Surrogacy Research Articles

What is the cure for absolute infertility? Biomedicalisation and routinisation of surrogacy and uterus transplantation in Nordic medical journals

AbstractThis article investigates 20 years of discursive struggles in Nordic medical journals around the process of legitimating and routinising gestational surrogacy and uterus transplantation in Finland and Sweden. The comparative analysis through critical discourse analysis suggests that influential health care professionals have contributed to different levels of legal and cultural adaptation of the methods, prioritising non-commercial gestational surrogacy in Finland and uterus transplantation in Sweden. The article identifies central discursive turning points in the medical journal discussions by interpreting them against the background of medical and policy developments in Finland and Sweden during the analysed twenty-year period. Legitimation and routinisation of surrogacy and uterus transplantation were developed through biomedicalisation by representing them as infertility treatments and emphasising the relational dynamics between donors and recipients—a connection that in the Nordic context is often based on kinship or close relationships. The diagnosis of absolute uterine factor infertility was central to representing women as on the boundary between fertile and infertile, as they may have functioning ovaries. Through the biomedicalised rhetoric of equal opportunities for biogenetic motherhood, the diagnosed women’s ambiguous reproductive status was used to legitimise the two methods as cures for absolute infertility, thereby reinforcing hegemonic family and kinship norms.

Evolution of gestational surrogacy through the years and the new challenges for its implementation

Evolution of gestational surrogacy through the years and the new challenges for its implementation

O-091 Severe maternal and neonatal morbidity among gestational carriers: a population-based cohort study

Abstract Study question Are gestational carriers at higher risk of severe maternal (SMM) or neonatal (SNM) morbidity, compared to patients using unassisted conception or in vitro fertilization (IVF)? Summary answer A higher risk of SMM and adverse pregnancy outcomes is seen among gestational carriers, without evident neonatal morbidity. What is known already The use of gestational carriers (GC) also known as “surrogate pregnancy” is increasing. Gestational carriage may be associated with adverse outcomes linked to both IVF techniques and exposure to foreign fetal antigens. Adverse outcomes of GC pregnancies are largely unknown. Study design, size, duration Retrospective population-based cohort study of 937,938 births, derived from existing administrative health datasets. Data were linked using unique for birthing woman and child identifiers and analyzed at ICES Ontario. The study excluded participants with untreated infertility, those utilizing ovulation induction or intrauterine insemination, and those with multifetal gestation. Participants/materials, setting, methods Singleton births at > 20 weeks gestation in Ontario, 2012-2021. Pregnancy characteristics were obtained from the Ontario Birth Registry database. Exposure groups were i) unassisted conception (comparison group 1), ii) IVF (comparison group 2), or iii) GC. Primary outcomes included validated composite outcomes of i) SMM and ii) SNM. Secondary outcomes included hypertensive disorders of pregnancy, cesarean delivery, preterm birth, and postpartum hemorrhage. Modified Poisson regression models generated relative risks adjusted for birthing woman’s characteristics (aRR). Main results and the role of chance Of all singleton births, 937,938 (97.7%) were from unassisted conception, 20,958 (2.2%) from IVF, and 956 (0.1%) from GC. GC were more likely to be parous, reside in a lower-income area, and have higher rates of chronic hypertension. GC were more likely than unassisted conception women to be older and be non-smokers, with some opposite trends when compared to IVF recipients. Respective rates of SMM were 2.4%, 4.6% and 7.1%. The aRR were 3.07 (95% CI 2.44-3.87) comparing GC to unassisted conception, and 1.88 (95% CI 1.46-2.42) comparing GC to IVF. Respective rates of SNM were 6.0%, 9.1% and 6.5%, generating aRR of 1.21 (95% CI 0.95-1.54) for GC vs. unassisted conception, and 0.78 (95% CI 0.60-1.00) for GC vs. IVF. Respective rates of hypertensive disorders were 6.6%, 11.6% and 13.9%. The aRR were 1.89 (1.61 - 2.21) comparing GC to unassisted conception, 1.42 (1.19 - 1.69) comparing GC to IVF. Respective rates of postpartum hemorrhage were 5.7%, 10.5% and 13.9%, generating aRR of 2.87 (2.43 - 3.38) for GC vs. unassisted conception, and 1.40 (1.17 - 1.67) for GC vs. IVF. Limitations, reasons for caution The databases did not include certain baseline details, including the reasons for opting for a GC and the sources of gametes. There is a chance that the measured association may be distorted or confounded by the unmeasured variables. Wider implications of the findings GC appear to be at an elevated risk of maternal morbidity, without evident risk of neonatal morbidity. Further studies are needed to understand the mechanisms involved. Eligibility for GC should be determined using consistent selection criteria, and consideration should be given to specialized obstetrical care to promote optimal pregnancy outcomes. Trial registration number Not applicable

