Surrogacy Research Articles

Misconduct in third-party assisted reproductive technology by participants and nonmedical professionals or entities: an Ethics Committee opinion

Physicians involved in third-party assisted reproductive technology arrangements who discover material misconduct or other undisclosed information by a party to the arrangement (such as a gamete or embryo donor, gestational carrier, or intended parent) or by a nonmedical professional participant or entity (such as a recruiting program, gamete or embryo bank, or lawyer) should encourage that party or professional participant to disclose such misconduct or information. In some instances, it is ethically permissible for the physician to either disclose material information to the affected party or to decline to provide or continue to provide care. In all cases involving the legal status or rights of the parties, physicians should recommend that patients seek independent legal professional advice. This document replaces the document "Misconduct in third-party assisted reproduction," last published in 2018. The use of a physician's own gametes for the purpose of reproduction without the informed consent of the recipient(s) is unethical and illegal, as well as never permissible.

Peculiarities of determining the origin of children born as a result of the use of assisted reproductive technologies in Ukraine, The European Union and The United States

The article considers the legal basis for determining the origin of children born as a result of the use of assisted reproductive technologies, and in particular through surrogate motherhood, analyzes domestic and foreign legislation regulating the procedure for determining the origin of the child. It is emphasized that the recognition of each person’s rights such as the right to create a family, the right to respect for private and family life, the right to procreation, poses the task for the State and the international community to create optimal mechanisms for regulating new rights that have arisen with the development of modern medicine.The article is aimed at a comprehensive analysis, disclosure of the essence and features of legal regulation of determining the origin of a child born through the use of assisted reproductive technologies under the legislation of Ukraine, the European Union and the United States.The author stresses that among the problems inherent in the institution of surrogate motherhood in countries of the world, it is necessary to highlight the following: lack of proper monitoring of surrogacy cases, inadequate control by state authorities, which ultimately can lead to violation of the rights of biological parents, surrogate mother, as well as the child himself; risk of genetic parents abandoning a child born with physical or mental disabilities. The author proved that the use of assisted reproductive technologies by the method of substitute (surrogate) motherhood can be carried out only in relation to citizens of Ukraine and foreigners-citizens of countries in which such a method of assisted reproductive technologies is not prohibited by law, and in cases where foreigners do not live in the country of citizenship, − also by law of the country of residence. In this case, the conditions for the use of substitute (surrogate) motherhood should be the genetic connection of the child with at least one of the future parents and the absence of a direct genetic connection of the child with the substitute (surrogate) mother, except in cases when the substitute (surrogate) mother is a relative of the future parents.

Risk of Stroke Hospitalization After Infertility Treatment

Stroke accounts for 7% of pregnancy-related deaths in the US. As the use of infertility treatment is increasing, many studies have sought to characterize the association of infertility treatment with the risk of stroke with mixed results. To evaluate the risk of hospitalization from hemorrhagic and ischemic strokes in patients who underwent infertility treatment. This population-based, retrospective cohort study used data abstracted from the Nationwide Readmissions Database, which stores data from all-payer hospital inpatient stays from 28 states across the US, from 2010 and 2018. Eligible participants included individuals aged 15 to 54 who had a hospital delivery from January to November in a given calendar year, and any subsequent hospitalizations from January to December in the same calendar year of delivery during the study period. Statistical analysis was performed between November 2022 and April 2023. Hospital delivery after infertility treatment (ie, intrauterine insemination, assisted reproductive technology, fertility preservation procedures, or use of a gestational carrier) or after spontaneous conception. The primary outcome was hospitalization for nonfatal stroke (either ischemic or hemorrhagic stroke) within the first calendar year after delivery. Secondary outcomes included risk of stroke hospitalization at less than 30 days, less than 60 days, less than 90 days, and less than 180 days post partum. Cox proportional hazards regression models were used to estimate associations, which were expressed as hazard ratios (HRs), adjusted for confounders. Effect size estimates were corrected for biases due to exposure misclassification, selection, and unmeasured confounding through a probabilistic bias analysis. Of 31 339 991 patients, 287 813 (0.9%; median [IQR] age, 32.1 [28.5-35.8] years) underwent infertility treatment and 31 052 178 (99.1%; median [IQR] age, 27.7 [23.1-32.0] years) delivered after spontaneous conception. The rate of stroke hospitalization within 12 months of delivery was 37 hospitalizations per 100 000 people (105 patients) among those who received infertility treatment and 29 hospitalizations per 100 000 people (9027 patients) among those who delivered after spontaneous conception (rate difference, 8 hospitalizations per 100 000 people; 95% CI, -6 to 21 hospitalizations per 100 000 people; HR, 1.66; 95% CI, 1.17 to 2.35). The risk of hospitalization for hemorrhagic stroke (adjusted HR, 2.02; 95% CI, 1.13 to 3.61) was greater than that for ischemic stroke (adjusted HR, 1.55; 95% CI, 1.01 to 2.39). The risk of stroke hospitalization increased as the time between delivery and hospitalization for stroke increased, particularly for hemorrhagic strokes. In general, these associations became larger for hemorrhagic stroke and smaller for ischemic stroke following correction for biases. In this cohort study, infertility treatment was associated with an increased risk of stroke-related hospitalization within 12 months of delivery; this risk was evident as early as 30 days after delivery. Timely follow-up in the immediate days post partum and continued long-term follow-up should be considered to mitigate stroke risk.

