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Objectives: The aim of the study was to find out what proportion of women with MRKHS have decided to become mothers and have children or would like to have children and consider various options for motherhood. Additionally, the survey aimed at identifying factors that might influence the women's decisions and opinions regarding adoption, gestational surrogacy (GS) and uterus transplantation (UTx). Material and methods: The study group consisted of 100 adult women with MRKHS who filled out questionnaires consisting of 56 questions. The survey was self-administered and anonymous. Results: Most of the study participants were under 30, lived in large cities (> 150 000 inhabitants) and declared to be heterosexuals in a steady relationship (p < 0.05). While 11 participants had children, 66 out of 89 childless women (74%) expressed a desire for motherhood, but as many as 80 surveyed women have felt pressured to have children. The number of participants for whom a biological relationship with offspring was significant and insignificant respectively equaled (p = 1.000). The majority of the study participants supported the process of legalizing GS in Poland (95 vs 4) yet would opt for commercial rather than altruistic GS (64 vs 31) (p < 0.05). Most respondents stated that UTx is consistent with their faith and conscience (91 vs 4) and found UTx ethical (88 vs 4) (p < 0.0001). Conclusions: The majority of Polish women with MRKHS express the need to become a mother, but only one in ten has a child. The women's interest in biological motherhood is significant. [ABSTRACT FROM AUTHOR]

Uterus transplantation (UTx) has evolved from a purely experimental procedure to a clinical treatment option available outside the clinical trial context, offering women with absolute uterine-factor infertility an opportunity to experience pregnancy. As UTx becomes better established and more widely known and performed, it is likely to be sought out by geographically and culturally diverse patients, particularly those whose religious beliefs impose barriers to other paths to achieve parenthood, such as gestational surrogacy and adoption. Many religions do not currently have official positions on UTx, meaning that clinicians involved in screening candidates can expect questions about how the UTx process aligns with various religious beliefs. This article provides a broad background on the current positions major world religions have taken on UTx (or its components) and the alternative paths to parenthood of gestational surrogacy and adoption. It is intended to help clinicians communicate the information necessary for individuals interested in uterus donation or transplantation to determine—in consultation with their spiritual advisors or religious authorities when needed—how these options align with religious beliefs or teachings. [ABSTRACT FROM AUTHOR]

New York's Child–Parent Security Act (CPSA) legalized compensated gestational surrogacy and created a simpler way for parents to establish their parental rights when utilizing assisted reproductive technology (ART). While this was a substantial step forward from past antiquated law, the CPSA continues to heavily regulate compensated genetic, otherwise known as traditional, surrogacy making it challenging to use. The CPSA infringes upon the right to procreate by limiting the ART methods available to those wanting to start a family. This Note proposes an amendment to the current CPSA, including the legalization of compensated traditional surrogacy in New York. Key points for the family law community: Traditional surrogacy agreements are declared contrary to the public policy of New York State and are void and unenforceable.Parties to a compensated genetic surrogacy agreement are subject to a civil penalty of up to $500.It is estimated that from 1999 to 2013, around 18,400 babies were born through surrogacy worldwide.The New York law on surrogacy explicitly does not apply to a woman who uses her own egg to conceive.There is currently no federal regulation of compensated surrogacy, and laws vary from state to state on legal surrogacy types. [ABSTRACT FROM AUTHOR]

This article studies the 1919 novel Eugenia by the prolific Yucatec writer and medical doctor Eduardo Urzaiz, focusing on gestational surrogacy and its implications as it is represented in this short novel. I argue that Urzaiz's fantasy of mainstreamed assisted reproduction technology and gestational surrogacy echoes current, more dissimulated discussions of what it means for affluent members of society with disposable income to place an order for a designer baby. While eugenics received a bad name after the excesses of the Nazi regime, its underlying principles certainly remain salient, as do the questions raised by contemporary watchdog institutes about what happens when science is not monitored by ethics. Novels like this speculative fiction presciently ask us to interrogate more fundamentally, what ethics are, and from whose limited cultural perspective we make universalist claims. [ABSTRACT FROM AUTHOR]

INTRODUCTION. Surrogate motherhood is a social phenomenon characterized by drawing up a legal contract stating that a woman will manage the child for other people, thereby giving up her right as a mother. This can be done under a wide range of situations depending on the reason to perform this practice such as the economic or altruistic one. This can lead to practices such as reproductive tourism according to the laws established in each nation. OBJECTIVES. Analyze surrogate motherhood throughout a scientific literature review. METHOD. A bibliographic review has been carried out through the PubMed and SciELO databases.RESULTS. Eleven articles are analyzed and there are various perspectives for surrogate motherhood; authors who support this practice and its legalization, authors who are against it and, finally, others that support its regularization. CONCLUSIONS. Surrogate motherhood has two sights: the ethical and the pragmatic. According to ethics, there’s a commodification of women without considering the risks and emotional aspects of being pregnant. On the other hand, from a pragmatic point of view, surrogate motherhood is a highly controversial subject that generates an international issue that is difficult to regulate. Finally, from a nurse’s point of view, it is essential to train the entire interdisciplinary team and create protocols of action in order to provide comprehensive and high-quality care.

