As a popular wisdom says: "The mother is not the one who gave birth, but that one who brought up a child". It seems that mankind has decided to follow it. A new form of motherhood was invented - the surrogacy. It is an unusual words combination. And, apparently, it offends the ear of many people. Besides, it is mentioned in a lot of scandals.

One of the latest and the most famous of them is observed with the liveliest interest in the U.S. (our newspaper wrote about it on August 22, this year). "A surrogate mother and unborn twins’ affair" – such a name this process received. A young Englishwoman Helen Beasley has given her consent to bear and give birth to a child for an American couple, who already had one son. Recently, it became clear that Beasley was pregnant with not one but with two babies. The parents, who "ordered" only one, demanded that she got rid of the second one, i.e, to have an abortion. Helen decisively refused to do this and was about to cancel the contract. She prefers to give birth to both of the twins and to find adoptive parents for them.

The case of Helen Beasley is not the unique one. There are, probably, more than a thousand surrogate mothers on Earth. When the marriage of two loving people is hopelessly barren, when both of the spouses are in despair, they have only one thing to do: to find a young healthy woman and to ask her: "Bear us a baby!", to pay her money, and she will become for a period of nine months just like an incubator for a fetus of another persons, she will bear and she will give birth to a child which will not be the hers one. It is exactly this kind of women who is called a surrogate mother. Once it was just a fantasy which could never come true. Someone considers it a sin. The Church condemns it. And a geneticist, probably, feels like a God.

Two things are the basis of such a way of procreation: “in vitro” fertilization (IVF) and the agreement between biological parents and a woman, who will substitute the mother. In other words, the genetic material plus the customer’s order. The main figure here is a woman - incubator. And, beside this, a lot of other problems: legal, medical, religious, moral ones.

Prehistory

The researchers began to study the “in vitro” fertilization in 1950ies. On July 25, 1978 in England, Louise Brown was born, who became the first child conceived out of the mother’s body. In 1979 in Melbourne Louise’s “brother-in-method” was born. In the early 90s a new era of the infertility treatment has started. With the help of cellular engineering, the doctors have begun to influence actively on the process of fertilization.

This method has worked his way up from some kind of sensation to a common, usual medical treatment. The essence of the process is as follows: an egg is fertilized by spermatozoa outside the mother's body under the special conditions and then it is kept for some time in the incubator, where it turns into an embryo, the embryo of the future human being, and then it is injected into the uterus, or is implanted. Then the things go according to the tradition: pregnancy, delivery. The egg can be both belong to the future mother or donated. As well as the sperm: either from the husband, either from a sperm bank, i.e. from other man.

The success of the IVF treatment depends on many factors: the age of the spouses, the state of their reproductive organs, the general condition of their bodies, the causes of the infertility themselves. But in any case it will be quite difficult to evaluate the chances accurately. The average efficiency of the program is usually not more than 30%.

First, Let’s Try to Do It by Ourselves

Doctors generally assert that at present every tenth couple in the world is not able to produce their progeny. To be more correct, is unable to produce their progeny by ordinary, natural way.

Some time ago, right after the sensational wedding of one Russian female pop singer who was far more than young (at that time she was well over forty) and a young novice singer (he was not yet thirty years old) the mass-media reported that the celebrities couple conceived a child in a test tube. These rumors were not confirmed, but the fact was quite possible. A woman who is well over forty, even forty-five, if the health condition and circumstances permit, can become a mother in case if an embryo from a test tube is put inside her. As for natural way, of course, it is unlikely. But the IVF could really help. Very not long ago, a famous Italian doctor Severino Antonori who is going to clone a human being, helped in this way to a woman of 63 years old to get pregnant and to give birth to a child. She became the oldest mother in the world, known to the science.

