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The Medico-legal Journal Sep 2020A consideration of the concept, law and practice of surrogacy, and the merits and demerits of the concept. A discussion of payments, foreign surrogacies, delay in...
A consideration of the concept, law and practice of surrogacy, and the merits and demerits of the concept. A discussion of payments, foreign surrogacies, delay in finality, and the need for control and regulation.
Topics: Health Care Costs; Health Expenditures; Humans; Surrogate Mothers; United Kingdom
PubMed: 32437632
DOI: 10.1177/0025817220923688 -
Journal of Assisted Reproduction and... Jun 2022Pregnancies conceived as contracted gestational carriers are a relatively new phenomenon for reproductive medicine. Since the intended parents control genetic screening...
OBJECTIVE
Pregnancies conceived as contracted gestational carriers are a relatively new phenomenon for reproductive medicine. Since the intended parents control genetic screening decisions, there may be differences in genetic decisions made for gestational carrier (GC) in vitro fertilization (IVF) pregnancies as compared to traditional non-gestational carrier IVF pregnancies. Our goal was to investigate the frequency and types of these genetic testing decisions.
METHODS
We performed a retrospective study of GC pregnancies counseled at a private maternal-fetal medicine practice between January 2006 and January 2021. Inclusion criteria were pregnancies that completed counseling with a certified genetic counselor and obtained high-resolution imaging. Controls were non-GC IVF pregnancies seen in the same period matched by parity, estimated delivery date (EDD), and the oocyte age utilized in conception. Statistical analysis included patient demographics, pre-implantation genetic testing (PGT-A) frequency and results, ultrasound imaging results, and the frequency with results of prenatal genetic screening (first or second-trimester serum screens), non-invasive prenatal testing (NIPT), or diagnostic testing (chorionic venous sampling (CVS) or amniocentesis).
RESULTS
One hundred and ninety one gestational carrier pregnancies were identified and 167 met inclusion criteria. Gestational carrier pregnancies were significantly more likely to pursue PGT-A, PGT-A with NIPT, first-trimester screening, and second-trimester screening. There were no differences in rates of amniocentesis or CVS over controls.
CONCLUSIONS
Regarding genetic counseling and screening options, our series is the first to demonstrate that gestational carrier parents seek additional genetic counseling resources, even with reassuring PGT-A and ultrasound.
Topics: Aneuploidy; Female; Fertilization in Vitro; Genetic Counseling; Genetic Testing; Humans; Pregnancy; Preimplantation Diagnosis; Retrospective Studies; Surrogate Mothers
PubMed: 35377088
DOI: 10.1007/s10815-022-02483-3 -
Developing World Bioethics Jun 2023This article examines the construction of parenthood, drawing on Brazilian cisgender, heterosexual, and homosexual couples' experiences in using assisted reproduction...
Assisted reproduction technologies and reproductive justice in the production of parenthood and origin: Uses and meanings of the co-produced gestation and the surrogacy in Brazil.
This article examines the construction of parenthood, drawing on Brazilian cisgender, heterosexual, and homosexual couples' experiences in using assisted reproduction technologies (ART), particularly the surrogacy. For that purpose, we interviewed: 1) a lesbian woman who had her daughter through her partner's pregnancy, using ART with anonymous donor semen; 2) a gay man who, together with his partner, used a surrogacy service under contract via a specialised offshore agency; 3) a woman who was a surrogate, in Brazil, for her sister-in-law and brother who lived abroad and, from abroad, sent an embryo fertilised for surrogacy; 4) a woman who resorted to her sister-in-law in order to be a mother by surrogacy, with ovules from the woman herself fertilised with semen from her husband; and 5) the sister-in-law mentioned in 4), who acted as surrogate for her brother and his wife. These interviews made it possible to think about the discursive construction of the legitimacy of such parenthoods, as it is produced by access to, and manipulation and circulation of, reproductive technologies and persons. This biomedical management of bodies sets up a material and discursive circuit that, in turn, produces a complex web of personal, normative, legal, professional and market relationships, particularly with a view to construction of a parenthood anchored in a notion of biologically-constituted origin. In this respect, biological, affective and social bonds merge to produce a precise placement of who is the father and/or who is the mother, as well as who are the important others and how they are linked to the child in a broader web of parenthood.
