What does a surrogate mother go through?

The term "surrogacy" has been caught in a storm of public opinion. Surrogacy technology is not medically perfect. In addition to facing ethical controversies, what other health risks do women who donate eggs and surrogate mothers have to face?

Written by reporter Song Meng (Medical and Health Group) Edited by Ding Lin

New Media Editor/Chen Xuanzhi Graphics/Chai Qingyan

Recently, the phenomenon of "surrogacy abandonment" has attracted great attention from the public. First, a surrogate mother in Sichuan was "cancelled" due to syphilis infection after embryo transplantation, and faced difficulties in settling down after giving birth to a child alone; then, a female celebrity was exposed for allegedly trying to abandon her surrogate child after giving birth overseas.

The discussion on this topic is not limited to the entertainment section, but has triggered a wider discussion. People focus on surrogacy mainly in terms of reproductive ethics and law. However, surrogacy technology is not perfect in medicine, and surrogate women have to bear huge risks in terms of physical and mental health...

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The rise and current situation of surrogacy

In medicine, "surrogacy" refers to the act of a fertile woman (i.e. surrogate mother) implanting a fertilized egg into the uterus to carry out pregnancy and childbirth for another person (the client) with the help of the achievements of modern medicine, especially human assisted reproductive technology and its derivative technologies.

Traditional surrogacy is actually "borrowing a uterus + borrowing eggs", that is, the sperm of the male who wants to be a surrogate is placed in the body of the surrogate through intrauterine insemination (IUI). Therefore, the child born by "traditional surrogacy" is also the child of the surrogate in the genetic sense.

However, there is a big difference between traditional surrogacy and the ancient "surrogacy". Because "surrogacy" does not use human assisted reproductive technology, but is conceived naturally (that is, the husband has sexual relations with a woman other than his wife). This practice obviously violates the principle of monogamy stipulated in my country's Marriage Law.

The earliest recorded modern surrogacy appeared in California in the mid-1970s. At that time, a couple anonymously searched for a surrogate mother through an advertisement. They finally got their wish through signing a contract and artificial insemination. The surrogate mother was also called the "first legal surrogate mother."

The huge controversy caused by celebrity surrogacy this time is gestational surrogacy that requires modern medical assistance, which is equivalent to "renting a womb". In this surrogacy method, both spouses are responsible for providing sperm and eggs (or at least providing reproductive cells of one party), and after completing in vitro fertilization, the embryo is implanted into the surrogate's uterus, and the surrogate completes the process of nurturing the fetus. In this case, the surrogate has no genetic relationship with the fetus.

△In traditional surrogacy, the surrogate provides the egg and uterus; in reproductive surrogacy, the surrogate only provides the uterus (picture from the Internet)

Surrogacy is expressly prohibited in most countries, including China, because it involves many ethical and sociological issues. However, there are also some countries that do not explicitly prohibit it, and even legalize it. However, many places have set restrictions on surrogacy. For example, the American Society of Reproductive Medicine recommends that surrogate mothers can only be used when there are medical problems that prevent the intended parents from becoming pregnant on their own (such as uterine deficiency or contraindications to pregnancy), or when there is a significant risk of death or harm to women or fetuses. In addition, some countries believe that the surrogate is the legal mother of the child, and the egg provider is only the biological mother of the child.

In my country, the first batch of surrogacy agencies that appeared in the 1990s were deemed illegal. However, since surrogacy was banned, there are still people who try their best to squeeze into the "grey area" for profit and turn commercial surrogacy operations underground. After nearly 20 years of development, underground surrogacy has gradually formed a mature industry chain.

The reporter searched online and found that there are relevant news about surrogacy agencies on social platforms such as Weibo and QQ, and surrogacy agencies are also conducting new media marketing so that they can communicate with customers at any time. They have a relatively complete industrial chain, including the client, surrogacy agency, surrogate mother, medical staff or clinics that implement surrogacy technology, and surrogacy drug and equipment providers. Many illegal surrogacy agencies have strong anti-detection capabilities and will separate the negotiation location, surrogate mother's residence, and operating room. Once they find danger, they will abandon the account at any time and register again.

△The reporter secretly visited a QQ group for cross-border surrogacy and frozen eggs with 266 members. The gender ratio of group members was almost the same, and more than half of them were young people born after 1990.

Surrogacy is not as simple as "paying money and receiving the goods". Surrogacy involves sperm and egg extraction, in vitro fertilization, and embryo transfer. This process involves many technical issues, as well as sociological and ethical issues, and there are many thorny hidden dangers.

