests at stake, in keeping with a fair and sustainable balance when regulating such practices.
Topics: Altruism; Australia; Child; Child Welfare; Commerce; Europe; Female; Humans; Israel; Italy; Japan; Medical Tourism; Pregnancy; Public Policy; Reproductive Techniques, Assisted; Russia; Social Problems; Surrogate Mothers; Thailand; Ukraine; United States
PubMed: 33429930
DOI: 10.3390/medicina57010047 -
Gynecologie, Obstetrique & Fertilite Nov 2014
Topics: Adult; Female; Humans; Reproductive Techniques, Assisted; Uterus
PubMed: 25444699
DOI: 10.1016/j.gyobfe.2014.09.010 -
Seminars in Reproductive Medicine Nov 2016Overt hypothyroidism in pregnancy, defined as an elevated serum thyroid-stimulating hormone (TSH) and reduced serum free thyroxine or a TSH >10 mIU/L, is known to have... (Review)
Review
Overt hypothyroidism in pregnancy, defined as an elevated serum thyroid-stimulating hormone (TSH) and reduced serum free thyroxine or a TSH >10 mIU/L, is known to have adverse effects on pregnancy. Subclinical hypothyroidism is typically defined as an elevated TSH and normal FT4 levels. There remains much controversy on the benefit of starting levothyroxine for mothers diagnosed with subclinical hypothyroidism. Recent studies are redefining the normal range for TSH in pregnancy, and the data on whether treatment of subclinical hypothyroidism improves outcomes for the mother and fetus are unclear. One confounding variable is the presence of thyroid peroxidase antibodies, as it may be a surrogate marker for other autoimmune disorders detrimental to pregnancy. If levothyroxine treatment is initiated, the dosing and monitoring strategy is different from nonpregnant individuals. Randomized clinical trials are underway that may better elucidate whether treatment of subclinical hypothyroidism is warranted.
Topics: Biomarkers; Dose-Response Relationship, Drug; Female; Humans; Hypothyroidism; Iodine; Pregnancy; Pregnancy Complications; Thyroid Function Tests; Thyroid Gland; Thyrotropin; Thyroxine
PubMed: 27741547
DOI: 10.1055/s-0036-1593488 -
Asian Bioethics Review Jul 2022Surrogacy is one of the desired reproductive technologies for family formation, yet surrogate mothers are subjected to unethical treatments and unbalanced power...
Surrogacy is one of the desired reproductive technologies for family formation, yet surrogate mothers are subjected to unethical treatments and unbalanced power relations in India. Such treatment obscures women's free decision-making and can be detrimental to their maternal self. Recently, the Surrogacy (Regulation) Act, 2021, has received the President's approval to regulate surrogacy practices by limiting them for the altruistic motives which have again provoked the burning debates regarding reproductive technologies, women's emancipation and procreative labour. The paper thus explores women's agency, maternal freedom and surrogate arrangements in Indian society. The complexity of the implementation of the law, vulnerability of surrogate labour, woman's bodily autonomy and reproductive choices have been analysed. This has been done through comprehensive feminist discussions on motherhood experience in terms of enforced vs. voluntary to find the way to protect women's freedom and subjectivity in the task of 'mothering as empowerment'.
PubMed: 35791331
DOI: 10.1007/s41649-022-00205-6 -
Best Practice & Research. Clinical... Feb 2019Women diagnosed with gynaecological cancer may face unwanted loss of fertility as well as all the other life-changing issues with which cancer and its treatments are... (Review)
Review
Women diagnosed with gynaecological cancer may face unwanted loss of fertility as well as all the other life-changing issues with which cancer and its treatments are associated. The decision to harvest and store gametes has to be made before commencement of treatment, and advances in these techniques have made this successful. Fertility sparing therefore must be discussed and offered at an early stage post diagnosis. Surrogacy is currently an evidence-based method of assisted reproduction, with mainly desirable outcomes for the commissioning mother, surrogate and child, without impacting on the cancer treatment and long-term survival. Surrogacy is therefore ethical as long as the autonomous rights of both the commissioning mother and gestational carrier are equally observed, they both have equal legal protection and due attention is paid to the short- and long-term welfare of any resulting offspring.
Topics: Female; Genital Neoplasms, Female; Humans; Infertility, Female; Pregnancy; Reproductive Techniques, Assisted; Surrogate Mothers
PubMed: 30553717
DOI: 10.1016/j.bpobgyn.2018.11.001 -
Ceska Gynekologie 2018The aim of this article is to give a critical overview of the main concepts used in surrogate motherhood, taking into account the influence of some terms, such as the... (Review)
Review
OBJECTIVE
The aim of this article is to give a critical overview of the main concepts used in surrogate motherhood, taking into account the influence of some terms, such as the commissioning parents, commercial surrogacy or the phrase „gift of life“, on a specific framework of interpretation of this reproductive model. Partial interest is to compare the findings with the results of foreign studies and propose alternative concepts suitable for scientific and political discourse in the Czech Republic.
DESIGN
Review.
SETTING
Department od Medical Ethics, Faculty of Medicine, Masaryk University, Brno.
METHODS
Summary of texts on surrogacy motherhood, published in the years 1986-2017 in the Czech Republic, taking into account the terminology used by the surrogacy. Comparison with foreign studies.
CONCLUSION
Terminology of surrogacy has its ethical and psychosocial consequences. In some cases, the terms implicitly include the attitudes of the authors. It is preferable to use preferential terms of surrogacy, surrogate mother. The use of the notion of commissioning parents becomes unacceptable. The use of the terms of intended parents is more correct, respecting the autonomy of the persons involved. The terms „commercial surrogate motherhood“ and „gift of life“ should be further discussed. Keywords surrogacy, surrogate mother, intended parents.
Topics: Czech Republic; Ethics, Medical; Female; Humans; Pregnancy; Surrogate Mothers
PubMed: 30848153
DOI: No ID Found