Surrogate Motherhood and IVF

1. Surrogate Motherhood and IVF Presentation by: MaryRose Meany, Derek Mullen, Alicia Panko, Amanda Roseberry, and Kimberly Ruel. Voice Thread Link: http://voicethread.com/share/2566545/

2. Surrogate Motherhood and IVFBrief Overview • IVF has been around only since the 1970s, but the idea of one woman bearing a baby for another is as old as civilization. • Surrogacy was regulated in the Code of Hammurabi, dating from 1800 B.C., and appears several times in the Hebrew Bible. • Global debate.

3. Types/options available • Artificial insemination (AI) • In vitro fertilization/Embryo transfer (IVF/ET) • In vitro fertilization with an egg donor (IVF/ED) • Artificial Insemination by Donor (AID)

4. In Vitro Fertilization • IVF is fertilization that takes place outside the body; in a glass dish, and the fertilized embryo or embryos are placed into the uterus. • The first IVF baby (Louise Joy Brown) was born in 1978. This technology has made substantial progress over the last 32 years (O’Connell 55).

5. Louise Brown • Mother underwent IVF due to blocked fallopian tubes. • Conceived in laboratory dish, then implanted in her mother. • Procedure was developed by Patrick Steptoe and Robert Edwards. • IVF • Had a normal childhood.

6. Why IVF? • Damaged Fallopian tubes • Severe endometriosis • Immune problems • Unexplained infertility • Could be the man or the woman • Older women

7. Typical Procedure for IVF Treatment • Ensure a good egg supply • Visiting the clinic daily for the next week • Collecting the eggs for IVF

8. IVF Procedure Continued. • Confirming Conception

9. IVF Procedure Continued.

10. Donors • Donor insemination • Egg Donation • Embryo Donation • Surrogate mothers • Full surrogacy • Partial surrogacy

11. Donor Insemination • Can use when: • The male partner is sterile or has very low sperm count. • The male carries a hereditary abnormality • Mature, single woman wants a child, but not a partner • The male partner may feel inadequate or jealous.

12. Donor Continued • Feelings may affect the couples life together, and the child once it is born. • Some women dislike the idea of using another man’s sperm to become pregnant. • Donors DO NOT have the right to anonymity.

13. Egg Donation • If the woman is infertile, donor eggs may be used in IVF. • Partner fertilizes the egg, and the woman will carry and give birth to the baby. • Hormonal drugs are used

14. Egg Donation Continued • Eggs are collected from donor via surgical techniques. • Main donors are usually relatives, unrelated donors, and IVF patients who may donate extra eggs produced during their treatment. • Donors DO NOT have the right to anonymity.

15. Embryo Donation • A couple who have been through IVF treatment may sometimes donate frozen, unused embryos to a childless woman. • Embryo is implanted and the woman gives birth to the child.

16. How it all Begins…

17. Benefits of IVF • Provides an opportunity for infertile couples to conceive a child of their own. • In vitro fertilization (IVF) is the most efficient way to treat infertility, with 34% successful conceptions and 28% live births (Konstantinidis 110).

18. Complications/risks associated with IVF • Highest risk for multiple pregnancies. • “Newborns conceived in this manner show poorer perinatal outcome, probably due to higher incidence of multiple pregnancies, possible adverse effects of IVF techniques and infertility” (Konstantinidis 110). • Premature & low birth weights • Ectopic pregnancies

19. Complications Continued • Ovarian hyper-stimulation syndrome (OHSS) • Link between IVF treatment and cancer, specifically ovarian and breast (O’Connell 54). • IVF failures resulting in grief are common. “Women with infertility may have higher negative psychoemotional experiences in their life than women without infertility” (Lee 507). • High cost of treatment

20. Surrogacy • Surrogate mother: a woman who bears a child on behalf of another. • Full surrogacy: a surrogate mother conceives/carries the child for an infertile woman. Insemination from the partner can be indirect or direct. • Partial surrogacy: an egg from the woman who is unable to conceive is fertilized with her partner’s sperm and is implanted into the surrogate mother’s uterus.

