Суррогатное материнство

Surrogacy

Surrogate maternity or surrogacy becomes a more and more wide-spread means of treating infertility in the whole world which consists in a woman (surrogate mother) carrying an embryo of intended parents. Yet, no genetic link is established between the surrogate mother and the baby she’s bearing. That type of surrogacy became available to people only in the late 70s of the last century when the first test-tube baby was born and it is called ‘gestational’ surrogacy. The number of children born through surrogacy has already surpassed thousands of hundreds. Our clinic specializes in surrogacy programmes and has a rich experience in this field.

Legal issues

The Russian Federation is one of the few lucky countries where surrogacy is legal and stipulated by specific legislation. The legal grounds of surrogacy are spelt out in the following legal acts: the Family Code of the Russian Federation (Paragraph 4 Article 51, Paragraph 3 Article 52), the Russian Act on Civil Health (art. 35) and the Federal Law on Civil Status #43 (Paragraph 5 Article 16). To access to surrogacy, a couple must have certain prescriptions. The marital status of legal parents is not important in this case, in Russia even single parents are entitled to the right to surrogacy. The indented parents’ nationality is of any importance neither, citizens of other countries enjoy the same rights in surrogacy as Russians do.

If a woman wishes to become a surrogate mother, she is to be aged from 20 to 35 (in Ukraine she can be up to 40), she shall also have a healthy child of her own, be mentally and somatically healthy, she should also agree to take part in a surrogacy programme.

Before launching a programme, the intended parents and the surrogate mother are to give their written consent to take part in the surrogacy programme and make up a medical service contract. Besides concluding a contract with the clinic, we strongly recommend you should make up another contract with the surrogate mother that would canvas the order of the implementation of your programme as well as the kind of relationship between the intended parents and the surrogate mother at all stages of programme implementation, the rights and obligations of the parties, the order of payment of the surrogate mother’s remuneration, penalties for breaching the document and some other issues. We strongly suggest that you should turn to professional lawyers specializing in this branch of law to avoid any faults when drawing up the document.

When the baby is born, the surrogate mother gives her consent on recording the intended parents on the Birth Registrar as the legal parents. The official consent form is signed in the maternity hospital just after the delivery before the surrogate mother’s release from hospital. Soon after the local Birth Registrar Office registers the child, and the parents are issued with the birth certificate for their baby on which they are deemed to be the baby’s legal parents. The registration procedure doesn’t take more than one day. The surrogate mother’s name is not mentioned on the certificate at all. After registering the baby, the surrogate mother is deprived of all the rights to the baby she has carried. For the past 15 years since 1995 when surrogacy was legalized in Russia, no surrogate mother has ever refused to give the baby to the intended parents.

The clinic is responsible for the implementation of the medical constituent of the surrogacy programme and holds no responsibility for legal consequences this programme might entail. To clear everything out we recommend you should consult only qualified specialists that deal in surrogacy.

Single parents

Certain lawyers believe only legally married couples can have access to surrogacy programmes in Russia. However, it’s not quite like that. The legislation allows access to surrogacy programmes for all major women of fertile age if she has appropriate medical indications, even if she is not officially married or is not in a de facto relationship. The Russian law protects the right of any woman to her right to maternity. Article 35 of the Russian Law on Healthcare precludes that ‘Any major woman of fertile age has the right to carry out an artificial insemination or implant an embryo’. Artificial insemination and embryo transfer are carried out in special medical institutions approved by the State with the single woman’s written consent.

Information regarding artificial insemination and embryo implantation as well as the donor’s ID are strictly confidential.

Therefore, the patient’s civil status when implementing ART programmes in Russia is not important, as any single woman can start a programme and determine her child’s father later, as it is provisioned by the Family Code of the Russian Federation. The only limiting factor here is the applicant’s age, she is to be major, i.e. older than 18, and be of fertile age. Under the age of fertility the law means the age in which one is physically capable of bearing and delivering a child. However, today great achievements in ART make this factor conventional in Russia.

Denial to the lawful right to maternity and registration of surrogate children is illegal and can be and ought to be resolved in Court. The country’s court system has already faced similar cases that were eventually won.

