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Attawet J. Mapping transnational commercial surrogacy arrangements in South and Southeast Asia. Med Leg J 2021; 89:128-132. [PMID: 33715522 DOI: 10.1177/0025817220985099] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Transnational commercial surrogacy is a form of medical tourism undertaken by intended parents in an attempt to seek surrogates in other countries. Most intended parents are from developed countries and seek their surrogates from developing countries, predominantly from South and Southeast Asia. This arrangement led to the establishment of surrogacy businesses in South and Southeast Asia, in countries such as India and Thailand. Subsequently, the business was banned in these countries, which led to a trend of moving it to neighbouring countries where there were no regulations or restrictions. This paper maps the movement of the industry and calls for attention to re-consider or re-frame commercial surrogacy in an international framework.
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Affiliation(s)
- Jutharat Attawet
- Faculty of Health, University of Technology Sydney, Ultimo, Australia
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2
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Attawet J, Wang AY, Farquhar CM, Jordan V, Li Z, Sullivan EA. Pregnancy and birth outcomes of single versus multiple embryo transfer in gestational surrogacy arrangements: a systematic review and meta-analysis. HUM FERTIL 2020; 25:217-227. [PMID: 32609023 DOI: 10.1080/14647273.2020.1785643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Multiple embryo transfer (MET) is associated with both an increased risk of multiple pregnancy and of live birth. In recent years, MET has become standard practice for most surrogacy arrangements. There is limited review of the use of MET versus single embryo transfer (SET) in surrogacy practice. The present review systematically evaluated the pregnancy outcomes of surrogacy arrangements between MET versus SET among gestational carriers. A systematic search of five computerized databases without restriction to the English language or study type was conducted to evaluate the primary outcomes: (i) clinical pregnancy; (ii) live delivery; and (iii) multiple delivery rates. The search returned 97 articles, five of which met the inclusion criteria. The results showed that clinical pregnancy (RR = 1.21, 95% CI: 1.06-1.39, n = 5, I2 = 41%), live delivery (RR = 1.29, 95% CI: 1.10-1.51, n = 4, I2 = 35%) and multiple delivery rates (RR = 1.42, 95% CI: 6.58-69.73, n = 4, I2 = 54%) were statistically significantly different in MET compared to SET. Adverse events including miscarriage, preterm birth and low birthweight were found following MET. Our findings support the existing evidence that MET results in multiple pregnancy and subsequently more adverse outcomes compared to SET. From a public health perspective, SET should be advocated as the preferred treatment for gestational carriers.
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Affiliation(s)
- Jutharat Attawet
- Faculty of Health, University of Technology Sydney, Ultimo, Australia
| | - Alex Y Wang
- Faculty of Health, University of Technology Sydney, Ultimo, Australia
| | - Cindy M Farquhar
- Faculty of Medical and Health Sciences, the University of Auckland, Auckland, New Zealand
| | - Vanessa Jordan
- Faculty of Medical and Health Sciences, the University of Auckland, Auckland, New Zealand
| | - Zhuoyang Li
- Faculty of Health, University of Technology Sydney, Ultimo, Australia
| | - Elizabeth A Sullivan
- Faculty of Health, University of Technology Sydney, Ultimo, Australia.,Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia
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Rumpik D, Rumpikova T, Pohanka M, Ventruba P, Belaskova S. Gestational surrogacy in the Czech Republic. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2018; 163:155-160. [PMID: 30238935 DOI: 10.5507/bp.2018.040] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 07/12/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Gestational surrogacy, is a treatment option for women with certain clearly defined medical problems, usually an absent uterus, to help them have their own genetic children. The aim of our study was to review, evaluate and share our experience and outcomes over the last 13 years of the largest surrogacy program in the Czech republic. METHODS A total of 75 intended mothers and 82 surrogate mothers participated in this study. A retrospective cohort study was performed. Anonymized data were collected on 130 cycles of gestational surrogate (2004-2017) directly from the Clinic database. RESULTS We performed 130 in vitro fertilization cycles with gestational surrogacy which involved 73 fresh embryo transfers and 57 frozen embryo transfers. We achieved 57 (43.9%) pregnancies and 42 (32.3%) live births. The rate of multiple pregnancies was only 2.3 %. The most common indication for using was an absent or damaged uterus (65%), followed by medical conditions precluding pregnancy (23%) and repeated in vitro fertilization cycles or pregnancy failure (12%). CONCLUSION In the 14 years of our experience, we have shown that treatment of young women with specific indications for gestational surrogacy is beneficial, successful and relatively free of complications. However, it is imperative to follow the medical indications for this treatment and specialist recommendations.