And here is another absolutely real event that took place in Russia. Moscow, 1995. A young woman, Muscovite of twenty-four years old, her name will not be disclosed. She had been married for several years, and both she and her husband wanted a child. She underwent gynecological surgery. The doctors warned: "If you want to give birth to a child, you should hurry up, do not drag it out: apparently, it will not be better". She tried to get pregnant; she received treatment at three doctors. The husband had health checkups - everything was normal, but there were no children. Finally, they decided to do the IVF. In August 1997 she was taken an egg and her husband was taken the sperm. The egg became mature, and in the incubator two embryos were born. She got a call at the work: "It is urgent! You should leave! We have to implant you the embryos. They cannot wait!" She left everything and she was in no minute at the hospital. The implantation was successful - both embryos were implanted into the uterus, after that it was another day of hospitalization with almost no movement: in order not to move or break something. Then the doctors told that if during the first 15 minutes the embryos did not survive, everything will be useless. And they did not survive inside her uterus. When she was weeping into the doctor receiver, she was said: "Well, what do you want? The probability is no more than 30%. And we are doctors, we are not gods."

"Give Birth to our Baby!”

So, the attempt of giving birth to a child by her own forces failed. Now the might-have-been mother will have to choose: either to be treated and to try more implantations or to find a surrogate mother for her baby.

The surrogate motherhood can be different, depending on the degree of couples’s infertility. "Traditional" or "partial" agreements involve the use of surrogate mother's egg and the sperm of the biological father. In such a way, for example, male homosexual couples can have their children. When the surrogacy is "full" ("gestational") there is no genetic relationship between the surrogate mother and the child. In the uterus of a surrogate mother is introduced the egg produced by biological parents. The surrogate mother must be a young woman, who is less than 35 years old, and, of course, healthy. She must have her own family: the husband, and at least two children. This is a necessary condition in order a woman could have somebody to shift her motherly feelings after she has given back a newborn and, in this way, to smooth out her feelings and emotions.

The technology of surrogacy has already existed a little bit less than twenty years. During this time period in the world about one and a half thousand children were born in this way. In Russia, according to official statistics, there are less than ten children born in the way like this. In the CIS the first baby was born in Kharkov, there a mother gave birth to a child for her own daughter with a congenital absence of the uterus. The child is 6 years old already.

All of Them Are Mine

As for Helen Beasley, who was discussed at the very beginning, both embryos managed to survive inside her uterus. She is pregnant with twins and only like this. And if even she, being a surrogate mother, refused to get rid of one of the children, it is hardly to imagine how must be difficult to decide to do this for a true mother, who is bearing the children conceived in vitro.

In one of the women's clinics in Mexico City, a woman was brought, she was not a surrogate mother and she had seven embryos who had survived. It was unlikely that she would be able to bear all the seven embryos - she would have died from exhaustion. Even when there only five children, it is hard to bear all of them. What she had to do? The doctors tried to persuade her and her husband, they were shouting: "We need to remove at least three of them, otherwise you will die! And all of them will die together with you! Was it for this sake you started to do all this?" She was screaming that a pious Catholic should not have an abortion, that she had been trying for too long time to get pregnant, so now it was not easy at all for her to put her children into garbage, the children for whose birth sake she had made such a lot of efforts. "But we won’t do it for all of them!" - The doctors insisted. "No matter how numerous they are, all of them are mine!" - her answer was like this. But, after some time had passed, and three fetuses were found in a wrong position and this could lead to their death even before the delivery. Then the mother agreed. Three of the embryos were removed, and as for the rest they were borne to the end of the pregnancy and they were successfully delivered.

The science and the religion were always in a contradiction. Especially in such a case. However, the talks about ethics, morals and religion are more relevant when a woman bears her own children herself. As for the surrogacy, here, firstly, the matter is about the financial transaction and the maternal instinct, at least the opinion of the majority is like this. It seems that because of this reason, the sharp rebuff, the decided refusal of Helen Beasley from having an abortion caused such a stir.