Advancements in reproductive techniques have raised increasingly diverse and complex questions that challenge our integrative needs and confront our fantasies both personal and as therapists'. In contemporary democracies, this is a topic that both fuels discussion and divides opinions, especially in ethical and legal contexts. We delve into the issues faced by grandparents of children born into non-traditional or atypical families, where conception involves assistance flom individuals outside the family, particularly in cases of gestational surrogacy (GS). Does GS imply a symbolic disappearance of the mother? The varied terms used, differing significantly among countries, add to the internal turmoil surrounding these changes. The use of the term "intended parents" rather than "requesting parents" highlights the notion of desire. Employing the most accurate terms possible will contribute to the development of a conducive legal framework. Grandparental bonds take various forms: natural, cultural, genetic, physical; they can also be "social" bonds, akin to those observed and felt within blended families. In the case of GS, "good enough" grandparents will aid the child in building an identity rooted in multiple backgrounds, that of an individual woven from different narratives within an extended family. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Multifetal gestation is more frequent among gestational carrier pregnancies than non-surrogacy IVF pregnancies. We aimed to evaluate the association between multifetal gestation and obstetric and neonatal morbidity among gestational carrier pregnancies. METHODS: Pooled cross-sectional study of birth certificate data from gestational carrier pregnancies in Utah from 2009 to 2018. Our primary outcome was a composite of severe obstetric morbidity; secondary outcomes included cesarean delivery (CD), hypertensive disorders of pregnancy, preterm birth (PTB), and a neonatal morbidity composite. Logistic regression was utilized to compare odds of these outcomes between gestational carrier pregnancies with and without multifetal gestation. RESULTS: A total of 361 gestational carrier pregnancies resulted in the delivery of 435 neonates during the study period. Of these, 284 were singleton pregnancies, and 77 were multifetal, a multifetal gestation rate of 21.3%. Baseline demographic characteristics did not differ between singleton and multifetal gestations. Multifetal gestation was not associated with higher rates of severe obstetric morbidity (odds ratio [OR] 1.87, 95% confidence interval [CI] 0.34-10.39). Multifetal gestation was associated with increased odds of neonatal morbidity (OR 9.49, 95% CI 5.35-15.83); PTB

PurposeWe sought to characterize severe obstetric morbidity among women who are gestational carriers compared to other patients.MethodsThis was a population-based study comparing gestational carrier pregnancies to non-surrogate pregnancies (non-surrogate IVF pregnancies, all non-gestational carrier pregnancies, and a cohort of matched controls) delivering in Utah between 2009 and 2018, using birth certificate data. Our primary outcome was a composite of severe morbidity, including death, ICU admission, eclampsia, HELLP syndrome, transfusion, and unplanned hysterectomy. Our secondary outcomes were cesarean delivery (CD) and hypertensive disorders of pregnancy.ResultsDuring the study period, 361 gestational carrier pregnancies and 509,015 other pregnancies resulted in live births. Severe morbidity was less common among gestational carrier pregnancies than IVF pregnancies (1.7% versus 5.5%, odds ratio [OR] 0.29, 95% confidence interval [CI] 0.12-0.70), but was not different when compared to all other pregnancies (1.0%, OR 1.61, 95% CI 0.72-3.60), or a cohort of matched controls (1.0%, OR 1.37, 95% CI 0.55-3.40). CD was less common among gestational carrier pregnancies than IVF pregnancies, but not different than all other pregnancies or matched controls. While frequency of hypertensive disorders of pregnancy was lower among gestational carrier pregnancies than IVF pregnancies, it was higher than all other women who delivered and comparable to matched controls.ConclusionSevere obstetric morbidity is uncommon among gestational carrier pregnancies. Women who are gestational carriers are at lower risk of morbidity and CD than others who conceive through IVF and do not appear to be at increased risk compared to matched controls.