In Summer 2009 in Krasnodar a ‘surrogate’ daughter was born to an unmarried 45 year-old woman. The officials of the Prikuban Registrar Office refused to register the baby, even though the surrogate mother had signed all the necessary documents. Their objection was that only the woman who had delivered the baby could be legally recognized as her mother. To resolve the dispute, the client was offered to take her own child for adoption. Following her lawyers’ recommendations, she filed a suit to establish her baby’s maternity. However, the dispute was resolved before going to court. Yelena Berezhinskaya, the Judge of the Prikuban Regional Court, particularly focused attention of the Registrar Office’s officials to the fact that their actions breached the law. She emphasized that ‘the law should be interpreted in the interests of the child and his mother, not in the interests of the law itself’. The Registrar Office recognized the plaintiff as the child’s legal mother before court upheld its verdict.

In Spring 2009 a 35 year-old unmarried woman from Saint-Petersburg became a mother. At first sight, that case would seem quite ordinary – there are more and more women who deliver at an advanced age all over the world, and around 30% of Russian pregnant women are not officially married. The thing was that the child had been delivered by a surrogate mother and the programme had been implemented with the help of an individual sperm donor.

When the child was born, the surrogate mother gave her consent to put the genetic mother’s name onto the Birth Registrar. However, the registration imposed certain problems: the Registrar Office refused to register the baby saying that the legislation in force did not allow single women to apply for surrogacy.

This case was resolved in Court. The verdict of the Court was that the law of the Russian Federation precluded that a single woman had the same rights with married women and was entitled to her right to maternity.

The Court also ruled that there was no law that would prohibit a single unmarried woman to become a mother by emphasizing that references to Paragraph 7 of Order 67 On Appliances of Assisted Reproductive Technologies in male and female infertility treatment of February 26, 2003 were not correct, because the first paragraph of the passage clearly states that legal grounds of surrogacy are spelt out in another legal act, which means that Order 67 of the Ministry of Healthcare of the Russian Federation does not concern any legal matters linked to surrogacy.

The Court said that Paragraph 4 of Article 51 of the Family Code provides for only one of all the possible cases, that is to register a child born through a surrogacy programme implemented for an officially married couple: ‘Parties who are registered as an officially married couple and who have given their consent to carrying out artificial insemination or embryo implanting are registered as the parents of the baby born as a result of the programme. Parties who are officially married and who have given their consent to implanting their embryo into the uterus of another woman to carry it can be registered as the baby’s parents only with the written consent of the woman who has delivered the baby (surrogate mother)’.

Judge Anna Korchagina by announcing the judgment pointed out that local Registrar Offices incorrectly generalize the provisions of Paragraph 4 Article 51 of the Family Code and said that claiming that a single woman is not entitled to take part in a surrogacy programme would be incorrect. The Court lawfully stated that such an interpretation of the law violates civil rights fixed by Articles 38, 45 and 55 of the present Constitution of the Russian Federation.

The Court highlighted that the mother’s formal consent is another proof that in no way she claims to be registered as the mother of the baby born as part of a surrogacy programme. Basically, passage 2 of Paragraph 4 of Article 51 of the Family Code spells out the rights of the surrogate mother.

The Court also resolved a long dispute as to whether unmarried parents had the right to take part in a surrogacy programme. According to the verdict, the Registrar Office’s position in the case contradicts the provisions of Article 12 of the Family Code of the Russian Federation that states that the intended parents are to be officially married to be allowed to access to a surrogacy programme.

However, the provisions of Paragraph 4 Article 51 of the Family Code do not require that a couple applying for a surrogacy programme should be officially married. Official marriage is an obligatory prerequisite to register the baby when it is born, yet, in no way is it an obstacle to launch a surrogacy programme at a reproductive clinic. Anyways, no limitation can be set up here, because there is no law that would force people into getting married or would deny their natural right to have a baby without being married.

