Italian gay fathers' experiences of transnational surrogacy and their relationship with the surrogate pre- and post-birth

Surrogacy in the United States: analysis of sociodemographic profiles and motivations of surrogates

RESEARCH QUESTION

What is the profile of women in the USA who become surrogates, and what is their power of decision and motivations?

DESIGN

This quantitative study was performed with 231 participants in the USA, given the country's long history of surrogacy, to help clarify the profile of women who become surrogates, their power of decision and motivations.

RESULTS

Descriptive and multivariate cluster analyses showed that women who become surrogates earn above the average income for their state of residency, have a high level of education, have health insurance, are employed, and decide to become a surrogate for prosocial/altruistic reasons.

CONCLUSIONS

In contrast to the premise of both radical feminism and ultra-conservative Catholicism, this study found that altruism and empathy are the primary motivations for participating in surrogacy processes, and that a woman's decision to become a surrogate is not motivated by social conditioning relating to poverty or social status.

The future of surrogacy: a review of current global trends and national landscapes

The practice of surrogacy is frequently the subject of media, scientific, social, regulatory and policy attention. Although it is, for many, an accepted form of assisted reproduction for those who would otherwise not be able to have children, surrogacy often generates strong feeling, particularly where there is any possibility of exploitation. Therefore, there is disagreement about how it should be regulated. In some countries, surrogacy is prohibited in any form, although this does not stop people using it. In others, it is unregulated but still practised. In some nations it is regulated in either a 'commercial' or an 'altruistic' model. This review article considers the possible regulatory future of surrogacy, initially from a UK perspective considering a recent review of the legal framework in a country where surrogacy works well (although some cross borders to access it), and then through an assessment of global trends and other national perspectives. It concludes that the international regulation of surrogacy, although potentially desirable, is unlikely. This being the case, it would be preferable for individual nations to regulate surrogacy so it can be undertaken in ways that are safe, ethical and protective of the best interests of children, surrogates, intended parents and families.

Male homoparenting and its challenges: an integrative literature review

This study aims to elucidate the challenges faced in the exercise of male homoparenting, through an integrative literature review. Following PRISMA guidelines, empirical studies from the last 22 years were analyzed, independently collected by four researchers using the PubMed and APA PsychNet databases, with the descriptors "Homosexuality, Male" and "Father". The results reveal the unique and complex reality faced by homosexual men in the parental context. While some studies highlight significant challenges, such as stigmas and social prejudices, others do not observe such difficulties. The decision to become a father among homosexual men is influenced by factors specific to their reality, in a context where parenthood is not widely accepted. The findings of this study emphasize the need to understand the complex interactions among individual, social, and cultural factors in male homoparenting. In summary, this study highlights the need for inclusive and diversity-sensitive approaches to support family well-being.

Israeli Single Gay Fathers' Choice of Lone Parenthood via Surrogacy: A Qualitative Study

This article focuses on Israeli single gay fathers' reproductive choices. Thematic analysis of 13 in-depth semi-structured interviews with Israeli single gay fathers yielded two themes related to their reproductive choice. The first theme pertains to their decision to become single fathers. Three dimensions were prominent in the participants' decision to pursue lone parenthood: the choice to fulfill parenthood as gay men; the choice to separate parenthood from couplehood; and the view of single parenthood as empowerment. The second theme pertained to the fathers' decision to use surrogacy, which was influenced by three key factors: the desire to parent a biological child, the desire for exclusive fatherhood, and the perceived advantages of surrogacy for single fathers. The findings indicate that the fathers narrated their reproductive experiences in terms of choice and autonomy, while negotiating with dominant concepts of parenthood as a two-parent, heteronormative and biogenetic phenomenon. These men referred to the challenge they posed to some of these concepts and the social barriers they encountered as factors that facilitated their coping skills in lone parenthood, thereby enhancing their agency. These findings highlight the contextual, multidimensional and relational nature of the reproductive choices of men from minority groups like single gay fathers.

