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.

Motives for desiring children among individuals of different sexual-romantic orientations: a cross-sectional study

PURPOSE

Little is known about the reasoning behind the desire to have children in non-heterosexual individuals. This study compares the motives of different sexual-romantic orientations and their preferred ways of fulfilling this desire.

METHODS

This was a monocentric cross-sectional study. Subjects were recruited via social media, personal contacts and queer organisations in Switzerland. An anonymous questionnaire comprised general questions about the participant's background, a validated survey about the desire to have children and additional non-validated questions addressing the impact of sexual-romantic orientation on the desire to have children. The inclusion criteria were adults without children and a completed questionnaire.

RESULTS

Of 837 participants, 642 were included in the study. Four groups of sexual-romantic orientations consisted of more than 35 participants: bisexual-biromantic (n = 38), heterosexual-heteroromantic (n = 230), homosexual-homoromantic (n = 159) and pansexual-panromantic (n = 55). Subgroups with a positive wish for a child rated all motives in the same order and with minimal numeric difference. The most important aspect seemed to be emotional involvement. Non-heterosexual-heteroromantic showed concerns about adverse reactions regarding their wish for a child. All orientations hoped for a biological child.

CONCLUSION

Our findings about bi-, hetero-, homo- and pansexual people and their motives for a desire to have children agree with the existing literature about hetero, homo and bisexual. The impact of the fear of adverse reaction and discrimination has been discussed before and is supported by our data. We suggest better support before and during the realization of the wish for a child as well as support for non-traditional aspiring parents.

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.

Single fathers' experiences of using egg donation and surrogacy to start a family

STUDY QUESTION

What are the experiences of single men using egg donation and surrogacy as a route to parenthood?

SUMMARY ANSWER

The fathers mainly had a positive relationship with the surrogate and simultaneously exercised agency, and experienced challenges, during the process of surrogacy.

WHAT IS KNOWN ALREADY

Little is known about single men's experiences of egg donation and surrogacy arrangements. Studies have focused on single men's decision-making processes about the use of surrogacy and family functioning once these families are formed. Questions remain about how fathers experience and navigate the process of surrogacy as a single man.

STUDY DESIGN, SIZE, DURATION

The study is an international, in-depth qualitative study of fathers who chose to begin a family and parent alone. Data were collected between 2018 and 2021 as part of a larger study of solo fathers with different routes to parenthood. The present study reports on 21 fathers who used surrogacy and egg donation to begin their family. The average age of the fathers was 44 years, the fathers had young children aged 6 years or younger, and lived in countries across Australia, Europe, and North America.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Purposive sampling was used to recruit participants. In-depth semi-structured interviews were conducted. Interview topics included fathers' experiences of the process of using egg donation and surrogacy, and navigating the relationship with the surrogate. The audio-recorded interviews lasted around 2 hours and were subsequently transcribed verbatim.

MAIN RESULTS AND THE ROLE OF CHANCE

Data were analysed using reflexive thematic analysis and qualitative content analysis. Most of the fathers chose an identifiable egg donor. Regarding the relationship with the surrogate, many fathers had remained in contact with her, but to differing degrees, and they generally reported positive relationships. Thematic analysis led to the identification of three themes relating to the fathers' experiences of choosing surrogacy as a single man: the ability to make choices; challenges and constraints; and special relationship.

LIMITATIONS, REASONS FOR CAUTION

Due to the variation between different countries regarding laws on surrogacy, contextual factors may have impacted on the experiences of single fathers, and the sample size was small. However, the research provides new insights into an area with little academic literature.

WIDER IMPLICATIONS OF THE FINDINGS

Given the growing trend of single men having children through surrogacy, the findings suggest that this new path to parenthood can be both rewarding and challenging. Single men may benefit from tailored support and counselling to help them navigate the surrogacy journey.

STUDY FUNDING/COMPETING INTEREST(S)

This study was funded by the Wellcome Trust (grant number 208013/Z/17/Z). The authors have no conflicts of interest to declare.

TRIAL REGISTRATION NUMBER

n/a.

