-
Reproductive Biomedicine Online Oct 2023How did Danish permanently infertile couples experience surrogacy when going abroad and what impact did the war in Ukraine and the COVID-19 pandemic have on this?
RESEARCH QUESTION
How did Danish permanently infertile couples experience surrogacy when going abroad and what impact did the war in Ukraine and the COVID-19 pandemic have on this?
DESIGN
A qualitative study was performed between May and September 2022. The in-depth semi-structured interviews were conducted with 14 permanently infertile couples across Denmark who were in different stages of using surrogacy. The interviews were transcribed and analysed using systematic text condensation.
RESULTS
All except one couple went abroad, mainly to Ukraine, to have an enforceable transparent contract, professionals to advise them and the possibility of using the eggs of the intended mother. They did not feel that this was a 'choice' but rather the only option they had to have the longed-for child. According to current Danish legislation, the intended mother could not obtain legal motherhood over the child, not even through stepchild adoption, and this increased the feeling of not being a 'worthy mother'. This study expanded on the term 'reproductive exile' by identifying four different forms of exile: the exiled Danish couple, the gestational carrier in exile, exile at home and, finally, the reproductive body in exile.
CONCLUSIONS
Understanding infertile couples' experiences when crossing borders is important for several reasons. It may, among others, assist politicians and authorities in developing a sound Danish legal policy on surrogacy to address the current issues of legal parenthood and avoid missing reproductive opportunities for permanently infertile couples.
Topics: Female; Humans; Pregnancy; COVID-19; Denmark; Infertility; Mothers; Pandemics; Surrogate Mothers; Ukraine; Male
PubMed: 37517186
DOI: 10.1016/j.rbmo.2023.06.013 -
Bioethics Jul 2023Assisted reproduction often involves biological contributions by third parties such as egg/sperm donors, mitochondrial DNA donors, and surrogate mothers. However, these...
Assisted reproduction often involves biological contributions by third parties such as egg/sperm donors, mitochondrial DNA donors, and surrogate mothers. However, these arrangements are also characterised by a biological relationship between the child and at least one intending parent. For example, one or both intending parents might use their own eggs/sperm in surrogacy, or an intending mother might conceive using donor sperm or gestate a donor embryo. What happens when this relationship is absent, as in the case of 'double-donor surrogacy' arrangements (DDS)? Here, a child is conceived using both donor eggs and sperm, carried by a surrogate, and raised by the commissioning parents. In this paper, I critically examine proposals to allow DDS in the United Kingdom, and the intentionalist justification for treating this practice distinctly (morally and legally speaking) from private adoption. I argue that the intentionalist approach cannot plausibly justify such a distinction and that other approaches to moral parenthood are also unlikely to succeed.
PubMed: 37467043
DOI: 10.1111/bioe.13204 -
Nutrients Apr 2023Insulin resistance (IR) is a prominent feature of polycystic ovary syndrome (PCOS). The importance of lifestyle interventions in the management of PCOS is strongly...
Insulin resistance (IR) is a prominent feature of polycystic ovary syndrome (PCOS). The importance of lifestyle interventions in the management of PCOS is strongly highlighted and it is suggested that diet and physical activity may significantly influence insulin sensitivity. Therefore, we evaluated the link between diet and physical activity and various indices of insulin resistance, including adipokines secreted by the adipose tissue in 56 PCOS and 33 healthy control women. The original food frequency questionnaire and Actigraph GT3X-BT were used to assess the adherence to the diet recommended in IR and the level of physical activity, respectively. We observed that higher levels of physical activity were associated with lower HOMA-IR and a greater chance of its normal value in PCOS group. No such relationship was observed for other IR indices and adipokines or for the diet. However, we noted a strong correlation between HOMA-IR (Homeostatic Model Assessment of Insulin Resistance) and HOMA-AD (Homeostatic Model Assessment-Adiponectin) in PCOS women. Additionally, when we used HOMA-AD we observed a higher prevalence of IR among PCOS women. Our study supports the beneficial role of physical activity in the management of insulin resistance in PCOS women. Moreover, our findings indicate that HOMA-AD may be a promising surrogate marker for insulin resistance assessment in women with PCOS.