Topics: Male; Pregnancy; Female; Child; Humans; Brazil; Surrogate Mothers; Reproduction; Sexual and Gender Minorities; Reproductive Techniques, Assisted
PubMed: 35332999
DOI: 10.1111/dewb.12350 -
International Journal of Reproductive... Sep 2022The social and cultural challenges facing surrogate mothers have been explored in several studies. However, few studies have discussed the motivations of surrogate...
BACKGROUND
The social and cultural challenges facing surrogate mothers have been explored in several studies. However, few studies have discussed the motivations of surrogate mothers, their expressions and interpretations of their lived experiences, and their feelings of personal and spiritual satisfaction.
OBJECTIVE
This study aims to present the positive experiences of surrogate mothers from a phenomenological perspective.
MATERIALS AND METHODS
Using a phenomenological approach, this study was conducted from September 2020 to January 2021 in the city of Yazd, Iran. Participant observation and semi-structured interviews were used to collect the data among 12 participants with at least 1 experience of surrogate motherhood.
RESULTS
Our findings showed that, despite having had harsh physical and socio-cultural experiences such as fear of social labeling and stigma, participants felt a kind of inner satisfaction and a positive view of their actions. A core theme found in the study was mothers' satisfaction. The main categories included feminine self-sacrifice and positive rewards. Feminine self-sacrifice included 2 sub-categories: creating happiness and conveying motherly feelings, while positive rewards included good childbirth, family acceptance, and halal income.
CONCLUSION
This study showed that surrogate mothers experience conflicting feelings of inner satisfaction and social stigma during surrogacy. Some of those interviewed were willing to go through surrogacy again, but they feared social labeling and stigma, being misunderstood by others who are not fully informed about surrogacy, and being subjected to family and social disapproval.
PubMed: 36340669
DOI: 10.18502/ijrm.v20i9.12067 -
European Journal of Obstetrics,... Jan 2020Social and legal equality for same-sex male couples continues to grow in many countries. Consequently, increasing numbers of same-sex male couples are seeking assisted... (Review)
Review
Social and legal equality for same-sex male couples continues to grow in many countries. Consequently, increasing numbers of same-sex male couples are seeking assisted reproductive technology to achieve parenthood. Fertility treatment for same-sex male couples is an undoubtedly complex issue and raises a variety of ethical concerns. Relevant considerations include ethical issues relating to the surrogate and a possible egg donor, the commissioning same-sex couple, the welfare of the child and the fertility clinic itself. This work analyses these arguments in the context of modern fertility services, providing reflection on the evidence present and what it means for clinicians today. Herein, we argue that fertility treatment for same-sex male couples via surrogacy agreements are acceptable, subject to considerations of each individual case, as in all assisted reproductive treatment. It is in the interest of open and equal access to health services that barriers to assisted reproductive technology for same-sex male couples should be minimised where possible.
Topics: Child; Child Welfare; Female; Fertility Clinics; Homosexuality, Male; Humans; Male; Pregnancy; Reproductive Techniques, Assisted; Surrogate Mothers; Tissue Donors
PubMed: 31760265
DOI: 10.1016/j.ejogrb.2019.11.011 -
Social Science & Medicine (1982) Jul 2020Childbirth practices shed light on cultural values, ideologies of gender and motherhood, and social inequalities. Transnational, commercial surrogacy presents a useful...
