Gestational surrogacy / Philippine Journal of Obstetrics and Gynecology

@#Some women may not be able to carry their own children even when capable of conceiving biological offspring. In-vitro fertilization and embryo-transfer (IVF-ET) through surrogacy can now make this possible for these women. Surrogacy however, is still considered unacceptable in the Philippines due to moral and legal issues. This article will explore the need and acceptability of surrogacy in this age of IVF-ET in a country where the prevailing social norms and religious values still disapprove of third-party assisted reproductive technology (ART). Medical indications that would benefit from gestational surrogacy were enumerated and briefly discussed. The differentiation between traditional and gestation surrogacy, as well as commercial and altruistic surrogacy were defined. IVF with gestational surrogacy is a feasible solution to a number of medical difficulties in the carrying of a gestation. Strictly regulating the practice and restricting its use only to cases with legitimate medical indications will prevent its misuse and exploitation. Moral issues, admittedly will still remain an issue particularly for commercial surrogacy. However, limiting these only to altruistic and gestational surrogacy in some cases may be an acceptable compromise.

Commercial Surrogacy: An Overview / Gestação de substituição comercial: Uma visão global

Abstract Objective Surrogacy is the process in which a woman carries and delivers a baby to other person or couple, known as intended parents. When carriers are paid for surrogacy, this is known as commercial surrogacy. The objective of the present work is to review the legal, ethical, social, and cultural aspects of commercial surrogacy, as well as the current panorama worldwide. Methods This is a review of the literature published in the 21st century on commercial surrogacy. Results A total of 248 articles were included as the core of the present review. The demand for surrogate treatments by women without uterus or with important uterine disorders, single men and same-sex male couples is constantly increasing worldwide. This reproductive treatment has important ethical dilemmas. In addition, legislation defers widely worldwide and is in constant change. Therefore, patients look more and more for treatments abroad, which can lead to important legal problems between countries with different laws. Commercial surrogacy is practiced in several countries, in most of which there is no specific legislation. Some countries have taken restrictive measures against this technique because of reports of exploitation of carriers. Conclusion Commercial surrogacy is a common practice, despite important ethical and legal dilemmas. As a consequence of diverse national legislations, patients frequently resort to international commercial surrogacy programs. As of today, there is no standard international legal context, and this practice remains largely unregulated.

Resumo Objetivo A gestação de substituição é o processo no qual uma mulher engravida e entrega um bebê a outra pessoa ou casal, conhecidos como pais pretendidos. Quando as gestantes são pagas, isto é conhecido como gestação de substituição comercial. O objetivo do presente trabalho é rever os aspectos legais, éticos, sociais e culturais da gestação de substituição comercial, bem como o panorama atual em todo o mundo. Métodos Trata-se de uma revisão da literatura publicada no século XXI sobre a gestação de substituição comercial. Resultados Um total de 248 artigos foi incluído nesta revisão. A demanda por tratamentos com gestação de substituição por mulheres sem útero ou com distúrbios uterinos importantes, homens solteiros e casais masculinos está aumentando constantemente em todo o mundo. Este tratamento reprodutivo tem dilemas éticos importantes. Além disso, a legislação é amplamente adiada em todo o mundo e está em constante mudança. Portanto, os pacientes procuram cada vez mais por tratamentos no exterior, o que pode levar a importantes problemas legais entre países com leis diferentes. A gestação de substituição comercial é praticada em vários países, na maioria dos quais não há legislação específica. Alguns países tomaram medidas restritivas contra esta técnica por causa de relatos de exploração destas mulheres. Conclusão A gestação de substituição comercial é uma prática comum, apesar de importantes dilemas éticos e legais. Como consequência de diversas legislações nacionais, os pacientes frequentemente recorrem a programas de gestação de substituição comercial internacionais. Atualmente, não existe um contexto jurídico internacional padrão e esta prática permanece em grande parte não regulamentada.