P-499 Long term psychological health of gestational surrogates in a low-income setting: five years after birth

Abstract Study question How does psychological health and experiences of surrogates in a cross-border commercial surrogacy setting change from pregnancy, 4-6 months, and five years post-birth? Summary answer Longitudinally surrogates’ psychological health did not significantly change. Majority had still not met the parents, continued hiding surrogacy, and reported mixed feelings for the child. What is known already Commercial surrogacy was banned in India in 2017 due to concerns related to exploitation and psychological harm. Power differentials between surrogates and intending parents and commercialization raised concerns regarding the psychological health of surrogates in low-income settings. Post the ban, surrogacy hotspots moved to countries like Mexico and Georgia embroiled in similar practices. There is however no academic literature on long-term psychological health of surrogates from low-income settings. Previous research showed that surrogacy pregnancy and prenatal attachment did not significantly contribute psychological harm post-birth. Instead, socio-cultural practices related to support during pregnancy and stigma increased depression scores post-birth. Study design, size, duration The fieldwork was administered in Mumbai, India, where international cross-border, gestational, and commercial surrogacy was being practiced. Data was collected over three phases: 1) during pregnancy 2) 4-6 months post-birth and 3) 5-6 years after surrogacy. Being a mixed-method design, findings include quantitative data on psychological health of surrogates from all three phases and qualitative data from phase 3 of the research. The study spans from 2014 to 2021. Participants/materials, setting, methods In-depth semi-structured interviews and standardized questionnaires (anxiety, depression, stress scale) were administered to 50 surrogates during pregnancy, 45 surrogates 4-6 months post-birth, and 19 surrogates 5-6 years post-birth. In phase III, mothers also responded to the perceived social support scale. Interviews included questions related to narratives and feelings about the baby, intending parents, surrogate hostel, fertility clinic, potential financial gain, perceptions of stigma, and the new law banning surrogacy. Fieldwork was administered at the clinic. Main results and the role of chance Three one-way repeated measures ANOVA were administered which showed that anxiety, depression, and stress of surrogates did not significantly differ over the three time-points, suggesting that practicing surrogacy did not significantly contribute to psychological harm. It is important to note that financial gain did not significantly improve their psychological over time. Non-parametric tests also did not show significant differences. Mean scores show a downward trend for anxiety and depression, but an upward trend for stress. The perceived social support scale showed that participants received support from family and significant other and least support from friends. However, support from family positively correlated with the stress scores of surrogates. Perhaps an overwhelming involvement of family adds to stress. Most surrogates were not in touch with friends from the surrogate hostel. Majority reported still thinking about the baby frequently, had mixed feelings, and were still hiding surrogacy. Most of them had not met the parents and child, did not know if intending parents should disclose to the child about surrogacy. Majority did not appreciate the new law and wouldn’t consider becoming surrogates without a payment. Prenatal bonding from phase 1 did not have any relationship with psychological health observed in phase 3. Limitations, reasons for caution The study’s sample size raises generalizability concerns. Diminishing sample sizes and potential social bias may affect robustness. Limited psychological measures and homogeneity assumptions suggest a need for caution in interpreting results. Wider implications of the findings This is the first longitudinal study on surrogate mothers from low-income settings practicing commercial surrogacy. Findings advocate policy reassessment, enduring support structures for surrogates, educational initiatives for transparency, international collaboration on best practices, and future research exploring cultural nuances and the perspectives of intending parents in cross-border commercial surrogacy. Trial registration number N/A

O-159 Domestic and cross-border reproductive care among same-sex male intended parents: comparing live birth rates (LBRs) in a national retrospective cohort in the United States (U.S.)