Australian intended parents' decision-making and characteristics and outcomes of surrogacy arrangements completed in Australia and overseas

Markets for international surrogacy often arise in jurisdictions with limited regulations regarding assisted reproductive technologies. In some countries, like Australia, regulated domestic surrogacy services are often sidestepped for international providers. This study describes how Australian intended parents decide where to pursue surrogacy and compares the characteristics and outcomes of arrangements completed within and outside of Australia. The findings show that, although intended parents preferred undergoing surrogacy in Australia, perceiving the process as too long and complicated was a common reason to pursue an international arrangement. Multiple embryo transfer, anonymous gamete donation, and a lack of counselling were common in international surrogacy arrangements. When compared to surrogacy arrangements completed in Australia, where single embryo transfer is mandatory for surrogacy cycles, the rates of multiple birth, preterm birth and neonatal intensive care in international surrogacy were higher. These findings raise concerns about the health and welfare of international surrogacy participants, particularly the surrogates and children. In lieu of any international instrument regulating surrogacy, improving access to surrogacy at a domestic level would reduce the number of people engaging with international arrangements and in turn, reduce the potential for harm.

Experiences and Meanings of Surrogate Pregnancy Among Gay Israeli Men Who Become Parents Through Overseas Surrogacy

This study explores the experiences of single gay men and gay men who raise children in couples who have created their families through surrogacy procedures in different countries and cultural contexts. The analysis of 39 in-depth, semi-structured interviews with these fathers suggests that the effects of medicalized reproduction on these men are twofold. Medicalized reproduction leads these men, on one hand, to feel alienated from surrogate pregnancy and the fetus, and on the other hand, to contribute to the construction of a new form of intimacy between the surrogates and the newborns. This highlights the paradoxical character of overseas surrogacy, which resonates with other forms of reproductive procedures. The importance of these findings is examined by means of a qualitative paradigm, through which we stress the complex impacts of medicalization on gestation, childbirth, and transition to parenthood among ART (i.e.: Assisted Reproduction Technologies) participants, in particular on gay men.

Medico legal and ethical aspects of surrogacy; A case report of a tragic maternal death from Sri Lanka

A case report from Sri Lanka on surrogacy leading to a tragic maternal death; medico-legal and ethical aspects. Surrogacy, with multiple ethical and legal issues associated with it, is practised worldwide. Although regulations are not available in Sri Lanka, we report a woman who had a tragic death as a complication of surrogate pregnancy. The body of a young mother with four living children was brought for autopsy examination. According to the documents provided, there was a controversy about the deceased's identity. A woman volunteered to show a pillow trapped in her abdomen, simulating a pregnancy. By surrogacy, her husband's sperm were inseminated in this woman's uterus artificially according to a contract. She was diagnosed and managed for pregnancy-induced hypertension in the second trimester. At 36 weeks of gestation, she was admitted to the hospital in labour. On admission, she was icteric with elevated blood pressure. A cesarean section delivered a baby, and it was noted that she had an abruption of the placenta. She developed a postpartum haemorrhage following delivery, and resuscitation failed, resulting in her death. She had elevated liver enzymes and low serum proteins before death. Autopsy findings included intense icterus, congested lungs, global ischemic changes in the myocardium, pale kidneys and fatty soft yellow liver. This case discusses many unanticipated legal and ethical issues related to surrogate pregnancy, especially in a lack of regulations regarding the practice and relatively cheap medical expenses.

Pathways to fatherhood: clinical experiences with assisted reproductive technology in single and coupled intended fathers

Objective

To explore the cycle characteristics and outcomes of single and coupled intended fathers (SCIFs) using assisted reproductive technology.

Design

Cross-sectional study.

Setting

Multicenter, fertility practices from 2016 to 2020.

Patients

In this study, cycles among SCIFs with access to fertility coverage from 2016 to 2020 were included.

