Rus Articles Journal

Surrogacy: the medicine, ethics, the right of

Not really harmonious term “surrogacy“ means a technique of transfer of the impregnated ova of the woman which for one reason or another cannot take out pregnancy, in an organism of other woman - substitute mother. The child born by this woman is given to genetic parents on the basis of the concluded arrangement. On supervision of doctors, the probability of emergence of pregnancy in that case makes 30% and more (according to some information, to 70%). This procedure becomes more and more popular in Russia; there are even databases of substitute mothers, and the press and church discuss morally - the moral problems connected with this medical technology.

Now in connection with a huge number of the various reasons of both medical, and social character, and also from - for adverse ecological factors the problem of infertility becomes one of the most actual. Ways of its decision become more diverse, allowing couple to have the child practically at any pathology.

So, the EKO procedure (extracorporal fertilization) becomes one of well proved ways of a solution. The essence of EKO consists in receiving from ovaries of the woman of mature ova, fertilization by their spermatozoa of the husband (or, at the request of both spouses, sperm of the donor), cultivation of the turned-out embryos in an incubator within 48 - 72 hours and transfer (replanting) of embryos in the patient`s uterus. But there are cases when even EKO or not productively, or is impossible on medical indications, and adoption for the psychological reasons cannot be carried out. Then the program of surrogacy comes to the rescue.

Conversation on this procedure should beginning

with transfer of indications. Those are:

we will look at

Now how there is a procedure.

the Preparatory stage

Originally is chosen the woman who has to become substitute mother as a result; its participation in this program is obligatory voluntary. Initial requirements to it are simple:

Most often someone from the examined relatives gets out to a role of substitute mother or absolutely the stranger - this choice is always individual, depending on wishes and preferences of a family.

When the arrangement between alleged substitute mother and genetic parents is reached by

, the woman who will bear the child makes tests and passes the following inspections:

of

B one of the Indian temples the fresco illustrating a legend of Makhavira`s conception (599 BC) is founder of Jainism. It is one more example of realization of idea of surrogacy. Makhavira was incidentally conceived in a belly of the woman of low estate. The tsar of gods Indra enjoined to transfer a fruit to the woman, worthy to give birth to the Great Hero. On a fresco two reclining women are represented: one of them - Devananda, the priest`s wife in whose belly Makhavira was conceived, another - the queen Trishala by whom he was replaced. Transfer of an embryo was carried out by a deity with the cervine head, Harinegameshin. As the legend says, the fruit was taken through a uterus and replaced in a belly of other woman with the greatest art.

If all inspections and analyses showed that the woman who agrees to take out the child is healthy, the following stage - synchronization of menstrual cycles genetic and substitute mother begins.

the Problem of this stage is achievement of necessary degree of a maturity an endometriya (an inside layer of a uterus) of substitute mother for implantation (attachment) of an embryo by the time of receiving and transfer of embryos. For this purpose substitute mother according to a certain scheme the hormonal drugs causing maturing an endometriya are injected, or synchronization is carried out in a natural cycle. During this preparation control of level of hormones is carried out to blood, ultrasonography - monitoring an endometriya and ovaries. It is natural that substitute mother during this period can apply only barrier methods of contraception, but not hormonal contraceptives.

Further when synchronization of cycles is reached, the EKO standard procedure at which the embryos received from genetic parents are transferred to a cavity of a uterus of substitute mother follows.

the EKO Procedure for all listed its participants consists of several stages.

For the woman:

According to indications to genetic mother conduct the following researches:

For the man:

Besides, for a married couple 35 years are more senior than

it is necessary the physician - genetic consultation.

Control methods

Ultrasonic monitoring is the main control method of development of follicles and an endometriya during induction of a superovulation. In the course of ultrasonic monitoring the quantity of follicles is stated, measurement of their average diameter is taken, thickness an endometriya is defined.

Hormonal monitoring consists in dynamic determination of concentration of yaichnikovy hormones in blood and supplements data of ultrasonic research on a maturity of follicles.

Indicators that the induction of a superovulation is successfully complete are diameter of a follicle - more than 17 mm, and also thickness an endometriya - 8 mm and more. For completion of maturing of ova the horionichesky gonadotrophin (HG) - hormone which stimulates an ovum exit from an ovary is intramuscularly entered. In 35 - 36 hours there will have to be an ovulation - an exit of follicles from an ovary.

the Puncture

follows Further a puncture of follicles of ovaries - receiving ova piercing of follicles the special needle entered through a vagina into a cavity of a small pelvis and an ovary and suction of ova. It occurs in 32 - 40 hours after the moment of introduction of HG. Procedure is carried out under ultrasonic control by means of special punktsionny needles. At impossibility of performance of a puncture through a vagina of an ovum can be received in the laparoscopic way, i.e. by a puncture of a forward belly wall under control of the special chamber entered into an abdominal cavity.

to

of Genetic mother before a puncture usually recommend the termination of meal and drink whenever possible in 8 hours prior to a puncture and local sanitation of a vagina (introduction to a vagina of the disinfecting candles or solutions) some days before a puncture for the purpose of decrease in risk of penetration of an infection during a puncture. After a puncture for several days insignificant painful feelings in a small pelvis are possible, but generally unpleasant consequences do not happen.

