Surrogacy Research Articles

Methodology for the development and application of clinical decisions support information technologies with consideration of civil-legal grounds

Currently, there are no clinical decision support information technologies (CDSIT) that would consider civil-legal grounds when forming a decision for clinicians. Therefore, the design, development, and implementation of CDSIT, which considers civil-legal grounds when forming decisions, are actual problems. Methodology for the development and application of knowledge-driven, rule-based, clinical decisions support information technologies with consideration of civil-legal grounds has been developed, which provides a theoretical basis for developing clinical decisions support information technology with consideration of civil-legal grounds and partial CDSITs regarding the possibility of providing medical services of a certain type. In addition to the conclusion about the possibility or impossibility of providing certain medical services, the developed methodology ensures the presence of all essential terms (from the viewpoint of civil law regulation) in the contract for the certain medical service's provision and/or the data on potential patients for the provision of such a service, as well as minimization of the influence of the human factor when making clinical decisions. It is advisable to evaluate the CDSITs with consideration of civil-legal grounds, developed according to the proposed methodology, from the viewpoint of the correctness of the decisions generated by them, as well as from the viewpoint of their usefulness for clinics. In this paper, experiments with the methodology-based CDSIT regarding the possibility of performing a surrogate motherhood procedure with consideration of civil-legal grounds were conducted. Such experiments showed the correctness of the generated decisions at the level of 97 %. Experiments also demonstrated the usefulness of such IT for clinics from the viewpoint of eliminating adverse legal consequences, as they might arise due to violation or disregard of legal, and moral and ethical norms.

Is the Writing on the Wall for the Genetic Link Requirement in Surrogacy Agreements?

For a valid surrogate motherhood agreement, section 294 of the Children's Act 38 of 2005 provides that the child born of the surrogacy arrangement must be conceived with the gamete of at least one of the commissioning parents. This ensures that a genetic link exists between a commissioning parent and the resultant child. In 2015, in the case of AB v Minister of Social Development 2016 2 SA 27 (GP), the constitutionality of the impugned provision was successfully challenged in the High Court; however, the applicant failed to convince the majority in the Constitutional Court (AB v Minister of Social Development 2017 3 SA 570 (CC)) that the removal of the genetic-link requirement would be in the resultant child's best interests. In 2023 another "double-donor" surrogacy matter is set to be decided by the High Court. The applicant's situation raises the question of whether the genetic-link requirement between commissioning parents and the resultant child should be extended to include a "sibling link". This would be applicable in situations where parents will lack a genetic link with the resultant child, but the child will still share a genetic link with an existing sibling. This article assesses the merits of the "sibling link" argument by considering the latest psychological evidence. This evidence confirms that donor-conceived surrogate children are well-adjusted and exhibit high self-esteem, despite lacking a biological and gestational link to their parents. It is argued that the reading in of a "sibling clause" into section 294 may be too narrow, and instead a reading in of a sentence that will allow the court "on good cause shown" to dispose of the genetic link requirement should be preferred.

Surrogacy in Russia: Current Trends in Family Planning in Comparison with Western Countries

The purpose of this study is to identify trends of surrogacy among the population of Russia in the XXI century. The relevance of the work is due to the interest of sociologists in family planning and the demographic situation in modern Russia, as well as the influence of Western culture on the domestic institution of the family. Methods of statistical and bibliographic analysis were applied. The work was carried out on the basis of a sociological survey. The object of the study is the socio-cultural sphere of Western and Russian society related to childbearing and family planning. The subject of the study is surrogacy. Special attention was paid to the attitude to this phenomenon, as well as modern trends related to surrogacy. The issue was considered both in the legal field and in the social sphere. The main conclusions of the study are: the need to improve the legal framework, the need to improve the protection of the rights of both surrogate mothers and people applying for this service. Nevertheless, in the course of the study, we found out that the sphere of family planning in Russia has not undergone any special changes and citizens still strive for independent childbearing. The scientific novelty of the work lies in the study of the assessment of citizens in relation to the possibility of having a child using surrogate motherhood. It is worth noting that this attribute of family planning is characteristic primarily for citizens of Western countries. The author's special contribution to the study is to establish the fact that there are no contradictions between the development of the traditional concept of family relations and innovations that are actively practiced in the West and form the entire financial industry.