Abstract Study question How common is cross-border reproductive care (CBRC) in the U.S. among international same-sex male intended parents? Do CBRC LBRs differ compared to domestic counterparts? Summary answer A substantial number of international same-sex male intended parents seek CBRC in the U.S. LBRs per transfer are reassuring and comparable to domestic counterparts. What is known already Same-sex male intended parents often work with a gestational carrier to have a genetically related child(ren); however, restrictive and/or discriminatory policies in their home countries may prevent access. Intended parents may seek CBRC in countries like the U.S. due to favorable regulations. However, the volume of CBRC activity among same-sex male intended parents has been difficult to estimate accurately due to poor sexual orientation data collection. Capitalizing on national databases that identify same-sex male intended parents is the first step to describing CBRC trends and their associated outcomes in a marginalized population that is often excluded in the literature. Study design, size, duration This national retrospective cohort study included U.S. based gestational carrier embryo transfer cycles from the Society for Assisted Reproductive Technology (SART) database in the years 2017–2020. Among participating clinics (n = 488), 6,168 cycles among same-sex male intended parents were identified. Relative risks (RRs) for LBRs per transfer were compared for cycles including domestic (i.e., U.S. based, n = 3,052) and internationally based (n = 3,080) patients. LBR and country data were missing for 546 and 36 cycles, respectively. Participants/materials, setting, methods The inclusion criteria were transfer cycles among male patients with male partners. Unadjusted and adjusted RRs for LBRs per transfer were calculated to compare domestic (reference) and internationally based groups using multivariable Poisson and logistic regression models with generalized estimating equations (GEEs). Models were adjusted for donor age, transfer type (i.e., fresh, frozen), day of transfer, number of embryos transferred, male infertility, and the use of intracytoplasmic sperm injection, assisted hatching, and preimplantation genetic testing. Main results and the role of chance Between 2017 and 2020, 6,168 cycles with an embryo transfer to a gestational carrier occurred among same-sex male intended parents in the U.S. In half of the cycles, the U.S. was a destination for CBRC (50%, n = 3,080) among which (48%, n = 1,540) were from one of 23 European countries. Regarding countries of residence for CBRC cycles (n = 3,080), those most reported were China (23%), France (19%), Israel (13%), Spain (11%), the United Kingdom (6.1%), Australia (4.1%), Germany (3.7%), Italy (2.6%), Switzerland (1.5%), Canada (1.5%), Belgium (1.4%), Singapore (1.0%), Taiwan (1.2%), Norway (1.2%) and The Netherlands (0.92%). Additionally, there were 76 cycles from 8 countries in South America (2.3%), 9 cycles from 6 countries in Africa (0.27%), and 3 cycles from 2 countries in Central America (0.089%). Most cycles were in the U.S. West (72%, n = 4,441; e.g., California [47%]). Median oocyte age was 26 years (interquartile range 24,28) with a majority of cycles involving single embryo transfer (78%, n = 4,802). LBR per transfer was 69% (n = 3,867). There was no statistical difference between live births for domestic versus CBRC cycles in the unadjusted (RR 1.14, 95% confidence interval [CI] 0.96, 1.37; p: 0.141) or adjusted regression models (aRR 1.06, 95% CI 0.86, 1.32; p: 0.572). Limitations, reasons for caution The SART surveillance system captures most (∼90%) but not all embryo transfer cycles in the US. Current gender identity data were not available. Only the individual identified as the patient (and not the partner) indicated country of residence. The rationale for pursuing CBRC in the U.S could not be explored. Wider implications of the findings This study highlights a substantial amount of CBRC among same-sex male intended parents choosing the US for reproductive care. Implementing improved sexual orientation and gender identity data collection strategies are critical to filling CBRC data deserts not only among same-sex male intended parents but all sexual and gender minority populations. Trial registration number Not applicable

O-179 From secrecy to transparency: The journey of donor identity in reproductive medicine in Portugal

