1. surrogacysurrogacy VAHID F MD 2006-1385 2006-1385

2. Definitions Natural surrogacy or partial surrogacy Gestational surrogacy, full surrogacy, or IVF surrogacy Genetic couples, commissioning couple or intended parents. Surrogacy host Natural surrogacy or partial surrogacy Gestational surrogacy, full surrogacy, or IVF surrogacy Genetic couples, commissioning couple or intended parents. Surrogacy host

3. IndicationIndication 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 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

4. CounselingCounseling

5. for the Genetic couples a review of all alternative treatment options a review of all alternative treatment options the need for counseling the need for counseling the need to find their own host(UK) the need to find their own host(UK) the practical difficulty and cost of treatment by gestational surrogacy the practical difficulty and cost of treatment by gestational surrogacy the medical and psychological risks of surrogacy the medical and psychological risks of surrogacy a review of all alternative treatment options a review of all alternative treatment options the need for counseling the need for counseling the need to find their own host(UK) the need to find their own host(UK) the practical difficulty and cost of treatment by gestational surrogacy the practical difficulty and cost of treatment by gestational surrogacy the medical and psychological risks of surrogacy the medical and psychological risks of surrogacy

6. potential psychological risk to the child potential psychological risk to the child the chances of having a multiple pregnancy 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 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 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 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 possibility that the host may wish to retain the child after birth the importance of obtaining legal advice the importance of obtaining legal advice potential psychological risk to the child potential psychological risk to the child the chances of having a multiple pregnancy 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 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 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 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 possibility that the host may wish to retain the child after birth the importance of obtaining legal advice the importance of obtaining legal advice

8. FOR THE HOST The full implications of undergoing treatment by IVF surrogacy The full implications of undergoing treatment by IVF surrogacy The possibility of multiple pregnancy The possibility of multiple pregnancy The possibility of family and friends being against such treatment 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 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 The normal medical risks associated with pregnancy and the possibility of caesarian section The full implications of undergoing treatment by IVF surrogacy The full implications of undergoing treatment by IVF surrogacy The possibility of multiple pregnancy The possibility of multiple pregnancy The possibility of family and friends being against such treatment 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 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 The normal medical risks associated with pregnancy and the possibility of caesarian section

9. Implications and feelings of guilt on both sides if the host should spontaneously abort a pregnancy 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 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 The possibility that the child may be born with a handicap Implications and feelings of guilt on both sides if the host should spontaneously abort a pregnancy 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 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 The possibility that the child may be born with a handicap

10. How and when to tell the child How and when to tell the child Breast feeding Breast feeding How and when to tell the child How and when to tell the child Breast feeding Breast feeding

11. Relationship of genetic mothers to surrogate hosts. Relations Relations Sister to sister 35% Sister to sister 35% Sister to sister in law 20% Sister to sister in law 20% Stepdaughter to stepmother 5% Stepdaughter to stepmother 5% Friends to friends 15% Friends to friends 15% Through an organization 25% Through an organization 25% Relations Relations Sister to sister 35% Sister to sister 35% Sister to sister in law 20% Sister to sister in law 20% Stepdaughter to stepmother 5% Stepdaughter to stepmother 5% Friends to friends 15% Friends to friends 15% Through an organization 25% Through an organization 25%

13. ResultsResults Live birth rate = 37 – 43% per genetic couple Live birth rate = 37 – 43% per genetic couple  prematurity  prematurity  low Birth weight  low Birth weight Lower rate of PIH and third trimester bleeding Lower rate of PIH and third trimester bleeding Spontaneous abortion 40%. Spontaneous abortion 40%. Live birth rate = 37 – 43% per genetic couple Live birth rate = 37 – 43% per genetic couple  prematurity  prematurity  low Birth weight  low Birth weight Lower rate of PIH and third trimester bleeding Lower rate of PIH and third trimester bleeding Spontaneous abortion 40%. Spontaneous abortion 40%.

14. ComplicationsComplications The host may wish to keep the child. The host may wish to keep the child. An abnormal child may be rejected by both genetic and host parents. 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 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 effects on the children born as a result of gestational surrogacy are not known. The host may wish to keep the child. The host may wish to keep the child. An abnormal child may be rejected by both genetic and host parents. 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 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 effects on the children born as a result of gestational surrogacy are not known.

15. The long term psychological effect on both the “genetic couple” and “host surrogates” is 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. A few of “genetic women” have responded poorly to follicular stimulation. The follicular responses of women with the Rokitansky-Kuster-Hauser syndrome were good. The follicular responses of women with the Rokitansky-Kuster-Hauser syndrome were good. The long term psychological effect on both the “genetic couple” and “host surrogates” is 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. A few of “genetic women” have responded poorly to follicular stimulation. The follicular responses of women with the Rokitansky-Kuster-Hauser syndrome were good. The follicular responses of women with the Rokitansky-Kuster-Hauser syndrome were good.