Gay Fatherhood Experiences and Challenges Through the Lens of Minority Stress Theory

Gay-fatherhood raises questions about hegemonic gender norms and traditional family systems in different contexts and countries. This study explores gay fathers' desires, motivations, and experiences of having a child. Participants' challenges and concerns regarding having and raising children also were explored. Data were obtained through in-person interviews of 11 self-identified gay fathers. The data were then analyzed using interpretive phenomenological analysis (IPA) analysis. The analytical results identified three themes that shed light on participants' desires and experiences of parenthood. These were: (1) innate motives to parent and gender role strains, (2) enacted stigma (i.e., acts of rejection due to sexual orientation and traditional gender roles), and (3) children's social rejection due to their parents' sexuality. The findings of this study stress the influence of contextual factors (stigma) and intrapersonal factors (internalized anti-gay prejudice) in participants' health and well-being. This study potentially tries to expand cultural awareness of research in this field.

The psychosocial outcomes of older parenthood in early to mid-childhood: a mini-review

Recent decades have seen a global trend towards delaying parenthood, referred to as the 'postponement transition'. Whilst there is plentiful research regarding obstetric and paediatric outcomes related to delayed parenthood, relatively little is known about the psychosocial outcomes associated with advanced parental age during early and middle childhood. This mini-review examines the current literature regarding the psychosocial functioning of families headed by older parents. First, we give an overview of the literature that examines the psychological wellbeing of older first-time parents. We then review the literature regarding the quality of the parent-child relationship in older parent families. Finally, we discuss the psychosocial adjustment and cognitive development of children of older parents. We conclude with suggestions for future research avenues.

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.

Children of Single Fathers Created by Surrogacy: Psychosocial Adjustment Considerations and Implications for Research and Practice

The existence of single-father families formed by surrogacy is becoming a more visible reality, even though this type of family organization is still perceived with stigma and negative attitudes by more traditional sectors of society, because it raises some concerns regarding the psychosocial well-being of children who are born into single-fathers' families via surrogacy, and in many cases, to gay single men who wish to become fathers. On the other hand, available research on the psychosocial well-being of these children is still very scarce and limited to a handful of Western countries. Hence, it is of utmost importance to examine studies that explore the psychosocial adjustment of these children. In this mini review, I show that all the studies revised demonstrate the good psychosocial adjustment of these children, and that they are as likely to flourish as children born into traditional families, even if they may find themselves exposed to prejudice and stigma. In conclusion, single fatherhood and surrogacy do not contribute to any adverse consequences to the children's psychosocial development and adjustment, and there is no observed evidence to why single men, irrespective of their sexual orientation, should not be fathers via surrogacy. Finally, implications for future research and interventions are also discussed.

The Social Experiences of Single Gay Fathers in Israel: An Intersectional Perspective

Through an intersectional lens, this study explores the experience of being a single gay father by choice in Israeli society, which continues to view the traditional heterosexual two-parent family as the ideal. Analysis of 15 in-depth, semi-structured interviews with single gay Israeli fathers suggests that their experiences are characterized by constant tension between their self-perceived social acceptance and sense of belonging on the one hand and their encounters with discrimination and bias on the other. The findings shed light on the ways in which the fathers' complex experiences are shaped by the intersection between their identity as parents and their two marginalized identities: single male parents and gay fathers. These identities were found to be highly contextual and affected by macro-level factors. As the fathers cope with their environment, they develop a sense of belonging alongside a deep sense of otherness, suggesting that the sense of belonging and the sense of otherness are not binary opposites, but rather two social categories that are continually constructed through the intersection between different identities and their interaction with macro-level factors, making single gay parenthood a multidimensional experience.

