Gestational surrogacy: Viewpoint of Iranian infertile women

The Ethical Standards of Sunni Muslim Physicians Regarding Fertility Technologies that are Religiously Forbidden

This research project is pioneering in that it is the first to provide empirical data regarding the ethical standards of Sunni Muslim physicians toward religiously prohibited reproductive technologies, a topic which is considered taboo in Muslim society. A total of 689 Sunni Muslim physicians rated their acceptance of 14 fertility treatments. They expressed objections to assisted reproductive technologies entailing gender selection, egg, sperm and embryo donation, and surrogacy. The findings show that the Sunni Muslim medical establishment avoids fertility options that are considered in violation of Islamic law, and Sunni Muslim physicians tend to obey religious law.

Exploring Infertile Couples' Decisions to Disclose Donor Conception to The Future Child

Background

Despite significant advances in reproductive technology, using donor assisted reproductive technology is a double-edged sword that has numerous challenges. One of the most challenging issues for couples is whether or not to disclose this information to donor offspring. This study, therefore, explored infertile couples’ decision to dis- close donor conception to their future child.

Materials and Methods

This qualitative study was conducted using content analysis approach in 2012 in the Milad Infertility Centre, Mashhad, Iran. Data were collected through semi-structured interviews with 32 infertile persons including nine couples and 14 women who were selected by purposive sampling. Data were analysed by conven- tional qualitative content analysis adopted by Graneheim and Lundman using MAXQDA 2010 software.

Results

Two categories were emerged: ‘not to disclose information to the child’ and ‘to disclose information to the child’. The first category consisted of three subcategories: 1. child support from probable harms; 2.to maintain healthy family relationships; and 3. lack of a compelling reason to disclose this information. The second category embraced four subcategories: 1. awareness of the others; 2. emergence of new living conditions; 3. appreciation for the donor; and 4. honesty among family members. The main reason for not disclosing information was to protect the child from probable harm.

Conclusion

Although protecting children from possible harms was a major reason for infertile couples' secrecy, keeping this secret would not be always easy. Therefore, increasing public awareness about the donation process in order to change the beliefs of community and eliminate the infertile couples’ concerns would help them to overcome this problem. Additionally, long-term psychological counselling during and after the donation process is highly rec- ommended.

Perspectives and attitudes of Jordanian medical and paramedical students toward surrogate pregnancy

PURPOSE

This study aims at investigating the perspectives of Jordanian medical and paramedical students on surrogate pregnancy.

METHODS

A questionnaire-based cross-sectional study design was used. The sample consisted of n=328 students of both genders. The questionnaire responses were numerically coded and analyzed across gender and the level of education.

RESULTS

Approximately, 18% of the students reported good awareness about the ethical dilemmas of surrogacy. The results showed a general reluctance to accept surrogate pregnancy as the majority (80.5% of male students and 97.6% of female students) had a negative attitude toward surrogacy. In addition, undergraduate students were less supportive to surrogate pregnancy than graduate students. Religious considerations were the main reason (accounts for about 70%) for driving negative attitude toward surrogacy.

CONCLUSION

The findings of the study indicate a general reluctance toward accepting the concept of surrogate pregnancy, which is mainly due to religious reasons.

Assisted reproductive technologies and the Iranian community attitude towards infertility

Since the late 1990s, assisted reproductive technologies (ARTs) have been legitimized in Iran through an official religious endorsement. Iran, under the dominant authority of the Shia sect, is now the most enthusiastic adopter of ARTs in the Muslim world, permitting all forms of treatments, including third party donation. This study examined the public perception of assisted conception and its influence on the adoption of these methods in Iran. The study was questionnaire-based and conducted in 2012 in Shiraz, the most populated city in the south of Iran. It included 405 Iranian residents selected through the cluster sampling method. The results indicated that respondents did not support all types of assisted reproduction. Amongst modern infertility treatment methods, IVF (using husband's sperm and wife's egg) was the most widely accepted. Gestational surrogacy and the use of donated gametes were less accepted. Demographic variables including gender, marital status, age, education and employment status were linked to significant differences in public opinion. It was concluded that members of the public require better information about gamete donation and surrogacy, as this could shape infertile couples' decision-making.