Storks and Jars: Within the World of Surrogacy Narratives

By analyzing public accounts of the experiences of surrogates and intended parents, this article aims at identifying popular American discourses on surrogacy, which remains a contested assisted reproduction technology. Focusing on first-person narratives, I look at the strategies of rationalization employed by people entering commercial surrogacy contracts, particularly in relation to the monetary exchange. I argue that even though the ethics of financial compensation is not questioned in most narratives by surrogates and intended mothers, the normalizing discourse on American surrogacy requires the issue of money to be downplayed – instead surrogacy is presented as an altruistic “gift of life.”

The #IVF journey: content analysis of IVF videos on TikTok

What patient populations and outcomes are depicted on IVF videos on the short-form video-sharing application 'TikTok'? This cross-sectional study investigated the 100 most-viewed videos utilizing the #IVF hashtag on TikTok. Only videos in English or Spanish were included in the analysis. An automated web-scraping platform was used to extract information from these videos. Standardized video coding was used to evaluate the featured subject(s), phase of care and IVF outcomes from the videos. Videos meeting the inclusion criteria (n=93) had 731 million views, 91 million likes and 893,000 shares. Patients' personal stories about IVF are over-represented relative to videos created by healthcare professionals. #IVF videos popular on TikTok disproportionately depict same-sex couples (38.1%), gestational carriers (14.0%), multiple gestations (60.0%) and live births (89.3%) relative to real-world data. Among the videos making scientific claims (n=16), nearly all were moderately to highly accurate (93.8%). Most videos had a positive (55.9%) or neutral (5.5%) tone towards IVF. Popular #IVF videos on TikTok contribute to public discourse about infertility, and highlight demographics that have traditionally been under-represented in health care. Videos rarely focused on health education or made informational claims, with low scores on measures of quality of information and actionability. This gap represents an opportunity for health providers and educators to create more engaging and educational content to reach patients considering IVF.

Transmission of Human Life with a Gestational Carrier

Transmission of Human Life with a Gestational Carrier

Problems of subjects and legal personality in family law

In family legislation, unlike civil legislation, the subjects of legal relations are not directly named. In addition to the disparity of norms concerning subjects of family legal relations, the mobility of the composition of such persons, due to the evolution of society and law, is a problem. A comparative analysis of the norms of law and doctrinal positions is carried out, as a result of which various classifications of subjects of family legal relations are identified, the inclusion of organizations and public legal entities, the family as a quasi-legal entity, is justified. As a result of the introduction of the institution of the foster family, new special subjects of family legal relations appeared — foster children and foster parents. In connection with the development of assisted reproductive technologies, the issue of qualification of potential parents, sperm donor and surrogate mother as subjects of family legal relations has been raised. There is a problem of legal qualification of the embryo. The problems associated with the legal personality of participants in family legal relations are revealed: the mixing of marital and family legal personality, the absence of separate norms on family legal capacity and legal capacity, etc. It is proved that the scope of family legal personality varies depending on age, a number of other legal facts, including other sectoral nature; it is associated with the goal-setting of the exercise of rights and performance of duties.