Correlates of Taiwanese Gay and Bisexual Men's Family-Building Preferences: A Mediation Analysis

This study investigated the role of filial piety, internalized homophobia, and desire for genetic relatedness with one's child in gay and bisexual men's family-building choice. A sample of 1,023 Taiwanese gay and bisexual men with a desire to have a child was recruited to complete an online survey that included the Contemporary Filial Piety Scale, the Chinese Internalized Homophobia Scale, and questions about desire for genetic relatedness with a child and acceptance of adoption and surrogacy. Mediation models, with desire for genetic relatedness as a mediator, were tested. The results show that those who chose surrogacy-only were older and had higher socio-economic status than those who selected adoption-only and both options. Filial piety and internalized homophobia were positively associated with the acceptance of surrogacy-only over adoption-only and both options. Desire for genetic relatedness mediated these relationships. This finding elucidates how sociocultural factors shape family-building preferences among gay and bisexual men.

Family Alliance and Intergenerational Transmission of Coparenting in Gay and Heterosexual Single-Father Families through Surrogacy: Associations with Child Attachment Security

Parents tend to internalize the coparenting model they experienced during childhood and enact it in their coparenting relationships as adults. These interactive patterns may, in turn, shape their children’s internal working models of attachment relationships. The present study recruited 31 gay and 28 heterosexual single-father families through surrogacy to examine family alliance quality and the mediating role of observed supportive and conflictual coparenting in the association between the coparenting quality single fathers experienced in their families of origin and the attachment security of their children. All single fathers lived in Italy, were cisgender and White, and had a child aged 6–12 years (M = 97.73 months; SD = 20.48; 47.5% girls) who they coparented with nonparental caregivers (i.e., 33 grandparents, 18 babysitters, 8 uncles/aunts). Families did not differ in family alliance dimensions based on fathers’ sexual orientation. Additionally, single fathers who experienced greater coparenting quality in their families of origin demonstrated lower levels of conflictual coparenting, which, in turn, were associated with greater child attachment security. In contrast, observed supportive coparenting did not mediate this relation. The results emphasize the need to reconceptualize the dyadic coparental unit in single-father surrogacy families to include extended family members and nonrelatives.

First clinical report of 179 surrogacy cases in the UK: implications for policy and practice

RESEARCH QUESTION

What implications for policy and practice can be derived from outcomes and trends observed across 8 years of a surrogacy programme in two UK-regulated IVF centres (London, Cardiff)?

DESIGN

Retrospective cohort study analysing surrogacy treatments undertaken between 2014 and September 2021.

RESULTS

Surrogacy continues to rise in popularity in the UK despite the inability of those supporting safe and professional practice to advertise to recruit surrogates. In two IVF centres regulated by the Human Fertilisation and Embryology Authority (HFEA), both the number of surrogacy treatments and the proportion of those undertaken on behalf of same-sex male intended parents increased year on year in the period studied. From a cohort of 108 surrogates, 71 babies were born to 61 surrogates (with five pregnancies ongoing) by February 2022. No statistically significant difference in live birth rates (LBR) was observed between the heterosexual couples and same-sex male couples. Sample sizes of single and transgender intended parents were too small (n < 5) to compare. The use of vitrified oocytes in surrogacy treatments has increased year on year, while fresh oocyte use has declined since peaking in 2019. There was no significant difference in LBR between fresh and vitrified oocyte usage across the cohort.

CONCLUSIONS

The number of surrogacy treatments steadily increased, with clear evidence that the proportion of same-sex male couples accessing surrogacy is a major contributor to this growth. Vitrified/warmed oocyte use now outstrips the use of fresh oocytes in the surrogacy treatment cycles studied here. The results represent a strong basis for supporting the liberalization of regulatory reform expected to be introduced in the UK later in 2022.

Lone parenthood in the COVID-19 context: Israeli single gay fathers' perspective

This article focuses on Israeli single gay fathers, using the Stress Process Model (SPM) as a framework to investigate their fathering experiences during the COVID-19 pandemic. Thematic analysis of 15 in-depth semi-structured interviews with Israeli single gay fathers during the third national lockdown revealed that their parenting experiences during the pandemic were shaped by both COVID-related stress exposure and interpersonal resources, which the fathers viewed as interactive. These fathers described three main pandemic-specific stressors: financial insecurity and workplace transformation, feelings of loneliness and isolation and health-related fears. Our findings highlight the cumulative effects of these stressors on the fathers' well-being. The fathers also described the ways in which their interpersonal resources (i.e., social networks and strengthened relationship with their children during the pandemic) facilitated their coping with the pandemic-related stressors. The study highlights the need for social workers to recognize the emerging family forms and to broaden their approach to parents during a time of ongoing community crisis, by addressing the differential effects on parents in diverse family structures.