In the last few decades, assisted reproductive technologies (ARTs) have become increasingly transregional and transnational, often involving travel within or between countries or even continents. Until recently, the global ART industry was marked by so-called 'reprohubs'—places (such as southern California, Dubai, Anand, and Mumbai) specializing in the provision of reproductive services. While reprohubs continue to exist, in the last few years, many have splayed out, transforming into something more akin to webs that encompass, but go beyond these hubs. These webs show a unique dynamic capability to tighten, entangle, or extend in reaction to local and global changes, a characteristic which became particularly obvious during the global Covid-19 pandemic. In this paper, we propose conceptualizing this new dynamic capability as 'reprowebs'—an approach that adds a new dimension to the existing conceptualization of reproductive travel and helps us to better understand current developments in the global ART industry. [ABSTRACT FROM AUTHOR]

Reproductive health technology allows married couples who experience infertility to have a child through assisted reproductive technology (ART), such as the in vitro fertilisation (IVF) process. The transfer of the extracted embryo to the woman’s womb is called surrogacy technology (gestational surrogacy). The legality of the practice of surrogacy is still questionable, both on a national and international level. This research discussed the legality of surrogacy in some religious countries, focusing on Indonesia. This research used normative juridical research methods or literature review through a comparative religion-legal approach. This study indicated that most do not have a specific legal instrument regarding surrogacy practice. International law also does not have a standard legal instrument regarding the legality of surrogacy. Legality is determined by each religious country’s national laws and customs. For example, Indonesian law prohibits this practice implicitly under Law No. 36 of 2009 concerning health. The United Kingdom legalised surrogacy through the Surrogacy Agreement Act 1985, which was amended to the Human Fertilization and Embryology Act 2008, Greece through the Greek Legislation Law 3089/2002 and Law 3305/2005, and India through the 2019 Surrogacy Regulation Bill. Those countries have their limitations and characteristics that rule surrogacy. Surrogacy is indeed a technological advancement in the health sector. However, for countries that are influenced much by religion, technological advances sometimes conflict with the culture and the belief that has long been followed by most of the population. For Indonesia, the largest of Sunni Islam ruled surrogacy against the law. Next, Iran, as a Shia Islam country, ruled that surrogacy is a legal action. Contribution: The research provided information and knowledge regarding the different settings of surrogacy practice. Most religious countries bravely rejected or put strict limits on the practice of surrogacy.

What are intended parents' experiences of surrogacy, understandings of the law, and views on legal reform, and how do these compare with those of surrogates? We conducted an online retrospective survey of intended parents who had treatment with a gestational surrogate in two clinics between March 2014 and October 2021. The 61 respondents ranged in age, occupation, and household income. Generally, they reported higher household incomes than surrogates, though this was not universal. Just over half of the respondents were heterosexual, while almost half were in same-sex male couples. Most were White. Over half met the surrogate through a non-profit surrogacy organization or 'online'. Most successfully established a pregnancy on their first surrogacy journey; in most of these cases, the surrogate delivered a child. Most respondents believed surrogates should not be the legal mother and there was general support for proposed reforms that would recognize intended parents as legal parents from birth. More ambivalence was apparent in relation to finances though expense models were preferred over payment models. There was general support for advertising. The UK anticipates draft new surrogacy legislation in spring 2023. This study could inform public and parliamentary debates in the UK and elsewhere. Moreover, the results from this survey can assist in the development of good practice models for the care of intended parents on the surrogate pathway. [ABSTRACT FROM AUTHOR]

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Risks to gestational surrogates became a concern for public health. In commercial gestational surrogacy arrangements, gestational surrogates are commonly recruited from low- to middle-income countries. Thailand is well known as a surrogacy hub in this regard. However, little is known concerning Thai surrogacy practice and the risks that Thai gestational surrogates experiences. The semi-structured interviews with fifteen Thai women who had been gestational surrogates were conducted over the telephone in Thai between March and May 2020 and lasted approximately 30 minutes. Thematic analysis was applied to analyse the translated interviews. The findings indicated that 'womb for work' was perceived as a surrogacy career among Thai women. 'Womb for work' was defined as a superordinate theme that consisted of three subthemes: (i) gestational surrogacy arrangements in Thailand; (ii) the business model of gestational surrogacy arrangements in Thailand; and (iii) risk experiences of gestational surrogates. Clear deficiencies in surrogacy practice and regulations were identified, which put gestational surrogates at risk, including those associated with embryo transfer, transnational gestational surrogacy, and unsupported pregnancies. This study shows the urgent need to introduce regulations to protect women's health transnationally in this domain more effectively. [ABSTRACT FROM AUTHOR]

In gestational surrogacy arrangements, the womb is often figured as a holding environment that brings the child of commissioning parents to fruition but does not shape fetal identity. This article probes the racial imaginary of such a figuration—what I term the "nonracializing womb"—where gestation is seen as peripheral to racial transmission. Drawing on feminist science studies frameworks and data from interviews with parents who commissioned surrogates, this article traces the cultural politics of the nonracializing womb, positioning it as an index for broader understandings of race, reproductive labor, and kinship that hinge on nuclear and biogenetic forms. It then problematizes this figure of gestation by engaging emerging research on environmental epigenetics, which offers a lively model of pregnancy as shaping fetal biology, blurring the lines between surrogate and fetus. I argue that epigenetics offers a resource to reimagine gestation as a racializing process, by theorizing race not as solely genetic, but as relational, socio-environmental, and forged through distributed kinship lineages. [ABSTRACT FROM AUTHOR]