La maternidad subrogada: retos para el derecho en un mundo globalizado / Surrogacy: challenges for the law in a globalized world / Barriga de aluguel: desafios para o direito em um mundo globalizado

Hay información que los primeros estudios y los primeros nacimientos de niños concebidos mediante fecundación in vitro tuvieron lugar en el último cuarto del siglo XX, pero el primer caso de litigio relacionado con maternidad subrogada (Johnson v. Calvert) se registra a comienzos de los 90 en EE.UU., ante la Corte Suprema de California, esto quiere decir, que la práctica de la maternidad subrogada es relativamente reciente. Los primeros desarrollos jurídicos conocidos son en jurisprudencia; la regulación sobre la materia ha sido posterior. El problema de investigación gira en torno a la pregunta ¿Cuáles son los alcances y límites del Derecho en relación con la maternidad subrogada? Para responderla, se determinan los alcances y límites de intervención del Derecho en relación con la maternidad subrogada en un mundo globalizado. La investigación es teórica con enfoque cualitativo. El método adoptado es el si stémico-estructural-funcional. Aunque comienza haciendo una descripción y comparación entre ordenamientos jurídicos de tres países: Colombia, EE.UU. y España, identifica los elementos esenciales de la maternidad subrogada y termina explicando cómo estos elementos interactúan en el derecho y cómo el derecho interactúa con la ética y la política en el contexto de la maternidad subrogada hoy en día.

There is information that the first studies and the first births of children conceived through in vitro fertilization took place in the last quarter of the 20th century, but the first case of litigation related to surrogacy (Johnson v. Calvert) is registered at the beginning of the 1990s in the USA, before the Supreme Court of California, which means that the practice of surrogacy is relatively recent. The first known legal developments are in jurisprudence, the regulation on the subject has been later. The research problem revolves around the question: what are the scope and limits of the Law in relation to surrogacy? To answer it, the scope and limits of intervention of the Law in relation to surrogacy in a globalized world are determined. The research is theoretical with a qualitative approach. The method adopted is the systemic-structural-functional. Although it begins by making a description and comparison between legal systems of three countries: Colombia, USA and Spain, it identifies the essential elements of surrogacy and ends by explaining how these elements interact in the law and how the law interacts with the ethics and politics in the context of surrogacy today.

Há informações de que os primeiros estudos e os primeiros nascimentos de crianças concebidas por fertilização in vitro ocorreram no último quartel do século XX, mas o primeiro caso de litígio relacionado à barriga de aluguel (Johnson versus Calvert) foi registrado no início da década de 1990 nos Estados Unidos, perante a Suprema Corte da Califórnia, isso significa que a prática da barriga de aluguel é relativamente recente. Os primeiros desenvolvimentos legais conhecidos estão na jurisprudência, já a regulamentação sobre o assunto foi posterior. O problema desta pesquisa tratou da questão: quais são os alcances e limites da lei em relação à barriga de aluguel? Para respondê-la, foram determinados os alcances e limites de intervenção do direito em relação à barriga de aluguel em um mundo globalizado. A pesquisa desenvolvida foi teórica com abordagem qualitativa. O método adotado foi o sistêmico-estrutural-funcional. O artigo inicia descrevendo e comparando os sistemas jurídicos de três países: Colômbia, Estados Unidos e Espanha; em seguida, identifica os elementos essenciais da barriga de aluguel e termina explicando como esses elementos interagem no direito e como o direito interage com a ética e a política no contexto da barriga de aluguel atualmente.

Una perspectiva sobre la gestación subrogada: la dimensión metafísica del embarazo / A new perspective on surrogacy The metaphysical dimension of pregnancy

A lo largo de este trabajo ofreceré una visión general del fenómeno del turismo reproductivo y analizaré el impacto de la externalización de los recursos reproductivos con el objetivo de gestación subrogada y servicios de tecnologías de reproducción artificial. Me enfocaré luego en la concepción metafísica de la gestación subrogada, y cómo esta configura el marco legal para los acuerdos de la subrogación. Este razonamiento llevará a la evaluación de un enfoque autosuficiente, para abordar las consecuencias de las vicisitudes reproductivas, y de su teorización en ascenso, con el propósito de centrar la experiencia de la gestación subrogada en el contexto del mercado reproductivo