LAPAROSCOPIC PERITONEAL COLPOPOIESIS: LONG-TERM ANATOMICAL AND FUNCTIONAL OUTCOMES

Objective: To evaluate the long‑term anatomical and sexual outcomes of laparoscopic peritoneal colpopoiesis among women with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome. Material and methods. We conducted a retrospective and observational single center study. Between January 2007 and May 2017, 16 patients with MRKH syndrome were treated with laparoscopic peritoneal colpopoiesis procedure. Results. The mean age of patients at the time of diagnosis was 18.8 years, and that at the time of hospitalization was 20.6 years. Concomitant congenital anomalies, such as urinary tract anomaly, were reported in six (37.5%) patients, various malformations of the cardiovascular system were reported in two (12.5%) patients. Mean surgery duration was 122.6 minutes (range 65 – 295 min); mean intraoperative blood loss was 75.3 ml (range 30 – 200 ml). Anatomical success, along with the absence of stenosis and reduction of the tissue flap was achieved in 100% cases. According to the female sexual function index (FSFI), results show good quality of sexual life. One of the patients, thanks to transvaginal donation of oocytes and surrogate motherhood, is raising her own child at the age of 3 years. Conclusion. Laparoscopic peritoneal colpopoiesis can be used as an effective and low-traumatic technique for creating a neovagina, taking into account the anatomical structure of the perineum.

Medical information technology for decision-making taking into account the norms of civil law

The task of this study is the design of medical information technology for decision-making taking into account the norms of civil law. The proposed medical information technology ensures the support when making medical decisions about the opportunity of reproductive technologies use (in vitro fertilization, surrogate motherhood), about the opportunity of transplantation and donation, about the opportunity of providing general medical services, about the opportunity of providing therapeutic services, about the opportunity of providing dental services, about the opportunity of vaccination. In addition, the designed information technology automates medical decision-making, minimizes the impact on medical decision-making, takes into account the norms of civil law when making medical decisions.

The Surrogacy (Regulation) Act, 2021: Analyzing the effectiveness of India's ban on commercial surrogacy

AbstractIn India, the issue of surrogacy has brought the entire field of assisted reproductive techniques under close scrutiny and debate. It has caused controversies as the state has interfered the process of surrogacy to make it ethically acceptable. Indian government acknowledged the Surrogacy (Regulation) Act, 2021, to protect women's reproductive rights. The Act aims to ban commercial surrogacy and promote altruistic surrogacy without any payment except for the surrogate mother's medical expenses and her insurance coverage. This Act is the object of the first analysis of this article; and second, it investigates how the Act affects prospective childless couples, willing single parents, and members of the LGBTQ community. Employing the interview method and neo‐institutional methodology, this article concludes that the Act made the surrogacy more complex as, in actuality, altruistic surrogacy is a myth because it would be difficult for intended couples to find a willing surrogate mother who will intend to give birth to a child at no cost. This will pave the way for under the table transaction. The Act made it illegal for foreign couples as well as intended Indian couples who already have a child and restricts the chances for the LGBTQ community and single parents.

The First 5 Years of Uterus Transplant in the US—A Report From the United States Uterus Transplant Consortium