Altruistic help or taking advantage of the situation? Social representations of surrogate motherhood.

Concerning Europe, the lay public, mainly in Central regions, still lacks information about what surrogacy is and how the process works in practice. It is one of the most controversial methods of assisted reproduction precisely because it goes against traditional social norms and ideas about the conception of life. The main aim of our study was to map the social representations of lay people that are formed in internet discussions. We focused on discussion forums over a time span of the last 10 years, from 2013 to 2022. We were also interested in whether perceived risks or benefits formed the core of social representations. Through a reflexive thematic analysis, we identified two distinct constructions of social representations of surrogacy, finding that value settings in terms of liberalism and conservatism appear to have the greatest influence on the anchoring and objectification of surrogacy.

Making a dead woman pregnant? A critique of the thought experiment of Anna Smajdor

In a thought-provoking article – or how she herself named it, ‘a thought experiment’ – the philosopher-medical ethicist Anna Smajdor analyzed in this journal the idea of whole-body gestational donation (WBGD) in brain-dead female patients, as an alternative means of gestation for prospective women who cannot or prefer not to become pregnant themselves. We have serious legal, economical, medical and ethical concerns about this proposal. First, consent for eight months of ICU treatment can never be assumed to be derived from consent for post-mortem organ donation; these two are of an incomparable and entirely different medical and ethical order. Moreover, the brain-dead woman is very likely to be medically unfit for high-tech surrogacy and the brain-dead state poses a high risk for deficient embryo/fetal development. Second, from a scarcity perspective, occupying an ICU bed for eight months appears to be unjust. The costs for eight months of ICU treatment are far too high compared to the costs of surrogacy for a living, selected, and healthy woman. Neither insurance companies nor prospective parents will want to pay these exceptionally high costs for a dead woman if a living surrogate mother can be hired for a considerably lower amount. Third, there is an increased risk for harm of the child to be in WBGD. And finally, WBGD risks violating the brain-dead woman’s dignity and harming the interests of her loved ones. In short, there is simply no need for brain-dead women as surrogates.

Elevated antimüllerian hormone levels are not associated with preterm delivery after in vitro fertilization or ovulation induction

To investigate the association between anti-Müllerian hormone and preterm birth risk in a larger cohort of patients who underwent either in vitro fertilization or ovulation induction with intrauterine insemination at a US academic fertility center. Retrospective cohort study SUBJECTS: Live singleton births from patients who underwent in vitro fertilization or ovulation induction between 2016 and 2020 at a single academic fertility center were included in this study. Patients were excluded if they had a missing pre-pregnancy AMH level, a pregnancy using donor oocytes or a gestational carrier, multiple gestations, a delivery prior to 20 weeks gestation, or a cerclage in place. AMH level MAIN OUTCOME MEASURES: The primary outcome was proportion of preterm delivery. Secondary outcomes included rate of pregnancy-induced hypertension, gestational diabetes, and small for gestational age. In the entire cohort (n=875), 8.4% of deliveries were preterm. Mean AMH values were similar between those with term and preterm births (3.9 vs 4.2 ng/mL, p=0.29). Similar proportions of patients with term and preterm deliveries had AMH levels greater than the 75th percentile (25% vs 21%, p=0.4). The odds of preterm birth were similar by AMH quartile after adjusting for history of preterm birth. Similarly, in the PCOS cohort, there was no difference between mean AMH values of term and preterm births (n=139, 9.6 vs 10.0 ng/mL, p=0.9). The proportions of PCOS patients with AMH levels greater than the 75th percentile were similar between those with term and preterm deliveries (25% vs 22%, p=0.9). The odds of preterm birth were similar by AMH quartile after adjusting for history of preterm birth. Elevated AMH levels were not associated with an increased risk of preterm birth in patients who conceived after in vitro fertilization and ovulation induction, including PCOS patients. Although studies suggest that AMH level may help stratify risk of preterm birth in this population, our findings indicate that further studies are needed prior to clinical application.