Indications

In Russia, anyone who is willing to turn to surrogacy is supposed to have specific indications set up by Order 67 of the Ministry of Healthcare of the Russian Federation On appliance of ART in male and female infertility treatment. The list of indications is rather broad. Still, there are some common indications, among these are:

  • absence of uterus (congenital or acquired);
  • uterine cavity or cervix deformity due to congenital malformations or to any diseases;
  • uterine cavity synechia, which cannot be treated;
  • somatic diseases contraindicating any child bearing;
  • repeatedly failed IVF attempts, when high-quality embryos were repeatedly obtained and their transfer wasn’t followed by pregnancy.
  • Social indications cannot be considered as a reason for hiring a surrogate mother.

Screening

All screenings can be done with the shortest possible delay at our clinic. Our clinic also recognizes the results of the analyses taken in different clinics, Russian or international ones. We recommend you prepare all the documents beforehand and fill in a special form. If needed, the screening may be repeated.

    Medical examinations for the surrogate mother:

  • blood type and Rhesus factor identification;
  • blood sample testing for syphilis, HIV, Hepatitis B and Hepatitis C (results are valid for 3 months);
  • tests for the following infections: chlamydiosis, genital herpes, ureaplasmosis, mycoplasmosis, cytomegaly, rubella (validity period: 6 months);
  • general urine sample test (validity period: 1 month);
  • clinical blood sample test + coagulation time (validity period: 1 month);
  • biochemical blood sample test: ALT, AST, bilirubin, sugar, urea (validity period: 1 month);
  • fluorogram (validity period: 1 year);
  • testing of samples taken from urethra and cervical channel for microflora and testing of actual vaginal cleanness (validity period: 1 month);
  • cytological test of smears taken from uterine cervix;
  • examination by general practitioner and report on the actual state of health and absence of any contraindications to child bearing (validity period: 1 year);
  • examination by and appropriate report from psychiatrist (one time);
  • general and special gynecological examination (before each superovulation inducement attempt).

Medical examinations of the intended parents.

All screenings can be done with the shortest possible delay at our clinic. Our clinic also recognizes the results of the analyses taken in different clinics, Russian or international ones. We recommend you prepare all the documents beforehand and fill in a special form. If needed, the screening may be repeated.

For the woman:

    Compulsory:

  • general and special gynecological examination;
  • ultrasound examination of small pelvis;
  • blood type and Rh identification;
  • clinical blood sample testing, including coagulation time (results are valid for 1 month);
  • blood sample testing for syphilis, HIV, Hepatitis B and Hepatitis C (results are valid for 3 months);
  • testing of samples taken from urethra and cervical channel for microflora and testing of actual vaginal cleanness;
  • general practitioner’s report on the actual state of health and chances for child bearing.

  • Per indications:

    • Examination of uterus and uterine tubes (hysterosalpingography or hysterosalpingoscopy and laparoscopy);
    • endometrial biopsy;
    • bacteriological testing of samples taken from urethra and cervical channel;
    • cytological testing of samples taken by way of uterine cervix smears;
    • blood sample testing for FSG, LG, Е2, Prl, T, cortisol, P, Т3, Т4, NNG and STG;
    • examination for antispermal and antiphospholipid antibodies;
    • examination for infections (chlamydiosis, uro- and mycoplasmosis, herpes simplex, cytomegaly, toxoplasmosis, rubella);
    • per-indication reports from other specialists.

    In case the surrogacy programme includes egg donation, the patient needs only the doctor’s certificate confirming that the patent is capable of carrying a pregnancy and that it is reasonable to use a donor’s oocytes.

    Indications to egg donation in surrogacy programmes:

    • absence of oocytes caused by natural menopause, premature ovarian failure syndrome, specific states of health typical for post-ovarian ectomy period, post-radiotherapy period or post-chemotherapy period, as well as abnormal development (gonad dysgenesis, Shereshevsky-Turner syndrome, etc.);
    • oocytal functional inferiority in female patients suffering gender-specific hereditary diseases (hemophilia, Duchesne myodystrophy, Х-linked ichthyosis, Charcot-Marie-Trusseau peroneal myotrophy, etc.);
    • repeated IVF failures in which the ovaries were insufficiently responsive to inducement of superovulation, and when embryos obtained were, more than once, of poor quality, and no pregnancy could be achieved after their transfer.

