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2.1 There are two types of infertility: biological and social.

The first type arises from a situation in which a couple or individual cannot reproduce due to certain physiological problems.
The second type arises from a socially determined inability of certain groups of the population to become parents.
Furthermore, the birth of a child (whether to a couple or to a single parent) creates the vertical family, which is the real basis and structure of any stable society.
Given that infertility has been regarded for centuries as a “divine punishment”, childless people have traditionally been viewed as deficient. Infertility inevitably leads to moral suffering and a lower social status. The inability to have children is one of the main causes of divorce.

The most efficient method to overcome both biological and social infertility is surrogacy, sometimes implemented in addition to gamete – or embryo –donation programs.

Surrogacy is as old as human history itself. The first infertile couple in history are Abraham and Sarah and the first known surrogate mother was Hagar, their maid, who bore a child in about 1910 BC (Gen. 16.1 -15). Although Abraham was 86 at the time, he was still able to conceive. Ishmael was the first historically recorded child born as a result of traditional surrogacy.

The right to procreate should not depend on gender, family, or sexuality. It is a natural, inalienable right of any person to provide intergenerational continuity and the further evolution of Homo Sapiens.
One of the main principles of modern bioethics is that the interest and welfare of the individual should have priority over the sole interest of science or society (Universal Declaration on Bioethics and Human Rights 2005).
Refusing to allow childless people to become parents (when they can have children through surrogacy) means refusing to treat them equally and is a classic example of selective discrimination.
People who desperately want to become parents are excluded from reproduction and deprived of existing reproductive technologies.
This refusal represents both de facto and de jure systems of censorship and an instrument of oppression. It entails the physical destruction of people who would otherwise be able to become parents through surrogacy and represents a sort of genocide.

If something is wrong with surrogate children in their new families (just as in the case of children not born through surrogates), it is the job of society and social services to take care of them. This is not an appropriate reason to deny reproductive rights: “For everyone who asks, receives; and he who seeks, finds; and to him who knocks, it shall be opened” (Luke 11:10)

The legal status of surrogacy in modern times varies greatly from one country to another, with two main types of regulation. In the first one, surrogacy is regulated by legislation. In the second one, it is not mentioned in laws and thus is not regulated.

2.2 What is Surrogacy?

Surrogacy Is a Third Party Reproduction Technic.
The phrase “third party reproduction” refers to the use of eggs, sperm, or embryos that have been donated by a third person (donor) to enable an infertile individual or couple (intended recipient) to become parents.
Traditional surrogacy refers to a treatment in which a woman is inseminated with sperm for the purpose of conceiving for an intended recipient. “The surrogate has a genetic and biological link to the pregnancy she might carry.”
In contrast, a gestational surrogate (also called a gestational carrier or uterine carrier) is an individual in which embryos created by the intended parents are transferred into the surrogate’s uterus, which has been prepared hormonally to carry a pregnancy. “The gestational surrogate has no genetic link to the fetus she is carrying.”
Traditional surrogacy arrangements often are perceived as controversial with the potential to be complicated both legally and psychologically. Despite the requirement for in vitro fertilization (IVF) to create embryos, the utilization of a gestational surrogate, legally, is a lower risk procedure and is the most common approach conducted in the treatments recommended by Global Surrogacy Ltd.

2.3 Building families

When building your family through surrogacy, it is important that you consider issues like these:

Emotional reactions
You may have many emotions when thinking about using a surrogate or donated sperm or eggs to build your family. If you are the partner whose sperm or eggs are not being used (or you are unable to carry a baby), you may feel a sense of loss or sadness about not having a genetic link with your child. These feelings may be compounded by guilt or a sense that you have disappointed your spouse or partner. You should talk about your feelings with your spouse, doctor, and counsellor before going ahead.

Decision-making challenges
Deciding  whether to use a surrogate or donated sperm or eggs may be one of the most difficult decisions you will make in your life. If you have a spouse or partner who is not as comfortable with this option, or if you feel pressured to agree to it in order to please someone else, please wait and think things through. These kind of pressures might later lead to regrets and could have a negative impact on your relationship with your spouse or partner and any resulting child(ren).

Telling others
The  approach you take to telling others about donation or surrogacy details will depend on many factors, including your comfort level about sharing information. You may choose to discuss your decision with family and friends before undergoing fertility treatments. Or you may do so only after getting pregnant, or after birth. Keep in mind that as soon as your baby is born, friends or family members may comment on their level of physical resemblance to you or to other family members.

