surrogacy VAHID F MD 2006-1385
Definitions • Natural surrogacy or partial surrogacy • Gestational surrogacy , full surrogacy, or IVF surrogacy • Genetic couples , commissioning couple or intended parents. • Surrogacy host
Indication • After hysterectomy for cancer For post partum Hemorrhage for menorrahgia • Congenital absence of the uterus • Repeated failure of IVF • Recurrent abortion • Severe medical conditions incompatible with pregnancy
for the Genetic couples • a review of all alternative treatment options • the need for counseling • the need to find their own host(UK) • the practical difficulty and cost of treatment by gestational surrogacy • the medical and psychological risks of surrogacy
potential psychological risk to the child • the chances of having a multiple pregnancy • the degree of control that the host should have over the child of the genetic couple both during the pregnancy and after • the possibility that a child may be born with a handicap • the risks to the baby of the host smoking and drinking during a pregnancy • the possibility that the host may wish to retain the child after birth • the importance of obtaining legal advice
FOR THE HOST • The full implications of undergoing treatment by IVF surrogacy • The possibility of multiple pregnancy • The possibility of family and friends being against such treatment • The need to abstain from unprotected sexual intercourse during and just befor the treatment • The normal medical risks associated with pregnancy and the possibility of caesarian section
Implications and feelings of guilt on both sides if the host should spontaneously abort a pregnancy • The possibility that the host will feel a sense of bereavement when she gives the baby to the genetic couple • The possibility that the child may be born with a handicap
How and when to tell the child • Breast feeding
Relationship of genetic mothers to surrogate hosts. • Relations • Sister to sister35% • Sister to sister in law20% • Stepdaughter to stepmother 5% • Friends to friends15% • Through an organization25%
Results • Live birth rate = 37 – 43% per genetic couple • prematurity • low Birth weight • Lower rate of PIH and third trimester bleeding • Spontaneous abortion 40%.
Complications • The host may wish to keep the child . • An abnormal child may be rejected by both genetic and host parents. • The question of whether it is ethical to pay hosts(and if so how much). • The long term effects on the children born as a result of gestational surrogacy are not known.
The long term psychological effect on both the “genetic couple” and “host surrogates” is not known. • A few of “genetic women” have responded poorly to follicular stimulation. • The follicular responses of women with the Rokitansky-Kuster-Hauser syndrome were good.