In a recent article in this journal, Alex Mullock, Elizabeth Chloe Romanis and Dunja Begović provide an analysis of gestational surrogacy and uterus transplantation (UTx) from the perspective of those who may decide to act as gestational surrogates and womb donors, referred to as 'womb‐givers'. In this article, I advance two sets of claims aimed at critically engaging with some aspects of their analysis. Firstly, I argue that the expression 'womb‐givers' obscures the biologically, socially and politically salient issue that those who engage in these practices are primarily persons and women. My contention is that this is of substance in discussions of the burdens and benefits of gestational surrogacy and UTx, which need to consider the specific position that women occupy in society, and the hierarchies that mediate their lives, experiences and preferences. Second, I argue that, if one were to take seriously the experiences and preferences of the women who may engage in these practices, and their bodily autonomy, then gestational surrogacy and UTx should be regarded as biologically and sociopolitically incommensurable. Mullock et al. overlook important aspects of gestational surrogacy, such as the embodied nature of pregnancy and childbirth, the sociopolitical significance of these experiences, and the often‐oppressive social norms that shape them. Whilst biology is not destiny, I suggest that it is socially and politically 'sticky' when it comes to this significance and norms, especially within the sphere of reproduction. Towards the end of the article, I query the authors' conceptualisation of bodily autonomy and of the instruments that enable its respect and promotion. [ABSTRACT FROM AUTHOR]

Objective To examine the psychological impact of gestational surrogacy on surrogates’ families. Background ASRM practice committee guidelines recommend that psychological counseling prior to surrogacy include consideration of a surrogate’s own family, but there has been little research to help guide mental health professionals (MHPs) providing implications counseling. Methods Fifty-nine family members from 16 surrogate families were recruited and data were collected on family relationships, child psychological well-being, and family experiences of surrogacy. Family members filled out a series of questionnaires based on their age and role in the family system. Results Participants included 16 surrogates (28 surrogate pregnancies) with an average time since first surrogate pregnancy = 2.93 years (range = 0–8 years). Overall, families of surrogates are functioning well across a number of psychological domains. There were some differences between surrogates and spouses regarding their perceptions of their children’s experience. A small number of children reported negative emotions about surrogacy and more research is needed to identify which children may be at risk. Children reported surrogacy having a positive impact on their lives and endorsed both pride and excitement about their mother being a surrogate. Conclusions There has been limited data to inform MHPs tasked with implications counseling prior to surrogacy in offering guidance to surrogates’ family members to help prepare them for the experience. This data can be used by MHPs providing implications counseling to help facilitate discussions about the potential impact of surrogacy tohelp ensure positive psychological outcomes for surrogates and their family members.

Shared motherhood IVF, poly parenthood, lesbian motherhood, gestational surrogacy, assisted reproduction, IUI, artificial insemination, gamete donation Keywords: shared motherhood IVF; poly parenthood; lesbian motherhood; gestational surrogacy; gamete donation; assisted reproduction; IUI; artificial insemination EN shared motherhood IVF poly parenthood lesbian motherhood gestational surrogacy gamete donation assisted reproduction IUI artificial insemination 777 779 3 05/04/23 20230501 NES 230501 The increasing accessibility of ART over the past 45 years has expanded the possibility for couples to have children genetically related to at least one parent despite infertility or a predisposition to passing on heritable genetic conditions. [Extracted from the article]

Surrogacy tourism in Asian countries has surged in recent decades due to affordable prices and favourable regulations. Although it has recently been banned in many countries, it is still carried out illegally across borders. With demand for surrogacy in developed countries increasing and economically vulnerable Asian women lured by lucrative compensation, there are efforts by guest countries to ease the strict surrogacy regulations in host countries. Despite a shift toward "altruistic surrogacy", commercial surrogacy persists. Recent research carried out by international organizations that seek to establish a legal relationship between the commissioning parents and children in cross-border surrogacy arrangements, under the guise of the "best interests of the child," appears to promote a resurgence of overseas commercial surrogacy rather than restrict it. Further commercialization of surrogacy should be prevented by carefully investigating the reality of the surrogacy process. [ABSTRACT FROM AUTHOR]