Interventions

None.

Main Outcome Measures

Our primary outcome was live birth rate. The secondary outcomes included the number of embryos transferred, miscarriage rate, and incidence of multifetal birth.

Results

Five single and 39 coupled intended fathers completed an in vitro fertilization cycle with a majority using egg donation and an agency-based gestational carrier (69.7%, 83/119). In most couples, both partners wanted to serve as the sperm source (64.4%, 29/45). The vast majority (97.7%, 43/44) also used preimplantation genetic testing for aneuploidy. Among the embryo transfer (ET) cycles (n = 27), most consisted of a single euploid ET (74.07%, 20/27), whereas the remaining consisted of a double euploid ET (25.92%, 7/27). The SCIFs had high rates of success, with a live birth rate of 85.19% (23/27). A mean of 1.26 ± 0.44 embryos were transferred, with a majority resulting in singleton birth (70.37%, 19/27).

Conclusions

Our study of SCIFs using assisted reproductive technology in the United States demonstrates that this population shares similar preferences for sperm source and the use of preimplantation genetic testing. Clinical outcomes suggest that this population is successful at achieving a live birth when using egg donation and a gestational carrier.

Peer Microaggressions and Social Skills among School-Age Children of Sexual Minority Parents through Assisted Reproduction: Moderation via the Child-Teacher Relationship

The impact of peer microaggressions and the child-teacher relationship on the social skills of children with sexual minority parents has received little attention. The current study used a mixed-method, multi-informant, two-wave longitudinal design to address this research gap. Thirty-seven children of lesbian mothers through donor insemination and 33 children of gay fathers though surrogacy (wave 1: Mage = 8.3 years, SD = 1.6; 51.4% female; wave 2: Mage = 9.9 years, SD = 1.7), all school-aged and residing in Italy, participated together with their 140 parents and 55 teachers. Approximately two-thirds of the children reported at least one peer microaggression and, on average, microaggressions were of a low intensity. Child-teacher relationships were of high quality (i.e., characterized by high safe haven-seeking and secure base use, and low conflict). Both parents and teachers reported high levels of child social skills. However, more intense W1 microaggressions predicted lower W2 social skills among children reporting a lower W1 child-teacher relationship quality, and greater W2 social skills among those reporting a higher W1 child-teacher relationship quality. These results support the child-teacher relationship as a potentially secure context in which children can "mentalize" negative experiences such as microaggressions and improve their social skills. In this vein, considering microaggression, attachment, and developmental intergroup theories, teachers must attune to the school experiences of children with sexual minority parents and cultivate caring classroom environments that are sensitive to family diversity.

The other side of the story: Intended parents' surrogacy journeys, stigma and relational reproductive justice

Current surrogacy research primarily focuses on commercial surrogacy with a particular emphasis on experiences of surrogate mothers, whereas intended parents' voices are dominated by western perspectives. Indigenous voices are only a whisper. This study presents another side of the surrogacy story by including the voices of intended parents residing in India, elicited through eight in-depth interviews. We assert there is need to understand Indian intended parents' socio-spatial experiences in the presence of a changing surrogacy law in India and the socio-cultural importance of childbearing and parenthood to move towards relational reproductive justice. By recognising the relational nature of surrogacy reproduction and drawing on the concepts of ethics of care in light of power and stigma discussions, this paper demonstrates how stigma is experienced by intended parents, its effect on their reproductive journey and wellbeing, as well as how stigma hinders achieving the vision of relational reproductive justice. We suggest that, in order to make surrogacy a positive experience for the people involved in surrogacy, there is a need to address stigma and view surrogacy as a relationship.

