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

Counseling

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 sister Sister to sister in law Stepdaughter to stepmother

35% 20% 5%

Friends to friends Through an organization

15% 25%

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.