Surrogacy

Supporters and opponents

There are constant disputes around surrogacy. On one side of the barricades are supporters of the use of surrogacy. For the most part, these are doctors whose duty it is to treat and help patients. On the other hand, there are opponents of surrogacy, who consider this practice immoral and immoral.

At the same time, most of the opponents have no idea what surrogacy is for, and how the technique works. The employees of the PR BAR communication agency asked Daria Valentinovna Shirokova, a reproductologist, a doctor of the highest category, the chief physician of the Art-Ivf reproductive health clinic, to tell about what surrogacy really is.

What is surrogacy and what is it for

Surrogacy is a method of medical care in which a woman who is unable to bear a child gets such an opportunity at the expense of another woman's healthy organ. At the same time, the need to use surrogate motherhood is not due to a whim at all, but to a number of diseases and malformations in the female body that exclude pregnancy naturally.

We are talking about absolutely legal treatment that does not go beyond the law. Our clinic and all medical organizations that help patients become parents with the help of reproductive technologies operate strictly within the legal framework. The norms on surrogacy are clearly spelled out in Article 55 of the Law "On the Basics of Protecting the Health of Citizens in the Russian Federation" dated November 21, 2011. In addition, in our work we rely on the Order of the Ministry of Health of the Russian Federation No. 107 dated 30.08.2012, where there are indications for the use of surrogacy and requirements for the examination of surrogate mothers.

For reproductive doctors, the question "Why do we need surrogacy?" sounds as strange as the question "Why do we need to treat a heart defect?" would sound for a cardiologist, and for a transplant specialist - "Why do we need organ transplantation?".

The answer to the question for a cardiologist and a transplant specialist is simple – to cure a person and give him the opportunity to live a healthy life. The answer to the question for a reproductologist is so that a person can raise their own children and create a healthy family. From this point of view, the claims that the practice of surrogacy is immoral and "potentially destructive to the institution of the family" sound at least strange.

The need to resort to the help of a surrogate mother arises if there are pathologies in the body of the expectant mother that lead to malformations of the female genital organs, if there are gynecological and general diseases, or if a woman has undergone surgery that does not allow carrying a child in the future. These contraindications are known to all doctors who have received medical education at the institute.

Aplasia, or a malformation in the female body associated with the absence of a uterus, is called the Rokitansky-Kustner syndrome. Unlike a heart defect, which is diagnosed in a child in the first days of life, a malformation of the uterus in a girl is determined later, in adolescence. This is a medical pathology that is quite fixable through the use of surrogate motherhood.

Diseases that do not allow carrying a child may be associated with acquired gynecological or general diseases, including heart disease – because of it, a woman even risks dying during childbirth.

In addition, Order No. 107n prescribes indications for the use of a surrogate mother, including "three or more unsuccessful IVF attempts." That is, the embryos obtained as a result of the IVF program and transferred to the uterine cavity of the biological mother did not lead to pregnancy.

The practice of surrogacy often seems controversial to people who do not understand how it is carried out. The most important thing you need to know about surrogacy is that the child does not have a genetic relationship to the woman who carried him.

The surrogacy program cannot be implemented without resorting to in vitro fertilization. Before a surrogate mother becomes pregnant, genetic parents need to enter into an IVF program, which implies:

• stimulation of ovulation in a genetic mother, in order to obtain female germ cells (oocytes)
• fertilization of oocytes by male cells of the genetic dad,
• obtaining embryos that will genetically belong to biological parents.

Thus, an embryo belonging to the genetic parents is transferred into the uterus of the surrogate mother. The child will not look like a surrogate mother at all – neither in behavior nor in appearance.

By the way, Dmitry Kiselyov, a Russian journalist and presenter on the Rossiya 1 TV channel, recently called for a change in attitude towards surrogate mothers. "It would be possible to draw an analogy of a surrogate mother with a wet nurse, which has always been respected in Russia. – The journalist noticed. – In a physiological sense, a surrogate mother is a wet nurse, because she gives the fetus only nutrients – no genetic admixture occurs there."

Why surrogacy cannot be considered a "whim of the rich"

Even if the "biological" parents have a lot of money, surrogacy cannot be resorted to in order to "save" health, preserve the figure or career. This does not apply to medical indications.

It is forbidden to conclude a contract with a surrogate mother without medical indications. Russian legislation clearly regulates the work of clinics using methods of reproductive technologies, including surrogacy programs.