ABSTRACT Women affected by absolute uterine-factor infertility (AUFI) were previously considered to have an untreatable condition, although uterus transplant has now changed this calculation. Although AUFI is a cause of female infertility (affecting 1 in 500 women), the counseling describing potential family-building options (gestational carrier or adoption) now includes a third choice of uterus transplant. This procedure is meant to restore reproductive ability and to allow gestation and childbirth. Further data regarding uterus transplant are essential to counsel appropriate individuals regarding this potential option. The US Uterus Transplant Consortium was formed in 2019 by centers performing uterus transplant in the United States: Baylor University Medical Center, Dallas, Tex; Cleveland Clinic, Cleveland, Ohio; and the University of Pennsylvania, PA. Accounting for approximately half of worldwide cases and of live births after uterus transplant, these centers have been instrumental in the evolution of the procedure, including the invention of novel surgical techniques for deceased donors, early embryo transfer, using the superior uterine veins for live birth and graft survival, and fully robotic living donor hysterectomies. This study examined data from all uterine transplants performed in the United States between 2016 and 2021, including donor, recipient, and offspring outcomes. Follow-up included the time from uterine transplant until the most recent visit. Evaluation of patients took place via a multidisciplinary transplant team and an independent living advocate. Primary outcomes of the study included patient survival (primary living donor outcome), allograft survival (30 days, 1 year, and 3 years), and live birth. Offspring primary outcomes included weight percentile and gestational age at delivery. During the study years (2016–2021), a total of 33 uterus transplants were performed, with 21 living and 12 deceased donors. No mortality of living donors or recipients was recorded. Overall, 25 of 33 uterus transplants had a viable graft at 30 days, and 19 of the 33 participants (58%) were able to achieve at least 1 live birth. A total of 8 recipients experienced graft loss (26%), and infection occurred in 10 participants (30%). Acute cellular rejection occurred for 10 participants within the 1-year graft survival group, but these patients were successfully treated. Time to the first menstrual cycle after transplant was a mean of 30 days (range, 10–59 days). Pregnancy following the transplant requires in vitro fertilization, as fallopian tubes are not transplanted with the uterus. For those participants who were able to conceive, the most common complications were gestational diabetes (12%), gestational hypertension (24%), and preeclampsia (12%). The mean gestational age at delivery was 36 weeks 6 days (range, 30 weeks 1 day to 38 weeks), with more than half (52%) being born after 36 weeks' gestation. After live birth, patients underwent a graft hysterectomy, the timing of which was determined by the patient (either during delivery or later in the recovery process). Medical indications for hysterectomy were conditions such as preeclampsia, acute kidney injury, abnormal placentation, and gestational diabetes. Overall, the first 5 years of US clinical experience of uterus transplant demonstrate technical feasibility and the ability of patients to have a live birth. High rates of technical success (76%) within US centers performing uterus transplants are promising. Despite the fact that the 1-year survival rate of the uterus transplant (76%) is lower than other organ transplant graft survival rates, the required longevity of the uterus differs from others. Nevertheless, a learning curve is expected to allow for improvements to this success rate over time. Based on the outcomes of uterine transplant described in this report, the authors conclude that the procedure is safe for both mother and child, as success is not limited to single centers, and is reproducible. They note that the success of the procedure is achieved both with living and deceased donors, and the rate of success is comparable to other infertility treatments. They conclude that the procedure ought to be recognized as an option for AUFI-diagnosed individuals desiring parenthood.

Consideration of the gestational carrier: an Ethics Committee opinion

Intended parents engage with gestational carriers (GCs) to achieve their personal reproductive goals. All GCs have a right to be fully informed of the risks as well as the contractual and legal aspects of the gestational-carrier process. The GCs have autonomy in making their own decisions regarding medical care and should be free from undue influences by the stakeholders involved. They should have free access to and receive psychological evaluation and counseling before, during, and after participating. In addition, GCs require separate independent legal counsel regarding the contract and arrangement. This document replaces the document of the same name, lastpublished in 2018 (Fertil Steril 2018;110:1017-21).

Immunomodulatory effect of granulocyte colony-stimulating factor in repeated implantation failures in embryo transfer programs

