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Outlines both traditional and IVF surrogacy, and to whom each is recommended.

What is surrogacy?

The term surrogacy is used when a woman carries a pregnancy and gives birth to a baby for another person or couple . Opinion on the morality of surrogacy is divided. Surrogacy is legally accepted in some countries such as UK as a treatment option for selected groups of patients. However, surrogacy is still not allowed in many countries such as Sweden. Legislation governing surrogacy varies between countries and even in same country such as the USA, where policies vary between states.

Religious attitudes to surrogacy varies. Roman catholic and Anglian Christian do not accept surrogacy because it contrary to the unity of marriage. Islam forbids surrogacy (pregnancy should be the fruit of a legitmate marriage). Surrogacy is not forbidden in both Jewish and Buddhist .

The number of parents having a baby using surrogate in England and Wales (UK) has almost quadruplet over the past 10 years

Surrogates can be divided into natural surrogates and IVF surrogates.

IVF surrogacy (gestational carrier) - full surrogate

This is where a woman carries a pregnancy created by the egg and sperm of genetic couple. The carrier is not genetically related to the child.

Natural surrogacy (traditional/straight surrogate)

Here, the surrogate is inseminated with sperm from the male partner’s of an infertile couple. The child that results is genetically related to the surrogate mother because her eggs is used and to the male partner but not to the commissioning female partner. Although it is the simpler of the two types of surrogacy in as much as conceiving is less complicated, mentally it can be the hardest to accept. Not only for the surrogate mother to give up her own biological child, but also for the intended mother to accept a child which her husband has fathered with another woman.

To whom surrogacy is advised?

There are several groups of patients that natural and IVF surrogacy may be advised to.

IVF surrogacy

  • Women whose ovaries are producing eggs but they do not have uterus this could be because they have had a hysterectomy (removal of uterus) performed due to cancer, severe hemorrhage or ruptured womb, or they were born without a uterus. This is by far the most common indication for IVF surrogacy.
  • A woman whose uterus is malformed or damaged and is incapable of carrying a pregnancy to term, may be recommended IVF surrogacy.
  • Women who suffer from medical problems such as diabetes, heart and kidney diseases and in whom a pregnancy would be life threatening. However, their long term prospect for health is good.
  • Repeated miscarriages where the causes of miscarriage have been fully investigated, may also suggest IVF surrogacy treatment.
  • Surrogacy is becoming popular option for male same-sex couples

Traditional surrogacy

  • Women who have no functioning ovaries due to premature menopause ( some may argue that the best option for these patients is egg donation).
  • A woman who is at risk of passing on a genetic disease to her offspring, may opt for traditional surrogacy.
  • As with IVF surrogacy, women who suffer from medical problems such as diabetes, heart and kidney diseases and in whom a pregnancy would be life threatening may select traditional surrogacy if their long term prospect for health is good.

Surrogacy for social reasons such as the inconvenience of carrying a child, fear of pregnancy or interrupting a career is not accepted.

Women who agree to become a surrogate may do so for compassionate reasons to help a sister, daughter or friend. Some women may agree to become surrogates for financial remuneration. However, commercial surrogacy is not allowed in the United Kingdom.

Between 30-40 IVF surrogacy procedures are carried out annually in the United Kingdom.

Uterine transplant

Uterine transplant is a new procedure and offer another option for young women who were either born without a uterus or had a damaged uterus or their wombs were removed for reason such as cancer. There have been two previous attempts to transplant a womb in Turkey and Saudi Arabia but both failed to produce babies. Dr Mats Brannstrom and colleagues performed nine uterine transplants from living relatives at Gothenburg University in Sweden 2013.The transplant operations did not connect the women's uteruses to their fallopian tubes, so they are unable to become pregnant naturally. But all who received a womb have their own ovaries and can produce eggs to be used for IVF treatment. The transplanted uteruses would be removed after the women have had "up to two children", so they can stop taking the immunosuppressant medication that helps their bodies accept the transplant. To date, two Swedish women gave birth by caesarean sections following uterine transplants.

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