Reprowebs: a conceptual approach to elasticity and change in the global assisted reproduction industry

In the last few decades, assisted reproductive technologies (ARTs) have become increasingly transregional and transnational, often involving travel within or between countries or even continents. Until recently, the global ART industry was marked by so-called 'reprohubs'-places (such as southern California, Dubai, Anand, and Mumbai) specializing in the provision of reproductive services. While reprohubs continue to exist, in the last few years, many have splayed out, transforming into something more akin to webs that encompass, but go beyond these hubs. These webs show a unique dynamic capability to tighten, entangle, or extend in reaction to local and global changes, a characteristic which became particularly obvious during the global Covid-19 pandemic. In this paper, we propose conceptualizing this new dynamic capability as 'reprowebs'-an approach that adds a new dimension to the existing conceptualization of reproductive travel and helps us to better understand current developments in the global ART industry.

Experiences of gestational surrogacy for gay men in Canada

This paper reports on findings from a qualitative study that examined how Canada's socio-political context influenced gestational surrogacy for same-sex male couples. Semi-structured interviews were conducted with gay fathers and gestational surrogates to investigate supports and barriers of pursuing surrogacy. Questions explored publicly available information, policies and practices of fertility clinics and hospitals, post-birth resources and cultural attitudes regarding same-sex parenthood. Findings suggest that in Canada, a global leader in LGBT rights and inclusive same-sex parenting legislation, participants encountered inadequate same-sex inclusive resources and insufficient provider competencies. The aim of this study was to inform individual and institutional recommendations to counteract biases in fertility care and post-birth services. Following interview analysis, five key strategies were identified: (1) more accessible information on paths to same-sex parenthood; (2) more inclusive fertility clinic and hospital practices; (3) recognition of same-sex fatherhood in formal documentation; (4) post-birth resources such as formula feeding, play groups and first aid courses intended for same-sex parent families; and (5) shifts in cultural attitudes of same-sex parenthood and, specifically, gay fatherhood. Approaches that subvert heteronormative discourses embedded in fertility and reproduction are required to legitimise and support same-sex parent families.

Father-child bonding and mental health in gay fathers using cross-border surrogacy during the COVID-19 pandemic

Research question

What are the psychological implications of the COVID-19 pandemic for father–child bonding and mental health among Italian gay fathers pursuing surrogacy in the USA or Canada?

Design

Between 20 March and 29 July 2020, this cross-sectional case–control study collected data on father–child bonding quality, depression, anxiety and somatization in 30 Italian gay fathers (n=15 families) who were having or successfully had a child through cross-border surrogacy during the COVID-19 pandemic. These fathers were compared with a sociodemographically similar group of 50 Italian gay fathers (n=25 families) who had children through cross-border surrogacy prior to the pandemic.

Results

Although father–child bonding quality and the mental health symptoms of fathers scored below the clinical cut-off points in both groups, fathers who had or were having a child during the COVID-19 pandemic reported poorer father–child bonding (estimate 3.04, SE 1.47, P=0.044) and more depressive (estimate –1.47, SE 0.49, P=0.005), anxious (estimate –1.96, SE 0.55, P<0.001) and somatic symptoms (estimate –2.48, SE 0.52, P<0.001).

Conclusions

The findings call for the development of international guidelines for cross-border surrogacy and underline the need for tailored and ongoing psychological and legal support for intended gay fathers to ease their strain and anxiety related to having a child through cross-border surrogacy during the COVID-19 pandemic.

Surrogacy and "Procreative Tourism". What Does the Future Hold from the Ethical and Legal Perspectives?