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Affiliation(s)
- David Rumpik
- Clinic of Reproductive Medicine and Gynecology Zlin, Zlin, Czech Republic.,Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry, Masaryk University Brno, Brno, Czech Republic
| | - Tatana Rumpikova
- Clinic of Reproductive Medicine and Gynecology Zlin, Zlin, Czech Republic.,Faculty of Humanities, Bata University Zlin, Zlin, Czech Republic
| | - Michal Pohanka
- Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry, Masaryk University Brno, Brno, Czech Republic
| | - Pavel Ventruba
- Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry, Masaryk University Brno, Brno, Czech Republic
| | - Silvie Belaskova
- International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic Corresponding author: David Rumpik, e-mail
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Söderström-Anttila V, Wennerholm UB, Loft A, Pinborg A, Aittomäki K, Romundstad LB, Bergh C. Surrogacy: outcomes for surrogate mothers, children and the resulting families—a systematic review. Hum Reprod Update 2015; 22:260-76. [DOI: 10.1093/humupd/dmv046] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 09/21/2015] [Indexed: 11/13/2022] Open
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Dar S, Lazer T, Swanson S, Silverman J, Wasser C, Moskovtsev SI, Sojecki A, Librach CL. Assisted reproduction involving gestational surrogacy: an analysis of the medical, psychosocial and legal issues: experience from a large surrogacy program. Hum Reprod 2014; 30:345-52. [DOI: 10.1093/humrep/deu333] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Anchan RM, Missmer SA, Correia KF, Ginsburg ES. Gestational carriers: A viable alternative for women with medical contraindications to pregnancy. ACTA ACUST UNITED AC 2013; 3:24-31. [PMID: 25664218 PMCID: PMC4315940 DOI: 10.4236/ojog.2013.35a2005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Compare the efficacy of surrogate or gestational carrier (GC) cycles to that of autologous in vitro fertilization (IVF)/intracytoplasmic sperm injections (ICSI) in patients with gynecologic or medical co-morbidities contraindicative to pregnancy. DESIGN Retrospective cohort study. SETTING Infertility patients from a single university hospital-based program from 1998-2009. INTERVENTIONS 128 GC cycles from 80 intended parents were identified and compared with 15,311 IVF or ICSI cycles. MAIN OUTCOME MEASURES The peak estradiol (E2), number of oocytes retrieved, cycle cancellation, ongoing pregnancy, and live-birth were compared between GCs and autologous IVF carriers. Indications for GC use were also identified. Multiple cycles contributed by the same patient were accounted for using multivariable generalized estimating equations and two-sided Wald p-values. RESULTS Uterine factors (67%) was the most common indication for using a GC, followed by non-gynecologic medical conditions including coagulopathies (13%), end stage renal disease (10%), cardiovascular disease (5%) and cancer (5%). Adjusting for age, ovulation induction in GC cycles had similar peak E2 levels and number of oocytes retrieved relative to IVF cycles (p = 0.23 and 0.43, respectively). Clinical pregnancy (49% vs. 42%, p = 0.28) and live-birth rates (31% vs. 32%, p = 0.74) were also comparable. A sub-analysis of GC cycles in those women with uterine factor indications, demonstrated significantly higher clinical pregnancy rates (OR = 2.0; CI = 1.2 - 3.5) with 60% greater odds of live-birth relative to IVF/ICSI cycles, however this odds was not statistically significant for differences in live-birth (CI = 0.9 - 2.9). Conclusions: GCs are a viable alternative to start families for patients with medical co-morbidities precluding pregnancy.