Abstract Thanks to significant medical advancements in reproductive medicine, people have more opportunities to achieve their parenthood goals. Third-party reproduction allows individuals and couples who might not otherwise be able to conceive to have the chance to build their family, thanks to the availability of donor gametes and gestational surrogacy. Gamete donation policy in Europe varies by country, raising ethical and legal concerns. In recent years, shifts from anonymity towards openness in donor legislation have occurred in several countries. Globally, in the last decade, there has been an increase in the number of families created using egg, sperm or embryo donation. The number of IVF/ICSI cycles using donor eggs or sperm in Portugal totalled 1890 in 2019 and 54 in 2020 (an unusual year due to the Covid-19 pandemic). In Portugal, the first medically assisted reproduction (MAR) law was approved in 2006, and gamete donations were anonymous. Ten years later, in 2016, Portugal’s MAR legal framework changed, and access to MAR was broadened to all women, independent of their marital status and sexual orientation. Therefore, treatment with donor sperm, oocytes, and embryos became available to recipients, including heterosexual couples, lesbian couples, and single women. In 2018, there was another change in the law and gamete donations became non-anonymous. In Portugal, identity-release donation allows the donor to remain anonymous to the intended parents during treatment (although they may have access to some non-identifying information about the donor). Nevertheless, the child can request the National Council for Medically Assisted Reproduction access to the donor’s personal information (full name) once they turn 18. Considering this legal framework, the number of previous donors who were contacted and asked whether they would maintain their donation despite the non-anonymity was residual. The identity-release framework did not seem to have affected the number of donations either. Donations are more frequent in private clinics than in the Portuguese public gamete bank, and this leads to waiting lists that can reach two years for a treatment involving oocytes or sperm donation. In this context, efforts to increase gamete donation, particularly in the National Health Service, are crucial. A study is currently being conducted in Portugal to pinpoint the main reasons why people do not consider being gamete donors. Preliminary results in a sample comprising 297 participants (82.2% females), with a mean age of 25.43 (SD = 7.88) years old and a mean of 14.09 (SD = 2.06) years of education, revealed that 73 (24.6%) stated that they would not consider being a donor because of the non-anonymity and 39 (13.2%) indicated that they would not consider becoming a donor due to concerns about being contacted in the future and requested responsibilities. These results may contribute to informing future initiatives aiming at promoting awareness on the topic of gamete donation. Another relevant topic is secrecy, which refers to parents not disclosing information to their offspring or their social group about donated gametes’ conception. Disclosing is recommended as an ongoing process, preferably when the child is young. This disclosure process may benefit from counselling or other support resources (e.g., children’s books, patients’ associations).

O-182 To err is human, also for those working in ART

Abstract Medically assisted reproduction (MAR) centers combine clinical and technical expertise with a very high complexity. Over the years, MAR centers have undergone increased intricacy due to incorporating laboratory techniques, such as cryopreservation of oocytes and embryos and micromanipulation, embryo culture, and pre-implantation genetic testing. Not only the technicality of the MAR laboratory profession is challenging, but the complexity of each phase has increased over the years; the patient population undergoing treatment has expanded, where not only the intended parents’ gametes are involved but also the utilization of gametes from egg and sperm donors, as well as including a gestational carrier receiving the embryo. These complexities have led to the implementation of rigorous control measures to mitigate the risk of errors. Nevertheless, a zero-risk fertility clinic is an illusion, given the many necessary interventions and manipulations in each treatment cycle. Errors in fertility practice involving gametes or embryos can be devastating to patients and clinical personnel, often raising psychological, legal, ethical, economic, and practical concerns. The most critical cases of risk of harm in MAR procedures involve misidentifying a patient, gamete, or embryo, called ‘mix-up,’ which could lead to dramatic consequences. Although the frequency is low, mix-up cases have been described worldwide. Other adverse events derive from preventable human actions, e.g., overlooking an embryo when carrying out assessments, dropping a dish, incorrect labeling, improper pipetting technique, unusually poor thawing, and inadvertent discard of the sample. Human error cannot be eradicated. In the old view, human error was perceived as the root cause of problems, with individuals being viewed as variables requiring control. Conversely, contemporary perspectives consider human error a symptom of deeper systemic issues. As suggested by the Institute of Medicine in 2000, which published the report “To Err Is Human,” the core of the problem lies not with the fallibility of healthcare personnel but the flawed systems within which they operate. Preventing errors is possible by incorporating safety into system processes and hospital structures. Latent errors are errors that arise due to system inefficiencies. In the context of MAR, these latent conditions can, amongst others, be work-related pressure, high workload, lack of communication between team members, distraction, a suboptimal setup of the lab, a lack of clarity in the procedures, and insufficient time for thorough communication. In the famous Reason’s Swiss cheese theory of error, these latent conditions are weaknesses (or gaps/ holes) in the system’s defense layers. When all the holes from each layer (i.e., policy, planning, design, communication) align, they will permit an error to cause harm. Understanding the theory of human errors and building safety into various layers of care processes in MAR are effective ways of reducing errors rather than blaming sentinel individuals. Errors within MAR centers can be prevented by designing the healthcare system at all levels to make it safer, making it hard for people to do the wrong thing and easy for people to do the right thing.

