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Surrogacy and In Vitro Fertilization

Bioethics presentation

Mark Mendoza

on 13 February 2014

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Transcript of Surrogacy and In Vitro Fertilization

Surrogate Motherhood
In vitro fertilization
People Who Used
In Vitro

After six in vitro fertilization attempts,
Celine Dion and her husband Rene Angelil
gave birth to their son Rene-Charles in
2000. A decade later, the couple once again used IVF to conceive their twin boys Eddy and Nelson, born in 2010.
The Chart-topping singer, who had previously suffered a miscarriage, underwent IVF treatments to get
pregnant. In 2011, Carey and her
husband Nick Cannon welcomed
their twins Moroccan and Monroe.
TV personalities Giuliana and her husband Bill Rancic was already struggling with fertility before news broke that she had been diagnosed with cancer. Unable to carry the embryos from her third IVF due to Giuliana's cancer medication, the couple enlisted a gestational surrogate. They welcomed their son Edward in August 2012.
After attempting to get
his wife
Carin Kingsland
Sugar Ray Frontman
Mark McGrath tried
IUI. The couple tried
IVF and finally gave
birth in 2012 to twins
Lydon and Hartley
During the 2010
World Cup in
South Africa, Cristiano
Ronaldo's son was
born to an unknown
surrogate in America.
It was alleged that
the striker paid as much as $10million
to ensure that the biological mother's
identity remained a secret.
He now has sole custody of the boy.
Neil Partick Harris and David Burtka are dads to 2-year-old twins Harper and Gideon. The couple revealed that each father fertilized one egg and twins were carried and born via one surrogate. They found an anonymous egg donor through a donation bank where they
were able to research her personal
and medical history.
"in place of another" meaning substitute
New solution to the old problem of not being able to reproduce an offspring
Babylonian law and custom allowed this practice and infertile woman could use the practice to avoid the divorce, which would otherwise be inevitable
Biomedical technique whereby a fertilized ovum is implanted into the uterus of another woman who will carry the baby to term either as a favor or for a fee, referred to as "womb for hire" or "uterus for rent"
Altruistic surrogacy
UK (no right to enforce a surrogacy contract)
Surrogacy-friendly nations
(even a single father can become registered as sole parent)
(surrogate mother has no legal claim even if it is created with her own eggs)
One known example is the Biblical story of Abraham and Sarah, a nomadic Hebrew couple who cannot conceive a child.
Sarah offered her Egyptian slave Hagar as a surrogate, but later drove her away from the camp when Hagar became impudent during her pregnancy.
Hagar fled to Egypt where an angel told her that her son Ishmael would become a leader amongst the Hebrews; she subsequently returned to Sarah and Abraham
The surrogate became proud and refused to give up the identity of the child and consequently the spouse had her and her child ousted.
In such cases...
health endangered by pregnancy
woman able to produce a normal ova
husband's semen
via in vivo or in vitro

after 3-5 days of embryo's growth
transfer of the embryo to the uterus of a healthy woman
surrogate is either paid by a fee or it is done as a favor
Traditional surrogacy - This involves naturally or artificially inseminating a surrogate mother with the intended father's sperm via IUI or IVF. With this method, the child is genetically related to its father and the surrogate mother.
Traditional surrogacy and sperm donor - Surrogate mother is artificially inseminated with donor sperm via IUI or IVF. The child born is genetically related to the sperm donor and the surrogate mother.
Gestational surrogacy - When the intended mother is not able to carry a baby to term due to hysterectomy, diabetes, cancer, etc., her egg and the intended father's sperm are used to create an embryo (via IVF) that is transferred into and carried by the surrogate mother. The resulting child is genetically related to its parents while the surrogate mother has no genetic relation.
Gestational surrogacy and egg donation - If there is no intended mother or the intended mother is unable to produce eggs, the surrogate mother carries the embryo developed from a donor egg that has been fertilized by sperm from the intended father. With this method, the child born is genetically related to the intended father and the surrogate mother has no genetic relation
Gestational surrogacy and sperm donation - If there is no intended father or the intended father is unable to produce sperm, the surrogate mother carries an embryo developed from the intended mother's egg (who is unable to carry a pregnancy herself) ad donor sperm. With this method, the child born is genetically related to the intended mother and the surrogate mother has no genetic relation.
Gestational surrogacy and donor embryo - When the intended parents are unable to produce either sperm, egg or embryo, the surrogate mother can carry a donated embryo (often from other couples who have completed IVF that have leftover embryos). The child born is genetically related neither to the intended parents not the surrogate mother.
In vitro fertilization - is a process by which an egg is fertilized by sperm outside the body.
In vivo fertilization - union of the sperm and ovum within the reproductive tract of the female; usually taken to mean artificial insemination in which the sperm is artificially introduced into the vagina, cervix, or uterine cavity to overcome the problem of infertility
Artificial insemination - the introduction of semen into the vagina or uterus by mechanical or instrumental means rather than by sexual intercourse.
health endangered by pregnancy
intended father
intended mother
surrogate mother
donor sperm
donor egg
donor/leftover embryo
IUI (intrauterine insemination) - involves a laboratory procedure to separate fast moving sperm from more sluggish or non-moving sperm. The fast moving sperm are then placed into the woman's womb close to the time of ovulation when the egg is released from the ovary in the middle of the monthly cycle.
Atruistic surrogacy - a situation where the surrogate receives no financial reward for her pregnancy or the relinquishment of the child (although usually all expenses related to the pregnancy and birth are paid by the intended parents such as medical expenses, maternity clothing, and other related expenses)
Commercial surrogacy - is similar to a business agreement and includes a contract between the surrogate and the intended parents, which includes coverage of her medical costs and payment for her services
For women:
medical problem with her uterus
had a hysterectomy that removed her uterus
medical condition that make pregnancy impossible or medically risky i.e. severe heart disease
unsuccessful in conceiving a child after undergoing a variety of assisted-reproduction techniques, such as IVF