Study Question: How do surrogates think, feel, and reflect on their experiences of being a surrogate over time?, Summary Answer: Despite continuing to require physical, emotional, and interpersonal labour, surrogates in this study reflected positively on their experiences of being a surrogate decades later., What Is Known Already: Research on families created through surrogacy shows that it can be a positive experience for both the intended parents and the surrogate. No existing research has examined the experiences of surrogacy for surrogates beyond 10 years post-birth., Study Design, Size, Duration: Semi-structured, qualitative interviews were conducted with 21 women who had completed a total of 71 surrogacy arrangements. Participants had given birth to their first surrogate child on average 20 years previously., Participants/materials, Settings Methods: Data were collected about (i) surrogates' relationships with the families they had helped, (ii) how important being a surrogate was to their own identity, and (iii) how they felt surrogacy was perceived by the public. Data were analysed according to the principles of reflexive thematic analysis., Main Results and the Role of Chance: Surrogates' reflections on their experiences were constructed into two themes: (i) hard work but worth it and (ii) part of who I am. Surrogacy had taken a physical toll on some participants, and for most, being a surrogate continued to involve emotional labour and effort to maintain relationships with the families. Making friends through the process and feeling proud of what they had done to help someone meant that overall, surrogates reflected positively on surrogacy and had incorporated their experiences as surrogates into a stable aspect of their identity., Limitations, Reasons for Caution: There is a risk of selection bias, with surrogates who had a more positive experience being more likely to continue to participate in the research. All surrogacies occurred within the UK. While the sample is relatively diverse in terms of surrogates' ages, current employment status, and relationship status, the sample lacks ethnic diversity. Most participants had been surrogates for heterosexual couples, and thus long-term relationships involving gay couples or single men may differ., Wider Implications of the Findings: The findings from this study show the importance of understanding surrogacy as a 'relational' process and suggest to prospective surrogates and intended parents what they may expect from their relationship over time. Given the findings that even as the children grow up, being a surrogate continues to require emotional labour, support should be made available to surrogates over the longer term if required., Study Funding/competing Interest(s): This project was funded by the Wellcome Trust [grant number 208013/Z/17/Z] and the University of Cambridge Returning Carers Scheme. The authors have no competing interests to declare., Trial Registration Number: N/A., (© The Author(s) 2024. Published by Oxford University Press on behalf of European Society of Human Reproduction and Embryology.)

Despite associated risk and public concern, commercial surrogacy remains a thriving business, and opportunities for gestational surrogates continue to exist. Surrogacy arrangements have been found to place gestational surrogates at risk, with little support or guidance to help them understand or mitigate these risk factors. This study aims to investigate the self-perception of gestational surrogates through their reflection of their own risk-related behaviours throughout the surrogacy process. Data were retrieved through interviews with fifteen Thai women who had first-hand experience of commercial surrogacy, and thematic analysis was used to interpret the data. Findings showed that the perceptions of 'trust,' 'commitment to obligation,' and 'unacceptable actions' reflected their behaviours exposing risks to detrimental behaviours, disempowerment, and isolation. Understanding these perceptions would be advantageous for health planning programmes or policies in surrogacy practice to promote women's heath as a whole. [ABSTRACT FROM AUTHOR]

Objective: To examine the psychological impact of gestational surrogacy on surrogates' families.Background: ASRM practice committee guidelines recommend that psychological counseling prior to surrogacy include consideration of a surrogate's own family, but there has been little research to help guide mental health professionals (MHPs) providing implications counseling.Methods: Fifty-nine family members from 16 surrogate families were recruited and data were collected on family relationships, child psychological well-being, and family experiences of surrogacy. Family members filled out a series of questionnaires based on their age and role in the family system.Results: Participants included 16 surrogates (28 surrogate pregnancies) with an average time since first surrogate pregnancy = 2.93 years (range = 0-8 years). Overall, families of surrogates are functioning well across a number of psychological domains. There were some differences between surrogates and spouses regarding their perceptions of their children's experience. A small number of children reported negative emotions about surrogacy and more research is needed to identify which children may be at risk. Children reported surrogacy having a positive impact on their lives and endorsed both pride and excitement about their mother being a surrogate.Conclusions: There has been limited data to inform MHPs tasked with implications counseling prior to surrogacy in offering guidance to surrogates' family members to help prepare them for the experience. This data can be used by MHPs providing implications counseling to help facilitate discussions about the potential impact of surrogacy tohelp ensure positive psychological outcomes for surrogates and their family members. [ABSTRACT FROM AUTHOR]

Background: The Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome is the most common cause of uterine aplasia, with a worldwide frequency of 1 in 4500 females. Although abundant literature is present regarding the different available methods for creating a neovagina in MRKH syndrome, the attention dedicated to these women’s reproductive potential remains insufficient. Methods: Online searches were carried out in PubMed database during November and December 2020. The search included a combination of the various terms (e.g., MRKH, vaginoplasty, uterus transplantation, infertility treatment, gestational surrogacy, etc.). The following inclusion criteria were used: (1) The articles should be written in English or French language. (2) The article should have been published by an official scientific organization. Results: Until few years ago, the only option for women with MRKH syndrome was legal adoption, now gestational surrogacy (GS) and uterine transplantation (UTx) have become new fertility options available to these patients. Discussion: GS is officially recognized in several countries and widely practiced. On the other hand, UTx, although the great recent technical improvements, is far from being an option for all women with MRKH syndrome secondary to its complexity and the necessary immunologic therapies.