Development and Validation of Attitude toward Gestational Surrogacy Scale in Iranian Infertile Couples

Background

Surrogacy is one of the most challenging infertility treatments engaging ethical, psychological and social issues. Attitudes survey plays an important role to disclosure variant aspects of surrogacy, to help meeting legislative gaps and ambiguities, and to convert controversial dimensions surrounding surrogacy to a normative concept that eliminates stigma. The aim of this study is to develop a comprehensive scale for gestational surrogacy attitudes.

Materials and Methods

Development process of gestational surrogacy attitudes scale (GSAS) performed based on a descriptive cross-sectional study and included a rich data pool gathered from literature reviews, a qualitative pilot study on 15 infertile couples (n=30), use of expert advisory panel (EAP) consisting of 20 members, as well as use of content validity through qualitative and quantitative study by the means of content validity ratio (CVR) and content validity index (CVI). Also internal consistence using Cronbach’s alpha and test-retest reliability using intracalss correlation coefficient (ICC) were evaluated. Application of GSAS was tested in a cross-sectional study that was conducted on 200 infertile couples (n=400) at Royan Institute, Tehran, Iran, during 2014.

Results

Final version of GSAS had 30 items within five subscales including "acceptance of surrogacy", "Surrogacy and public attitudes", "Child born through surrogacy", "Surrogate mother", and "Intentional attitude and surrogacy future attempt". Content validity was represented with values of CVR=0.73 and CVI =0.98. Cronbach’s alpha value was 0.91 for the overall scale, while ICC value due to test-retest responses was 0.89.

Conclusion

Acceptable level of competency and capability of GSAS is significantly indicated; therefore, it seems to be an appropriate tool for the evaluation of gestational surrogacy attitudes in Iranian infertile couples.

Religious aspects of assisted reproduction

Human response to new developments regarding birth, death, marriage and divorce is largely shaped by religious beliefs. When assisted reproduction was introduced into medical practice in the last quarter of the twentieth century, it was fiercely attacked by some religious groups and highly welcomed by others. Today, assisted reproduction is accepted in nearly all its forms by Judaism, Hinduism and Buddhism, although most Orthodox Jews refuse third party involvement. On the contrary assisted reproduction is totally unacceptable to Roman Catholicism, while Protestants, Anglicans, Coptic Christians and Sunni Muslims accept most of its forms, which do not involve gamete or embryo donation. Orthodox Christians are less strict than Catholic Christians but still refuse third party involvement. Interestingly, in contrast to Sunni Islam, Shi'a Islam accepts gamete donation and has made provisions to institutionalize it. Chinese culture is strongly influenced by Confucianism, which accepts all forms of assisted reproduction that do not involve third parties. Other communities follow the law of the land, which is usually dictated by the religious group(s) that make(s) the majority of that specific community. The debate will certainly continue as long as new developments arise in the ever-evolving field of assisted reproduction.

Attitudes of Iranian infertile couples toward surrogacy

BACKGROUND:

Surrogacy arrangements are multifaceted in nature, involving multiple controversial aspects and engaging ethical, moral, psychological and social issues. Successful treatment in reproductive medicine is strongly based on the mutual agreement of both partners, especially in Iran where men often make the final decision for health-related problems of this nature. AIM: The aim of the following study is to assess the attitudes of Iranian infertile couples toward surrogacy.

SETTING AND DESIGN:

This descriptive study was conducted at the infertility clinic of Hamadan university of medical sciences, Iran.

MATERIALS AND METHODS:

The study sample consisted of 150 infertile couples selected using a systematic randomized method. Data collection was based on responses to a questionnaire consisting of 22 questions.

STATISTICAL ANALYSIS:

P <0.05 were considered to be statistically significant.

RESULTS:

While 33.3% of men and 43.3% of women surveyed insisted on not using surrogacy, the overall attitudes toward surrogacy were positive (53.3% of women and 54.6% of men surveyed).

CONCLUSION:

Although, there was not a significant difference between the overall positive attitudes of infertile women and men toward surrogacy, the general attitude toward using this method is not strongly positive. Therefore, further efforts are required to increase the acceptability of surrogacy among infertile couples.