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Fertility and Sterility May 2020The goals of a gestational surrogacy relationship are to have a healthy baby for the intended parents while maintaining the medical and psychological well-being of the... (Review)
Review
The goals of a gestational surrogacy relationship are to have a healthy baby for the intended parents while maintaining the medical and psychological well-being of the gestational carrier. A successful gestational surrogacy relationship will result also in good psychosocial outcomes for the gestational carrier, intended parents, and child. Finding a gestational carrier who will achieve these goals would be the ideal. This article focuses on key medical, reproductive, and ethical considerations to optimize clinical outcomes in gestational carrier cycles. Recommendations from available clinical guidelines regarding gestational surrogacy are reviewed, along with updates from current literature.
Topics: Choice Behavior; Humans; Live Birth; Maternal Health; Policy Making; Reproductive Medicine; Reproductive Techniques, Assisted; Surrogate Mothers
PubMed: 32386618
DOI: 10.1016/j.fertnstert.2020.03.024 -
Indian Journal of Medical Ethics 2015In the most recent attempt to regulate commercial surrogacy, the Ministry of Home Affairs (MHA) has issued a notice altering the category of visa for foreign nationals...
In the most recent attempt to regulate commercial surrogacy, the Ministry of Home Affairs (MHA) has issued a notice altering the category of visa for foreign nationals entering into commercial surrogacy arrangements from "tourist" to "medical". Upon close scrutiny, it becomes clear that this measure is a far too hasty and unprincipled step. Given the varying laws across different countries, commercial surrogacy has been an area marked by a fair amount of legal ambiguity and conflict, for example, with respect to the citizenship status of the child and legally accepted parentage of commissioning parents. The MHA's step towards addressing some of the dilemmas is, however, grossly inadequate and discriminatory. In spite of its seeming advantages, of some administrative and legal oversight of the industry, the notice will impact the existing practices in questionable ways since its provisions remain to be vetted through the lens of medical ethics and social justice. The measures, which are supposed to ensure legality, disambiguation and some degree of security for the commercial surrogate, end up giving a clean chit to the industry for the time being. If the step taken by the MHA was meant to be urgent, one wonders at the lack of motivation to strengthen public debate and produce a piece of legislation that can address the various concerns and dilemmas generated by the assisted reproductive technologies (ARTs). This is especially with reference to legislation that ensures the health and democratic rights of those who are at a disadvantage due to the power imbalance in commercial surrogacy arrangements.
Topics: Bioethics; Child; Commerce; Female; Government Regulation; Humans; India; Internationality; Medical Tourism; Motivation; Parents; Pregnancy; Reproductive Techniques, Assisted; Social Justice; Surrogate Mothers
PubMed: 25716437
DOI: 10.20529/IJME.2015.008 -
Fertility and Sterility Nov 2018Professionals who discover misconduct or other undisclosed information that would be material to the participation of another party (such as a donor, gestational... (Review)
Review
Professionals who discover misconduct or other undisclosed information that would be material to the participation of another party (such as a donor, gestational carrier, intended parent, or lawyer) in an assisted reproductive technology arrangement should encourage disclosure to that party. In some instances, it is ethically permissible for the physician either to disclose material information to the affected party or to decline to provide care. In all cases involving the legal status or rights of the parties, referral to legal professionals is advised. This document replaces the document of the same name, last published in 2014 (Fertil Steril 2014;101:38-42).
Topics: Directed Tissue Donation; Ethics Committees; Female; Humans; Male; Physician's Role; Professional Misconduct; Reproductive Techniques, Assisted; Surrogate Mothers; Third-Party Consent
PubMed: 30396537
DOI: 10.1016/j.fertnstert.2018.08.030 -
Neuropsychopharmacology : Official... May 2022While non-suicidal self-injury (NSSI) occurs in the general population at a surprisingly high rate, with higher rates among certain clinical populations, its etiology...