Topics: Female; Humans; Insulin Resistance; Case-Control Studies; Polycystic Ovary Syndrome; Diet; Exercise; Adipokines
PubMed: 37432289
DOI: 10.3390/nu15092111 -
Philosophy, Ethics, and Humanities in... Jul 2023Comprehensive commercial surrogacy became legal in India in 2002, and many foreigners, including individuals and same-sex couples, sought Indian surrogacy services due...
BACKGROUND
Comprehensive commercial surrogacy became legal in India in 2002, and many foreigners, including individuals and same-sex couples, sought Indian surrogacy services due to their affordability. Numerous scandals resulted, with increasing calls for the government to eliminate the exploitation of women in lower social strata. In 2015, the Indian government decided to exclude foreign clients and commercial surrogacy remained legal for local Indian couples only. Furthermore, to eliminate exploitation, the concept of altruistic surrogacy was introduced in 2016. In 2020, some restrictions within altruistic surrogacy practice were removed. Controversy remains, however, in various sectors, not least because surrogacy is a relatively new concept in India. In this paper, the advantages and disadvantages of both altruistic and commercial surrogacy in the Indian context are considered, and more appropriate policy concerning surrogacy practices is suggested.
METHODS
This paper is based on fieldwork conducted in India from 2010 to 2018. Interview surveys were conducted among doctors, policy makers, activists, former surrogates, and brokers. Government documents and media reports were also important sources.
RESULTS
Surrogacy for commercial purposes began in India in 2002, and stakeholders within the commercial surrogacy industry became well established. It was found that such stakeholders were strongly opposed to altruistic surrogacy as introduced in 2016. It was also found that women in lower social strata still sought some form of financial compensation from their reproductive labor. Controversies surrounding altruistic surrogacy continue within Indian society.
CONCLUSION
Policies and practices aimed at eliminating exploitive need to consider the Indian context carefully. Any surrogacy practice might potentially be exploitive, and the distinction between commercial and altruistic surrogacy is too simplistic to be useful, with more nuanced understanding required. It is of critical importance that investigation continues on how to eliminate the exploitation of Indian surrogate mothers throughout the process, regardless of monetary compensation. The entire surrogacy process should be managed with sensitivity, particularly in relation to the well-being of the mother and child.
Topics: Female; Humans; Pregnancy; Altruism; India; Policy; Reproduction; Surrogate Mothers
PubMed: 37420245
DOI: 10.1186/s13010-023-00130-y -
Animals : An Open Access Journal From... Jun 2023In an ongoing study of the striped hyena (), we observed that in the nine different females, alloparenting by the daughters of a previous litter was not uncommon and...
In an ongoing study of the striped hyena (), we observed that in the nine different females, alloparenting by the daughters of a previous litter was not uncommon and occurred on fifteen different occasions, twice with two helpers. Alloparenting persisted from when the cubs are approximately a month old until they reach the age when they go out foraging with their mothers at 10-12 months. Helpers perform most maternal duties, except suckling, even in the mother's presence. Helpers accrued indirect fitness and practiced parenting before reaching sexual maturity. Future studies must study the reproductive biology of the striped hyena in the wild throughout its geographic range to elucidate additional breeding properties that have not yet been identified. The continued persecution of striped hyenas and the lack of information about their breeding rituals and capabilities in the wild mean that this study of their different reproduction strategies, focusing on surrogate mothers, is of great conservation importance. The fact that we have found cooperative breeding in this solitary species suggests that there is much more to uncover of the enigmatic striped hyena in the wild.
PubMed: 37370424
DOI: 10.3390/ani13121914 -
Health Physics Oct 2023Organ dosimetry data of the atomic bomb survivors and the resulting cancer risk models derived from these data are currently assessed within the DS02 dosimetry system...
Fetal and Maternal Atomic Bomb Survivor Dosimetry Using the J45 Pregnant Female Phantom Series: Considerations of the Kneeling and Lying Posture with Comparisons to the DS02 System.