    For the man:

    Compulsory:

    • blood sample testing for syphilis, HIV, Hepatitis B and Hepatitis C (results are valid for 3 months);
    • spermogramme.

    Per indications:

    • blood type and Rh identification;
    • andrologist’s consultation;
    • examination for infections (chlamydiosis, uro- and mycoplasmosis, herpes simplex, cytomegaly).

    For patients over 35 years old a genetic screening is normally required.

    IVF stages

    • selection of surrogate mother;
    • patients’ medical screening;
    • induction of superovulation;
    • monitoring of follicle genesis and endometrial development;
    • ovarian follicle puncture;
    • collecting and preparing the sperm;
    • insemination of oocytes and in vitro cultivation of embryos;
    • transfer of embryos into the uterine cavity;
    • maintaining of the lutein phase within the stimulated menstrual cycle;
    • diagnostics of early-stage pregnancy.

    Selection of surrogate mother:

    Selection of surrogate mother:  The clinic can offer you a rich database of surrogate mothers who have already been carefully screened in accordance with the provisions of Order 67 of the Ministry of Healthcare of the Russian Federation. There is no waiting list, we can start implementing your surrogacy programme immediately.

    Sometimes, patients prefer hiring their own relatives or friends as surrogate mothers.

    You may as well consult a special surrogacy agency to find a surrogate mother. When choosing among agencies, beware of frauds. The agency should have an experience in this field. What is worst is looking for a surrogate mother in the Internet.

    Synchronization of the surrogate mother's and the genetic mother's menstrual cycles

    The clinic can offer you a rich database of surrogate mothers who have already been carefully screened in accordance with the provisions of Order 67 of the Ministry of Healthcare of the Russian Federation. There is no waiting list, we can start implementing your surrogacy programme immediately.

    Sometimes, patients prefer hiring their own relatives or friends as surrogate mothers.

    You may as well consult a special surrogacy agency to find a surrogate mother. When choosing among agencies, beware of frauds. The agency should have an experience in this field. What is worst is looking for a surrogate mother in the Internet.

    Superovulation induction

    To increase chances of successful fertilization hormonal medication stimulating the follicle genesis is prescribed to patients. Thus, the patient’s ovaries produce more than one oocyte.

    To induce superovulation only drugs that are registered in the Russian Federation can be used. Selection of specific stimulation patterns and medication, as well as adjustment of dosage and introduction of modifications into the induced superovulation protocol are performed on an individual basis.

    As a rule, the stimulation starts on the 2nd or 3rd day of the cycle and lasts for 10-12 days. The following drug groups can be used here: selective modulators of estrogen receptors (SMER); gonadotropines (human menopausal gonadotropine – hMG; follicle stimulating hormone – FSH; recombinant FSH – rFSH; recombinant luteinizing hormone – rLH; chorionic gonadotropine – CG); agonists of gonadotropine releasing hormone (a-GnRH); antagonists of gonadotropine releasing hormone (ant-GnRH).

    Monitoring of follicle genesis and endometrial development

    During the stimulation regular ultrasound and hormonal monitoring is carried out. Ultrasound monitoring allows to estimate the ovarian response to the stimulation, determine the number of follicles, their rate of growth, modify the stimulation pattern if needed and choose the best moment to induce CG – medication that finalizes the stage of follicle growth.

    Ultrasound monitoring is the principal method to carry out dynamic control over the development of follicles and endometrium during superovulation induction. Ultrasound monitoring makes it possible to precise the number of follicles available and their average diameter (as per sum total of two measurements made) and to measure the endometrial thickness.

    Hormonal monitoring implies dynamic identification of estradiol (Е2) and progesterone (Prg) concentrations in blood and, therefore, is a supplement to ultrasound examination results to estimate the maturity of the follicles.

    Criteria of the completion of superovulation induction and prescription of CG

    The induction of superovulation is completed at the moment when the leading follicles become more than 17 mm in diameter and the endometrial thickness exceeds 8 mm. Some other indicators to complete the induction depend on how active steroid genesis (Е2 concentrations in blood plasma) is.