Potential risks and ethical considerations inherent in surrogacy arrangements place tremendous responsibility on mental health professionals performing the necessary assessments, yet there is little discussion and no consensus on the best testing protocol. In the U.S., the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) and the Personality Assessment Inventory (PAI) are the most common psychological measures used to screen gestational surrogates (GSs), although these self-report symptom inventories reveal tendencies to underreport, deny problems and present positive impressions that may conceal important clinical information. This study examines the utility of a multi-method approach in the psychological evaluation of GS candidates. A total of 43 women cleared to be GSs completed the PAI and an abbreviated protocol of a narrative construction assessment measure (The Thematic Apperception Test (TAT)) as part of the psychological screening process. Findings of the study show that utilising a multi-method approach in the psychological consideration of a GS can address the limitations inherent in a single-measure assessment approach. Including a narrative measure such as the TAT that is less affected by defensiveness found on self-report scales may allow for more subtleties in interpretation, helping assessors to identify women who may have particular psychological vulnerabilities. These might then be addressed through implications counselling. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to discuss about gestational surrogacy motherhood agreements from the point of view of feminist theories, and the way in which these statements are translated into arguments for or against a regulation. The final aim is to think the way in which this argument could be construed in order to create the required regulation in a context of legal vacuum and regulatory uncertainty. [ABSTRACT FROM AUTHOR]

A 20‐year‐old woman was diagnosed with an ovarian dysgerminoma on the right ovary and underwent fertility‐preserving right salpingo‐oophorectomy and staging. Eight months later she was found to have a left ovarian solid mass. She underwent controlled ovarian hyperstimulation and oocyte cryopreservation before total abdominal hysterectomy, left salpingo‐oophorectomy, and exploratory surgery were performed. The patient was optimally debulked, with no recurrent cancer to date. Thirty‐six oocytes were mature and cryopreserved using vitrification. Now, the patient's mother has undergone embryo transfer that resulted in a clinical pregnancy, acting as a gestational carrier, for her daughter. To our knowledge, this is the first case describing the uterine transfer of embryos into a gestational carrier where the embryos were generated using oocytes obtained through controlled ovarian hyperstimulation in the context of active ovarian cancer. In the appropriate clinical setting, women desiring future fertility with a diagnosis of ovarian cancer without the option of ovarian‐sparing surgery may be candidates for controlled ovarian hyperstimulation for the purposes of fertility preservation, especially if altruistic gestational carriers are available and willing. SYNOPSIS: A case report describing a patient's mother as an intergenerational gestational surrogate for an embryo created from oocytes retrieved from an ovary with dysgerminocarcinoma. [ABSTRACT FROM AUTHOR]

To evaluate the desire for parenthood and reproductive outcomes of young cervical cancer survivors who underwent fertility-sparing surgery or fertility preservation procedures for invasive cervical cancer. All women <45 years who underwent fertility-sparing treatment for invasive cervical cancer in a tertiary referral center in the Netherlands between January 2009 and January 2020 were identified. Fertility-sparing treatment options included Vaginal Radical Trachelectomy (VRT) for patients with early-stage disease and fertility preservation techniques (FP) when requiring Radical Hysterectomy (RH) or chemoradiotherapy. Data on reproductive intentions – and outcomes were retrieved from medical files and questionnaires. 75 patients were identified of whom 34 underwent VRT, 9 RH and 32 had (chemo)radiotherapy. 26 patients started FP of whom 23 (88.5%) successfully preserved fertility through cryopreservation of embryos, oocytes and ovarian tissue. After a median follow-up of 49 months, 5 patients developed recurrent disease and died. Reproductive outcomes were retrieved in 58 patients. 89.6% maintained their desire for parenthood after cancer treatment. Following VRT, we report a pregnancy rate of 61.9% among the patients attempting conception (n = 24). 15 patients conceived 21 pregnancies which resulted in 15 live-births, yielding a live-birth rate of 75.0%. Following RH or (chemo)radiotherapy, 3 surrogate pregnancies were established (21.4%) using frozen-thawed material with good neonatal outcomes. Many cervical cancer survivors maintain the desire to become parents eventually. In early-stage disease, VRT shows good reproductive outcomes without compromising oncological safety. For those requiring gonadotoxic treatment fertility preservation and gestational surrogacy provides a promising alternative for achieving a biological offspring. • The majority of cervical cancer survivors desiring fertility-sparing treatment, maintain their desire for parenthood after cancer treatment. • For patients with early-stage disease, vaginal radical trachelectomy shows good reproductive outcomes. • For patients requiring (chemo)radiotherapy, fertility preservation is successful in the majority of patients. • Gestational surrogacy with frozen-thawed material enables those without a (functional) uterus to have a genetic offspring. [ABSTRACT FROM AUTHOR]