21. Surrogate Mothers • “Much of Europe bans the practice, and 12 states, including New York, New Jersey and Michigan, refuse to recognize surrogacy contracts” (Ali 2008). • Development of laws

23. Soft Law • This law will not only protect the surrogate but also enhance her autonomy • “‘Soft law’ is that part of law concerned not with crimes and torts but instead with permissions” (Damelio and Sorenson 2008). • This law will provide a class for those woman still interested in having surrogacy contracts • Past surrogate experience • Process of surrogacy • Contract policies

24. Needs for Surrogacy • Why would women want another woman to carry their child? • Unable to conceive • Self-obsessed, shallow New Yorkers to avoid stretch marks • International couples who turned to America

25. Why Be a Surrogate? • Many military wives have taken on roles as surrogate mothers to supplement the family income, some while their husbands are serving overseas. • Several agencies reported a significant increase in the number of wives of soldiers and naval personnel applying to be surrogates since the invasion of Iraq in 2003.

26. Benefits Of Surrogacy • One reason for the rise in surrogacies is that technology has made them safer and more likely to succeed. Some clinics now boast a 70 to 90 percent pregnancy success rate--up 40 percent in the past decade. • Embryologists can now inject a single sperm directly into the egg. The great majority of clinics can now test embryos for genetic diseases before implantation. RicRoss, lab director at La Jolla IVF in San Diego, says these advances have helped "drop IVF miscarriage rates by 85 percent.”

27. Benefits Continued • All surrogates agreed that the grueling IVF treatments, morning sickness, bed rest, C-sections and stretch marks were worth it once they saw their intended parent hold the child, or children (multiples are common with IVF), for the first time. "Being a surrogate is like giving an organ transplant to someone," says Jennifer Cantor, "only before you die, and you actually get to see their joy.” • That sense of empowerment and self-worth is one of the greatest rewards surrogate mothers experience. "I felt like, 'What else am I going to do with my life that means so much?' " says Amber Boersma, 30, of Wausau, Wis. Another stay at home mom surrogate mother stated: "Some people can be successful in a major career, but I thought I do not want to go through this life meaning nothing, and I want to do something substantial for someone else. I want to make a difference."

28. The Risks • Giving up the baby: Most gestational carriers say it is still the hardest part of the job, and some have a rougher time than others. Gina Scanlon recalls the days after: "When you go home it's so quiet, the crash comes. It's not the baby blues. It's not postpartum depression. It's that the performance is over. I was practically a celebrity during the pregnancy--someone was always asking me questions. After I had them, no one was calling. Now nobody cares. You're out. You're done. It's the most vain thing. I felt guilty and selfish and egotistical."

29. Lifestyle Considerations • It is expensive for a couple to hire a surrogate mother • “Typically, surrogacy agreements in the United States involve payments of $20,000 to $25,000 to the woman who bears the child” (Ali and Kelley 2008) • Religion is a major influence amongst people in the world today and can influence whether or not a person will hire a surrogate mother • There is also a debate amongst religious groups about whether a assisted reproduction is appropriate • Christian and Islamic religions all oppose surrogacy • Judaism states “Full surrogacy is permitted only when the gametes are provided by both parties of the commissioning couple (CC), who are married according to the law of the country” (Schenker 2005)

30. Pros and Cons • Pros: surrogacy allows couples who cannot have due to reasons such as infertility, the experience of having a child. • Cons: It can be difficult for surrogate mothers when it comes time to part with the child they carried. It may be considered exploitation of women who are not economically strong.

31. Complications • The surrogate mother may not want to part with the child after she carried it for 9 months. • Wants visitation rights. • Developmental problems in the child.

32. Ethical Issues • Religion, especially Roman Catholics, are against this. • Many conservative Christians decry the practice as “tampering with the miracle of life” • Some medical ethicists describe the process of arranging surrogacy as "baby brokering,” • Much of Europe bans the practice. • Some states recognize surrogacy, and others forbid it.

33. Ethical Issues Continued • Lack of maternal connectivity with pregnancy • Eventually lead to “designer babies” • The perfect human • Playing God • Surrogate mother attachment • Depersonalizing an intimate aspect of human life

34. Conclusion • Surrogate motherhood is still a debatable and complex issue. • If indefinitely brings happiness and joy to a couple that is unable to conceive a child. However, this joy is countered by exploiting another person. • While the IVF experience requires a lot of time, taking a lot of medication, is expensive, and emotionally trying, the couples that are able to conceive a healthy child, report it is all worth it.