The objective: to determine the effectiveness of intrauterine administration of granulocyte colony-stimulating factor depending on endometrium immune phenotype in patients with repeated implantation failures in embryo transfer programs.Material and methods. Endometrial biopsy during the implantation window in an artificial cycle before and (in some patients) after intrauterine administration of granulocyte colony-stimulating factor (G-CSF) was performed in 42 patients with repeated implantation failures and gestational carriers (20 women) as a control group. Flow cytometry was used to count classes and subclasses of endometrial lymphocytes in endometrial tissue samples.Results. The population of endometrial immune cells in patients with repeated implantation failures and fertile women was compared. Pregnancy and live birth rates depending on endometrium immune phenotype in patients with repeated implantation failures after intrauterine administration of granulocyte colony-stimulating factor in embryo transfer program were determined and the effect of intrauterine administration of granulocyte colony-stimulating factor on endometrial immune phenotype was evaluated.High expression of HLA-DR and CD16 on uterine natural killers is reliably associated with successful implantation after intrauterine administration of granulocyte colony-stimulating factor in an embryo transfer program. It was established that in the group with an immature immune endometrial phenotype the frequency of pregnancy (53.8 %) and the frequency of live births (53.8 %) were twice higher compared to the rest of the patients with other variants or the absence of changes in the immune profile (pregnancy rate and frequency live birth rate – 26.9 %).Conclusions. One-third of patients with repeated implantation failures in genetically tested embryos transfer programs have a unique immune status of endometrium characterized by high expression of HLA-DR and CD16 on uterine natural killers. Intrauterine administration of granulocyte colony-stimulating factor leads to decrease of HLA-DR and CD16 expression on uterine natural killers and promotes successful implantation in embryo transfer program in this group of patients.

Knowledge, attitude and perception about surrogacy among urban working women

Introduction and Aim: Infertility is a social stigma in India. Infertility affects 10% of the population in India. Surrogacy is an advanced form of assisted reproductive technique (ART) wherein one woman bears a baby for another woman. Surrogacy is an alternative for the infertile parents for whom it is difficult to have a baby due to medical reasons. The aim was to assess the knowledge, attitude, and perception about the ethical issues involved in surrogacy among urban working women.
 Methods: A self-administered questionnaire was devised to determine knowledge, attitude, and perception about surrogacy among young working women. Questionnaire was sent for validation and then distributed to urban working women between the age group of 25-35 years. The questionnaire consisted of 21 questions with a range of 4-point response options and 1 open-ended question. Based on their response given a descriptive analysis was done using SPSS 16.
 Results: The urban women were aware of the ethical principles. 63% believe women should not be forced and have complete autonomy in making decisions. 60% believed Surrogate mothers and the baby born of surrogacy should not be ill-treated by the community and 70% said they should be given respect like any other human being.
 Conclusion: Altruistic surrogacy should be promoted and not commercial surrogacy as commercial surrogacy leads to the exploitation of the mother’s womb for money. 70% of women in our study believe that the Indian government should not promote surrogacy and in order to protect the rights and prevent injustice suitable Laws should be made and put into action.

Gestational Surrogate’s Autonomy

The necessary consent of the surrogate mother is a safeguard of both her autonomy and her self-dispositionand guarantees not only the protection of human value (article 2, paragraph 1 of the GreekConstitution) but also the protection of her personality (article 5 paragraph 1 of the Greek Constitutionand article 57 the Greek Civil Code). It is worth noting, after all, that sometimes it is necessary to restrictthe freedom of some people, in order to ensure the freedom of others. The gestational surrogate expectantis not forced for her act. Autonomy presupposes the possibility of formulating and implementinga decision, as a form of personal freedom, having as a result that pressure opposes the obstructionof the surrogate mother and the future parents to do what they want and therefore feel free and notbe oppressed indirectly. On the other hand, Ronald Dworkin reports on the importance of autonomy inreproduction. According to the liberal view of human value, a behavior is not characterized as inhumanand degrading, nor immoral, in case it is not perceived as such by the subject who participates in it oraccepts it. Otherwise, an objective approach to this principle would be in case that a behavior is consideredto be inhuman by social criteria and regardless of the expression of the individual’s free consentand her possible desire to continue in activities offensive to the individual.