Childbirth practices shed light on cultural values, ideologies of gender and motherhood, and social inequalities. Transnational, commercial surrogacy presents a useful lens through which to view the social dynamics that shape childbirth experiences. Surrogacy challenges dominant views on the naturalness and inevitability of maternal-fetal bonds because it involves the separation of gestation from motherhood. What ideologies inform childbirth practices in the consumer-driven context of surrogacy in which the woman giving birth is neither the consumer nor the "mother"? Based on multi-sited ethnographic research between 2014 and 2017 and in-depth interviews with 120 participants in the Mexican surrogacy industry, I argue that doctors draw on normative ideologies of kinship, gender, and maternal-child bonding to justify and normalize the use of Caesarean sections among surrogates. The ideology espoused by these doctors reinforces the notion that maternal-fetal bonding is natural and inevitable, constructs women as irrational and driven by hormones, and presumes that bonding between surrogate mothers and the children they gestate is detrimental to the surrogacy process. Furthermore, the proffered justifications for the Caesarean sections reproduces stereotypes about poor Mexican women as risky patients, contributes to the "disposability" of their labor, and reinforces a hierarchy in which the perceived interests of intended parents and children are elevated above those of surrogate mothers. This article contributes to social science studies of medicine by demonstrating how classist and racist stereotypes, and folk notions of kinship, gender, and maternal-child bonding are biologized in medical practice.
Topics: Cesarean Section; Child; Female; Humans; Parturition; Pregnancy; Surrogate Mothers
PubMed: 32464414
DOI: 10.1016/j.socscimed.2020.113063 -
Indian Journal of Pediatrics May 2022While a Cochrane review (2016) showed that kangaroo mother care (KMC) initiated after clinical stabilization reduces mortality by 40%, evidence of the effect of... (Review)
Review
While a Cochrane review (2016) showed that kangaroo mother care (KMC) initiated after clinical stabilization reduces mortality by 40%, evidence of the effect of initiating KMC immediately after birth without waiting for babies to become stable was unavailable until recently. This research gap was addressed by a multicountry, randomized, controlled trial co-ordinated by WHO. This trial was conducted in five hospitals in Ghana, India, Malawi, Nigeria, and Tanzania. Implementation of this trial led to development of the "mother-newborn care unit (MNCU)." Mother-newborn care unit or mother-newborn intensive care unit (M-NICU) is a facility where sick and small newborns are cared with their mothers 24 × 7 with all facilities of level II newborn care and provision for postnatal care to mothers. The mother is not a mere visitor, but she has her bed inside the special newborn care unit (SNCU)/newborn intensive care unit (NICU) and as a resident of MNCU, becomes an active caregiver and is involved in continuum of neonatal care. The study results show that intervention babies in MNCU had 25% less mortality at 28 d of life, 35% less incidence of hypothermia, and 18% less suspected sepsis as compared to control babies cared in conventional NICU. World Health Organization is in the process of reviewing the current recommendations on care of preterm or LBW newborns considering new evidence that has become available. However, it would require national policy change to permit mother and surrogate in SNCU/NICU 24 × 7, making the concept of zero-separation a reality.
Topics: Child; Female; Humans; India; Infant, Low Birth Weight; Infant, Newborn; Intensive Care Units, Neonatal; Kangaroo-Mother Care Method; Mothers; Randomized Controlled Trials as Topic
PubMed: 35244878
DOI: 10.1007/s12098-022-04145-9 -
Persons and women, not womb-givers: Reflections on gestational surrogacy and uterus transplantation.Bioethics Nov 2022In a recent article in this journal, Alex Mullock, Elizabeth Chloe Romanis and Dunja Begović provide an analysis of gestational surrogacy and uterus transplantation...