Market and Morality

As for medical aspects, this issue is completely settled - technically it can be implemented and people implement it. But as for legal, moral and ethical problems, very often they become insurmountable. As well as the cloning, the surrogacy provokes controversies, scandals and unprecedented trials. Apart from the purely scientific thirst for knowledge, experiment and creation, that during all the human history inevitably faced with the social and ecclesiastical condemnation and distrust, when we are talking about the enterprise like this, the question is about big amounts of money, because the procedure is not one of the cheap ones. If you add to this confidentiality, semi-legality (somewhere it is prohibited by law at all), the complexity, labour intensiveness, risk of failure (after all it is just an experiment) and a lot of other legal and simply human nuances. That is why, it turns out that at least in one-third of the cases the scandal is inevitable.

Of course, the conception “in vitro” and any other experiments related to human gene material convert the children into some kind of goods, creating the situation when the rich people can hire women to bear their children. In such a way, the motherhood becomes as a contract job, where, as in any business, the desire for personal gain dominates. Hence, the surrogate motherhood is the market, business, commerce. But, according to one of the lawyers of our country, it does not make sense to prohibit surrogate motherhood by law. Because in this way we would face the same situation as have those countries where abortions are prohibited. If one cannot do this legally, she will do this secretly, using dirty hands and a crochet hook, and as a result every third women will die after such an operation from peritonitis. The same will happen to the surrogate motherhood: if something is prohibited by law, it will be done by the way of law evasion.

The church sees this as dehumanizing, immoral trend that undermines the sanctity of marriage and family. Even the opinions of feminists all over the world concerning this practice are divided. On the one hand, the freedom of conscious of the decision to give birth to a baby for someone can be considered as the right to self-determination. On the other hand, it can be considered as a sexual exploitation.

However, for the childless couple it is the only way to get a child who will be genetically "their own" for the husband or wife. The treatment in question which makes possible the birth of so much desired child, in fact, is not so much different from the adoption. Could be that this is not about the commercialization of reproduction, but about a deeply human act of love and cooperation. This act is connected, of course, with the potential dangers for a surrogate mother, but she is able to evaluate them in terms of money and can consciously take the risk.

Due to the numerous moral, ethical and religious aspects of the issue, the national legislation and policies in most countries set limits to the surrogacy. In some countries (France and Germany) it is completely forbidden. In other countries only commercial surrogacy agreements are prohibited and any claim concerning these agreements shall not be legally considered. These countries include Canada, Israel, Great Britain, Victoria state (Australia), New Hampshire and Virginia states (USA).Finally, some states set limits to the use of reproductive technologies in connection with the surrogate motherhood (Denmark, Norway, Sweden).

I Agree to Work as a Substitution of a Mother

Search for surrogate mothers is held in different ways depending on the country. In Russia, everything is up to the couple that wants to have a baby. There is no "bank" of women who are ready to offer their services of surrogacy. (At least the doctors think like this.) But Russia has access to foreign databases of surrogate motherhood. Besides, in various centers of Reproduction and Gynecology, we can hear the calls when women are offering themselves as surrogate mothers.

In the U.S. this issue is solved in other way. A web site http://www.eggbank.corn - is a huge database that offers information on 300 egg donors.

One of the main problems of the surrogate motherhood program is psychological instability of the woman who decided to become a surrogate mother. Which were her reasons to do so? If she is alone and she has a lot of financial problems, the fact of the pregnancy itself will be an additional stress for her and it will be added to those stress factors she already has. And it is often when she crocks up, and when the child is born, she, being affected by the laws of nature, begins to love the child. And nothing can balance nor replace this feeling. These women are often reluctant to give back their children. As a general rule, the litigations on this issue, which took place over the world, are related either with single women or with those women who are civilly married, who usually do not seem to have stability in their marital statuses.

The reasons that could make a Russian woman to become an incubator for someone else's fetus are quite clear. Imagine that a young provincial girl will receive for such a service at least five thousand dollars, and this money will be more than enough in order to arrange one’s life in some small Russian town. Who would dare to blame such a surrogate mother? Those who do not know how the most of the population in the Russian Federation lives can cast a stone at her.