Assessing Surrogate Motherhood in Islam

Este ensayo reflexiona sobre la impermisibilidad de la maternidad subrogada en la mayoría de los países del Islam, con la excepción de Irán. Sin ser un estudio omnicomprensivo, se realiza una valoración de las principales razones que impiden a las parejas musulmanas acceder al método de asistencia reproductiva de la maternidad subrogada. El planteamiento de este ensayo es que la maternidad subrogada no es permitida dado que bajo el derecho islámico no es posible negar la maternidad. La presunción de la maternidad está sustentada tanto en el Corán como en el idioma árabe y se refleja en las interpretaciones que realizan los estudiosos del Islam. Se concluye que la maternidad subrogada gestacional es la única variante de la maternidad subrogada que puede ser compatible con los principios del Islam.

Ethical Need for a Fertility Decision-Aid for Transgender Adults of Reproductive Age

Ethical Need for a Fertility Decision-Aid for Transgender Adults of Reproductive Age

Dietary practices and nutritional status of children served in a social program for surrogate mothers in Colombia

BackgroundDietary practices are acquired in the family context and in turn can affect the health of family members, especially the nutritional status of children. The objective of this study was to determine the relationship between nutritional status and feeding practices in children from foster families served by the SOS Children's Villages program in Cartagena, Colombia.MethodsThe study had a cross-sectional design. Through a non-probabilistic purposive sampling, 139 children from 0 to 5 years of age from the SOS Children's Villages Cartagena program were involved. The sociodemographic background of the participants was recorded and the nutritional status of the children was evaluated through anthropometric and biochemical measurements. Dietary practices were measured by means of a standardized questionnaire. Analyses were performed with Poisson regression models with robust variance. These regression models provided prevalence ratios (PR) with their respective 95% confidence intervals (95%CI).ResultsAmong dietary practices, it was observed that most families eat together at home (63.3%), watch television when they eat (55.4%), and have dietary norms (80.6%). Consumption of plant foods was predominantly high, especially vegetables (86.3%), fruits (92.1%), cereals (84.9%), root vegetables, and bananas (93.5%). Consumption < 4 times/week of soft drinks and industrialized juices increases 14.3 times the probability of low weight-for-height in the study population compared to the group that does not consume them. On the other hand, watching television while eating (PR: 2.82, 95%CI 1.32—4.69) and consumption of sweet snacks (PR: 2.24, 95%CI 1.03—4.87) increased the probability of low height-for-age; while having eaten norms at home decreased the probability of low height-for-age in the study population by 50%.ConclusionIt is necessary to develop and implement interventions such as preventive measures and early diagnosis of inappropriate feeding behaviors to ensure adequate nutritional status among children under 5 years of age.

Effect of Parity on Placental Histopathology Features in Singleton Live Births Following IVF.

The aim of this study was to evaluate the effect of parity (primipara vs multipara) on the histopathology of the placenta in singleton live births following in vitro fertilization. We conducted a retrospective cohort study evaluating data of all IVF resulted live births from one university affiliated hospital during 2009-2017. All patients had the placenta sent for pathological evaluation. Exclusion criteria were history of miscarriage or elective termination of pregnancy, abnormal uterine cavity findings, previous uterine surgery, in vitro maturation cycles, gestational carrier cycles, oocyte recipient cycles, preimplantation genetic diagnosis cycles, and multiple pregnancies. The outcomes measured included anatomical, inflammation, vascular malperfusion, and villous maturation placental features. A multivariate analysis was conducted to adjust the results for factors potentially associated with placental pathology features. A total of 395 live births were included in the final analysis and were allocated to the study groups according to parity: primipara (n = 273) and multipara (n = 122). After adjustment for potential confounding factors, multiparity was found to be significantly associated with delayed villous maturation (OR 4.9; 95% CI 1.2-19.8) and primiparity was significantly associated with maternal vascular malperfusion (OR 0.6; 95% CI 0.3-0.8). We showed that parity has an impact on placental histopathological changes which in turn may affect perinatal outcome.