Background and objectives: To explore the ethical and legal complexities arising from the controversial issue of surrogacy, particularly in terms of how they affect fundamental rights of children and parents. Surrogacy is a form of medically-assisted procreation (MAP) in which a woman "lends" her uterus to carry out a pregnancy on behalf of a third party. There are pathological conditions, such as uterine agenesis or hysterectomy outcomes, that may prevent prospective mothers from becoming pregnant or carry a pregnancy to term; such patients may consider finding a surrogate mother. Many issues relating to surrogacy remain unresolved, with significant disagreements and controversy within the scientific community and public opinion. There are several factors called into play and multiple parties and stakeholders whose objectives and interests need to somehow be reconciled. First and foremost, the authors contend, it is essential to prioritize and uphold the rights of children born through surrogacy and heterologous MAP. Materials and methods: To draw a parallel between Italy and the rest of the world, the legislation in force in twelve European countries was analyzed, eleven of which are part of the European Union (France, Germany, Italy, Spain, Greece, Netherlands, Belgium, Denmark, Lithuania, Czech Republic and Portugal) and three non-members of the same (United Kingdom, Ukraine and Russia), as well as that of twelve non-European countries considered exemplary (United States, Canada, Australia, India, China, Thailand, Israel, Nigeria and South Africa); in particular, legislative sources and legal databases were drawn upon, in order to draw a comparison with the Italian legislation currently in force and map out the evolution of the Italian case law on the basis of the judgments issued by Italian courts, including the Constitutional and Supreme Courts and the European Court of Human Rights (ECHR); search engines such as PubMed and Google Scholar were also used, by entering the keywords "surrogacy" and "surrogate motherhood", to find scientific articles concerning assisted reproduction techniques with a close focus on surrogacy. Results: SM is a prohibited and sanctioned practice in Italy; on the other hand, it is allowed in other countries of the world, which leads Italian couples, or couples from other countries where it is banned, to often contact foreign centers in order to undertake a MAP pathway which includes surrogacy; in addition, challenges may arise from the legal status of children born through surrogacy abroad: to date, in most countries, there is no specific legislation aimed at regulating their legal registration and parental status. Conclusion: With reference to the Italian context, despite the scientific and legal evolution on the subject, a legislative intervention aimed at filling the regulatory gaps in terms of heterologous MAP and surrogacy has not yet come to fruition. Considering the possibility of "fertility tourism", i.e., traveling to countries where the practice is legal, as indeed already happens in a relatively significant number of cases, the current legislation, although integrated by the legal interpretation, does not appear to be effective in avoiding the phenomenon of procreative tourism. Moreover, to overcome some contradictions currently present between law 40 and law 194, it would be appropriate to outline an organic and exhaustive framework of rules, which should take into account the multiplicity of interests at stake, in keeping with a fair and sustainable balance when regulating such practices.

Same-sex male couples and single men having children using assisted reproductive technology: a quantitative analysis

RESEARCH QUESTION

How do same-sex male couples (SSMC) and single men perceive their experience of using assisted reproductive technology (ART) in Canada; what factors contribute to their experience and the decisions made throughout the ART process?

DESIGN

This cross-sectional study used an anonymous online survey to gather exploratory data (between August 2018 and August 2019) about participant experience and decision-making considerations, for SSMC and single men internationally who had undergone ART in Canada. The survey was accessed by 145 individuals; 98 participants were included in the final analysis. Statistical Package for the Social Sciences (SPSS) was used for quantitative analysis.

RESULTS

Four out of five participants had a positive overall experience of using ART in Canada. Having the social support of knowing others who had previously pursued ART, and needing to work with multiple egg donors, were found to affect overall experience significantly. Agencies were the most common way for intended parents to connect with third parties. Major factors men considered when choosing an egg donor included medical history, physical attributes, personality and temperament, ethnicity, and education; they tended to select gestational surrogates who had similar lifestyle values to themselves. Most coupled survey respondents created embryos using each partner's spermatozoa (73.6%).

CONCLUSIONS

This exploratory study expands on limited knowledge of the current topic, identifying key areas for future research. Most SSMC and single men, domestic and internationally, had a positive experience pursuing ART in Canada to have children. Research on the experiences of SSMC and single men and decision-making considerations should continue.