Legal issues
Your state or territory may have specific laws concerning the rights and responsibilities of donors, surrogates, and recipients. You should consider getting advice from a lawyer. Your fertility clinic may also be able to guide you.


Surrogacy as a Family Building Option
Families deserve thoughtful support from clinicians and organizations familiar with the dynamics of families created through gestational surrogacy in order to prepare for the journey ahead and support feelings that emerge throughout the process.
By Abby MacDonald, LICSW, Massachusetts General Hospital Fertility Center

With the recent surge of surrogacy in media and in celebrity magazines, those who consider building their families through gestational surrogacy now sense some legitimacy of this pathway to have the child (or children) for whom they have yearned.

However, media presentation of a complex paradigm creates a challenge. In broad form, media glosses over the practice, which minimizes or distorts the medical process and psychological adjustments a person or couple must make in building a family.

What makes gestational surrogacy a family building option for some?

The American Society of Reproductive Medicine (ASRM) supports surrogacy when there is a medical contraindication for parents to biologically reproduce and a gestational womb is required for genetic parenthood (for at least one of the intended parents).

It is essential to point out, however, that there are two forms of surrogacy – one of which is infrequently practiced in modern medicine.

We might call surrogacy the original form of assisted reproductive technology (ART).

The Judeo-Christian bible is full of stories in which a woman bares a child for another.

These surrogacy arrangements did not come with the technology, counseling or legal contracts from which we benefit today.
In today’s terminology, we would describe these pre-ART arrangements as “traditional surrogacy”– the person who carries the pregnancy bares a genetic relationship with the baby as well.
Since in “traditional surrogacy,” the surrogate is carrying her own biological child, the courts have examined the legality of a person “signing away her rights” prior to pregnancy (see the case of Baby M).
“Traditional surrogacy,” is a very uncommon option due to the psychosocial and legal complexities involved.
That being said, it is important to differentiate this type of controversial surrogacy to what is now commonly practiced, which is called “gestational surrogacy.”

Gestational surrogacy is one where the child has some genetic tie to the parents who will raise him or her, but the gestation occurred in another woman’s body. While the child has at least one point of genetic connection to the parents who will raise him or her, a sperm or egg donor may be used as well. This is accomplished through the stimulation of the intended mother (or donor’s) ovaries; at the same time the gestational carrier’s uterine lining is developed. When the time is right, an embryo is created (though the fertilization of the egg with the partner or donor’s sperm) and transferred to the gestational carrier.
We say it takes a village to raise a child, and in this case, it takes a village to create one.

Prior to pregnancy even occurring, the gestational carrier, her partner (if she has one) and the intended parents undergo extensive medical testing, psychological consultation, assessment and screening, and have consulted with reproductive attorneys, surrogacy agencies, insurance companies, and many hours of asking themselves, “Is this the right path for me?”

As someone who is regularly involved with the counseling of intended parents and gestational carriers, I am often amazed at the resilience and fortitude of all involved, and the mutual wonderment of each other’s roles in this unique formation of a family.

The logistics of managing a family-building process beyond the members of the family has to be examined.
We frequently visit the natural tension that is created when a process that may have once been considered intrafamilial (parent-child) becomes interfamilial (parent-child-gestational carrier and her family), and decisions that get made have to consider the health, safety and well-being of a third party.
The counseling that I offer couples who choose surrogacy as their family building option requires a careful examination of how their infertility has impacted them emotionally.
For many, we attend to the feelings of loss related to not having the experience of the intended mother carrying their baby.
For others, it may be a question of better understanding the experience of a carrier, and the needs and boundaries that are helpful to be mindful of in these arrangements. The common thread for most patients I see is worry about the process, pregnancy and parenting beyond surrogacy. This is best approached with open-hearted awareness of one’s feelings. Families deserve thoughtful support from clinicians and organizations familiar with the dynamics of families created through gestational surrogacy in order to prepare for the journey ahead and support feelings that emerge throughout the process.

About the Author
Abby MacDonald, LICSW is the clinical social worker for the Massachusetts General Hospital Fertility Center. In this role, she offers counseling, education and consultation to individuals and couples who need support related to their family building journey. In addition to her role at MGH, Abby has a private practice treating individuals and couples in Cambridge, MA.

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