‘Agency, voice and choice’: reflecting on assisted reproductive technologies through select Indian films

ABSTRACT The article examines the contested aspects of neoliberalism through cinematic narratives, addressing the issue of Assisted Reproductive Technology (ART) in India, a debated subject in socio-legal spheres. Existing literature extensively discusses the biopolitical and bioethical dimensions of commercialization and commodification, particularly concerning organ, egg, sperm donations, and gestational commercial surrogacy. This research endeavors to scrutinise and appraise the ethical quandaries emanating from the technological transformation of motherhood, as portrayed in fictional representations. These narratives shed light on the difficult situations faced by surrogates and egg donors, who are often driven by familial or socio-economic pressures to provide their reproductive services. Consequently, they become commodified within the context of India's In Vitro Fertilization (IVF) industry. Ergo, through the films I Am (2010) and Mimi (2021), this article probes into the intertwining socioeconomic situations of the large percentage of infertile women and claims that the positive discourse around the ‘new Indian women’ is inherently diluted and undermined. Additionally, the research emphasizes that ART—and more importantly, a new agency for single women—is reiterated within the political and socio-historical contexts of the films discussed.

Racial disparities in the outcomes of euploid single frozen-thawed embryo transfer cycles – analysis of the Clinical Outcome Reporting System of the Society for Assisted Reproductive Technology 2016–2018 data

ObjectiveTo evaluate if in pregnancies conceived with the transfer of single genetically tested embryos, maternal race and ethnicity relate to pregnancy outcome. DesignRetrospective cohort. SubjectsAutologous frozen -thaw embryo transfer (FET) cycles with transfer of single genetically tested embryo in SART-CORS for years 2016-2018; cycles associated with diagnoses of recurrent pregnancy loss, gestational carrier, donor egg and donor embryo were excluded. ExposureInformation on race and ethnicity linked with in vitro fertilization and FET cycles available in the SART-CORS. Main Outcome MeasuresMultivariable analyses utilizing generalized estimating equation examined the relationship between categories of race and ethnicity with the following outcomes: Pregnancy (+βhCG following FET), clinical pregnancy, pregnancy loss (early [at gestation <13 weeks] and late [loss between ≥13 and <20 weeks]), preterm (<37 weeks), term (≥37 weeks) and live birth. Covariates adjusted for included age, BMI, AMH, infertility diagnosis and smoking history. Results79,416 FET cycles met the eligibility criteria. Information on race and ethnicity was specified for 50,820 (64.0%) and was not known in 28, 723 (36%) of the cycles . The population was predominantly non-Hispanic White (NHW, 44%). Non-Hispanic Black [NHB] comprised 2.7%, Asian 12.3%, Hispanic 3.4%, American Indian, Pacific Islander, Hawaiian and Alaskan [AI_AL_PI_H] 0.2%. Nearly 1.0 % self-identified with more than one race. On multivariable analyses, pregnancies in NHB and in Hispanic women (compared to NHWs) were significantly more likely to result in in preterm birth (p<0.001). Compared to NHW women, the likelihood of live birth was significantly lower in NHBs (p<0.01), Asian (p=0.04), Hispanic (<0.01) and AI_AL_PI_H women (p<0.01). . The likelihood for delivery by Cesarean was also disproportionately higher in the NHB (p=0.047), Hispanic (p=0.007) and in women identifying with more than one race (0.023)compared to NHWs . ConclusionRacial and ethnic differentials are apparent in the outcomes of FET conceived pregnancies resulting from the transfer of single genetically tested embryos.