While non-suicidal self-injury (NSSI) occurs in the general population at a surprisingly high rate, with higher rates among certain clinical populations, its etiology is not well-understood. Consequently, the DSM-5 lists NSSI as requiring further research. This study utilizes a translational model of naturally-occurring NSSI to assess the role of early parental neglect and variation in the serotonin transporter genotype (5-HTT) in the etiology of NSSI. Subjects (N = 161) were rhesus macaques (Macaca mulatta) reared in one of three conditions (mother-reared (MR), peer-reared (PR), or surrogate peer-reared (SPR)), and classified as NSSI (n = 18) or non-NSSI (n = 143). Subjects were genotyped for 5-HTT and their behaviors were recorded during an ecologically-meaningful, stress-evoking, intruder paradigm. Two weeks prior to testing, blood samples were obtained and assayed for plasma cortisol and adrenocorticotropic hormone (ACTH) concentrations. NSSI subjects were more likely to be SPR, paralleling human studies showing that individuals that exhibit NSSI tend to have experienced abuse or neglect early in life. Results also indicated that variation in the 5-HTT genotype differentiated the NSSI subjects. NSSI subjects that were homozygous for the L allele exhibited high plasma ACTH and high rates of stress-induced stereotypies; whereas NSSI subjects with the s allele exhibited impulsive behaviors, including frequently approaching the potentially dangerous intruder, high rates of aggressive vocal threats, and more activity. These results suggest that there may be different 5-HTT genotype-mediated NSSI typologies and that both early experiences and variation in the 5-HTT genotype may be important factors in understanding the etiology of NSSI.
Topics: Adrenocorticotropic Hormone; Animals; Genotype; Humans; Macaca mulatta; Self-Injurious Behavior; Serotonin; Serotonin Plasma Membrane Transport Proteins
PubMed: 33854202
DOI: 10.1038/s41386-021-00994-8 -
American Journal of Public Health Jan 1989This paper examines artificial reproduction (AR) within a broad comparative perspective and with specific reference to Czechoslovak law, medicine, and demography. It... (Review)
Review
This paper examines artificial reproduction (AR) within a broad comparative perspective and with specific reference to Czechoslovak law, medicine, and demography. It proceeds form an analysis of the social context that gives rise to technologies of AR to a review of the two principal technologies, artificial insemination (AI) and in vitro fertilization (IVF). A final section briefly discusses some of the implications of AR for new judicial conceptions of motherhood and fatherhood.
Topics: Czechoslovakia; Demography; Fertilization in Vitro; Humans; Insemination, Artificial; Internationality; Mothers; Social Control, Formal; Social Values; Spermatozoa; Surrogate Mothers
PubMed: 2642370
DOI: 10.2105/ajph.79.1.57 -
Developmental Psychobiology Nov 2020This longitudinal study spans two generations of rhesus monkeys. First, the study investigates the effects of early rearing experiences on the maternal behavior of...
This longitudinal study spans two generations of rhesus monkeys. First, the study investigates the effects of early rearing experiences on the maternal behavior of first-generation mothers (rates of premature infant rejection) and, second, the study investigates the effects of maternal rejection on the behavior of second-generation infants. Rhesus macaque mother-infant dyads (Macaca mulatta-N = 176) were observed twice weekly, with each session lasting 300 s. First-generation mothers were raised in one of three conditions: as mother-reared controls (MR; [n = 95]), in peer groups (PR; raised without adults but with constant access to three same-aged peers [n = 49]), or with an inanimate surrogate (SPR; raised with an inanimate fleece-covered, surrogate mother and limited daily peer-group interactions [n = 32]). Second-generation infants were all raised by their differentially reared mothers and statistically grouped into one of two groups: those that were rejected by their mothers beginning at a more-typical weaning age (controls), starting in the third month of life (n = 108), and those that were prematurely rejected, with mothers showing rejections before the third month of infant life (n = 68). Overall, PR mothers exhibited the highest rates of premature infant rejection, except for month 1 of infant life, when SPR mothers exhibited the highest rates of rejection. Intriguingly, after month 1, SPR mothers showed high rates of infant cradling and seldom rejected their infants. Independent of their mothers' early rearing environment, prematurely rejected infants displayed more aggression and passive vigilance, and were cradled and groomed less by their mothers, and there was evidence that the overall rates of rejection after the first 2 months of life had a cumulative negative effect on the developing infant. Post hoc analyses of plasma cortisol levels showed that the prematurely rejected infants had higher cortisol concentrations, suggesting a high level of stress in the prematurely rejected infants. These results suggest that maternal presence during infancy has long-term effects on a female's future maternal skills which, in turn, have intergenerational consequences for the socioemotional development of second-generation infants.
Topics: Age Factors; Animals; Animals, Newborn; Emotions; Longitudinal Studies; Macaca mulatta; Maternal Behavior; Social Environment
PubMed: 32162325
DOI: 10.1002/dev.21959 -
The Hastings Center Report Mar 2023Over the past several decades in which access to abortion has become increasingly restricted, parents' autonomy in medical decision-making in the realms of fetal care...