Through this work I will offer an overview of the phenomenon of reproductive travel and analyse the impact of the outsource of reproductive resources for the purpose of surrogacy and artificial reproductive technologies services. I will focus then on the metaphysical understanding of surrogacy, and on how it shapes the legal framework for surrogation agreements. This reasoning will lead to the evaluation of a Self-sufficient Approach, for tackling the consequences of reproductive travel, and of an Upstream Theorization, for the purpose of centring the experience of the gestational surrogate in the context of the reproductive market

subrogación en series: una narrativa sobre la metafísica del embarazo / Surrogacy in Series: A Narrative on the Metaphysics of Pregnancy

Se analizan dos series que, con diferencia de quince años, abordan el tema de la maternidad subrogada: Shameless y Little fires everywhere, con el foco en las cuestiones bioéticas y sociales involucradas en ellas. A partir de los relatos de apego entre la gestante y la persona nacida o por nacer, se pone a prueba el concepto de "metafísica del embarazo", tal como lo trabaja Suki Finn, ofreciendo un escenario novedoso para un tema complejo y controvertido

Two series are analyzed that, with a difference of fifteen years, address the issue of surrogate motherhood: Shameless and Little fires everywhere, with a focus on the bioethical and social issues involved in them. From the stories of attachment between the pregnant woman and the person born or unborn, the concept of "metaphysics of pregnancy" is examined, as Suki Finn works, offering a novel scenario for a complex and controversial issue

Cuando el cuerpo no puede / When the Body can't

En el presente trabajo nos proponemos visibilizar el padecimiento psíquico de las mujeres que atraviesan un cáncer ginecológico y que, además, deben hacer frente a la imposibilidad de gestar como consecuencia de la enfermedad. Y también reflexionar sobre el trabajo del psicólogo en este ámbito. Para cumplir con nuestro objetivo nos valdremos del episodio cinco de la segunda temporada de la serie televisiva estadounidense "New Amsterdam" (S2, E 5), estrenada en el año 2018 en Netflix, la plataforma de streaming estadounidense

In this paper we intend to make visible the psychological suffering of women who go through a gynecological cancer and who, in addition, must face the impossibility of gestating as a result of the disease. And also reflect on the work of the psychologist in this area. To meet our goal, we will use episode five of the second season of the American television series "New Amsterdam" (S2, E 5), premiered in 2018 on Netflix, the American streaming platform

Ethical and psychological issues of surrogacy / 四川精神卫生

The purpose of this article is to discuss the ethical and psychological issues of surrogacy. A lot of psychological issues will arise as a result of the many complicated and controversial difficulties in law， science， morality and public policy， and therefore a study of the ethical and psychological issues of surrogacy will contribute to a better understanding and management of these issues.

Infertility & assisted reproduction: A historical & modern scientific perspective

Infertility has always been considered as a social stigma and has often been treated as socially, mentally and physically damaging experience for the childless women rather than man. Fatherhood was more a social rather than biological concept, thereby making childlessness a legitimate ground for divorce and a matter of disgrace for women. Every country has its own set of customs and traditional beliefs for the relief of childlessness. While introducing a second wife was one way to overcome the predicament of childlessness, divorce was also an available choice. There were several myths that contemplated the human concerns and their needs during ancient times. It is evident that types of the infertility and their treatment in the modern era have some historical background and different representations in the ancient civilizations. The present review discusses the historical and modern perspectives of infertility and assisted reproduction and their importance in different cultures.

Possible Risk Analysis of Surrogacy and Legislative Proposals / 中国医学伦理学

Objective: To better understand surrogate technology,so as to enable surrogacy to be used more or-derly,rationally and legitimately in Chinese society as one of human assisted reproductive technologies.Methods:Through literature retrieval and other methods,this paper analyzed the possible risks of surrogate behavior at various stages.Results: China explicitly prohibited surrogacy,but surrogacy existed objectively.The risk of surrogacy ex-isted in the entire process of surrogacy,and the risks varied in different stages.There lacked perfect legal protec-tion for the rights and interests of all parties.Conclusion: It is not effective to ban surrogacy negatively in order to avoid ethical and legal disputes,and surrogacy is often illegal for many times.It should only formulate the authori-tative laws actively to respond to surrogacy issues,standardize the ethical principles of surrogacy,access condi-tions,and illegal punishment,and fundamentally deal with possible risks so as to effectively protect the rights and interests of all parties of surrogacy.Therefore,the introduction of the legislative regulation on surrogacy should not be delayed.