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Affiliation(s)
- Raymond M Anchan
- Department of Obstetrics, Gynecology and Reproductive Biology, Brigham & Women's Hospital and Harvard Medical School, Boston, USA
| | - Stacey A Missmer
- Department of Obstetrics, Gynecology and Reproductive Biology, Brigham & Women's Hospital and Harvard Medical School, Boston, USA.,Channing Laboratory, Department of Medicine, Brigham & Women's Hospital and Harvard Medical School, Boston, USA.,Department of Epidemiology, Harvard School of Public Health, Boston, USA
| | - Katharine F Correia
- Department of Obstetrics, Gynecology and Reproductive Biology, Brigham & Women's Hospital and Harvard Medical School, Boston, USA
| | - Elizabeth S Ginsburg
- Department of Obstetrics, Gynecology and Reproductive Biology, Brigham & Women's Hospital and Harvard Medical School, Boston, USA
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Raziel A, Friedler S, Gidoni Y, Ben Ami I, Strassburger D, Ron-El R. Surrogate in vitro fertilization outcome in typical and atypical forms of Mayer-Rokitansky-Kuster-Hauser syndrome. Hum Reprod 2011; 27:126-30. [DOI: 10.1093/humrep/der356] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Dermout S, van de Wiel H, Heintz P, Jansen K, Ankum W. Non-commercial surrogacy: an account of patient management in the first Dutch Centre for IVF Surrogacy, from 1997 to 2004. Hum Reprod 2009; 25:443-9. [PMID: 19945960 PMCID: PMC2806181 DOI: 10.1093/humrep/dep410] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Surrogacy was prohibited in the Netherlands until 1994, at which time the Dutch law was changed from the general prohibition of surrogacy to the prohibition of commercial surrogacy. This paper describes the results from the first and only Dutch Centre for Non-commercial IVF Surrogacy between 1997 and 2004. METHODS A prospective study was conducted of all intended parents, and surrogate mothers and their partners (if present), in which medical, psychological and legal aspects of patient selection were assessed by questionnaires and interviews developed for this study. RESULTS More than 500 couples enquired about surrogacy by telephone or e-mail. More than 200 couples applied for surrogacy in the Centre, of which, after extensive screening, 35 couples actually entered the IVF programme and 24 completed the treatment, resulting in 16 children being born to 13 women. Recommendations for non-commercial surrogacy are given, including abandoning the 1-year waiting period before adoption, currently dictated by law, avoiding a period of unnecessary psychological distress. CONCLUSIONS Our study has shown that non-commercial IVF surrogacy is feasible, with good results in terms of pregnancy outcome and psychological outcome for all parents, and with no legal problems relating to the adoption procedures arising. The extensive screening of medical, psychological and legal aspects was a key element in helping to ensure the safety and success of the procedure.
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Affiliation(s)
- Sylvia Dermout
- Department of Obstetrics and Gynaecology, Zaans Medisch Centrum, PO Box 210, 1500 EE Zaandam, The Netherlands.
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Duffy DA, Nulsen JC, Maier DB, Engmann L, Schmidt D, Benadiva CA. Obstetrical complications in gestational carrier pregnancies. Fertil Steril 2005; 83:749-54. [PMID: 15749509 DOI: 10.1016/j.fertnstert.2004.08.023] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2004] [Revised: 08/09/2004] [Accepted: 08/09/2004] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To report two cases of severe obstetrical complications in gestational carrier pregnancies and to review our clinical experience and compare our results with those reported in the literature. DESIGN Retrospective analysis. SETTING A university IVF program. PATIENT(S) Women without a functioning uterus or those whose pregnancy would exacerbate a medical condition were enrolled in the gestational carrier pregnancy program. INTERVENTION(S) IVF cycles using oocytes from genetic mothers (or oocyte donors) were performed, with ET to gestational carriers. MAIN OUTCOME MEASURE(S) Clinical pregnancy rates, obstetrical complications, and neonatal outcomes. RESULT(S) Ten couples underwent a total of 13 cycles using gestational carriers. A clinical pregnancy rate of 69% (9/13) was achieved. An intrapartum hysterectomy and a late puerperal hysterectomy were required because of severe obstetrical complications. The late puerperal hysterectomy was performed for placenta accreta in a triplet gestation. This carrier sustained multiple cerebral infarcts and blindness. One triplet infant died secondary to a hypoplastic left ventricle and complications of prematurity. A second gestational carrier with a singleton gestation underwent a hysterectomy for a uterine rupture, and the infant has cerebral palsy. CONCLUSION(S) The past medical and obstetrical histories of potential gestational carriers must be closely scrutinized, and candidates must be thoroughly counseled about the potential risks involved in the procedure.