Bioethics - Origins and Birth. Inaugural Lecture

Bioethics is the study of ethical issues emerging from advances in Biology, Medicine and our environment. The oldest sub-discipline of Bioethics is Medical Ethics. This can be traced back to the earliest writings in Egypt and Mesopotamia, in the 3rd millennium BCE. The “Hippocratic Oath” was the most important milestone dominating ethical rules for 2,500 years. With the advent of Christianity, these early ethical rules were expanded and accepted throughout the Western World. However, the term Medical Ethics itself was only coined in 1803 by Thomas Percival, outlining the obligations and conduct expected of healthcare practitioners and institutions. Regrettably, subsequent codes of ethics did not provide for any legal repercussions. As a result, during the Nuremberg Trial for Nazi physicians, only patient deaths were punishable, while all other heinous acts could not be punished. Remarkably, no country worldwide had legislation to prosecute physicians who had violated their oath. The Nuremberg Code and the Geneva Declaration, which followed offered again merely guidelines for physicians. With the rate of medical knowledge doubling at an accelerated pace from every 50 years in the 1950s to every 2 months today, new ethical dilemmas have emerged that cannot be resolved by the current recommendations. The discovery of genes, cloning, genetic manipulation, selection criteria for chronic haemodialysis and transplantation, contraceptives for birth control, abortion, brain death, vegetative state, the right to die and euthanasia, along with extracorporeal fertilisation, surrogate motherhood, sexual relations and numerous other ethical issues, have become significant concerns that will need to be reconsidered in the future. What is deemed acceptable in one country may still be prohibited in another. Legal regulations are often implemented years after the ethical problems have arisen, and many physicians have found themselves caught in the middle and incarcerated. With the advent of the Industrial Revolution, the atomic bomb, gene discovery, and manipulation, and many other developments, the Earth has entered a new geological epoch, known as the “Anthropocene”. As we are unable to foresee what lies ahead, it is imperative that we pass down to our students and future generations the timeless ethical principles that we have inherited from our forebears and adapted to our era. These values encompass the safety of patients, respect for their autonomy, avoidance of harm and promotion of well-being, detailed information and informed consent, respect of confidentiality, impartiality towards all patients irrespective of gender, race, religion or beliefs, treatment, pain relief, fairness, and concurrently, respect for the rights of all humans, animals, and nature. It is imperative that these values are always kept at the forefront of our minds. These will enable our students, successors, nursing staff, theologians, lawyers, sociologists, psychologists, administrative personnel, and ethical committees to find common ground and prevent conflicts with patients, their families, or society. The cultivation of self-control, constructive criticism of our decisions, and quality control shall remain our duty forever.

Bridging Reproductive and Productive Work: The Case of Surrogates in California

ABSTRACT In this article, we explore the perspectives of commercial gestational surrogates in California, USA. Women who gestate for others reveal themselves as important agents in the process of giving meaning and cultural legitimacy to their practice, thus demonstrating their capacity to act in their own interest and resignify their work in their own terms. To them, surrogacy is more than wage labor. They assert the importance of their experience as a source of professional skills, downplaying its monetary value and placing it within favorable moral frameworks, thus finding cultural legitimacy. In doing so, they bridge the divide between traditional female reproductive work (unpaid emotional, relational, and care work) and productive work (paid professional work in the public sphere). They achieve this without subverting the underlying values of western kinship. The results shed light on employability and entrepreneurship of surrogates in the fertility industry of California.

Surrogate Motherhood: World Experience and Practice of Legal Regulation

Surrogate Motherhood: World Experience and Practice of Legal Regulation

Surrogacy and the significance of gestation: Implications for law and policy.

Gestational surrogacy is ethically complex, generating very different responses in law and policy worldwide. This paper argues that contemporary surrogacy law and policy, across many jurisdictions, fail to give sufficient attention to the significance of the relationship between the child and the gestational surrogate. This failure risks repeating the mistakes of historical, discreditedapproaches to adoption and donor-assisted conception. This paper argues that proper recognition of the significance of gestation must be an organising principle in surrogacy law and policy. The paper begins by pointing to examples of surrogacy law and practice where the role of the gestator is unacceptably minimised, most notably the framing of the surrogate as a mere 'carrier'.It goes on to examine the nature of gestation, including consideration of contemporary scholarship on the metaphysics of pregnancyand emerging work in epigenetics, and argues that current evidence supports the view that the gestational relationship must be taken more seriously than it currently is. The paper then draws analogies with parenthood in donor-assisted conception and adoption to argue that approaches to parental status in novel family formations that fail to promote transparency and seek to deny the truth of familial relationships are doomed to fail. The paper concludes by suggesting some implications for law and policy that flow from placing sufficient emphasis on the gestational role. The overarching thesis of this paper is that gestational surrogacy is ethically permissible when these fundamental requirements are adhered to, and that surrogacy law should proceed on this basis.