Introducción. La existencia de mujeres españolas que optan por la subrogación transfronteriza como camino hacia la maternidad es una realidad, pues a pesar de considerarse legalmente nulo cualquier acuerdo de subrogación desarrollado en España, se contempla la inscripción en el Registro Civil de los nacidos por subrogación en países en los que la misma es legal. A pesar de ello, no existen apenas estudios españoles acerca de la experiencia vivencial de maternidad de dichas mujeres. Por ello, investigar la vivencia de las madres intencionales españolas, entendida como una forma más de maternidad, puede ser de interés para el desarrollo tanto de la matronería como de cualquier profesión relacionada con la atención maternal y perinatal. Objetivo. Realizar una aproximación comprensiva a la experiencia vivencial de las mujeres españolas no gestantes que optan por la subrogación como camino hacia la maternidad. Metodología. Se enfocó el estudio desde un punto de vista cualitativo, seleccionando como marco teórico la fenomenología interpretativa; se emplearon entrevistas en profundidad de tipo semiestructuradas, abiertas e individuales, alcanzando un tamaño muestral de 10 mujeres. Resultados: se identificaron 6 categorías emergentes, 24 temas y 2 subtemas. Discusión. Todas las participantes se mostraban satisfechas con su experiencia vivencial de maternidad. No obstante, se hace patente la carencia y necesidad de atención maternal, al demandarla las entrevistadas directa o indirectamente en los discursos. Los profesionales especialistas en Obstetricia y concretamente las matronas disfrutan de una posición única y privilegiada para ofrecer dicha atención maternal. Abstract Introduction. The existence of Spanish women who opt for cross-border surrogacy as a path to motherhood is a reality, because despite being considered legally void any surrogacy agreement developed in Spain, is contemplated the registration in the Civil Registry of those born by surrogacy in countries where it is legal. Despite this, there are hardly any Spanish studies on the life experience of motherhood of these women. For this reason, investigating the experience of Spanish intentional mothers, understood as another form of motherhood, may be of interest for the development of both midwifery and any profession related to maternal and perinatal care. Objective. To carry out a comprehensive approach to the life experience of non-pregnant Spanish women who choose surrogacy as a path to motherhood. Methodology. The study was approached from a qualitative point of view, selecting interpretive phenomenology as the theoretical framework; In-depth interviews of a semi-structured, open and individual type were used, reaching a sample size of 10 women. Results. 6 emerging categories, 24 topics and 2 subtopics were identified. Conclusions. All the participants were satisfied with their life experience of motherhood. However, the lack and need for maternal care becomes evident when the interviewees demand it directly or indirectly in the speeches. Professional specialists in Obstetrics and specifically midwives enjoy a unique and privileged position to offer such maternal care.

Interest in the future, clinical implementation of uterus transplantation for uterine factor infertility was recently boosted by the demonstration of proof-of-concept for deceased uterus donation/transplantation. The ethical dimensions of living and deceased uterus transplantation are explored and addressed in the paper through their comparison to the ethical elements of an existing, legal, assisted reproduction practice in some high-income countries, i.e., gestational surrogacy. A set of six ethics lenses is used in the comparative analysis: reproductive autonomy and rights, informed choice/consent, relevant critical relational theories, health equity, theoretical application of the accepted living donation standard, and comparative benefits and burdens considerations. Gestational surrogacy, as currently practiced in some high-income countries, is the assumed, theoretical base-threshold for determination of ethical acceptability in assisted reproduction practices. The analysis demonstrates that (at the present time): 1) the ethical acceptability of living uterus donation/transplantation is less than that of gestational surrogacy in high-income countries, and 2) the ethical acceptability of deceased uterus donation/transplantation is roughly equivalent to that of gestational surrogacy. This leads to the conclusion that, at the present time, only one version of uterus transplantation practice, i.e., deceased uterus transplantation, should be considered ethically acceptable for possible clinical implementation in high-income countries. [ABSTRACT FROM AUTHOR]

Legalization of altruistic gestational surrogacy not only gives infertile couples a chance to have their own child and prevent illegal acts of commercial surrogacy, but it also makes a positive impact to the national population structure by securing a stable total fertility rate. In general, the current legal framework on surrogacy is comprehensive and adaptable into to Vietnam's fine customs and traditions. However, there is still room for improvement. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Surrogacy gives hope to couples who are unable to carry child on their own. Single men, women and samesex couples can also opt surrogacy to have their own genetic child. Surrogacy has adjourned the practice of adoption by childless couples who can bear the cost of surrogacy. Recent past has witnessed the blooming of surrogacy clinics all over the world. Eligibility of surrogates, process, legality and expenses, involved in surrogacy, differ from country to country. Most of the countries do not have surrogacy regulating legislation in force. Few countries prohibit surrogacy, while some ban commercial surrogacy and permits altruistic one. Even international surrogacy is not allowed in some jurisdictions. Easy availability and low costs of surrogacy procedures in developing countries have made surrogacy a lucrative business. India developed into a hub of commercial surrogacy with no harsh laws, regulating surrogacy clinics. Even though commercial surrogacy has been banned, still lack stringent laws, governing surrogacy clinics in the country, creating a legislative vacuum. Legal and ethical issues surrounding the surrogacy are also complex, thereby making it difficult to differentiate whether surrogacy is a boon or bane. The need of the hour is to legalize altruistic surrogacy and prohibit commercial one. Till laws being enacted and appropriate monitoring authorities are instituted, one has to assess with his/her conscience what is right and where wrong begins. [ABSTRACT FROM AUTHOR]