In a recent article in this journal, Alex Mullock, Elizabeth Chloe Romanis and Dunja Begović provide an analysis of gestational surrogacy and uterus transplantation (UTx) from the perspective of those who may decide to act as gestational surrogates and womb donors, referred to as 'womb-givers'. In this article, I advance two sets of claims aimed at critically engaging with some aspects of their analysis. Firstly, I argue that the expression 'womb-givers' obscures the biologically, socially and politically salient issue that those who engage in these practices are primarily persons and women. My contention is that this is of substance in discussions of the burdens and benefits of gestational surrogacy and UTx, which need to consider the specific position that women occupy in society, and the hierarchies that mediate their lives, experiences and preferences. Second, I argue that, if one were to take seriously the experiences and preferences of the women who may engage in these practices, and their bodily autonomy, then gestational surrogacy and UTx should be regarded as biologically and sociopolitically incommensurable. Mullock et al. overlook important aspects of gestational surrogacy, such as the embodied nature of pregnancy and childbirth, the sociopolitical significance of these experiences, and the often-oppressive social norms that shape them. Whilst biology is not destiny, I suggest that it is socially and politically 'sticky' when it comes to this significance and norms, especially within the sphere of reproduction. Towards the end of the article, I query the authors' conceptualisation of bodily autonomy and of the instruments that enable its respect and promotion.
Topics: Pregnancy; Female; Humans; Uterus; Infertility, Female; Organ Transplantation; Tissue Donors; Reproduction; Surrogate Mothers
PubMed: 35996925
DOI: 10.1111/bioe.13078 -
International Journal of Molecular... Oct 2022Developmental instability (DI) is thought to be inversely related to a capacity of an organism to buffer its development against random genetic and environmental...
Developmental instability (DI) is thought to be inversely related to a capacity of an organism to buffer its development against random genetic and environmental perturbations. DI is represented by a trait's inter- and intra-individual variabilities. The inter-individual variability (inversely referred to as canalization) indicates the capability of organisms to reproduce a trait from individual to individual. The intra-individual variability reflects an organism's capability to stabilize a trait internally under the same conditions, and, for symmetric traits, it is expressed as fluctuating asymmetry (FA). When representing a trait as a random variable conditioned on environmental fluctuations, it is clear that, in statistical terms, the DI partitions into "extrinsic" (canalization) and "intrinsic" (FA) components of a trait's variance/noise. We established a simple statistical framework to dissect both parts of a symmetric trait variance/noise using a PCA (principal component analysis) projection of the left/right measurements on eigenvectors followed by GAMLSS (generalized additive models for location scale and shape) modeling of eigenvalues. The first eigenvalue represents "extrinsic" and the second-"intrinsic" DI components. We applied this framework to investigate the impact of mother-fetus major histocompatibility complex (MHC)-mediated immune cross-talk on gene expression noise and developmental stability. We showed that "intrinsic" gene noise for the entire transcriptional landscape could be estimated from a small subset of randomly selected genes. Using a diagnostic set of genes, we found that allogeneic MHC combinations tended to decrease "extrinsic" and "intrinsic" gene noise in C57BL/6J embryos developing in the surrogate NOD-SCID and BALB/c mothers. The "intrinsic" gene noise was negatively correlated with growth (embryonic mass) and the levels of placental growth factor (PLGF), but not vascular endothelial growth factor (VEGF). However, it was positively associated with phenotypic growth instability and noise in PLGF. In mammals, the mother-fetus MHC interaction plays a significant role in development, contributing to the fitness of the offspring. Our results demonstrate that a positive impact of distant MHC combinations on embryonic growth could be mediated by the reduction of "intrinsic" gene noise followed by the developmental stabilization of growth.
Topics: Mice; Animals; Female; Humans; Placenta Growth Factor; Mothers; Endothelial Growth Factors; Vascular Endothelial Growth Factor A; Phenotype; Mice, Inbred BALB C; Mice, Inbred C57BL; Mice, SCID; Fetus; Gene Expression; Mammals
PubMed: 36293324
DOI: 10.3390/ijms232012467 -
CMAJ : Canadian Medical Association... Apr 2022
Topics: COVID-19; Female; Humans; Influenza A Virus, H1N1 Subtype; Influenza, Human; Pandemics; Pregnancy
PubMed: 35379661
DOI: 10.1503/cmaj.211069