    To finalize the process of oocyte maturing, CG is induced (recommended dosage: 5,000 – 10,000 IU at a time, intramuscularly).

    Follicle puncture and oocytes retrieval

    Puncture of ovarian follicles and aspiration of oocytes are carried out 32-40 hours after CG’s induction. It can be done on-site, in a minor-operation room, usually through transvaginal access under ultrasound control, with special needles designed for puncture purposes. In case transvaginal puncture is not possible (ovaries are located atypically, etc.), oocytes can be retrieved through laparoscopy.

    The puncture does not take more than 15-20 minutes and is not dangerous for the patient. After the operation the woman stays in a special post-care unit for 1,5-2 hours under surveillance of the medical staff. After that she can be released home.

    If there are necessary medical indications, a donor’s oocytes can be used. An anonymous donor is chosen by the patients basing on the phenotypic description provided by the clinic.

    Sperm collection and registration for IVF

    Specially prepared husband’s or donor’s sperm is used in IVF. Sexual abstinence of 3-5 days is recommended for the man before sperm collection. The sperm is collected through masturbation. Sterile container intended for collection of the ejaculate should be marked appropriately. Sperm collecting is to be performed in an appropriate room with a separate entrance, appropriate interior design and lavatory with a washbasin. The sperm may be frozen for a later use.

    An anonymous donor is chosen by the patients basing on the phenotypic description provided by the clinic.

    Oocyte insemination and in vitro embryo cultivation

    Follicular liquid obtained after the follicle puncture is placed into a Petri dish. The material is examined by a stereomicroscope. At this stage qualitative estimate of the retrieved oocytes is carried out. Then they are transferred into a cultivation environment. The dish is placed into an incubator imitating the uterine flora and environment.

    Both fresh and cryconserved spermatozoa should be washed of any seminal plasma before use. Fraction of morphologically normal and top-mobile spermatozoa should be separated from all other spermatozoa. Today 2 principal methods for sperm processing are used: flotation centrifugation and density centrifugation.

    If the spermogramme results are not sufficiently good, ICSI (intracytoplasmic sperm injection) is then recommended which ensures conception even if there are few viable spermatozoa.

    Presence of fertilized oocytes is usually estimated 12-18 hours later, when male and female pronuclei become clearly visible. Zygotes are put into a fresh cultural medium, where initial embryo development takes place. Embryos are cultivated in a special incubator during 2-5 days.

    Embryo transfer into the uterine cavity

    Embryos can be transferred into the uterine cavity at various stages, starting from the zygote stage and up to the blastocyte stage, which is usually formed in humans 5-6 days after fertilization.

    It is recommended to transfer not more than 3 embryos into the uterine cavity. However, it is possible to transfer a greater number of embryos, if expected implantation probability is low. Embryos are transferred with special catheters that are induced into the uterine cavity through the cervical channel.

    In case of the cervical channel permeability impairment which cannot be treated, embryo transfer can be performed through the uterine wall (transmyometrally). Mandrin-containing needle can be put into the uterine cavity transvaginally, transabdomenally or transurethrally.

    To increase the chances of implantation the so-called assisted hatching can be used. In this procedure the outer layer of the embryo is hatched out in order to help it implant into the uterus.

    Maintaining of lutein phase within the stimulated menstrual cycle

    Lutein phase within the stimulated menstrual cycle is usually maintained by progesterone or its analogues.

    In case there is no risk of ovarian hyperstimulation syndrome (OHS), maintaining of the lutein phase can include inducement of CG-based drugs, normally prescribed on the embryo transfer date, and, afterwards, each 2-4 days (on the individual basis).

    Diagnostic of early-stage pregnancy

    Pregnancy diagnostic methods involving identification of beta-CG content in blood or in urine are performed 12-14 days after the embryo transfer date. The first ultrasound screening can be carried out 21 days after the embryo transfer date.

    Surrogate mother’s pregnancy surveillance

    Pregnancy surveillance after IVF and particularly after carrying out a surrogacy programme is special. Our clinic specializes in maintaining such pregnancies at all stages. You can order pregnancy surveillance by trimesters or for the whole period at our clinic.

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