Children's Exploration of Their Surrogacy Origins in Gay Two-Father Families: Longitudinal Associations With Child Attachment Security and Parental Scaffolding During Discussions About Conception

Evidence is lacking about the factors that are pivotal in enhancing the exploration of surrogacy origins in children of gay fathers during middle childhood. The present study examined the separate and combined influences of child attachment security and parental scaffolding (i.e., fathers' attempts to accept, encourage, and emotionally support their children's expression of thoughts and feelings) during discussions about conception on children's exploration of their surrogacy origins in 30 Italian children born to gay fathers through gestational surrogacy. Within each family, both father-child dyads (n = 60) participated in a 5-minute videotaped conversation regarding an aspect of the child's conception when children were mean aged 8.3 years (t1). At this time, children were also administered the Security Scale Questionnaire to evaluate their attachment security. Approximately 18 months later (t2; M age = 9.9 years), children were interviewed about their surrogacy origins. Linear mixed models (LMMs) for longitudinal data indicated that, with higher levels of parental scaffolding, only children who perceived greater attachment security reported greater exploration of their surrogacy origins. The findings are the first to underscore the importance of conversations about surrogacy within the context of parent-child attachment relationships, as well as the importance of fathers sensitively supporting their children as they explore their origins during middle childhood. In doing so, it is expected that fathers will likely facilitate their children's positive integration of their surrogacy conception into a coherent sense of identity during adolescence.

Societal pressures and procreative preferences for gay fathers successfully pursuing parenthood through IVF and gestational carriers

This retrospective study surveyed decision-making and challenges among 78 gay cisgender male couples utilizing in-vitro fertilization (IVF) and a gestational carrier. While most couples (67.1%) found the decision to actively pursue fertility treatment 'not difficult', 32.9% felt that it was 'somewhat difficult' or 'very or extremely difficult'. Almost 30% of couples had not undertaken financial planning for treatment, which introduced delays of > 2 years for 25.3% of participants. Conceiving twins was 'important to very important' in 52.3% of couples, and 84.2% of couples chose to transfer two embryos to 'increase the odds' or reach an ideal family size in a single attempt despite increased complications with multiple pregnancies. Paternal leave was granted for one partner in 47.3% of couples, and for both partners in 43.2% of couples. One-third of couples reported experiencing discrimination, prompting a partner to seek employment, and 38% changed jobs or careers. For 80.3% of couples, the estimated cost exceeded US$100,000. Couples where one partner was aged > 50 years were significantly more likely to find the decision to actively pursue fertility treatment 'very or extremely difficult' (28.6%), and less likely to agree on becoming parents (64.3%). Gay male couples undergoing assisted reproduction face challenges regarding decision-making, lack of infertility benefits and discrimination, which appear to be influenced by age and country of residence. Policy and educational changes are needed, including broader fertility benefits, more egalitarian parental leave, and greater awareness of risks inherent to multiple gestation.

Parents' relationship with their surrogate in cross-border and domestic surrogacy arrangements: comparisons by sexual orientation and location

Objective

To study heterosexual and gay couples' relationship with their surrogate and their disclosure decisions when the surrogacy arrangement was completed domestically compared with internationally.

Design

Cross-sectional study.

Setting

Not applicable.

Patient(s)

Participants were 40 gay couples and 76 heterosexual couples who had domestic surrogacy in the United Kingdom (UK) (n = 38) or international surrogacy in the United States (n = 58) or Asia (20). Most (75%) of the children were aged <4 years.

Intervention(s)

Online surveys containing open-ended and multiple-choice questions.

Main Outcome Measure(s)

Experiences of finding a surrogate, relationship with the surrogate, and disclosure to the child were examined among UK parents who had undergone surrogacy in the UK, United States, or India/Thailand.

Result(s)

Parents who had surrogacy in the UK and United States felt very involved in the pregnancy compared with those who had surrogacy in Asia. Couples whose surrogacy was completed in Asia were less likely to want contact with their surrogate after the birth and were also less likely to have any current contact with the surrogate. Parents who had surrogacy in the UK and United States described positive relationships with their surrogate. Gay couples intended to tell their child about surrogacy more than heterosexual couples.