Laboring to Conceive: Reducing Barriers to Fertility Care for Same-Sex Mothers Pursuing Parenthood

Infertility clinics and providers in the United States have made efforts to become LGBTQ-inclusive, yet patients in same-sex partnerships continue to face disproportionate barriers to accessing fertility services when pursuing parenthood. This narrative case study of a same-sex couple’s “labor to conceive” illustrates some of the structural barriers to family building that lesbian mothers face when seeking fertility care, including insurance coverage of fertility treatments, federal regulations for sperm donation, and legal definitions of parenthood. Exclusionary medical and legal systems are discussed, as are the informal strategies that this same-sex couple utilized to negotiate and circumvent these barriers. A patient-centered model of advocacy that facilitates access to and protection of same-sex partners seeking (in)fertility services is presented. Intervention points at the (1) Logistical and (2) Societal levels are considered with respect to three domains of same-sex reproduction: (A) insurance; (B) sperm donation; (C) legal adoption.

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.

The other face of advanced paternal age: a scoping review of its terminological, social, public health, psychological, ethical and regulatory aspects

BACKGROUND

There is a global tendency for parents to conceive children later in life. The maternal dimension of the postponement transition has been thoroughly studied, but interest in the paternal side is more recent. For the moment, most literature reviews on the topic have focused on the consequences of advanced paternal age (APA) on fertility, pregnancy and the health of the child.

OBJECTIVE AND RATIONALE

The present review seeks to move the focus away from the biological and medical dimensions of APA and synthesise the knowledge of the other face of APA.

SEARCH METHODS

We used the scoping review methodology. Searches of interdisciplinary articles databases were performed with keywords pertaining to APA and its dimensions outside of biology and medicine. We included scientific articles, original research, essays, commentaries and editorials in the sample. The final sample of 177 documents was analysed with qualitative thematic analysis.

OUTCOMES

We identified six themes highlighting the interdisciplinary nature of APA research. The 'terminological aspects' highlight the lack of consensus on the definition of APA and the strategies developed to offer alternatives. The 'social aspects' focus on the postponement transition towards reproducing later in life and its cultural dimensions. The 'public health aspects' refer to attempts to analyse APA as a problem with wider health and economic implications. The 'psychological aspects' focus on the consequences of APA and older fatherhood on psychological characteristics of the child. The 'ethical aspects' reflect on issues of APA emerging at the intersection of parental autonomy, children's welfare and social responsibility. The 'regulatory aspects' group different suggestions to collectively approach the implications of APA. Our results show that the field of APA is still in the making and that evidence is lacking to fully address the issues of APA. The review suggests promising avenues of research such as introducing the voice of fathers of advanced age into the research agenda.

WIDER IMPLICATIONS

The results of this review will be useful for developing policies and preconception health interventions that consider and include prospective fathers of advanced age.

Iranian model of decision making to use surrogacy: A grounded theory Study

Identifying the process of making the decision to use a surrogate mother can create a broad knowledge of this concept. In this grounded theory study, participants were selected through snowball sampling method and obtaining an informed consent, in-depth interviews were conducted face to face and recorded. Then, all the interviews, field notes, and memos were analyzed using Strauss-Corbin 1998 method. Analysis of the statements of the participants boiled down to 487 initial codes, 311 codes, 14 subcategories, and six categories. In the conceptual model of this process, "the hope to have a child" was an influential concept that interacted with other concepts.

