Journal of Reproduction & Infertility
Volume:9 Issue: 1, 2008

Upon birth of the first IVF baby, the possibility of having a baby by couples who were infertile due to major problems in the reproductive system was materialized. Development of IVF tech-niques has yielded the opportunity to apply surrogacy and gamete or embryo donation procedures in the form of third party reproduction for couples suffering from the lack a major reproductive element. Surro-gacy seems indispensable for the couples who possess all the factors involved in pregnancy but due to lack of functional uterus, they are deprived from having a child. IVF/ICSI has provided the opportunity for such couples to form healthy embryos in laboratories and transfer it to the third party uterus in due time. Surrogacy agreement will be settled whenever a woman announces her readiness for bearing the couple's embryo and undertakes to relinquish the baby to the embryo owners upon delivery. Based on the source of ovum in embryo formation, surrogacy will fall into two principal groups, including gestational and conventional surrogacies. However, surrogacy is also classified into various types in terms of third party’s semen or ovum application. The use of these methods with third party interference in the formation and birth of the baby requires significant juridical, legal, ethical and cultural (and even sociological and psychological) considerations. In response to Avicenna Research Institute’s inquires from religious authorities, there is currently a broad consensus among religious scho-lars on authorization of surrogacy in Iran and they reject the right of surrogate mothers to refuse returning the newborn. Unfortunately, due to lack of codified laws, couples inclined to benefits of surrogacy, either withdraw or resort to illegal conducts. For example, according to the current law, the birth certificate will be issued solely under the name of the woman who gives birth to the newborn and with respect to the facts stated, physicians have to violate the law and issue the birth certificate under the name of gamete owners or uterus owners have to be hospitalized under the name of women seeking surrogacy treatment. The settlement of an agreement between couples applying for surrogacy and the uterus owner may raise various legal, cultural or medical issues. Infertility clinics play a key role in supporting health, providing necessary consultations and supervision following the aforementioned mutual agreements. Silence of law and emergence of any disagreement in the treatment procedure may contribute to unresolv-able problems between the two parties. Nowadays, the possibility of using surrogacy treatment across the country on one hand and the grave need of infertile couples to benefit from this technique on the other hand, emphasize the necessity for improvising well-addressed laws and providing the opportunity to resolve the relevant problems in a move to strengthen family foundations. Enhancing public information on ART and developing and providing infertile couples with the possibility to experience parenthood, will contribute to invoke sympathy and generosity among women to participate in an altruistic sacrifice: surrogacy.

Advances in medical science especially in the field of new methods for the treatment of infertility has brought changes in the process of human reproduction. Alongside the ability of using these methods in experimental sciences, new complex questions arise in other fields of science such as psychology, sociology, philosophy, jurisprudence and law. Based on the jurists’ verdict on permission or prohibition of hiring a surrogate uterus and their reasoning, a question is raised regarding the relationship of the infant born through surrogacy. On the basis of current definitions in the language of jurists and lawyers, “Relationship” is any bloody liaison between two persons that reaches fulfillment through the birth of one of them from the other or from a third party. Then, we will proceed to define the word relationship from lexical and legal points of view, and specify the childs father and mother. In fact, the basic problem is the identification of legal parents of the infant born through surrogacy. Undoubtedly, the concept of relationship from the viewpoints of Islamic jurispru-dence and law reaches fulfillment in family, but what is important for contemplation is the ability of relation where the infant is born through the action of artificial insemination by the spermatozoid of a stranger. Based on the jurist’s verdict about infant is born through the action of artificial insemination we conclude: 1- Employment of an alternative womb especially between is not contract with Islamic rules provided it dose not bring about committing of any other sin. 2- In the all kinds the father of infant is born through this methods is same man that give the sperm and his mother is the woman that give the ovum.

Assisted reproductive technology has greatly revolutionized chances of repro-duction offered to infertile couples and it has helped them maintain their family integrity. This technology, like any other new medical technology, has brought up questions regarding its ethical goodness or badness. As its objectives, this article discusses the ethical issues regarding surrogate motherhood according to bioethical principles. Autonomy is one of bioethical principles, which its implication in surro-gacy is referred to as refraining from safe life style, prenatal care or refusal of giving the child to its genetic parents. Complete consultation by independent specialists for all the involved parties could maintain the individuals autonomy in giving voluntary informed consent to this technique and increase her commitment toward the desired responsibility in the contract. Other ethical principles, which are brought up in this process, are beneficence and non-malfeasance. To regard these moral principles, all screening procedures and physical examinations should be practiced with utmost care to minimize any risk to the surrogate mother and the baby. Justice is another ethical issue which is observed in this technology. Surrogacy as a means of commercial profit is instrumentalization and exploitation of low-income women for the interest of high-income people. Establishing methods to control payment for surrogacy and making it an altruistic act, instead of a business, could help eliminate this unethical aspect. Surrogacy could be an ethically acceptable and altruistic act for helping infertile couples if all ethical standards are practiced. Supervision of independent ethics committees is essential for assuring the fulfillment of these standards.