Conclusion(s)

The specific country where couples conducted their surrogacy arrangement (i.e. United States, UK, or Thailand/India) was associated with how involved they were in the pregnancy and their contact with the surrogate over time. Limitations of the study include use of survey methodology and that the representativeness of the sample is not known.

Challenging Oedipus in changing families: Gender identifications and access to origins in same-sex parent families created through third-party reproduction

Socio-cultural changes and advancements in assisted reproduction over the past 40 years have led to a rise in new family forms, including same-sex parent families formed through donor insemination or surrogacy, wherein the loving couple does not coincide with the generative couple and the parents do not embody sexual difference. Can we still understand the gender identification processes and the path of accessing one's origins through the lens of the Oedipal complex? In keeping with the Freudian concepts of "psychosexuality," "primal scene" and "family romance," as well as the more recent developments in psychoanalysis, attachment theory and infant research, this article aims at revisiting the Oedipal "complex" as Oedipal "complexity," which may apply irrespective of parents' anatomical characteristics. However, this "complexity" does not renounce parents' bodies and sexuality as important to children's development. Maintaining the concept of third following the parental couple, and position within generations in the idea of Oedipal complexity, the authors suggest that a child's development pathways will depend not only on the intersection of the child's Oedipal and pre-Oedipal levels, but also on the parents' early relational events and internalisation of their own parental figures, which are not necessarily pre-determined by their gender or sexual orientation.

Surrogacy: Challenges and Ambiguities

Surrogacy is an increasingly frequent form of family building and allows individuals to become parents despite an infertility diagnosis or a biological impossibility. Positive outcomes for both the surrogacy child and the surrogate mother have been reported, including in cases of same-sex male couples and single persons. There is an on-going debate because remuneration does not necessarily involve undue inducement of the surrogate or transformation of the child into a commodity. The right to regret and the doctors' autonomy are also addressed in this paper. Nevertheless, literature on surrogacy is scarce, and most of the existing studies have important methodological limitations, so further investigation is much needed. We believe that counselling should be granted for both intended parents and surrogate, in order to prevent the majority of problems. We also agree that parental vetting should be possible, focusing the doctor's responsibility also in the future child.

Evaluation of Attitudes Toward Same-Sex Parenting in the Italian Context: Adaptation of a French Questionnaire

This study investigated the psychometric properties of the Italian version of a French scale to detect attitudes toward same-sex parenting. The Italian sample was split into two subsamples. On one, exploratory factor analysis (EFA) was conducted to detect the factor structure of the Italian scale, and on the other, confirmatory factor analysis (CFA) was run to find the data's best fit model. The scales' internal consistency was evaluated using Cronbach's alpha. The questionnaire's convergent validity was also evaluated. EFA extracted a four-factor solution, in accordance with the original French scale's validation study. CFA showed that the translated scale had good consistency, similar to that of the original version, showing satisfactory internal consistency for three of four subscales. There will be benefits to further validation studies of the translated scale on the Italian population and it may possibly be innovative and useful in both research and social fields.

Cross-border surrogacy: Experiences of heterosexual and gay parents in Sweden

INTRODUCTION

Surrogacy is a controversial method of assisted reproduction that is not permitted in many countries. While there is some evidence that families following surrogacy seem to fare well, there is limited knowledge about the experiences of parents who turn to cross-border surrogacy. The aim of the present study was therefore to investigate the experiences of heterosexual parents and gay fathers who chose cross-border surrogacy to have a child.

MATERIAL AND METHODS

This cross-sectional survey describes the experiences of 30 families (18 heterosexual parent and 12 gay father families). Participants were recruited through a website for a Swedish surrogacy interest group. The participants were requested individually to complete a postal questionnaire including study-specific questions on their experiences of disclosure and the Swedish Parenting Stress Questionnaire.