Kontribusi Maqāshid al-Syarī’ah dalam Pengembangan Bioetika Islam

Advancements in medicine and biology have brought significant changes in medical practices, giving rise to new ethical issues such as surrogate motherhood and egg or sperm donation. In such cases, bioethics is essential. However, the prevailing bioethics is predominantly Western, diverging from Islamic ethical principles, thus potentially leading to different ethical conclusions. Hence, Islamic bioethics needs to be introduced and developed. One instrument used in this development is maqāshid al-Syarī’ah. This article aims to examine the contribution of maqasid al-shariah in the development of Islamic bioethics. Employing a literature review method, the article explores literature on Islamic bioethics and maqāshid al-Syarī’ah. The study's findings suggest that maqāshid can bridge Islamic principles with existing realities, enabling Islamic bioethics to address contemporary bioethical issues without compromising Islamic values.

Особенности рассмотрения дел по обязанию произвести государственную регистрацию рождения ребенка, рожденного суррогатной матерью

An integral part of the cases arising from the legal relations of surrogate motherhood considered by the court are cases on the obligation to make state registration of the birth of a child born by a surrogate mother. The article examines the peculiarities of the consideration of cases of this category in court, numerous examples from judicial practice are given. The authors consider it expedient to change the jurisdiction of these cases and justify that cases on making an act record of the birth of a child from a surrogate mother should be considered as soon as possible and are subject to immediate execution.

LAW AND ECONOMICS IN SURROGACY MARKETS

The concept of reproductive justice can offer a framework for complex and nuanced analyses of surrogacy, taking into account the agency of surrogates and potential vulnerability of intended parents. When we define surrogacy contracts, we mean the situation in which the fertilized egg of a married couple is inserted into the uterus of a surrogate mother and carried to term by a woman who has no genetic connection with the fetus. Surrogacy contracts offer a way to supply a genetic connection that adoption contracts cannot provide. This paper argues that surrogacy with heavy regulation is a step forward into the future because it incorporates the best legal solution to custody disputes while also attaining the most economically efficient solution. This paper argues the same about surrogacy markets becoming a standard and prudent practice because calling babies a Pareto-efficient exchange that benefits everyone at the expense of no one. Surrogacy can be an excellent option for a set of biological parents who desire a child but cannot carry a pregnancy for health reasons, with potential framework for the psychological and sociological effects of mental health and abortion. The status of surrogacy agencies within the United States allows for heavy legal and economic regulation of surrogacy markets. When the law of contracts and property are incorporated into surrogacy markets, it is easier and more “efficient” for couples to make bargains with surrogate gestational carriers.

Intimate strangers: Commercial surrogacy in Russia and Ukraine and the making of truth By VeronikaSiegl, Ithaca, NY: Cornell University Press, 2023. 306 pp.

Intimate strangers: Commercial surrogacy in Russia and Ukraine and the making of truth By VeronikaSiegl, Ithaca, NY: Cornell University Press, 2023. 306 pp.

Gestational carrier cycles: embryology trends, national guideline compliance, and resultant perinatal outcomes in the United States, 2014–2020