Surrogacy relationships: a critical interpretative review

Based on a critical interpretative review of existing qualitative research investigating accounts of 'lived experience' of surrogates and intended parents from a relational perspective, this article proposes a typology of surrogacy arrangements. The review is based on the analysis of 39 articles, which belong to a range of different disciplines (mostly sociology, social psychology, anthropology, ethnology, and gender studies). The number of interviews in each study range from as few as seven to over one hundred. Countries covered include Australia, Canada, Greece, India, Iran, Israel, Italy, Mexico, Norway, Russia, Sweden, UK, Ukraine, and the USA. Most studies focus only on surrogacy practices in one country (although often with intended parents from other countries), and some include several countries (e.g. interviewees from several countries or fieldwork in different field-sites). The proposed typology goes beyond the division between altruistic versus commercial, and traditional versus gestational surrogacy, in order to inform further research and to contribute to bioethical and policy debates on surrogacy in a transnational context. Four types of relations are identifiable: open, restricted, structured, and enmeshed. The criteria which influence these relationships are: the frequency and character of contact pre- and post-birth; expectations of both parties; the type of exchange involved in surrogacy arrangements; and cultural, legal, and economic contexts. The theoretical contribution of the article is to further the development of a relational justice approach to surrogacy.

Understanding Parenting Intentions Among Childfree Gay Men: A Comparison With Lesbian Women and Heterosexual Men and Women

Introduction

There is a growing interest in the parenting intentions of gay men. Prior research has found that gay men are less likely to become parents compared to their heterosexual and lesbian peers, but we know very little about why this discrepancy exists. Our first aim was to investigate whether the strength of parenting intentions is similar or different among childfree gay men compared to lesbian women, and heterosexual men and women. Our second aim was to explore the extent to which the theory of planned behavior (TPB) model (attitude, subjective norms, and self-efficacy) is universal in predicting the strength of parenting intentions across gender and/or sexual orientation.

Methods

The study was based on a United States cross-sectional, internet-based survey of childfree people who want to become parents in the future. The sample consisted of 58 gay men, 66 lesbian women, 164 heterosexual people (128 women and 36 men).

Results

A Bayesian ANCOVA showed no support for a gender difference in the strength of parenting intentions. Moderate evidence was provided for gay men and lesbian women reporting a similar strength of parenting intentions compared to their heterosexual peers. Bayesian linear regression analyses showed that perceived positive and negative life changes were stronger predictors of the strength of parenting intentions for men than for women. Perceived positive life changes predicted the strength of parenting intentions similarily across sexual orientations. For gay men and lesbian women, perceived parental acceptance of future parenthood was a weaker predictor of the strength of parenting intentions compared to heterosexual people.

Conclusion

Those who perceived parenthood as bringing positive life changes, especially for men, expressed stronger parenting intentions.

Comparison of perinatal outcomes between spontaneous vs. commissioned cycles in gestational carriers for single and same-sex male intended parents

PURPOSE

To determine whether gestational carrier (GC) in vitro fertilization (IVF) cycles (commissioned cycles) for same-sex or single male intended parents have an increased incidence of adverse perinatal outcomes compared with spontaneous cycles in the same GCs.

DESIGN

GC singleton pregnancies were identified from a database of 895 commissioned cycles from a large fertility center. Of these, 78 commissioned cycles met inclusion and exclusion criteria and were compared with 71 spontaneous cycles by the same GCs. The primary outcome was the composite score for adverse perinatal outcomes. Secondary outcomes included mode of delivery, birthweight, and gestational age. Chi-square test of association and Mann-Whitney U tests were used to compare categorical and continuous variables between the cohorts, respectively. Logistic and linear regressions controlling for GC age were constructed to determine the influence of GC cycle type on adverse perinatal outcomes.

RESULTS

Commissioned cycles were significantly associated with adverse perinatal outcomes (25.6% vs. 9.9%; p = 0.02) and lower average gestational age (38.7 ± 1.5 vs. 39.4 ± 0.9; p < 0.001) compared with spontaneous cycles. Commissioned cycle increased the likelihood of adverse perinatal outcomes (OR 3.3; p = 0.03) and was a significant independent predictor of a lower average gestational age (β = 0.897; p < 0.001). There were no significant differences in the incidence of vaginal deliveries or cesarean sections between commissioned and spontaneous cycles.