Organ dosimetry data of the atomic bomb survivors and the resulting cancer risk models derived from these data are currently assessed within the DS02 dosimetry system developed through the Joint US-Japan Dosimetry Working Group. In DS02, the anatomical survivor models are limited to three hermaphroditic stylized phantoms-an adult (55 kg), a child (19.8 kg), and an infant (9.7 kg)-that were originally designed for the preceding DS86 dosimetry system. As such, organ doses needed for assessment of in-utero cancer risks to the fetus have continued to rely upon the use of the uterine wall in the adult non-pregnant stylized phantom as the dose surrogate for all fetal organs regardless of gestational age. To address these limitations, the Radiation Effects Research Foundation (RERF) Working Group on Organ Dose (WGOD) has established the J45 (Japan 1945) series of high-resolution voxel phantoms, which were derived from the UF/NCI series of hybrid phantoms and scaled to match mid-1940s Japanese body morphometries. The series includes male and female phantoms-newborn to adult-and four pregnant female phantoms at gestational ages of 8, 15, 25, and 38 wk post-conception. In previous studies, we have reported organ dose differences between those reported by the DS02 system and those computed by the WGOD using 3D Monte Carlo radiation transport simulations of atomic bomb gamma-ray and neutron fields for the J45 phantoms series in their traditional "standing" posture, with some variations in their facing direction relative to the bomb hypocenter. In this present study, we present the J45 pregnant female phantoms in both a "kneeling" and "lying" posture and assess the dosimetric impact of these more anatomically realistic survivor models in comparison to current organ doses given by the DS02 system. For the kneeling phantoms facing the bomb hypocenter, organ doses from bomb source photon spectra were shown to be overestimated by the DS02 system by up to a factor of 1.45 for certain fetal organs and up to a factor of 1.17 for maternal organs. For lying phantoms with their feet in the direction of the hypocenter, fetal organ doses from bomb source photon spectra were underestimated by the DS02 system by factors as low as 0.77, while maternal organ doses were overestimated by up to a factor of 1.38. Organs doses from neutron contributions to the radiation fields exhibited an increasing overestimation by the DS02 stylized phantoms as gestational age increased. These discrepancies are most evident in fetal organs that are more posterior within the mother's womb, such as the fetal brain. Further analysis revealed that comparison of these postures to the original standing posture indicate significant dose differences for both maternal and fetal organ doses depending on the type of irradiation. Results from this study highlight the degree to which the existing DS02 system can differ from organ dosimetry based upon 3D radiation transport simulations using more anatomically realistic models of those survivors exposed during pregnancy.
Topics: Infant, Newborn; Child; Adult; Pregnancy; Humans; Male; Female; Atomic Bomb Survivors; Radiometry; Radiation Injuries; Fetus; Posture
PubMed: 37358430
DOI: 10.1097/HP.0000000000001710 -
Journal of Law and Medicine May 2023This article examines the United Kingdom Supreme Court decision in Whittington Hospital NHS Trust v XX [2020] UKSC 14. The case centred on whether damages could be...
This article examines the United Kingdom Supreme Court decision in Whittington Hospital NHS Trust v XX [2020] UKSC 14. The case centred on whether damages could be awarded for the cost of a commercial surrogacy arrangement in California, following clinical negligence by the hospital that left the plaintiff unable to carry her own children. After examination of this case, the article outlines and compares the United Kingdom and Australian surrogacy laws. It then discusses how a similar case would be decided in Australia and argues that the result would be the same in some Australian States. It also discusses the concept of reproductive autonomy and the importance of this concept when considering cases involving the loss of fertility.
Topics: Surrogate Mothers; Humans; Infertility; Malpractice; Personal Autonomy; Reproductive Rights; United Kingdom; Australia
PubMed: 37271957
DOI: No ID Found -
EClinicalMedicine Jun 2023To implement the immediate Kangaroo mother care (iKMC) intervention in the previous multicentre, open-label, randomised controlled trial, the mother or a surrogate...
Effect on neonatal sepsis following immediate kangaroo mother care in a newborn intensive care unit: a post-hoc analysis of a multicentre, open-label, randomised controlled trial.
BACKGROUND
To implement the immediate Kangaroo mother care (iKMC) intervention in the previous multicentre, open-label, randomised controlled trial, the mother or a surrogate caregiver and neonate needed to be together continuously, which led to the concept of the Mother-Newborn Care Unit (MNCU). Health-care providers and administrators were concerned of the potential increase in infections caused by the continuous presence of mothers or surrogates in the MNCU. We aimed to assess the incidence of neonatal sepsis in sub-groups and the bacterial profile among intervention and control neonates in the study population.