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Affiliation(s)
- Deirdre A Duffy
- Department of Obstetrics and Gynecology, Danbury Hospital, Danbury, Connecticut, USA
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Raziel A, Schachter M, Strassburger D, Komarovsky D, Ron-El R, Friedler S. Eight years' experience with an IVF surrogate gestational pregnancy programme. Reprod Biomed Online 2005; 11:254-8. [PMID: 16168227 DOI: 10.1016/s1472-6483(10)60966-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The aim of this study was to retrospectively audit eight years' experience of an IVF surrogate gestational programme and to compare the outcome of surrogacy due to absence of the uterus with surrogacy indicated for repeated IVF failure and recurrent abortions. A total of 60 cycles of IVF surrogate pregnancy were initiated in 19 treated couples. Absence of the uterus was the indication for surrogacy in 10 cases: Rokitansky syndrome (eight cases) and post-hysterectomy (two cases) designated as group A. The indications in the remaining nine patients (group B) were: IVF implantation failure (three cases), habitual abortions (four cases) and deteriorating maternal diseases (two cases). IVF performance and subsequent pregnancy outcome of groups A and B were compared. There was no difference in ovarian stimulation parameters and in IVF performance between the groups A and B. The overall pregnancy rate per transfer was 10/60 (17%). The pregnancy rates per patient and per transfer were 7/10 (70%) and 7/35 (20%) in group A compared with 3/9 (33%) and 3/25 (12%) in group B. A median number of three treatment cycles were needed to achieve pregnancy. In conclusion, the existence or absence of the uterus in the commissioning mothers is irrelevant for their IVF performance and conception rates. In patients who conceived after more than three IVF cycles, an additional 'oocyte factor' might be present.
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Affiliation(s)
- Arieh Raziel
- Infertility and IVF Unit, Assaf Harofeh Medical Centre, Tel-Aviv University, Zerifin, 70300, Israel.
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Gagin R, Cohen M, Greenblatt L, Solomon H, Itskovitz-Eldor J. Developing the role of the social worker as coordinator of services at the surrogate parenting center. SOCIAL WORK IN HEALTH CARE 2004; 40:1-14. [PMID: 15831430 DOI: 10.1300/j010v40n01_01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
A law permitting couples to conceive biological children through surrogacy was legislated in Israel in March 1996. The Rambam Medical Center has established the only nonprofit Surrogate Parenting Center at a public hospital in Israel. The multidisciplinary teamwork at the Center is case managed by a social worker. An important role of the social work intervention is consultation and support for the couple and the surrogate at all stages of the process. The case study presented in the article illustrates the need for sensitive and professional intervention due to the complexity of the surrogacy process and the crisis it involves for both the surrogate and the couple. In light of the growing parenting surrogacy cases in the United States, Europe, and Israel, a structured social work intervention model is described, which may be implemented at public or private surrogate parenting centers.
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Affiliation(s)
- Roni Gagin
- Social Work Department, Rambam Medical Center, Haifa, Israel
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Söderström-Anttila V, Blomqvist T, Foudila T, Hippelainen M, Kurunmaki H, Siegberg R, Tulppala M, Tuomi-Nikula M, Vilska S, Hovatta O. Experience of in vitro
fertilization surrogacy in Finland. Acta Obstet Gynecol Scand 2002. [DOI: 10.1034/j.1600-0412.2002.810811.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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