Over the past several decades in which access to abortion has become increasingly restricted, parents' autonomy in medical decision-making in the realms of fetal care and neonatal intensive care has expanded. Today, parents can decide against invasive medical interventions at gestational ages where abortions are forbidden, even in cases where neonates are expected to be seriously ill. Although a declared state interest in protecting the lives of fetuses and newborns contributes to justifications for restricting women's autonomy with regards to abortion, it does not fully explain this discrepancy. We believe that social portrayals of women as complying with or shirking their reproductive function play a major role in explaining it. The growing divide between a woman's rights as a reproductive being and as a parent suggest that abortion restriction is rooted in a historical societal desire for women to serve as reproducers and in the corresponding fear of them abandoning this allotted role in pursuit of social equality. The Dobbs v. Jackson (2022) decision is not based in a view of abortion as a medical act occurring between a doctor and patient, as Roe v. Wade (1973) did, but decision-making about fetal therapy or NICU care is still viewed as occurring between a doctor and patient or surrogate because in this act a woman is seen as fulfilling her role as mother.
Topics: Infant, Newborn; Humans; Pregnancy; Female; United States; Intensive Care Units, Neonatal; Motivation; Abortion, Legal; Abortion, Induced; Fetal Therapies
PubMed: 37092649
DOI: 10.1002/hast.1472 -
Fertility and Sterility May 2020The role of a mental health professional (MHP) in the psychological assessment of gestational carrier (GC) candidates has evolved over time, with clinical practices well... (Review)
Review
The role of a mental health professional (MHP) in the psychological assessment of gestational carrier (GC) candidates has evolved over time, with clinical practices well established in the United States. Current ASRM guidelines recommend that all GC candidates undergo a psychosocial consultation and psychological testing (where deemed appropriate). Practice standards are relatively consistent among mental health disciplines, with assessments typically involving a clinical interview and the administration of a single, objective, self-report personality inventory. Although recent studies have established normative data for GCs, there has been little research into which assessment protocols are best suited to answer the referral questions of interest. Current challenges for MHPs placed in a gate-keeping role include providing a thorough screening using measures that typically yield defensive profiles that make them difficult to interpret. Research is emerging that suggests that using a multimethod approach in the psychological assessment of GCs may yield a more comprehensive psychological profile of GC candidates. This could allow MHPs to determine psychological appropriateness with more confidence and contribute additional data to be used in pre-surrogacy counseling. Assessing the psychological appropriateness of a woman to serve as a GC is a complex process, and there are a multitude of factors that must be considered, not the least of which are the psychological well-being of a potential GC, her partner, and her children throughout the process and beyond.
Topics: Female; Humans; Interview, Psychological; Mental Health; Personality Inventory; Predictive Value of Tests; Pregnancy; Referral and Consultation; Reproductive Medicine; Reproductive Techniques, Assisted; Surrogate Mothers
PubMed: 32312559
DOI: 10.1016/j.fertnstert.2020.02.104 -
BMJ (Clinical Research Ed.) Nov 2003
Review
Topics: Adaptation, Psychological; Adoption; Counseling; Embryo Transfer; Female; Humans; Infertility; Insemination, Artificial; Male; Patient Selection; Reproductive Techniques; Surrogate Mothers
PubMed: 14604935
DOI: 10.1136/bmj.327.7423.1098 -
Lab Animal Feb 2021For the production and rederivation of mouse strains, pseudopregnant female mice are used for embryo transfer and serve as surrogate mothers to support embryo...
For the production and rederivation of mouse strains, pseudopregnant female mice are used for embryo transfer and serve as surrogate mothers to support embryo development to term. Vasectomized males are commonly used to render pseudopregnancy in females, generated by surgical procedures associated with considerable pain and discomfort. Genetically modified mouse strains with a sterility phenotype provide a non-surgical replacement and represent an important application of the 3Rs (Replacement, Reduction, Refinement). However, the maintenance of such genetically modified mouse strains requires extensive breeding and genotyping procedures, which are regulated procedures under national legislation. As an alternative, we have explored the use of sterile male hybrids that result when two wild-type mouse subspecies, Mus musculus musculus and Mus musculus domesticus, interbreed. We find the male STUSB6F1 hybrid, resulting from the mating of female STUS/Fore with male C57BL/6J, ideally suited and demonstrate that its performance for the production of oviduct and uterine transfer recipients is indistinguishable when compared to surgically vasectomized mice. The use of these sterile hybrids avoids the necessity for surgical procedures or the breeding of sterile genetically modified lines and can be generated by the simple mating of two wild-type laboratory strains-a non-regulated procedure. Furthermore, in contrast with the breeding of genetically sterile mice, all male offspring are sterile and suitable for the generation of pseudopregnancy, allowing their efficient production with minimal breeding pairs.
Topics: Animals; Female; Infertility; Male; Mice; Mice, Inbred C57BL; Phenotype; Pregnancy; Pseudopregnancy; Vasectomy
PubMed: 33398200
DOI: 10.1038/s41684-020-00692-w