Psychological assessment of gestational carrier candidates: current approaches, challenges, and future considerations

Surrogates' experience during the COVID-19 pandemic: mental health, social support, and relationship with intended parents

PURPOSE

To examine surrogates' mental health, social support, and relationship with intended parents (IPs) during the COVID-19 pandemic from March 2020 to February 2022.

METHODS

Data were collected between April 29, 2022 and July 31, 2022, at an academic IVF center in Canada using an 85-item online anonymous cross-sectional survey that included three standardized scales measuring mental health (PHQ-4), loneliness, and social support. Eligible surrogates actively involved in surrogacy during the study period received email invitations.

RESULTS

The response rate was 50.3% (338/672); 320 submitted surveys were analyzed. Two-thirds (65%) of respondents experienced mental health concerns during the pandemic and were significantly less comfortable about seeking mental health support than those without concerns. Nonetheless, 64% were highly satisfied with their surrogacy experience; 80% received a high level of support from their IPs, and 90% reported a good relationship with them. The final hierarchical regression model identified five significant predictors, explaining 39.4% of the variance in PHQ-4 scores: a prior mental health history, COVID-19 impact on personal life, surrogacy satisfaction, loneliness, and social support.

CONCLUSIONS

COVID-19 created an unprecedented challenge to surrogacy care, increasing surrogates' risk of experiencing mental health symptoms. Our data show that IP support and the surrogate-IP relationship were fundamentals to surrogacy satisfaction. The findings are relevant to fertility and mental health practitioners in identifying surrogates who are more susceptible to mental health challenges. Fertility clinics should ensure adequate psychological screening of surrogate candidates and proactively offer mental health support services.

Commercial Surrogacy: An Overview

OBJECTIVE

 Surrogacy is the process in which a woman carries and delivers a baby to other person or couple, known as intended parents. When carriers are paid for surrogacy, this is known as commercial surrogacy. The objective of the present work is to review the legal, ethical, social, and cultural aspects of commercial surrogacy, as well as the current panorama worldwide.

METHODS

 This is a review of the literature published in the 21st century on commercial surrogacy.

RESULTS

 A total of 248 articles were included as the core of the present review. The demand for surrogate treatments by women without uterus or with important uterine disorders, single men and same-sex male couples is constantly increasing worldwide. This reproductive treatment has important ethical dilemmas. In addition, legislation defers widely worldwide and is in constant change. Therefore, patients look more and more for treatments abroad, which can lead to important legal problems between countries with different laws. Commercial surrogacy is practiced in several countries, in most of which there is no specific legislation. Some countries have taken restrictive measures against this technique because of reports of exploitation of carriers.

CONCLUSION

 Commercial surrogacy is a common practice, despite important ethical and legal dilemmas. As a consequence of diverse national legislations, patients frequently resort to international commercial surrogacy programs. As of today, there is no standard international legal context, and this practice remains largely unregulated.

Recommendations for practices using gestational carriers: a committee opinion

This document provides the latest recommendations for the screening, evaluation, and psychoeducational and legal counseling of gestational carriers and intended parents. It incorporates recent information from the US Centers for Disease Control and Prevention, US Food and Drug Administration, and American Association of Tissue Banks, with which all programs offering gestational carrier services must be thoroughly familiar. This document replaces the previous document of the same name, last published in 2017 (Fertil Steril 2017;107:e4-10).

The psychological impact of surrogacy on the families of gestational surrogates: implications for clinical practice

OBJECTIVE

To examine the psychological impact of gestational surrogacy on surrogates' families.

BACKGROUND

ASRM practice committee guidelines recommend that psychological counseling prior to surrogacy include consideration of a surrogate's own family, but there has been little research to help guide mental health professionals (MHPs) providing implications counseling.

METHODS

Fifty-nine family members from 16 surrogate families were recruited and data were collected on family relationships, child psychological well-being, and family experiences of surrogacy. Family members filled out a series of questionnaires based on their age and role in the family system.

RESULTS

Participants included 16 surrogates (28 surrogate pregnancies) with an average time since first surrogate pregnancy = 2.93 years (range = 0-8 years). Overall, families of surrogates are functioning well across a number of psychological domains. There were some differences between surrogates and spouses regarding their perceptions of their children's experience. A small number of children reported negative emotions about surrogacy and more research is needed to identify which children may be at risk. Children reported surrogacy having a positive impact on their lives and endorsed both pride and excitement about their mother being a surrogate.

CONCLUSIONS

There has been limited data to inform MHPs tasked with implications counseling prior to surrogacy in offering guidance to surrogates' family members to help prepare them for the experience. This data can be used by MHPs providing implications counseling to help facilitate discussions about the potential impact of surrogacy tohelp ensure positive psychological outcomes for surrogates and their family members.

The Role of Religion and Spirituality in Conceptualizing Reproductive Loss: Clinical Implications of the Narratives of Gestational Surrogates in the USA

Reproductive losses experienced by gestational surrogates, who do not share a genetic connection to the child they are carrying, may not be acknowledged or treated as compassionately as women who lose their "own" pregnancies. In-depth, semi-structured interviews were conducted with 17 gestational surrogates from diverse religious backgrounds. Grounded theory analysis of data included line-by-line coding, and emergent themes were identified. The results suggest that understanding and utilizing the religious/spiritual beliefs of a gestational surrogate may be one way for health professionals to provide implications counseling prior to surrogacy and also as a means to help process and grieve losses that may occur within surrogacy.