Those couples who cannot successfully carry the pregnancy, surrogate pregnancy is a family building option for them. It is a type of pregnancy in which a woman gives birth to a baby for a person who is not able to have children.
In the surrogate pregnancy process, eggs from the woman itself who will carry the baby or from the egg donor are fertilized with sperm from a sperm donor to form an embryo. Then, an embryo is implanted into the surrogate mother’s uterus until birth. Surrogate pregnancy is a good option for men and women who are on anticancer treatments (such as chemotherapy or radiation therapy that can cause infertility) and want to have children.
In this document, Section-1 will discuss the types of surrogate pregnancy. Section-2 will emphasize Womb Transplantation as an alternative option for Surrogate pregnancy. Section-3 will discuss issues associated with womb Transplantation.
Section-1: Types of Surrogate Pregnancy:
Surrogate pregnancy is mainly of two types i.e. Traditional surrogates and Gestational surrogates.
- Traditional Surrogate: – In a traditional surrogate, the woman gets artificially inseminated with the father’s sperm. The surrogate mother is the baby’s biological mother because the surrogate mother’s egg was fertilized by the father’s sperm. Most commonly, traditional surrogacy is performed through intrauterine insemination (IUI).
- Gestational Surrogates: – A in-vitro fertilization (IVF) process, in which eggs are gathered from the mother, fertilize with the father’s sperm, and then, place the embryo into the uterus of a gestational surrogate. Then the baby carries by surrogate until birth. Gestational surrogate in this process is called “Birth Mother”.[2,3]
Section-2: Womb Transplantation As An Alternative Option For Surrogate Pregnancy
Womb transplant (also known as Uterus transplant) is successfully introduced as a treatment option for women with absolute uterine factor infertility (AUFI). Approximately 3 to 5 % of the female general population have absolute uterine factor infertility (AUFI).
Women without uterus, non-functional uterus, or badly damaged uterus, are enabled to become pregnant via using Womb transplant. Womb transplant involves transplanting the uterus to a woman from a living or deceased donor. Womb transplant is different from other transplantation and involves four parties, i.e., recipient, donor, partner of the recipient, and the possible future child. Womb transplant is a real and valid alternative to adoption or Surrogacy.
Success for organ transplantation depends on whether the organ works properly in the host’s body or not. But success is defined more narrowly for uterus transplant, because in this case, not only does the uterus have to work, but the woman has to give birth to a healthy baby.
Section-2.2: – Advantages of Womb Transplantation over Surrogate pregnancy:
Womb transplant improve recipient well-being and flourish human in a significant way. Womb transplants are ethically challenging and different from other most solid organ transplantation because it is not life-saving as like others.
- Womb transplant aims at relieving reproductive suffering, like ostracism, shame, depression, and sadness.
- Womb transplant is the better option in a country where surrogacy is strictly regulated that it is not practically accessible or prohibited.
- Womb transplant provides both the gestational experience and more importantly, a genetic child that the recipient would not otherwise be able to have.
- Countries like the USA, where surrogacy is legal, also prefer womb transplant because of a wish to bear her genetic child, moral concerns about using a paid surrogate, and the psychological and social complications in society.
- Women prefer womb transplant over surrogacy because they also want to avoid the impersonal and commercial nature of a relationship that is mainly associated with surrogacy.
- Womb transplant also gives pride and personal dignity to gestate and birth her child.
- Womb transplant is also preferred because paid surrogacy, is a costly procedure and less likely to be covered in public or private insurance policies.
- Surrogacy involves the acceptability of one woman transferring the work of gestation and childbirth to another woman thus controversy involves surrogacy. But this type of controversy is not associated with womb transplantation.
- Womb transplant is less fraught with ethical difficulties than surrogacy.
- It is a temporary therapy and the length of therapy is limited; thus, long-term complications are not associated with it.
Section-3: – Issues Associated with Womb Transplantation
Surgical complications are associated with womb (uterus) transplants. The woman who undergoes transplantation is at risk because living donor uterus transplant, the cesarean section to deliver the baby, and the hysterectomy after the delivery are at risk.
Women undergoing uterus transplantation will receive Immunosuppressive medications until the uterus is removed. Two types of risks are associated with immunosuppressive medications, i.e.
- Side effects and other complications associated with immunosuppressive agents.
- Increase in pregnancy complications in women due to immunosuppressive medications.
- Increased risk of lower birth weight and preterm delivery are associated with the children born from recipients of organ transplants.
- Risks to the uterus living donor are similar to those associated with a radical hysterectomy. Injury to the ureter, the iliac vessels, the pelvic nerves, the bladder, and the rectum are potential risks.
- Woman who becomes a gestational surrogate carrier accepts all potential risks associated with in-vitro fertilization, pregnancy, delivery, and postpartum issues.
Psychological Issues: The candidate has to be psychologically ready to undergo major surgery to receive another woman’s uterus. The candidate also needs to bear the physical burden that a living donor friend or family member would incur to help her.
Perpetuating Stereotypes: The transplant may be driven by an internalized stereotype. Due to internalized stereotypes, the risk associated with a woman’s health, donor’s health, and that of the fetus may not be considered.
- Womb transplantation can threaten the autonomy of the donor and subject her to pressure.
- Risks like exploitation of women’s bodies and secret compensation agreements are associated with womb transplants.
- Womb transplantation is more expensive and has higher side effects as compared to other alternatives for absolute uterine factor infertility (AUFI).[6,7,8]
Womb or uterus transplantation is a condition that involves transplanting the uterus to a woman from a living or deceased donor. The success of the womb transplantation depends on two factors i.e. does the uterus have to work properly and the woman has to give birth to a healthy baby.
Womb transplantation is a better option where surrogacy is strictly regulated and it also provides a gestational experience as well as the genetic child. Womb transplantation is still in the experimental phase. Side effects and complications associated with womb transplantation are very high as compared to other alternative treatments for absolute uterine factor infertility (AUFI). Donor, recipient, and child everyone at risk to critical issues in womb transplantation. Thus, womb transplantation is not a better option as compared to surrogate pregnancy.