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Opinion: NYS Must Revisit its Rushed Move to Legalize Surrogacy

6 Comments

  • Heather Bathwick
    Posted July 9, 2020 at 4:33 am

    Why is Gary Powell quoted in this and why should his opinion matter? He is a UK citizen who lives in the UK, not New York. His “Center for Bioethics and Culture” is an anti-surrogacy nonprofit that harasses and demeans gay parents. Center for Bioethics and Culture’s founder, Jennifer Lahl, has worked with anti-LGBT hate groups like Manif, Heritage, and Robert Oscar Lopez’s International Children’s Rights Institute.
    Also, while http://www.legalizesurrogacywhynot.com is quoted as an authority on health issues related to surrogacy, there is zero information as to who is behind that site. Lahl might have something to do with that site though (and this letter), as the people featured in it are the same ones she features in her campaigns.

    • Kathleen Webster
      Posted July 20, 2020 at 5:19 pm

      Not sure why someone from the UK can’t weigh in – sexism and gay oppression don’t stop at our borders. Site source of harassment, define demeaning? I’m not a fan of such things. We don’t have to agree on everything to agree on particular policies. Here’s a better source on risks for women – I couldn’t find it on websites “Protecting Modern Families: Surrogacy Agreements and Children Born Through Assisted Reproduction Testimony May 29, 2019 Wendy Chavkin, MD, MPH”
      While many are debating the varied rights and interests involved, I want to call your attention to the health risks posed by commercial surrogacy to the women who become pregnant, and also to the women who provide the eggs (known as egg “donors,” although they are paid to do so) and to the resulting children.
      Pregnancy is normal and wonderful – but it can also be dangerous. Until the 20th century, women and newborns often died in the process. Even today, too many women die or have serious complications. Recently the news has covered the shocking black: white gap in American maternal mortality rates (1). Yet, even the white rates are both high and increasing. The Centers for Disease Control recently reported that pregnancy-related deaths have been increasing and that for every woman who dies giving birth in this country, more than 50 others suffer severe complications including hemorrhage requiring blood transfusion, hysterectomy, and respiratory failure (2).
      Moreover, the risks for women acting as commercial surrogates are above and beyond the risks of normal pregnancy and childbirth because of the use of IVF in all commercial surrogacy arrangements and because the women are deciding to undergo these risks while being incentivized by large sums of money. Furthermore, because the health professionals involved are generally paid by the commissioning parents- money that is funneled through a system of surrogacy brokers and gamete banks, which all take a cut–they may engage in medical practices to please their primary clients that are not in the best interests of egg providers and women acting as surrogates, nor even of the future babies.
      Let me lay these out ( I have included citations so that you can see the scientific evidence underpinning my statements). I will start with a brief note about the concept of risk. Risk is not prediction. Saying that a group with a certain exposure or characteristic has an increased risk of bad outcome X doesn’t mean that any individual will have that outcome, but rather, that more members of that group will have that outcome than those without that exposure or characteristic. Both public health professionals and legislators are expected to consider both individual and population risks and benefits. While we all know people who have had successful IVF experiences, when we look at the whole population, we see that women who undergo IVF for their own pregnancies have higher rates of pregnancy and delivery complications compared to women who conceive naturally, and that women who act as surrogates have even higher rates (3,4) Surrogates even have higher complication rates than in their
      Therefore, to ask someone to become pregnant on someone else’s behalf is to ask her to put herself at real risk.
      own naturally conceived pregnancies. This is particularly concerning, as women who act as surrogates should have better outcomes than women who undergo IVF for infertility, since they are generally healthier and younger. So why is this happening?