Double-donor surrogacy and the intention to parent.

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.

Nuclear transfer improves the developmental potential of embryos derived from cytoplasmic deficient oocytes

Embryo development after fertilization is largely determined by the oocyte quality, which is in turn dependent on the competence of both the cytoplasm and nucleus. Here, to improve the efficiency of embryo development from developmentally incompetent oocytes, we performed spindle-chromosome complex transfer (ST) between invitro matured (IVM) and invivo matured (IVO) oocytes of the non-human primate rhesus monkey. We observed that the blastocyst rate of embryos derived from transferring the spindle-chromosome complex (SCC) of IVM oocytes into enucleated IVO oocytes was comparable with that of embryos derived from IVO oocytes. After transferring the reconstructed embryos into the uterus of surrogate mothers, two live rhesus monkeys were obtained, indicating that the nuclei of IVM oocytes support both the pre-and post-implantation embryo development of non-human primates.

The advantages and disadvantages of altruistic and commercial surrogacy in India

BackgroundComprehensive 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.MethodsThis 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.ResultsSurrogacy 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.ConclusionPolicies 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.

Validation of prognosis-based in vitro fertilization grant selection criteria

To validate a prognosis-based scoring system for invitro fertilization (IVF) grant allocation. Retrospective cohort study. A 501(c)(3) nonprofit foundation that awards donated IVF cycles and grants to those with demonstrated financial need. In contrast to lottery-based or subjective allocation systems, applications are scored according to medical prognostic criteria in addition to personal characteristics. Grant recipients from 2015 to2019. None. Live birth rate (LBR) and cumulative LBR (CLBR) among grant recipients were compared with 2019 Society for Assisted Reproductive Technology (SART) national averages. A total of 435 applications were reviewed, with 59 grants awarded for 51 autologous IVF cycles, 6 donor oocyte cycles, and 2 gestational carrier cycles, resulting in 39 live births after initial embryo transfer (LBR 61.9%) and 43 CLBRs (CLBR 72.9%). Among autologous cycles, the mean (±SD=3.9 years) age was 31.8 years, and LBR and CLBR were 62.8% and 68.6% vs. 28.2% and 37.1% among all autologous SART cycles, respectively. A subanalysis of grant recipients aged <35 years (n=39) revealed LBR and CLBR of 66.7% and 74.4% vs. 40.7% and 47.8% among autologous SART cycles aged <35 years, respectively. A scoring system incorporating medical criteria identified IVF grant applicants with a high likelihood of achieving a LB. Although most IVF grant programs select recipients through a lottery or personal characteristics, a prognosis-based scoring system should be considered to maximize LBR in a limited resource setting.

Surrogacy in the Philippine Context: Bane or Boon?

Surrogacy is the procreative practice by which a woman gestates an embryo with which she has no biological connection for another person, eventually relinquishing the child to the other party. This practice involves financial remuneration for the surrogate mother depending on the agreed amount of both parties. The moral issue becomes more known and patronized by other countries, especially first-world countries. Some countries already legalized surrogacies with their parameters. Others are practicing it with their own norms and standards with precautionary measures. However in the Philippines, though dominantly Catholic, already been practiced surrogacy by some Filipinos due of poverty. They would try to give in thinking that it would alleviate them from poverty at their wombs expense. Some Filipinos who can afford the process chose other races. Though, the issue is not largely being discussed by the majority because it is prohibited in the said country. But in its subtle manner it is being performed. In this accord, a moral issue that challenges the authority of both Civil and Ecclesiastical not only in the Philippines but also in other countries will be on how to answer the problem morally. With this, it might be an attempt to consider in a wider perspective whether surrogacy is a gift -which means has a purpose to serve humanity or evil because of its immoral implication to humanity.