The increased use of gestational carriers has expanded family-building opportunities for people and couples unable to carry pregnancies on their own. National American Society of Reproductive Medicine guidelines for gestational carriers have changed over time to reflect advances in reproductive technology and mounting evidence supporting the medical benefits associated with singleton gestations. Assess changes in gestational carrier cycle practice patterns and resultant pregnancy outcomes in the United States in relation to changing national American Society of Reproductive Medicine guidelines, which changed in 2013 and2017. This retrospective study used data from the Society for Assisted Reproductive Technology Clinic Outcomes Reporting System and included all cycles that were reported from 2014-2020 involving an embryo transfer to a gestational carrier. Binomial regression models evaluated trends in preimplantation genetic testing for aneuploidy, American Society of Reproductive Medicine guideline adherence, number of embryos transferred, and pregnancy outcomes over time. Of the 40,177 gestational carrier transfer cycles from 2014-2020, there was a significant increase in frozen-thawed cycles (41.3% increase), use of assisted hatching (53.4% increase), intracytoplasmic sperm injection (50.0% increase), and preimplantation genetic testing for aneuploidy (155.7% increase). The likelihood of preimplantation genetic testing for aneuploidy was higher in 2020 than in 2014 for autologous oocyte transfers to gestational carriers, both for those aged ≥38 years (adjusted relative risk, 2.38 [95% confidence interval, 2.11-2.70]) and than those aged <38 years (adjusted relative risk, 2.85 [95% confidence interval, 2.58-3.15]). As preimplantation genetic testing for aneuploidy usage increased, single embryo transfer rose for both autologous (adjusted relative risk, 2.22 [95% confidence interval, 1.94-2.50]) and donor cycles (relative risk, 1.91 [95% confidence interval, 1.81-2.02]). This shift toward single embryo transfer corresponded with a decrease in multiple embryo transfer by 79.2% and subsequent decreases in multiple gestations by 68.8% in donor and 73.6% in autologous oocyte cycles from 2014-2020. Gestational carrier cycles remained highly adherent to changing American Society of Reproductive Medicine guidelines throughout the study period. Among live births, there was a 19.4% and 7.9% increase in term deliveries among donor and autologous oocyte cycles, respectively, from 2014 to2020. Practice patterns have drastically changed throughout the study period, with major increases in the use of preimplantation genetic testing for aneuploidy, intracytoplasmic sperm injection, assisted hatching, and frozen transfers. In response to changing American Society of Reproductive Medicine guidelines, the use of multiple embryo transfers has decreased for gestational carrier cycles with subsequent decreases in multiple gestations and miscarriages and slight increases in live birth rates.

Humoral Immunity across the SARS-CoV-2 Spike after Sputnik V (Gam-COVID-Vac) Vaccination.

SARS-CoV-2 vaccines have contributed to attenuating the burden of the COVID-19 pandemic by promoting the development of effective immune responses, thus reducing the spread and severity of the pandemic. A clinical trial with the Sputnik-V vaccine was conducted in Venezuela from December 2020 to July 2021. The aim of this study was to explore the antibody reactivity of vaccinated individuals towards different regions of the spike protein (S). Neutralizing antibody (NAb) activity was assessed using a commercial surrogate assay, detecting NAbs against the receptor-binding domain (RBD), and a plaque reduction neutralization test. NAb levels were correlated with the reactivity of the antibodies to the spike regions over time. The presence of Abs against nucleoprotein was also determined to rule out the effect of exposure to the virus during the clinical trial in the serological response. A high serological reactivity was observed to S and specifically to S1 and the RBD. S2, although recognized with lower intensity by vaccinated individuals, was the subunit exhibiting the highest cross-reactivity in prepandemic sera. This study is in agreement with the high efficacy reported for the Sputnik V vaccine and shows that this vaccine is able to induce an immunity lasting for at least 180 days. The dissection of the Ab reactivity to different regions of S allowed us to identify the relevance of epitopes outside the RBD that are able to induce NAbs. This research may contribute to the understanding of vaccine immunity against SARS-CoV-2, which could contribute to the design of future vaccine strategies.

Regulating surrogacy intermediaries: a comparative analysis of regulatory approaches and implications in the Chinese context

Abstract This article addresses the significant research gap concerning the regulation of surrogacy intermediaries in China’s rapidly growing surrogacy market. Employing a ‘law in context’ perspective, it explores the question of how to effectively regulate surrogacy intermediaries in the Chinese context. Situated within China’s unique socio-cultural landscape, where procreation carries profound significance, the study navigates the complexities of surrogacy regulation, including ethical dilemmas, rights infringements and regulatory ambiguities. The article advocates for the regulation of surrogacy in China to prevent possible exploitation, referencing three international models: prohibiting commercial surrogacy, governing non-profit surrogacy organisations and imposing duties on for-profit surrogacy agents. The aim is to construct a robust, context-sensitive regulatory framework for surrogacy in China, focusing on identifying suitable intermediaries and defining the scope of effective regulatory oversight.