      First, in commercial surrogacy, women are implanted with embryos created from other women’s eggs, and studies have shown that women who use eggs from other women have increased risk of preeclampsia, a serious condition that can occur during pregnancy, delivery, and the postpartum period (5,6). Preeclampsia is not only dangerous at the time it occurs but is associated with increased risk of cardiovascular disease, heart failure, and stroke for the rest of these women’s lives (7,8,9).
      Second, women acting as surrogates are even more likely to have more than one embryo transferred during an IVF cycle than are women undergoing IVF for infertility, and therefore are more likely to have twins or even triplets (10). Between 1999 and 2013, more than two-thirds of the infants born to women acting as surrogates were from twin (or more) pregnancies (11). Twins are generally delivered by cesarean section which, in addition to the risks of major surgery, increases the risk of serious complications in subsequent pregnancies, including placental abruption (12), the cause of death of surrogate Brooke Lee Brown (13). Because of well-known risks to both mother’s and children’s health from pregnancies with more than one fetus (14), best medical practice is to transfer one embryo into the uterus during IVF, as is normative in Europe. Here however, transfer of more than one embryo is more likely when the pregnant woman is acting as a surrogate. While women acting as surrogates generally receive a financial bonus for pregnancies with twins, the amount they are paid is only a fraction of what it would cost for the commissioning parents to repeat the surrogacy process for an additional child. Because commissioning parents may not be informed of the medical risks of twinning to both pregnant women and their future children, they may believe that “two for the price of one” is an attractive option, and doctors may implant two embryos to please them .Any legislation that benefits commissioning parents or the doctors who care for them at the expense of surrogates or babies would be unethical.
      Let’s now look at the risk for babies born to surrogates. Children who are twins or triplets or whose mothers were preeclamptic while pregnant with them are more likely to be born too soon or too small. Children born too early and too small have increased hospitalizations and are more likely to have learning disabilities, ADHD, cerebral palsy, epilepsy, hearing and vision loss, and a host of other problems (15, 16). Moreover, even though cesarean section is widespread, recent data show that children delivered by cesarean are more likely to have asthma, diabetes, and obesity (17).
      The third population of concern is women who sell their eggs. More than half of surrogacy arrangements involve the use of purchased eggs, either because the commissioning parents are single or gay men, or because the female partner does not produce viable eggs. The going rate for providing a cycle’s worth of eggs in major cities is $8-10,000 (although women may receive more if they have high SAT scores, are athletes or musicians, or have other desirable traits, incorrectly thought to be genetically transmissible), an enticing sum for an indebted college student or underemployed young woman. The process involves injecting high doses of hormones that cause the ovaries, which normally produce only one egg a month, to produce dozens. This can lead to ovarian hyperstimulation syndrome, a potentially
      serious complication associated with abdominal pain, nausea, blood clots, potential surgical repair of the ovaries, and in rare cases, death (18). Young women are more likely to have this complication and thus should receive lower doses of hormones.
      The American Society for Reproductive Medicine recommends that women not undergo ovarian stimulation more than six times (19), although there is no evidence that even six cycles are safe. Even so, because there is no system in place to track egg donors, there is no way to monitor how many times a woman has produced eggs for money and women have reported undergoing more than 15 cycles. The lack of follow-up of egg providers means that we have no idea if multiple rounds of ovarian stimulation during the prime reproductive years will affect women’s later health. Egg providers’ reports of infertility and hormonally related cancers should be investigated (20,21).