METHODS
This is a post-hoc analysis of the previous iKMC trial, which was conducted in five level 2 Newborn Intensive Care Units (NICUs) one each in Ghana, India, Malawi, Nigeria, and Tanzania, in neonates with birth weight 1 to <1.8 kg. The intervention was KMC initiated immediately after birth and continued until discharge and compared to conventional care with KMC initiated after meeting stability criteria. The primary outcomes of this report were the incidence of neonatal sepsis in sub-groups, sepsis-related mortality and bacterial profile of isolates during hospital stay. The original trial is registered with the Australia and New Zealand Clinical Trials Registry (ACTRN12618001880235) and the Clinical Trials Registry-India (CTRI/2018/08/01536).
FINDINGS
Between November 30, 2017, and January 20, 2020, 1609 newborns in the intervention group and in the control group 1602 newborns were enrolled in iKMC study. 1575 newborns in the intervention group and 1561 in the control group were clinically evaluated for sepsis. Suspected sepsis was 14% lower in intervention group in sub-group of neonates with birth weight 1.0-<1.5 kg; RR 0.86 (CI 0.75, 0.99). Among neonates with birth weight 1.5-<1.8 kg, suspected sepsis was reduced by 24%; RR 0.76 (CI 0.62, 0.93). Suspected sepsis rates were lower in intervention group than in the control group across all sites. Sepsis related mortality was 37% less in intervention group than the control group; RR 0.63 (CI 0.47-0.85) which was statistically significant. The intervention group had fewer cases of Gram-negative isolates (n = 9) than Gram positive isolates (n = 16). The control group had more cases of Gram-negative isolates (n = 18) than Gram positive (n = 12).
INTERPRETATION
Immediate Kangaroo Mother care is an effective intervention to prevent neonatal sepsis and sepsis related mortality.
FUNDING
The original trial was funded by the Bill and Melinda Gates Foundation through a grant to the World Health Organization (grant No. OPP1151718).
PubMed: 37251633
DOI: 10.1016/j.eclinm.2023.102006 -
Postgraduate Medical Journal May 2023Surrogacy is a method of assisted reproduction in which a woman bears a child on behalf of a couple or individual with the intention of handing over care of the child to... (Review)
Review
Surrogacy is a method of assisted reproduction in which a woman bears a child on behalf of a couple or individual with the intention of handing over care of the child to the intending parent(s) at or soon after birth. The law surrounding surrogacy is complex for healthcare professionals, surrogates and intending parent(s) to navigate. This review article summarises the laws and potential legal complications of surrogacy in the UK. While altruistic surrogacy is permitted, commercial surrogacy is outlawed in this country. Both traditional and gestational surrogacy may be performed and UK law now also permits surrogacy for same sex couples, unmarried couples and single individuals as intending parent(s). Legal parenthood of the child is transferred from the surrogate to the intending parent(s) via application for a parental order between 6 weeks and 6 months after birth. Legal complications include time restrictions for parental order applications and breaches of reasonable payments to surrogates.
Topics: Pregnancy; Female; Child; Humans; Surrogate Mothers; Altruism; United Kingdom
PubMed: 37227980
DOI: 10.1136/postgradmedj-2022-141625 -
Cureus Apr 2023With the advent of major scientific and technological advancements in obstetrics and gynecology, surrogacy is quickly becoming a viable alternative to enable people of... (Review)
Review
With the advent of major scientific and technological advancements in obstetrics and gynecology, surrogacy is quickly becoming a viable alternative to enable people of all genders to become parents. However, its path toward reality is still fraught with legal and ethical dilemmas. With the Surrogacy Act of 2021 coming into effect earlier this year, the present article aims to dissect the various legal nuances involved while also considering the societal norms governing the actual scenario at ground zero. Our review discusses the aspects of eligibility criteria, the health implications, the rights of the surrogate mother and the child born, the financial burden, and compensation. We aimed to bring attention to this act and its implications on marginalized segments of society, with an attempt to bring beneficial changes for them. In this review, we provide viable alternatives adopted across the globe to solve the identified issues to make the present act non-discriminatory and more rewarding to all involved beneficiaries.
PubMed: 37213977
DOI: 10.7759/cureus.37864