Unable to adopt a child due to:
marital status
sexual orientation
Choosing a Surrogate

According to experts:
at least 21 years old
has already given birth to at least one healthy baby so she understands first-hand the medical risks of pregnancy and childbirth and the emotional issues of bonding with a newborn
has passed a psychological screening by a mental health professional to uncover any issues with giving up the baby after birth
willingly signs a contract agreeing to her role and responsibility in the pregnancy, such as steps she'll take to ensure prenatal care and to relinquish the baby after birth.
In the Philippines

In the legal point of view, in the absence of law on surrogacy in the Philippines, surrogate mother is deemed to be the mother of the child. The putative parents have no vested right conferred upon them by law to enforce a specific right that can be considered to be legally demandable and enforceable as the right to be recognized as the parents of the child, more so for wife to claim as the lawful mother of the child that was born out of the womb of the surrogate.

Cases of Artificial Insemination: Article 164 of the Family Code of the Philippines: "Children conceived as a result of artificial insemination of the wife with the sperm of the husband or that of a donor or both are likewise legitimate children of the husband and wife, provided that both of them authorized or ratified such insemination in a written instrument executed and signed by them before the birth of the child.

The contract made between a couple and a surrogate is invalid and against the public policy of the Philippines.
Opted to use surrogacy in order to have children. The surrogacy happened in Moscow, Russia in August 2011. The whole contract cost him Php6 million per child but was charged an additional half of the amount because he was having twins.
Compensation to th surrogate is usually at $10,000 (Php447,700) for her services. If unfulfilled (backs out), the surrogate gets nothing. In miscarriage, surrogate receives partial payment.
Whose names are listed in the birth certificate of the baby?
Parental rights are not guaranteed after a surrogate pregnancy. What if the surrogate decides to keep the baby?
Should the couple bond with the child during pregnancy of the surrogate or just wait 'til her delivery?
Is surrogacy a solution in preserving a marriage especially if the woman is unable to conceive?
Is it right for society to permit women to make contracts about the use of their body?
Use of a surrogate and the eggs of the surrogate; what do you tell your growing child?
Should the surrogate be a part of the child's life?
In Vitro Fertilization
Also known as test-tube fertilization
Performed in a petri dish or test tube
Conception outside the womb by artificial means, "procreation without sex" or "baby making without love making"
Done through a technique called laparoscopy.
Preparation for IVF

Ovarian reserve testing - determine the quality and quantity of the eggs, might test the concentration of FSH, estrogen, and anti-mullerian hormone in the blood during the first few days of the menstrual cycle, often done together with an ultrasound to help predict response of ovaries to fertility drugs
Semen analysis
Infectious disease screening such as HIV, STD
Uterine cavity exam - might involve a sonohystergraphy - in which a fluid is injected through the cervix into the uterus.
Or it might include a hysteroscopy - in which a thin, flexible, lighted telescope (hysteroscope) is inserted through the vagina and cervix into the uterus.
FSH - secreted by the pituitary gland which stimulates the development of primary follicles

Corpus luteum - essential for establishing and maintaining pregnancy in females. The corpus luteum secretes progesterone, which is a steroid responsible for the dcidualization of the endometrium (its development) and maintenance, respectively.