      In light of these concerns about the health consequences of commercial surrogacy, the current bill should be revised to include protections for the health of the women and children involved. Women should be at low risk for medical complications of pregnancy and best medical practices should be followed, such as single-embryo transfer and only medically indicated cesarean section. All parties involved—women acting as surrogates, egg providers, and commissioning parents— should have to undergo an informed consent process in which they are told exactly what we know and don’t know about potential risks to women’s and children’s health from these procedures. Importantly, the bill should include provisions for follow-up studies so that we learn about the consequences for women and children.
      The proposed bill implies that the names of the commissioning parent or parents are the only ones on the birth certificate, leaving children unable to trace their biological identities and health histories. As we know from people conceived by anonymous egg and sperm donation, as well as from those placed in closed adoptions, many of these children later yearn for this information both to help them come to terms with their identities and also to gain access to their medical histories. For this reason and for public health purposes, it is important that an original birth certificate be registered that lists the name of the woman who acted as surrogate and an identification number for the egg (or sperm) provider that may be linked to her (or his) genetic data and medical record. This may be sealed and made available to the child at age 18, and a second “social” birth certificate with the name(s) of the commissioning parent(s) can be created for daily use.
      Couples and individuals who seek commercial surrogacy as a way to form families do so out of the desire to love and raise a deeply wanted child. While legislators understandably want to devise policies supporting this human desire, like physicians, you also have a responsibility to do
      Nor do we know the long-term consequences for women acting as surrogates for undergoing the hormonal treatments necessary for IVF. Since IVF leads to birth less than half of the time, many such women will undergo multiple rounds.
      no harm. Rather than allowing new harms that we will regret in the decades to come, you can revise this bill to avert these unintended health consequences for women acting as surrogates, the babies born and the egg providers. You can ensure that New York State sets a model of caution and care for women and children that the nation can follow
      Chavkin Testimony References
      1. https://www.cdc.gov/mmwr/volumes/68/wr/mm6818e1.htm?s_cid=mm6818e1_w
      2. https://www.cdc.gov/reproductivehealth/maternalinfanthealth/severematernalmorbidity.html
      Qin J1, Liu X2, Sheng X3, Wang H3, Gao S4.Fertil Steril. 2016 Jan;105(1):73-85.e1-6. doi: 10.1016/j.fertnstert.2015.09.007. Epub 2015 Oct 9.
      4. Woo I, Hindoyan R, Landay M, et al. Perinatal outcomes after natural conception versus in vitro fertilization (IVF) in gestational surrogates: a model to evaluate IVF treatment versus maternal effects. Fertil Steril. 2017;108(6):993-998.
      5.Masoudian P, Nasr A, de Nanassy J, Fung-Kee-Fung K, Bainbridge SA, El Demellawy D. Oocyte donation pregnancies and the risk of preeclampsia or gestational hypertension: a systematic review and metaanalysis. Am J Obstet Gynecol. 2016;214(3):328-339.
      6. Savasi VM, Mandia L, Laoreti A, Cetin I. Maternal and fetal outcomes in oocyte donation pregnancies. Hum Reprod Update. 2016;22(5):620-633.
      7. Brown MC, Best KE, Pearce MS, et al. Cardiovascular disease risk in women with pre-eclampsia: systematic review and meta-analysis. Eur J Epidemiol 2013;28(1):1-19.
      8.Stuart JJ, Tanz LJ, Missmer SA, et al. Hypertensive Disorders of Pregnancy and Maternal Cardiovascular Disease Risk Factor Development: An Observational Cohort Study. Ann Intern Med 2018.
      9. Wu P, Haththotuwa R, Kwok CS, et al. Preeclampsia and Future Cardiovascular Health: A Systematic Review and Meta-Analysis. Circ Cardiovasc Qual Outcomes 2017;10(2).
      10. White PM. “One for Sorrow, Two for Joy?”: American embryo transfer guideline recommendations, practices, and outcomes for gestational surrogate patients. J Assist Reprod Genet. 2017;34(4):431-443.
      11. Perkins KM, Boulet SL, Jamieson DJ, Kissin DM. Trends and outcomes of gestational surrogacy in the United States. Fertil Steril. 2016;106(2):435-442.e2.
      3. Assisted reproductive technology and the risk of pregnancy-related complications and adverse
      pregnancy outcomes in singleton pregnancies: a meta-analysis of cohort studies.