Investigation and Ethical Analysis on Surrogacy / 中国医学伦理学

Objective:To investigate the current situation of surrogate in China,analyze the reasons,and then provide effective suggestions and countermeasures.Methods:A questionnaire survey was conducted among medical staff and patients in an institution with assisted reproductive technology (ART),combining literature review and sociological research methods such as data maps,to explore and analyze the surrogacy.Results:The number of institutions with ART increased rapidly and its regulation became difficult.More surrogate network was observed in first-tier cities as well as the eastern and southeastern coastal provinces.That respondents agreeing with surrogacy was quite serious in some provinces.The reasons of surrogate were patients' needs,social concepts,weak government supervision,and so on.Conclusions:It should improve the laws of ART,explore long-term supervision mechanism,strengthen the management of internet,shield the information about surrogate,enhance medical ethics education for ART staff,and guide the infertility patients to establish the correct ethical concepts.

The Controversy of Surrogacy and its Ethical Analysis under the Perspective of Population and Social Vicissitude / 中国医学伦理学

With the aggravation of population aging and the change of social convention,especially after the introduction of two-children policy,some families wish to have two children can not be achieved due to various reasons.Therefore,they use assisted reproductive technology to achieve fertility aspirations.Surrogate is a controversial topic in the assisted reproductive technology,the contradictions between the normal reproductive rights of the infertile woman and the women who have lost their children but passed the age of childbearing and the bad ethical consequences and rights disputes of surrogacy.How to avoid the bad ethical consequences and meet the demand of reasonable surrogate is the major issue worthy to be discussed.

Surrogacy World’s Perspective – A Review.

Nowadays surrogacy is a process practiced in many countries of the world and spark a deep interest in many couples that consider it as the only way to realize their dream to have a family.This article focuses on the increasing conclusion of international surrogacy agreements as a consequence of the different countries’ approaches, and aims to provide analysis of the different attitudes shown, specifically, by the Italian, Californian, Indian and English legal system. The article highlights the importance of the protection of human rights of people involved in surrogacy process underlining that,in particular with regard to the unborn child, it will be the best interest of the child to represent the guiding principle.

Late Presentation of Mayer-Rokitansky-Kuster-Hauser Syndrome in the Tropics-Northern Nigeria.

Mayer-Rokitansky-Kuster-Hauser syndrome is a congenital malformation characterized by failure of the mullerian duct to develop, resulting in missing of the uterus and upper part of the vagina in women showing normal development of secondary sexual characteristics and a 46, XX karyotype. It is the second most common cause of primary amenorrhea after Turner’s syndrome. A 30 year old nulliparous lady who has been married for 13years presented with history of primary amenorrhoea. Examination revealed a young lady, with normal female pubic and axillary hair distribution, and breast was at tanner stage 4. Pelvic examination showed a normal sized clitoris, labia majora and minora, normal urethra, and blind ended vagina extending to about 7cm. Abdomino-pelvic USS revealed both kidneys normal in position and size, hypoplastic uterus measuring 1.05cm in anteroposterior diameter, left adnexium and pouch of Douglas were normal. Buccal and peripheral blood smear show Barr bodies and drumstick appendages suggested karyotype is XX. She subsequently had diagnostic laparoscopy which revealed a streak of thickened ligament at the position of the uterus. Both ovaries and their ligaments were visualised with a follicular cyst on the right ovary. We made a diagnosis of mullerian agenesis. The couple were counselled and the poor prognosis for fertility explained since they did not seem to have significant problem with intercourse. Gestational surrogacy is a viable treatment option for patients with Rokitansky syndrome and was offered to this patient, but couldn’t afford it due to the prohibitive cost of the procedure.

Demographic Profile of Travellers Seeking Reproduction Tourism Services.