Hukum Inseminasi Buatan dan Bayi Tabung serta Implementasinya

This paper aims to examine the In Vitro Fertilization (IVF) program from the perspective of Islamic law, and positive law in Indonesia, so that it is clear whether the practice of IVF is religious or Indonesian law. In conducting the analysis, the authors use a type of qualitative literature research with a normative approach. The results of this paper are: (1) The artificial insemination program for IVF is permitted in Islamic law, with the condition that the sperm must come from the husband himself. In vitro insemination with the Surrogate Mother's uterus rental model, there are two opinions. The first opinion states that surrogacy is prohibited because it creates a mix of lineages which are also related to mahram and inheritance. The second opinion states that Surrogate Mother is allowed for emergency reasons. (2) Implementation of IVF in Indonesia is regulated in Law Number 36 of 2009 concerning Health. The law regulates the conditions and procedures that must be met to be able to participate in the program so that babies born in the program do not violate ethics in society and religion.

SURROGACY: PROBLEMS OF DEFINITION AND CONTRACTUAL REGULATION

For a more effective understanding of the legal relations of surrogacy, it is necessary to determine the structure of such legal relations. The article examines the basis for the emergence of legal relations of surrogate motherhood, gives an idea of the object of legal relations and the contract of surrogate motherhood, as well as the subject composition of such legal relations. The problems of the conceptual apparatus in this area are also considered and the need to reflect in the legislation of the Republic of Uzbekistan the relevant provisions on the regulation of legal relations of surrogate motherhood is justified

PENANAMAN EMBRIO PADA RAHIM ISTRI YANG LAIN

This paper discusses the practice of IVF (in vitro fertilization) by another wife's womb. This practice was declared haram by the fatwa of the Indonesian Ulama Council on June 1979. The reason is it will cause complexity in matters of inheritance. Especially, between child and owner of the ovum and surrogate mother. This research is a qualitative research with normative juridical approach. This research is a library research. This research use documentation techniques. This study concluded that the complexity in the inheritance problem that is feared in the MUI's fatwa can be overcomed by determining their nasab relationship. Because the nasab relationship is one of the reasons for inheritance. So the authors conclude that the practice of IVF from husband and wife by another wife's womb is legally, and the children born through the process end up with surrogate mother who have conceived and given birth.

CROSS-BORDER SURROGACY AND THE RIGHT TO RESPECT FOR FAMILY LIFE

Surrogacy is indisputably connected with the right to respect for family life guaranteed by Article 8 of the European Convention on Human Rights and Fundamental Freedoms. In the practice of the European Court of Human Rights (ECHR), many issues are open as disputable, among other things also in the context of the connection between cross-border surrogacy and the right to respect for family life. Taking into account the circumstances of each specific case, ECHR considered, first of all, the question of the (non)existence of a genetic link between the intended parents and the child born by the surrogate mother, the duration of cohabitation between them and the legal uncertainty that surrogacy creates, i.e., their possible impact on the violation of the right to respect for family life.

Performing IVF for surrogacy before confirmation of the surrogacy agreement by the court: a critical analysis of recent case law in South Africa

The regulation of surrogacy in South Africa centres on a scheme of judicial confirmation of surrogacy agreements before the start of the surrogate pregnancy. If such confirmation is granted by the court, actions taken in the execution of the surrogacy agreement are lawful, and the agreement itself is enforceable. Against this background, the question has arisen: is it lawful to perform in vitro fertilisation (IVF) before confirmation of the surrogacy agreement? This is a salient question: In circumstances where egg retrieval needs to take place in anticipation of surrogacy, and where sperm is available but where the surrogacy agreement has not (yet) been confirmed, there are significant clinical advantages to first creating embryos through IVF before cryopreservation—rather than cryopreserving the eggs. However, in the recent case of Ex ParteMCM, the court held that it is unlawful to perform IVF in anticipation of surrogacy where the surrogacy agreement has not (yet) been confirmed. The correctness of this decision is comprehensively analysed with reference to the two main statutory instruments that are relevant to the topic: the Children’s Act and the Regulations relating to the Artificial Fertilisation of Persons. This article concludes that Ex ParteMCM interpreted the Regulations incorrectly, and that on a proper construction of both the relevant statutory instruments, the law does not prohibit IVF in anticipation of surrogacy where the surrogacy agreement has not (yet) been confirmed.