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.

Abstract Background Gestational surrogacy is one of the options for women whom pregnancy is contraindicated. Despite of increasing demand for gestational surrogacy, its various aspects are controversial. The unique nature of surrogacy causes surrogate mothers to face a variety of problems such as, ethical confusion, psychological disturbance and reproductive health matters. Therefore, it is necessary to develop a comprehensive care program for reproductive and sexual health providing specific care at prenatal and pregnancy as well as delivery and postpartum period in socio- cultural context of Iran. Methods This research is an exploratory study with the qualitative-quantitative sequencing design (mixed) that is consisted of three sequential phases. In the first phase, following a qualitative approach, the researcher will explain needs of reproductive and sexual health in surrogate mothers. In the second phase, a primary reproductive and sexual health care program is designed for surrogate mothers in which, in addition to using the qualitative study results, related papers and texts will be also used. In the third phase of the study, reproductive and sexual health care program will be evaluated by RAND method (RAM). Discussion The results of this mixed method study are expected to lead to the development of a reproductive and sexual health care program meeting the needs of surrogate mothers and are in accordance with the cultural conditions of the research community, ultimately leading to improvement in reproductive and sexual health of surrogate mothers.

This article aims to explore some of the fundamental notions that connect the narrative of feminist emancipation to the experience of motherhood. It elucidates any inherent contradictions, appraises their implications for motherhood and assesses their respective salience today for feminist thought. It does so, in particular, by setting motherhood in a wider context where contradictions to feminist theory surface clearly: namely, through dialogues from empirical findings in contemporary motherhood studies and in the context of surrogacy and artificial reproductive technologies (ARTs). Ostensibly, one of the prominent tenets of classic feminism has been its disparaging view of motherhood as being the bastion of women's subordination in a patriarchal society – the corollary being that the emancipation of women could happen only through opposition to or, at best, despite motherhood. The first two sections of the article present classic concepts related to domestic life and motherhood that lambast institutions of male domination, still highly influential in shaping discussions of women's movements around the world. The third section focuses on feminism's controversy over the practice of surrogacy and contends that the epistemological distinction between giving birth and mothering posited by feminism actually legitimizes ARTs' continuing transformation of women's bodies into 'open access flesh'. This is the terrain on which today technology, not patriarchy, is erected. The fourth section surveys a range of vibrant, recent motherhood studies and reclaims the empowering capacity of motherhood at grassroots level, with wider implications. The conclusion raises the issue of 'mothering as empowerment' as a missing piece in the broader landscape of feminist theory, particularly in light of findings that there is a significant concurrence of values and practices characterizing how women with children self-define themselves, as both moral and social agents. [ABSTRACT FROM AUTHOR]

Gestational surrogacy is spreading across the world and it is increasingly accepted as an available way to make babies: the procreative process, the procurement of gametes, the recruitment of women and the relationships between the various subjects are administered by international agencies. At the same time there are signs of resistance such as transnational mobilizations calling for the universal ban of a practice that is viewed as a form of commodification of women and children. The author introduces the articles included in this monograph issue, which is an original contribution to a sociological understanding of an unprecedented social practice with peculiar characteristics: the presence of a new social actor, the surrogate woman, and the intentional separation of the newborn from the woman he or she identifies as their mother (although they are not genetically related). Because of these characteristics, surrogacy's impact on the social role and subjective experience of motherhood, its imaginary and narrative, as well as on the status of the child, is not comparable to other forms of assisted procreation and family formation. [ABSTRACT FROM AUTHOR]

Reproductive losses experienced by gestational surrogates, who do not share a genetic connection to the child they are carrying, may not be acknowledged or treated as compassionately as women who lose their "own" pregnancies. In-depth, semi-structured interviews were conducted with 17 gestational surrogates from diverse religious backgrounds. Grounded theory analysis of data included line-by-line coding, and emergent themes were identified. The results suggest that understanding and utilizing the religious/spiritual beliefs of a gestational surrogate may be one way for health professionals to provide implications counseling prior to surrogacy and also as a means to help process and grieve losses that may occur within surrogacy. [ABSTRACT FROM AUTHOR]