Reproductive medical tourism is by some accounts a multibillion dollar industry globally. Transnationally, it involves the travel between nations of individuals seeking assisted reproductive technologies in foreign countries. Through a structured literature review, we identified the demographic characteristics of those seeking these services. Data from 14 peer-reviewed studies were synthesized. Most studies described travel within Europe, with Belgium being the destination most often cited. Key findings include that those travelling for reproductive purposes are typically over 35 years of age, likely to selfidentify as homosexual, bisexual or transgendered. The most frequently mentioned reason for travel was the lack of appropriate services in the home country.

The Subrogacy Trap

En el presente nos dedicamos a analizar el tema de la “maternidad subrogada” y los avatares para las dos partes involucradas en el marco de una relación que se regula mediante la firma de un contrato comercial. La acción nos deja abierta la posibilidad de cuestionar el impacto de la Maternidad Subrogada sobre la función materna, el deseo materno, partiendo de la premisa de que la llamada Industria de la Fertilidad cuenta con un poder capaz de instituir un nuevo tipo de subjetividad al interior de la misma, desdoblándola al someter a los cuerpos deseantes a la lógica impuesta desde el mercado a través de su agente: el consumidor...

In this paper, we address the issue of the "Surrogate Motherhood", by analyzing the film "The Subrogacy Trap". Using it as "empirical evidence" we analyze the complexity of the phenomenon and its impact on the two parties involved in a context that is that of a relationship regulated by the signing of a commercial contract: the "contracting parents", and the "surrogate mother". The action of the film opens up to us the possibility of questioning the impact of this particular practice on key human symbolic institutions, like the "maternal function", and the "maternal desire", but also over the bodies, the material and symbolic body of a person. We based our conclusions on the premise that the so called "Fertility Industry " has the power to impact directly on them by establishing new kinds of subjectivities inside these symbolic institutions. Also, this same power tends to subdue the desiring bodies, transforming them into commodities, with the help of coercive technologies/tools, imposed from a logic that answers that of the global political-economy of our time, through his main agent: the consumer.

Assisted Reproduction and Cross-Border Maternal Surrogacy Regulations in Selected Nations.

Aims: To ascertain the laws and policies of selected high income countries, with respect to the disposition of their citizens seeking assisted reproductive technologies (ARTs) internationally. Study Design: Literature review. Methodology: PubMed, Scopus and Google of various ART terms with terms relating to regulations in the selected nations of Australia, Canada, New Zealand, the UK, the USA, and Israel. Results: All nations except the USA have a federal ART regulatory presence, distinguish between gestational and traditional surrogacy, and between paid and unpaid surrogacy. Policies concerning the repatriation of children produced by ART abroad vary widely. Conclusions: Heterogeneous regulations are one of the drivers of the global reproductive tourism industry. Domestic regulations are likely affected by both the values of a specific population and the needs of the industry.

Surrogacy and women's right to health in India: Issues and perspective.

The human body is a wonderful machine. The future of child birth in the form of test tube babies, surrogate motherhood through new reproductive and cloning technology will introduce undreamt of possibilities in the sexual arena. Surrogacy is a method of assisted reproduction whereby a woman agrees to become pregnant for the purpose of gestating and giving birth to a child for others to raise. In some jurisdictions the possibility of surrogacy has been allowed and the intended parents may be recognized as the legal parents from birth. Commercial surrogacy, or "Womb for rent", is a growing business in India. In our rapidly globalizing world, the growth of reproductive tourism is a fairly recent phenomenon. Surrogacy business is exploiting poor women in country like India already having with an alarmingly high maternal death rate. This paper talks about paternity issues and women's right to health in context of surrogacy. Government must seriously consider enacting a law to regulate surrogacy in India in order to protect and guide couples going in for such an option. Without a foolproof legal framework, patients will invariably be misled and the surrogates exploited.

Current issues on a standard for surrogate pregnancy procedures / 대한생식의학회지

While Korea does not have any legal statement on surrogacy, treatments are carried out in practice. As a result, every Institutional Review Board (IRB) of each fertility clinic faces an ethical predicament in reviewing each case. There is a need to arrange the institutions' own standards of surrogate pregnancy procedures before the establishment of national or professional regulation. This article examines the legal, social, and medical issues of surrogacy to help IRBs to judge their cases.