RESULTS

All couples but one were still living together and had a child (3 months to 5 years). Parenting stress levels were generally low and were not related to sexual orientation. While almost all parents were open about the child's mode of conception in contacts with health care, gay fathers were significantly more open about using surrogacy in contacts with preschool (P = 0.004) and child recreational activities (P = 0.005) compared with heterosexual parents. A majority described being treated positively or "as any other parent" in these contexts.

CONCLUSIONS

Heterosexual and gay parents reported low levels of parenting stress and generally experienced positive or neutral reactions to their parenthood in contacts with healthcare providers, in preschool, and in the child's recreational activities.

Dualism, Tension, and Integration: Dialectics as a Theme of Integration in Daily Lives of Israeli Gay Men Who Became Fathers Through Overseas Surrogacy

This article explores the constructed meanings of lived experiences of Israeli gay men who became parents through commercial overseas surrogacy. Based on the analysis of 39 in-depth, semistructured interviews with gay fathers, we show that their parenting experiences are shaped in contradictory ways, allowing them to adopt a reflective position in relation to existing social frameworks. Data from in-depth interviews reveal three major themes. The first refers to the gap between biogenetic and social concepts of parenthood and kinship. The second presents the dialectics between continuity and change that gay parenthood exhibits. The third theme focuses on the impact of these contradictions on gay parents' identities and the construction of autonomy concepts in their lives. By doing so, we highlight the importance of tensions and contradictions in shaping the daily living experiences of gay parents, as well as the importance of dialectics in promoting gay parents' integration within heteronormative society.

Gay fathers' motivations for and feelings about surrogacy as a path to parenthood

Study question

Why do gay men choose to start their families through surrogacy?

Summary answer

Most fathers chose surrogacy because they considered adoption to be a less desirable and/or accessible path to parenthood.

What is known already

Little is known of gay fathers' motivations to use surrogacy as a path to parenthood over and above other forms of family building, such as adoption, and no studies have examined fathers' satisfaction with the surrogacy process.

Study design size, duration

This study used a cross-sectional design as part of a larger investigation of parent-child relationships and child adjustment in 40 gay father surrogacy families. Multiple strategies (e.g. surrogacy agencies, social events and snowballing) were used to recruit as diverse a sample as possible. Data were obtained from 74 fathers (in 6 families only 1 father was available for interview).

Participants/materials, setting, method

Semi-structured interviews, lasting ~1 h, were conducted in the family home (65%) or over Skype (35%) with 74 gay fathers (35 genetic fathers, 32 non-genetic fathers and 7 fathers who did not know or did not disclose who the genetic father was), when the children were 3-9 years old.

Main results and the role of chance

Genetic and non-genetic fathers were just as likely to want to become parents and had similar motivations for choosing surrogacy as a path to parenthood. Most fathers (N = 55, 74%) were satisfied with surrogacy and were satisfied (N = 31. 42%) or had neutral feelings (N = 21, 28%) about their choice of who would be the genetic father. Most fathers received supportive reactions to their decision to use surrogacy from both families of origin (e.g. parents, siblings) (N = 47, 64%) and from friends (N = 63, 85%).

Limitations, reasons for caution

Although diverse recruitment strategies were used, data were obtained from a volunteer sample. Therefore, the possibility that fathers who had a positive surrogacy experience may have been more likely to participate in the study, and therefore introduce bias, cannot be ruled out. Due to the high average annual income of the fathers in the study, findings may not generalize to gay fathers with lower incomes.

Wider implications of the findings

It is often assumed that parents' primary motivation for using ART is to have a genetic connection to the child. This study revealed that whilst genetic fatherhood was important for some gay fathers in surrogacy families, it was not important for all. This information will be of use to surrogacy agencies and organizations supporting men who are considering the different routes to parenthood.

Study funding/competing interest(s)

This work was funded by the Wellcome Trust [097857/Z/11/Z] and the Jacob's Foundation. None of the authors has any conflict of interest to declare.

Trial registration number

N/A.