Fertilisation

So, ova of genetic mother are taken and transferred to embryologists. What`s next? There is a most important further - “an insemination of ova and cultivation of embryos of in vitro“, i.e. fertilization of the received ova the husband`s sperm (the genetic father) in a test tube.

the genetic father hands over to

Before a puncture of follicles of genetic mother sperm. Before sperm delivery sexual abstinence within 3 - 5 days is recommended to the man. Receiving sperm is carried out by masturbation.

Further the ova received from the wife are impregnated by the husband`s sperm. It occurs as follows: the follicular liquid received as a result of a puncture of follicles is placed in Petri`s cup, at the same time the assessment of quality of the received ova then they are transferred to a special incubator together with sperm is carried out. The fact of fertilization of ova can be estimated in 12 - 18 hours. If everything passed successfully and fertilization took place, they are placed on special Wednesday where there is an initial development of embryos.

the Repeated assessment of fertilization is carried out by

in 24 - 26 hours. Control of fertilization of ova is exercised when viewing cups with the cultivated cages under a microscope. However still it is not enough their existence for the solution of a question of a possibility of transfer of embryos in a cavity of a uterus of substitute mother: at first it is necessary to make sure of normal development of embryos. It is possible to judge it only proceeding from quantity and quality of the sharing cages of an embryo and not earlier than in a day after fertilization when the first signs of crushing of cages appear.

If fertilization did not happen, all operation is repeated anew in other menstrual cycle.

Transfer of embryos

If fertilization took place, there comes the following stage - transfer of embryos in a cavity of a uterus of substitute mother which is prepared for it by preliminary hormonal therapy.

Procedure of transfer is carried out by

on a gynecologic chair: the doctor accurately enters a special catheter into a uterus, the embryologist brings the special syringe filled with liquid in which there are embryos them smoothly enter by means of a catheter into a uterus cavity via the channel of a neck of a uterus. It is absolutely painless procedure. In case it cannot be made for one reason or another, transfer of embryos can be executed through a uterus wall (transmiometralno). At the same time the needle can be entered into a cavity of a small pelvis through a vagina or a forward belly wall. No more than three embryos are usually transferred though also the bigger quantity - is possible at the estimated reduced probability of implantation.

After transfer of embryos of substitute mother is given so-called hormonal support by progesteronsoderzhashchy preparations - it improves a condition of an internal cover of a uterus - an endometriya and increases thereby chances of a successful attachment of embryos.

of Substitute mother needs to refrain from sexual contacts for 2 weeks after transfer of embryos, and also to refuse intense physical work and physical activity. When the result is known?

Embryos transfer on 17 - y day of a menstrual cycle (days consider of the first day of periods), diagnostics of pregnancy according to contents a beta - HG in blood or in urine is carried out in 12 - 14 days from the moment of transfer of embryos, and with 15 - go day appoint special hormonal preparations, and at a positive test for pregnancy this treatment is continued till 12 - 14 weeks of pregnancy.

Ultrasonic confirmation of the fact of pregnancy can be carried out by

since 21 days after transfer of embryos.

After pregnancy came, substitute mother is under supervision of doctors.

to

Morally - ethical aspects of auxiliary reproductive technologies

by

As it was already told, in connection with surrogacy there is a number morally - ethical problems which have no unambiguous decision yet. Are most actively discussed in mass media, in society and in church following.

Opponents of surrogacy consider that it turns children into similarity of goods, creating a situation in which rich people will be able to employ women for incubation of the children. They claim also that the motherhood becomes at the same time contractual work therefore the aspiration to benefit can prevail over advantage reasons for contracting parties here.

From here the strengthening problem connected with it and actively discussed within church in the society of the dehumanization and immorality undermining many moral foundations, including sanctity of marriage and a family.

fears that need to give mature it for 9 months and the born ““ child can injure some substitute mothers psychologically even if first it seemed to it that she will be able to leave such child without special experiences Exist. And such cases not a rarity.

questions of psychological adaptation of the child in this situation are Also important

: whether it is necessary to inform the child about a way of its birth, are possible or its impossible relations with substitute mother.

What can be told about it? Yes, serious problems - as medical, and morally - psychological - exist. But their gradual decision and overcoming are a natural way of entry into our everyday life of those new technologies which - at the global level - help mankind to exist, and on private - to be the parents who are lucky enough to hold on hands of the long-awaited and beloved child.

of
of

B of 1985, despite resistance from the British medical association, Patrick Steptou and Robert Edwards - pioneers of EKO - for the first time suggested to use surrogacy for treatment of infertility. After long discussion with independent Ethical committee they carried out the program of surrogacy to the Great Britain`s first married couple. Embryos of genetic parents were transferred to the sister of the infertile woman, and in 1989 the first child at substitute mother was born.