      12. PLoS Med. 2018 Jan 23;15(1):e1002494. doi: 10.1371/journal.pmed.1002494. eCollection 2018 Jan.Long-term risks and benefits associated with cesarean delivery for mother, baby,
      and subsequent pregnancies: Systematic review and meta-analysis. Keag OE1, Norman JE2, Stock SJ2,3.
      13. https://www.huffpost.com/entry/american-surrogate-death_b_8298930
      14. https://www.asrm.org/globalassets/asrm/asrm-content/news-and-publications/practice-
      guidelines/for-non-members/elective_single_embryo_transfer-noprint.pdf
      15. https://www.marchofdimes.org/complications/long-term-health-effects-of-premature-birth.aspx

      16. Preterm birth and risk of chronic kidney disease from childhood into mid-adulthood: national cohort
      study.
      Crump C, Sundquist J, Winkleby MA, Sundquist K. BMJ. 2019 May 1;365: l1346. doi: 10.1136/bmj.l1346.
      17. PLoS Med. 2018 Jan 23;15(1):e1002494. doi: 10.1371/journal.pmed.1002494. eCollection 2018 Jan.Long-term risks and benefits associated with cesarean delivery for mother, baby,
      and subsequent pregnancies: Systematic review and meta-analysis.
      Keag OE1, Norman JE2, Stock SJ2,3
      18. Bodri D. Risk and Complications Associated with Egg Donation. In: Sauer MV, ed. Principles of Oocyte
      and Embryo Donation. London: Springer London; 2013:205-219.
      Practice Committee of the American Society for Reproductive Medicine; Practice Committee of the Society for Assisted Reproductive Technology.
      19. Fertil Steril. 2014 Oct;102(4):964-6. doi: 10.1016/j.fertnstert.2014.06.035. Epub 2014 Jul 23. Repetitive oocyte donation: a committee opinion.

      20. Reprod Biomed Online. 2017 May;34(5):480-485. doi: 10.1016/j.rbmo.2017.02.003. Long-term breast cancer risk following ovarian stimulation in young egg donors: a call for follow-
      up, research and informed consent. Schneider J1, Lahl J2, Kramer W3.

      21. https://www.statnews.com/2017/01/28/egg-donors-risks/

  • Zoe
    Posted July 9, 2020 at 1:36 pm

    To say the truth Ukraine pleasantly surprised me as I have used services of one local clinic. The third world country, weak state, debilitated economy and collapsing infrastructure. But it can be seen local clinics show rather good results in the sphere of reproductive medicine. Surrogate mothers are carefully checked in accordance with the international requirements. Appropriate price, “all inclusive” programs, and even 100% guarantee. Al these I have found in Ukraine, Feskov Human Reproduction Group, and was really satisfied. Despite this fact Ukraine is a country where majority of Europeans are afraid to go to. However those ones who have visited Ukraine found that it’s a beautiful, civilized country. I saw on own practice it is really country with high rates of success in the field of ART. This country, located in the Eastern Europe, has the most loyal legislation concerning surrogacy. It’s all because of the legality of the procedure and good prices, many Europeans go to Ukrainian clinics. And I understand them as I also took an advantage of surrogate motherhood there)) There is a good point that you don’t need to wait long for a surrogate, Feskov has big database of surrogate and they will help you choose the right one for you.

  • Helen Raimy
    Posted July 14, 2020 at 8:07 am

    Are you talking about this clinic? https://www.mother-surrogate.com/

    • Kathleen Webster
      Posted July 20, 2020 at 5:22 pm

      These appear to be ads for Ukrainian surrogacy clinics where Eastern European women are ‘offered’ (“The third world country, weak state, debilitated economy and collapsing infrastructure”) to risk their lives on behalf of wealthy U.S. citizens.

  • Kathleen Webster
    Posted July 20, 2020 at 5:13 pm

    Author wrote: I missed a sentence after “It coldly calculates creating the conditions whereby a woman is paid to discount her own life to enhance someone else’s and provide profit for others.” Here tis: Where there are competing claims, it is the “right to life” of the women whose bodily health would be jeopardized that must hold sway. That’s why abortion is a necessary (and many feel, awful) ‘right’ because there has to be a right not to risk your life on behalf of anyone else – even a child. “

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