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The "Eighty-One Difficulties" Experienced by Egg Donors and Surrogate Mothers

Since female egg donation is much more complicated than male sperm donation, and considering the egg preservation technology itself and the source of eggs, there is currently no egg bank. Therefore, in the surrogacy "assembly line", female egg donors and surrogates have to go through "interlocking" steps such as egg retrieval, egg retrieval, embryo transfer, pregnancy and delivery. Behind these seemingly simple steps, there are many risks and hidden dangers.

▍Ovulation stimulation before egg retrieval

A reproductive medicine expert once pointed out on Weibo: "Most of those who come to hospitals or the black market to seek surrogacy now do not have uterine problems. Almost all of them are considering maintaining their body shape and do not want to give birth themselves, or they want to find eggs from young and beautiful women. Therefore, surrogacy and illegal egg donation in the underground black market are almost inseparable."

Under the temptation of profit, some illegal surrogacy agencies will carry out the so-called "egg donation" business, and even under the guise of "donating eggs with love", they will clearly mark the price and recruit women to provide eggs. However, the number of human eggs is limited. In a normal woman's menstrual cycle, only 1 to 2 follicles will develop into mature eggs. Underground surrogacy agencies may allow egg donors to abuse ovulation-inducing drugs without knowing it. Under the action of the drugs, the follicles that originally stopped growing will continue to grow, so these surrogacy agencies can obtain multiple eggs at one time, and some even take 20 to 30 eggs at a time.

△Inducing ovulation through hormone injection (Photo source: babygest.com)

There are certain risks in taking ovulation-inducing drugs. These drugs are generally hormonal drugs used to treat infertility caused by ovulation disorders and decreased ovarian function in women. For healthy women, the abuse of ovulation-inducing drugs may bring some immeasurable risks. Among them, milder symptoms include paroxysmal skin burning sensations, mood swings, headaches, abdominal distension and bowel sounds, swelling in the ovarian area, menstrual disorders caused by drug reactions, and may also cause temporary menopausal symptoms (vaginal dryness, hot flashes, etc.); heavier effects can cause egg donors to experience ovarian hyperstimulation syndrome (a serious side effect caused by the use of ovulation-inducing drugs, the main symptoms are pleural and abdominal effusion, ovarian cystic enlargement, and may also cause dehydration, vascular embolism, liver and kidney function damage, stroke, etc.), lifelong infertility, and even life-threatening conditions.

(Image source: babygest.com)

In addition, ovulation induction may also cause other adverse consequences, such as ovarian torsion. Once the ovary is torsion, its blood supply will be affected, and ovarian ischemia and necrosis will soon occur.

▍Egg retrieval

The puncture and egg retrieval has very high requirements for the surgical environment. The operating room must be sterile, dust-free and constant temperature. Egg retrieval requires a 35-centimeter-long needle to pierce the vaginal wall first, then the ovary, and finally suck out the follicles. This process will leave a wound on the ovary.

(Image source: babygest.com)

However, underground surrogacy agencies may have problems such as excessive indoor bacteria, improper operations, and repeated use of instruments during the egg retrieval process. The impact of these problems can cause postoperative infection, pelvic inflammatory disease, and affect the normal fertility of the egg retrieval recipient; in severe cases, they can cause infection with infectious diseases such as hepatitis B, syphilis, and AIDS, and even endanger their lives. In addition, bleeding caused by the operation and damage to the ovaries will also affect the fertility and life safety of the egg retrieval recipient. Regarding egg retrieval accidents, there have been unfortunate precedents abroad: a woman as young as 17 died after egg retrieval, a woman as young as 23 died of ovarian hyperstimulation syndrome after egg retrieval, and so on.

(Image source: babygest.com)

Embryo transfer

The fertilized eggs or embryos formed in in vitro fertilization may be frozen before the surrogate is determined. The embryo transfer surgery will be performed after the surrogate is determined. The freezing process may affect the survival rate of the embryo. There are also some medical risks in the embryo transfer process.

(Image source: babygest.com)

For the fetus, some infectious diseases carried by the surrogate mother (such as hepatitis, AIDS, syphilis, etc.) may also be transmitted to the fetus through the placenta. In countries where surrogacy is legal, formal surrogacy agencies will conduct background checks (production history, health history, criminal history) before accepting surrogate mothers. Surrogate mothers also need to undergo drug and medicine tests, physical health examinations, psychological tests, etc. If the surrogate mother has a husband or boyfriend, they also need to undergo a physical examination together to ensure that they have no infectious diseases. Underground surrogacy agencies may not be so strict in their inspections of sperm and egg donors.

▍Nurturing life

Since the surrogate mother is not pregnant naturally, the internal environment such as hormones in the body is different from that of a normal pregnancy, so the surrogacy agency will intervene by artificially injecting hormones (such as progesterone and progesterone) to make the body "prepare for pregnancy". Among them, the progesterone injection is an oily agent, which is generally used when the embryo is implanted and the fetus is preserved. In order to maintain fetal growth, underground surrogacy agencies may continue to use this agent for surrogates for about three months. However, the skin's absorption rate will slow down with the increase in the number of injections, causing redness, swelling, pain and other reactions at the injection site of the surrogate mother.