Surrogate Motherhood in India: An Analysis of Surrogacy (Regulation) Act, 2021

Surrogate Motherhood in India: An Analysis of Surrogacy (Regulation) Act, 2021

Ambiguity Affirmed: Commentary on the Judgement of the European Court of Human Rights in the Case of Valdís Fjölnisdóttir and Others v. Iceland of 18 May 2021

The text comments on the European Court of Human Rights judgement of 18 May 2021 in the case of Valdís Fjölnisdóttir and others v. Iceland. The case is another judgement of the ECtHR dealing with the phenomenon of surrogate motherhood. Indeed, the legal consequences of surrogate motherhood vary and result in challenges both in national and international legal contexts. The judgement commented on is of high importance as it dealt with links between surrogate motherhood and adoption, as well as illustrated modern challenges for civil status registration. The text provides for an in-depth analysis of the judgement concerned and identifies some ambiguity and lack of consistence in the Court’s approach to surrogate motherhood. In the course of its analysis the Valdís Fjölnisdóttir and others case is assessed as a lost chance in this respect.

Legal regulation of the use of surrogate motherhood technology in Ukraine during a full-scale war

A systematic study of the problems of legal regulation of the use of surrogate motherhood technology in Ukraine during a full-scale war was carried out. It has been established that the procedure of full surrogate motherhood is allowed in Ukraine (the surrogate mother must not have a genetic connection with the child). At the same time, the lack of clear legal requirements for the procedure of surrogacy, the relatively low cost of its implementation caused a fairly high level of demand among foreigners for the use of this reproductive technology. Until February 24, 2022, the demand in Ukraine for surrogacy services was extremely high, including due to the ban on surrogacy for foreigners in India, our state was one of the centers of surrogacy at the world level. After February 24 last year, the situation changed significantly. The problems that arose due to the full-scale war and are related to ensuring the personal safety of surrogate mothers, their evacuation, and the preparation of documents for newborn children are analyzed.It has been studied which legal norms currently remain valid in regulating the procedure of surrogate motherhood. The simplification of the rules for crossing the state border and the procedure for granting permission to parents to leave with their children based on birth certificates are analyzed. The practical practices that changed after the war in a number of foreign embassies were analyzed.A comparative analysis of four draft laws submitted to the parliament at the end of 2021 and in January 2022, which should regulate the field of reproductive medicine, was carried out. The positive sides of individual provisions, as well as existing gaps, are highlighted.In addition, the need to adopt a special law that would regulate the use of various reproductive technologies in Ukraine, including surrogate motherhood procedures, is substantiated. It has been proven that the new law should clearly define the possibilities of using surrogate motherhood by foreigners and guarantee special legal protection for children born to surrogate mothers. It is also important to clearly regulate the procedure for the export of reproductive material abroad, as well as the responsibility of all parties for non-fulfillment of the contract, unless the impossibility of fulfillment due to force majeure is proven.

Этические вопросы суррогатного материнства

Глобальный рынок коммерческого суррогатного материнства растет значительными темпами. Каждый год тысячи женщин соглашаются за определенную плату выносить ребенка для другой женщины. В результате тысячи детей рождаются, зачатые одной женщиной, но востребованные другой. Центральный аргумент этой статьи заключается в том, что к суррогатному материнству следует подходить как к сложным коммерческим, этическим, юридическим отношениям. В данный момент времени идет активная международная торговля матками, спермой и яйцеклетками. Есть быстро развивающиеся медицинские технологии, которые, несомненно, увеличили как спрос на услуги суррогатного материнства, так и предложение от суррогатных матерей. Однако правовые основы рынка, регулирующие суррогатное материнство, нормы, законы, развиваются значительно медленнее. Одни государства, как, например, США, Франция, Германия, Австрия, регулируют вопросы, связанные с суррогатным материнством, в основном, в форме запрета, другие государства — создают максимально либеральное законодательство, как, например, Индия, Россия, Казахстан. В статье автором сделан вывод о том, что этические и моральные вопросы суррогатного материнства разделили на два лагеря все страны в мире: сторонники и противники, которые сравнивают его с рабством женщин. Обоснована необходимость установления мер безопасности, гарантирующих, что в этой сделке не будет эксплуатации женщин, находящихся в трудном финансовом положении.

Impact of the war in Ukraine and the COVID-19 pandemic on transnational surrogacy – a qualitative study of Danish infertile couples’ experiences of being in ‘exile’

Research questionHow 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? DesignA 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. ResultsAll 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. ConclusionsUnderstanding 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.