CONCLUSIONS

Commissioned cycles confer a greater incidence of composite perinatal complications and were independently associated with a lower average gestational age when compared with spontaneous pregnancies carried by the same GC despite a confirmed healthy uterine environment, sperm samples, and donor oocytes.

Pathways to Fatherhood: Psychological Well-Being Among Israeli Gay Fathers Through Surrogacy, Gay Fathers Through Previous Heterosexual Relationships, and Heterosexual Fathers

This study explored differences in psychological well-being as assessed by life satisfaction, parenthood satisfaction, depressive symptoms and the Big Five personality dimensions among 219 Israeli fathers; 76 gay men who had become fathers through a heterosexual relationship, 63 gay men who had become fathers through surrogacy, and 78 heterosexual men. After controlling for sociodemographic characteristics, gay fathers through surrogacy reported greater satisfaction with parenthood, greater satisfaction with their lives, and reported higher levels of extraversion when compared to heterosexual fathers. No significant differences emerged between the three groups on depressive symptoms, neuroticism, conscientiousness, agreeableness, and openness to experience. These findings emphasize the predominant similarities and some possible differences on psychological well-being between the different paths to fatherhood. This study is one of the first to compare several paths to fatherhood on psychological well-being, thus illuminating the contribution of fatherhood route to psychological well-being in an era where gay men are increasingly becoming fathers in diverse ways.

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.

Self-Perceived Parental Role and Mental Health Concomitants Among Israeli Gay and Heterosexual Fathers

In this study we examined the association between self-perceived parental role and adverse mental health (indicated by depressive symptoms, neuroticism, and negative affect) in a sample of 82 Israeli gay fathers (Mean age = 39.57, SD = 6.70) that were individually matched with 82 heterosexual fathers (Mean age = 39.11, SD = 7.88). Results showed that although self-perceived parental role was associated with adverse mental health, this association was moderated by sexual orientation, such that a significant negative association between self-perceived parental role and adverse mental health was evident only among gay fathers. The findings are understood by features of gay fatherhood, which is intentional and purposeful, and usually achieved after contending with particular difficulties in the journey to fatherhood. These features presumably shape the perceived parental role, and thus may link more strongly with lower levels of adverse mental health among gay fathers, compared to heterosexual fathers.

Can Children Have Ordinary Expectable Caregiving Environments in Unconventional Contexts? Quality of Care Organization in Three Mexican Same-Sex Planned Families

The aim of this research was to explore the elements that configure the quality of care among three Mexican same-sex planned families: two female-parented families (through donor insemination) and a male-parented one (through adoption). The first family consisted of two mothers and a 3-year-old daughter; the second one had two mothers and a 1.5-year-old set of boy twins and the third family consisted of two fathers and a 2-year-old girl. It was assumed that Ainsworth’s notions of quality of care organization are useful in order to understand caregiver–child attachment relationships, regardless of the parents’ sexual orientation. A collective case study was selected due to the fact that these families shared their “unconventionality” (i.e., parents were not heterosexual) and the fact that they were planned, but each one constituted a particular case with a unique configuration. Four trained independent observers used the q-sort methodology (Maternal Behavior Q-Sort and Attachment Q-Sort) to describe parents’ and children’s behavior, respectively. The findings showed that parents were highly sensitive and all children used them as a secure base. To provide an in-depth examination of which elements configure the quality of care, a semi-structured interview with each parent was carried out. Through a thematic analysis, an over-arching theme named Affections and Emotions was identified, together with six subthemes: (1) Creating an affective environment; (2) Being available; (3) Acknowledging and expressing emotions; (4) Perceiving, interpreting and responding adequately to the child’s real self; (5) Taking the child’s perspective into account; and (6) Agreeing on roles and dividing the tasks. In order to showcase the particular configuration of gay parenting, the male-headed family narrative is reported in detail, because gay parents have been perceived as violating traditional gender roles as well as the hegemonic model of masculinity. The findings were consistent with the notion of quality of care as proposed by Ainsworth and her collaborators. The implications of the methodological device and research regarding same-sex planned families are discussed so as to understand the organization of the caregiving environment.

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.

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.