Surrogacy is defined as becoming pregnant and giving the infant to another couple as his or her commissioning parents. In commercial surrogacy, the surrogate mother accepts being surrogate for money. In Iran, nowadays, commercial surrogacy does exist. In this article, it is shown that commercial surrogacy is unethical. The arguments to be covered are: 1- Commercial surrogacy is against human dignity, 2- The nature of commercial surrogacy is exploitive because of high probability of coercion and because of impossibility of taking a valid consent from such women, especially in developing countries and among poor people, 3- Elimination of altruistic surrogacy, and 4- Worldwide partial consensus regarding banning commercial surrogacy. Although commercial surrogacy may have some benefits, it is too harmful to be accepted just because of such benefits. Surrogacy is ethical only if it is altruistic. Therefore, a committee composed of people without any conflict of interests should verify that the surrogate mother is a close relative or a friend of the commissioning parents and she has accepted being a surrogate without any coercion and that her consent is valid. In addition, special counseling should be available for the surrogate mother and the commissioning parents.

Surrogacy is a treatment option available to women with medical problems, including mal-formations of uterus, like mullerian agenesis, to help them have their own genetic children. The indications for this infertility treatment option include absent uterus, recurrent abortions, repeated IVF failures and some other medical conditions. With regards to the effects of this approach on patients’ lives, it is necessary to evaluate the psychological and social aspects of surrogate motherhood. The purpose of this study is to review the results of researches done on surrogacy, experiences of surrogate mothers and the effect of this method on their marital and social relationships and their psychological health. This article is a literature review of articles published from 1990 to 2007. It has been suggested that relinquishing the child may be extremely distressing and may result in psychological problems for surrogate mothers. It has also been feared that the surrogate mother may prenatally form a bond with the baby that would make it particularly difficult for her to hand over the child to the commissioning parents. For those women who do relinquish the child, the risk of post-natal depression, as well as feelings of anger or guilt, may add further strain to the woman's psychological health. Such that woman may enter into surrogacy arrangements because of financial hardship without being fully aware of its potential risks. Other concerns relating to surrogacy include the impact on the surrogate mother's partner, her parents or any existing children, and its destabilizing effects on her family integrity. On the other hand, case series that have explored the experiences of surrogates and commis-sioners, have not noted any substantial psychological problems and surrogates have not experienced a higher than average postpartum depression rate. By a comprehensive and precise consultation and support of an expert team, many of these surrogate mothers could experience this period positively. Surrogate pregnancy should be treated as a high-risk psychological experience. In addition, it is recommended that surrogates receive professional counseling before, during and after pregnancy.

Practice of gestational surrogacy, in which the surrogate mother is not the biological contributor of the egg, has attracted the attention of many infertile married couples in Iran as a solution to infertility, and among the majority of Shiite legal authorities, it is an accepted form of assisted reproduction. Data used in this paper has been drawn from a larger study undertaken in Tehran, Iran in 2006 for the author’s master’s degree. Ethnographic methods for research were used in infertility centres and clinics, e.g. in-depth interviews with surrogates and intended parents, with medical doctors and counsellors, and interviews with Islamic scholars as well as many hours of participant observation in different infertility clinics in Tehran. This paper discusses the process by which surrogate mothers in their social environments participate in surrogacy arrangements. The way they redefine the process of making kinship in the field of assisted reproduction to fit their decision into a moral and religious framework and to achieve their respective goals_ altruism, financial interests, gift exchange or reproduction_ enable them to reshape definitions of pregnancy, motherhood and the process of conception in their respective social contexts. Evaluating local knowledge and decision making processes and the role they play, are important issues in finding legitimate solutions to transform surrogacy from a controversial issue into a normative concept in infertility treatments.

The agreement of the infertile couples to use another woman’s uterus for gestational purposes and nurturing the embryo that belongs to the couples, and finally submitting the newborn to them by the surrogate mother, is based on the contract format of “Ested’ā” and “Ejaabat”_ plea and granting. The parties to this contract are the infertile couples and the surrogate mother who accepts the embryo to nurture. According to the general principles of contracts, the existence and validity of such a contract is due to the intentions bound to the parties. Based on relativity principle of contracts, it is said that consequences of such a contract, will be limited to the parties of the contract (i.e. the surrogate mother and the couples). Contrary to the principle that the obligation against the third party is not valid, some third-party individuals or entities will be affected consequent to such contracts because of social life of the involved parties as human beings. The suffered loss can be economical or moral. The indirectly injured parties can be individuals like relatives of the surrogate mother or entities like her insurer organization. On the other hand, some other individuals would be injured directly due to this contract, and will be deprived from their civil rights. These include the husband of the surrogate mother and her infant baby. The embryo himself which is the subject-matter of the contract, from the point of view that recognizes him or her as a human being and not an object, in case of infringements and breaches of his/ her rights to genesis and completion on behalf of the parties to the contract, is regarded as a third party that appoints individual trustee authorities or other legal bodies to file a suit to protect his/ her rights. Introducing, classifying the injured third party and discussing the type of infringed rights and eventually studying the methods of contribution of the mentioned parties is an important issue that has to be significantly addressed in the codification of relevant Acts.

Infertility is known as one of the major problems that raises serious concerns due to its influence on social and family ties. Therefore, infertile couples have to resort to all methods of reproduction to overcome the problem. Surrogacy is considered one of the assisted reproductive techniques involving the third party and it is recommended to some infertile couples. According to the Iranian Civil Law, physicians are assigned to issue the birth certifi-cate for the offspring of the woman who has delivered it, while issuing unreal birth certificates will undoubtedly bring about penal fines. Applying surrogacy and issuing birth certificates makes the law turn a blind eye to the matter in certain cases which contradicts physicians’ assigned duties in this regard. Considering what was mentioned above and with regards to the current problems which emphasize the urgent amendment of the law, the authors try to introduce a short-term solution to the problem. In this approach, the birth certificate along with other documents is recorded by the executive medical team to be used to issue an ID card for the child regarding his or her biological parents.