How surrogate mothers and "biological" parents find each other

There are different ways. For example, biological parents can take over the search for a suitable candidate. But if medical contraindications are revealed after the examination of a potential surrogate mother, then doctors will reject this candidacy.

Agencies that recruit women who have expressed their intention to become a surrogate mother can help in finding a surrogate mother. Agencies work with both public and private clinics. Agency employees organize the examination of women, refer them to the clinic doctors for approval, and monitor compliance with all legal norms prescribed in the legislation and regulations.

According to Article 55 of Federal Law No. 323-FZ of November 21, 2011, "a woman can be a surrogate mother:

• between the ages of twenty and thirty-five,
• having at least one healthy child of her own,
• who received a medical report on a satisfactory state of health,
• who gave written informed voluntary consent to medical intervention,
• consent of the spouse if the surrogate mother is married.

A woman who is married, registered in accordance with the procedure established by the legislation of the Russian Federation, can be a surrogate mother only with the written consent of her spouse. A surrogate mother cannot be an egg donor at the same time."

How to understand that a surrogate mother is healthy

The candidate for surrogate mothers is carefully examined according to Order No. 107n. The surveys include:

• general (clinical) blood test, biochemical blood test, coagulogram, blood tests for syphilis, HIV, hepatitis B and C, herpes simplex virus 1, 2, cytomegalovirus, rubella virus
• microscopic examination of the separated genitals for pathogenic microorganisms, fungi and parasites
• microscopic examination of vaginal smears and cytological examination of the cervix
• microbiological examination for chlamydia, mycoplasma and ureaplasma
• general urine analysis
• ultrasound examination of the pelvic organs
• lung fluorography (for women who have not undergone this study for more than 12 months)
• electrocardiogram.

In addition, an examination and consultation with a general practitioner is necessary. The candidate must provide a certificate that is not observed in the narcological dispensary.

As a rule, agencies that recruit a woman monitor her lifestyle. The expectant mother can live on the territory controlled by the agency – for example, in an apartment that is rented for her. At this time, the woman is undergoing examinations, so that agency representatives can judge how disciplined she is and how carefully she fulfills all appointments and requirements.

After embryo transfer in the Art-Ivf clinic, doctors monitor the surrogate mother for the entire duration of pregnancy. At the same time, it is supervised by agency employees.

Can "biological" parents communicate with a surrogate mother

The Art-Ivf clinic prefers to cooperate with agencies that provide an opportunity for open communication between biological parents and surrogate mothers – of course, regulating this process in the interests of all participants.

Biological parents can personally see the surrogate mother, monitor medical examinations and her lifestyle during pregnancy. All this is prescribed in the contract.

What will happen if the surrogate mother refuses to give the baby to "biological" parents

In practice, such cases are rare. After all, most surrogate mothers, receiving financial remuneration for their services, want to improve the financial situation of their own children who live next to them, and do not seek to leave another child. In addition, the surrogate mother is obliged to give the child according to the contract.

To avoid complications during the transfer of a child, the first thing we start with in our clinic is a discussion with a surrogate mother about the inevitable result after childbirth – the transfer of the child to biological parents. We need to make sure that the surrogate mother understands that she will have to give the baby away after birth. Agency employees take over the discussion of legal and financial issues.

Judging by the current judicial practice in Russia, the court will be on the side of the surrogate mother. If a woman has given birth and does not want to give the child away, the court will not take into account that, from the point of view of biology, this is not an embryo belonging to her.

Because of this, it may seem that the law does not sufficiently protect biological parents. But it is important to understand that a surrogate mother, in principle, carries serious risks. After all, the child may not be born – for example, due to an illness acquired during pregnancy, an unexpected injury. If this is not spelled out in the contract, then it will be up to the court to decide how the remuneration will be paid in this situation. That is why it is necessary that the contract provides for everything, down to the smallest detail.

What you need to know about surrogacy

Surrogacy is a legal medical practice, enshrined in Law No. 323 of November 21, 2011 "On the Basics of Protecting the Health of Citizens of the Russian Federation" and the Order – Order of the Ministry of Health No. 107n of August 30, 2012.

A surrogate mother is a healthy woman who voluntarily helps other people find the happiness of parenthood. Without her, the couple would never have been able to give birth to their child.

A baby who is born from a surrogate mother will not look like her either in appearance or in behavior. From the point of view of genetics, this is a child of "biological" parents.

"Biological" parents can find a surrogate on their own, but more often special agencies are engaged in this. They carefully select applicants, organize a survey and help to draw up a legally competent contract that will protect all participants.

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