Luteinising hormone - reduces secretion of estrogen and stimulates the development of corpus luteum

Anti-Mullerian hormone - best endocrine marker for assessing the age-related decline of the ovarian pool in healthy women; thus it has a potential ability to predict future reproductive lifespan

Intracytoplasmic sperm injection (ICSI) - sperm cell is directly injected to the egg cell. Used when sperm numbers are very low or have difficulty penetrating the egg
Infertility Issues

Fallopian tube damage or blockage
Ovulation disorders
Premature ovarian failure (insufficient release of eggs)
Uterine fibroids
Previous tubal sterilization or removal; impaired sperm production or function
Unexplained infertility
Genetic disorder
Fertility preservation for cancer or health conditions
Walter Heape, physician and professor at University of Cambridge
first known case of embryo transplantation
1976 referral to Dr. Steptoe, John and Lesley Brown
Bilateral tube obstruction
10 November 1977, experimental procedure in vitro using a laparoscope
Dr. Robert Edwards, studied human fertilization of egg cells in the laboratory, started 1960s
Dr. Patrick Steptoe, laparoscopy pioneer
Louise Brown, first "test-tube" baby, 25 July 1978
Dr. Robert Edwards and Dr. Patrick Steptoe
Louise, Cameron and Wesley
View on Surrogate Motherhood and IVF

On surrogacy
Greatest benefit is tat the childless couple will have a child that is genetically linked to one or noth individuals. However, I am not entirely in favor of the process. Justice demands that we give what is due and we get what we merit for our conduct in life. Is it really okay to pay somebody or ask someone for a favor of carrying a child you want to have? The pregnancy itself is hard holistically, what more when a child you carry in your stomach for 8-9 months then be taken away from you afterward. There are many neglected children in foster homes that needs and wants love and a family.

Autonomy allows the individual to act freely in accordance with his/her self-chosen plan. Asking somebody related or unrelated to the couple is somewhat diminishing autonomy. Carrying a child that may not be related to the surrogate mean that you chose to be controlled by other people on how to live your life. There are a lot of risks associated with pregnancy and surrogacy that cannot be paid especially in the emotional and psychological aspect.

Beneficence states that no harm should be done to anyone and we should contribute to their welfare and growth. Surrogacy I believe is an unselfish act, even to those who just wants the money after the process, because who would want to be burdened by a heavy responsibility by others. The surrogate's life is also at risk because pregnancy can cause complications in one's health and well-being.
On In vitro fertilization

The solution to infertility especially for couples that are trying to conceive for a long time. Although it is morally unacceptable to Christian ethics belief of the preservation of the biological process of human reproduction and contest the manipulation of living embryos, I am in favor to the procedure. The process primarily involves the couple without any third party and with their mutual decision. Autonomy states the right of n individual to determine what is good for him/herself and for others acting on the basis of his/her values or principles. The child is born coming from the egg and sperm cell of the couple, is genetically related to both, with the help of the advances in medicine.

Beneficence states to do no harm and produce the good. The IVF process may cause pain to the individual because of the needles injected for fertility and probes that passes inside the woman's body but the outcome, birth of the baby, is beneficial to the couple.
Multiple births - if more than one embryo is implanted in the uterus. Higher risk or early labor and low birth weight.
Ovarian hyperstimulation syndrome - use of injectable fertility drugs in which the ovaries become swollen and painful.
Miscarriage - especially with increased maternal age
Egg-retrieval procedure complication - bleeding, infection, damage to blood vessel
Ectopic pregnancy - about 2-5% of women who use IVF
Birth defects - increased maternal age
Stress - financially (starts at $12,000 or Php537,240), emotionally, physically
What will happen to unwanted embryo/s?
Is by-passing infertility okay?
Spread of infectious diseases
Mix-ups - human error in identifying the right embryo
Pre-implantation genetic diagnosis or screening
Pregnancy after menopause - even after menopause the uterus is fully capable of carrying out a pregnancy. IVF has allowed women to be pregnant in their fifties and sixties.
Same-sex couples, single and unmarries parents
Profit desire of the industry - For instance, in 2008, a California physician transferred 12 embryos to a woman who gave birth to octuplets (Suleman octuplets) The Medical Board of California sought to have fertility doctor Michael Kamrava, who treated Suleman, stripped of his license. State officials allege that performing Suleman's procedure is evidence of unreasonable judgment, substandard care, and a lack of concern for the eight children she would conceive and the six she was already struggling to raise.
Anonymous donors - Olivia Pratten, a donor-conceived Canadian, sued the province of British Columbia for access to records on her donor father's identity in 2008. "I'm not a treatment, I'm a person, and those records belong to me," Pratten said. In May 2012, a court ruled in Pratten's favor, agreeing that the laws at the time discriminated against donor children and making anonymous sperm and egg donation in British Columbia illegal.
By Mark Mendoza
Full transcript