(Image source: babygest.com)

Some "clients" seeking surrogacy may also have requirements for the gender of the child. In order to increase the "success rate of gender" and the overall probability of the birth of the child, the surrogacy agency will implant multiple embryos into the surrogate. Once multiple embryos survive at the same time, the agency may arrange for the corresponding fetal reduction surgery, so the surrogate may be forced to repeatedly undergo transplantation, abortion, fetal reduction and other operations until the requirements are met.

Many surrogate mothers are not aware of these shady dealings before they go on the operating table.

In fact, natural childbirth itself is a risky behavior (pregnancy with heart disease, amniotic fluid embolism, uterine rupture, heavy bleeding, infection, etc.), so under normal circumstances, pregnant women need to undergo regular pregnancy tests and disease screening. However, in surrogacy agencies that put profit first, the quality of prenatal care for surrogates may vary.

Therefore, during pregnancy, the risk of miscarriage and premature birth for surrogate mothers may be much greater than that of normal pregnant women. Once miscarriage occurs, it may further lead to some complications (such as heavy bleeding, infection, etc.), and may also cause the surrogate mother to be infertile for life, or even septic shock, which is life-threatening. There was such a precedent abroad: a 30-year-old surrogate mother suddenly had convulsions and cardiac arrest during pregnancy.

(Image source: babygest.com)

In addition, some surrogacy agencies use "twins" as a selling point. In order to increase the number of fetuses, they will let surrogates have multiple pregnancies. Women with multiple pregnancies are more likely to have malposition of the fetus, stillbirth, and dystocia than those with single pregnancies.

▍“When the melon is ripe, it falls off the tree”

In order to protect the fetus, surrogacy agencies generally ignore the physical health of surrogates. In order to increase the success rate, illegal agencies will let surrogates stay in bed for the first three months of pregnancy to "nourish the fetus" and reduce the risk of miscarriage. This restriction may affect the mental health of surrogates.

Even so, the live birth rate of some surrogacy agencies is not high, and surrogates may have to go through several pregnancies before they can successfully "deliver". Moreover, in order to reduce the risk of fetal birth, these agencies often choose caesarean section.

(Image source: slate.com)

It is not only the surrogate mothers who are harmed. Compared with naturally conceived fetuses, surrogate fetuses have higher rates of premature birth, perinatal morbidity, low birth weight, and mortality, and their physical condition after birth is also worse.

Psychological trauma

In addition to the possible physical impact on pregnant women and fetuses, surrogacy may also have a certain impact on their psychology.

For surrogate mothers, pregnancy is also a "physical and mental reshaping". Although the fetus in the womb is not related to them by blood, during the days of pregnancy, surrogate mothers may unconsciously develop feelings for the fetus in the womb. In some countries that allow surrogacy, surrogate mothers even have the right to choose whether to contact the child. If they want to retain custody of the child after the child is born, there is a great chance of success. However, in countries where surrogacy is not protected by law, surrogate mothers can only give up all rights to their future children in a contract.

Professor Hira Saravanan of the Department of Anthropology at the University of Heidelberg in Germany once recorded this story when she was researching surrogacy in India: "Some surrogate mothers hope to keep in touch with their children to find out how they are doing, but the reality is the opposite of what they want. This is because surrogate mothers are mostly unable to contact their clients and children, and some clients are even completely anonymous to the surrogate. One surrogate mother hoped that her client would call her to inform her about the child's situation, and kept her old mobile phone number for 7 years, but she never received a call." Therefore, some surrogate mothers may be traumatized by the loss of their children and develop mental illnesses.

And those so-called "problem babies" who are abandoned by their biological parents as "unqualified products" due to diseases (such as renal displacement, congenital heart disease, premature birth, anal atresia), where will they go when they grow up? If they survive, in addition to the long-term impact of congenital diseases, what kind of psychological process will they have in the process of growing up? And if the "qualified products" born by surrogacy know their origins, will their psychology still be as pure as "normal children"?

References:

1. Ding Xiang Yuan: Help me give birth to a child, and then we will have no relationship anymore?

mp.weixin.qq.com/s/Jtrm1egucE_96EQH73tpKw

2. Guokr: What happened in a big country that once allowed commercial surrogacy?

mp.weixin.qq.com/s/4ybZINuDG2Tpz1eSVY6TpA

3. China News Weekly: Investigation | Uncovering the secrets of China's underground surrogacy industry

mp.weixin.qq.com/s/tcT9wyB-oeo8tck3yO4SYQ

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