35. References • Ali, L. (2008). The Curious Lives of Surrogates. (cover story). Newsweek, 151(14), 44-51.http://web.ebscohost.com.library.norwich.edu/ehost/detail?sid=5bbf0d25-366d-44f7-ab40-89bd39f67bd8%40sessionmgr15&vid=4&hid=8&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=c8h&AN=20099 12237 • Clark, P. (2009). Embryo donation/adoption: medical, legal and ethical perspectives. Internet Journal Of Law, Healthcare & Ethics, 5(2), 2http://web.ebscohost.com.library.norwich.edu/ehost/detail?vid=8&hid=8&sid=5bbf0d25-366d-44f7-ab40-89bd39f67bd8%40sessionmgr15&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=c8h&AN=2010255621 • Cohen, C. (2008). Some perils of "waiting to be born": fertility preservation in girls facing certain treatments for cancer. American Journal Of Bioethics, 8(6), 30-32. • Damelio, J., & Sorensen, K. (2008). ENHANCING AUTONOMY IN PAID SURROGACY. Bioethics, 22(5), 269-277. doi:10.1111/j.1467-8519.2008.00629.x • Daniel, L. (2008). Unnatural selections.British Journal of Midwifery, 16(6), 395.Retrieved from EBSCOhost on 06 October 2011. • Dodsworth, C., Toth-Fejel, T., &Stangebye, Z. (2008). For what we do, and fail to do. American Journal Of Bioethics, 8(7), 29-31. • Kharb, D. (2007). Assisted reproductive techniques ethical and legal concerns.Internet Journal of Law, Healthcare & Ethics, 4(2), Retrieved from EBSCOhost.http://web.ebscohost.com/ehost/detail?sid=2a9a132b-4e30-4da3-81c3-ebea9e369632%40sessionmgr14&vid=12&hid=25&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=c8h&AN=2009541221 • Konstantinidis, G., Spasojevic, S., &KosticTodorovic, M. (2010). Newborns from in vitro fertilization conceived pregnancies. Journal Of Maternal-Fetal & Neonatal Medicine, 23110-112. doi:10.3109/14767058.2010.509930. • Lee, S., Wang, S., Kuo, C., Kuo, P., Lee, M., & Lee, M. (2010).Grief responses and coping strategies among infertile women after failed in vitro fertilization treatment. Scandinavian Journal Of Caring Sciences, 24(3), 507-513. doi:10.1111/j.1471-6712.2009.00742.x. • Marino, T. (2008).Natural embryo loss -- a missed opportunity. American Journal Of Bioethics, 8(7), 25-27.

36. References Continued • O'Connell, N. (2010). Are women of all ages now pinning too much hope on IVF?.Nurse Prescribing, 8(2), 54-56. • Ord, T. (2008). The scourge: moral implications of natural embryo loss. American Journal Of Bioethics, 8(7), 12-19. • Parks, J. (2010). Care of Ethics and the Global Practice of Commercial Surragacy.Bioethics, 24(7), 333-340. doi:10.1111/j.1467-8519.2010.01831.x http://web.ebscohost.com/ehost/pdfviewer/pdfviewer?vid=14&hid=25&sid=2a9a132b-4e30-4da3-81c3-ebea9e369632%40sessionmgr14 • Raymond, J. (1990). Reproductive gifts and gift giving: The altruistic woman. Hastings Center Report, 20(6), 7.Retrieved from EBSCOhost.http://web.ebscohost.com/ehost/detail?vid=22&hid=25&sid=2a9a132b-4e30-4da3-81c3ebea9e369632%40sessionmgr14&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=c8h&AN=2009455062 • Savulescu, J., &Goold, I. (2008).Freezing eggs for lifestyle reasons.American Journal Of Bioethics, 8(6), 32-35. • Schenker, J. G. (2005). Assisted reproductive practice: religious perspectives. Reproductive Biomedicine Online, 10(3), 310-319. • Sophonsritsuk, A., Choktanasiri, W., Weerakiet, S., &Rojanasakul, A. (2005).Comparison of outcomes and direct cost between minimal stimulation and conventional protocols on ovarian stimulation in in vitro fertilization.Journal Of Obstetrics &Gynaecology Research, 31(5), 459-463. • Surrogate Mothers, Inc. (1984-2003).  Comparison of Options. Available.<http://www.surrogatemothers.com/options.html>. • Su, T., & Chen, Y. (2006).Transforming hope: the lived experience of infertile women who terminated treatment after in vitro fertilization failure. Journal of Nursing Research (Taiwan Nurses Association), 14(1), 46-53. Retrieved from EBSCOhost. • Zoloth, L., Backhus, L., & Woodruff, T. (2008).Waiting to be born: the ethical implications of the generation of "NUBorn" and "NUAge" mice from pre- pubertal ovarian tissue. American Journal Of Bioethics, 8(6), 21-29.