According to the Law, Against the law and Out of the Law

It is not surprisingly, that having such a lot of questions a special committee of the American Society for the Suppression of infertility (1986) dropped a hint of doubt of ethical nature concerning the surrogacy, which "can not be removed until a sufficient data to evaluate and assess the risks and possible advantages of the treatment in question are received".

It is obvious that for some women offering their services as surrogate mothers, the main stimulus is money, and it can incite them into providing false information concerning their health or life circumstances. There are cases where infertile couples, looking for a suitable woman who could play the role of the mother tried to persuade one of their relatives to do this. On the other hand, some unscrupulous lawyers and doctors, or those ones who do not consider this process seriously, sometimes they are so attracted by the prospect to make good money during the selection process of surrogate mothers that they become unable to act in the interests of their clients. And still, as hundreds of previously childless couples can testify to, the benefits of such a method of infertility treatment are invaluable.

However that may be, the legislation in this area is so ill-considered that the legal confusion arises always and everywhere, here and abroad. At one time all the America with lively interest was following the trial Johnson versus the Calvert’s, which had raised many questions relating to the surrogate motherhood in general. The couple who have no children due to removal of the Mrs. Calvert’s uterus, entered into an agreement on the surrogate mother services with a young unmarried nurse called Anna Johnson. For $ 10,000 the latter agreed to carry the pregnancy to term being pregnant with the fetus conceived during the fertilization of Mrs. Calvert egg by the sperm of her own husband. However, shortly before the delivery, Mr. Calvert suddenly changed his mind and ... filed a lawsuit to the Court of California to recognize Anne Johnson as a mother of this child. Ultimately, the court did not sustain a claim, saying that genetically this child is a child of the Calvert family, and the surrogate mother, though she was pregnant with this child for long 40 weeks, only played the role of the nurse, whom the parents entrusted their child for some time. However, not everyone agreed with the decision of the court - millions of the women who experienced the process of giving birth, who are familiar with the feeling of a new little life, believe that it is pregnancy and childbirth, and not the genetic material of germinal cells, makes a woman a mother.

In general, the surrogate motherhood is an inexhaustible source of all kinds of curious incidents and confusions concerning the status of family members. For example, if a woman was pregnant with the fetus, conceived from the egg of her own daughter, fertilized by the sperm of the son-in-law, in this case whom she will be as regards to the newborn child - the mother or grandmother? Or his mother and grandmother at the same time? The history of reproduction knows a lot of the cases like this.

In the international context the agreements on surrogacy will be practiced as before, including those between citizens of different countries, and the disputes may arise, and the answer to these disputes cannot be found within the existing legislative restrictions on the level of one country.

Me and my Parents

The last thing in this case what people think about, as it often happens, is the hero of the whole enterprise - the child and his or her rights. First of all, the child may inherit genetic defects from the surrogate mother. The most important thing is the psychological adaptation of the child. If your child is explained (or accidentally finds out) that he or she was born not by the mother, but by another woman, will it cause some problems? And if the child meets with this woman after his birth (as it happens when a surrogate mother is a relative or some person who is close to the family), how can it affect on the child in the future?

In addition, a newborn may have no genetic relation with one of the parents or even with both of them. Any man and any mother will need to have a moral courage to deal with it. Because then the father will have to bring up the son who was born thanks to the semen of another man. Or the mother will bring up her daughter, born from the egg of absolutely another woman. Somewhere there will be a woman who carried somewhere under her heart a child of another persons, and then she had been taking hormones for a long time in order to calm down the storm in the body, called the maternal instinct. A child conceived in a flask, matured in the incubator and brought into the world not by to those people whom he or she calls mom and dad will probably think some time that the adults just simply entertain him telling the fairy-tales about some kind of miracles. And it is good, if it is like this.

As Old as the Hills

The legend says the following. The prince Vardhamana, who had a honorable nickname Mahavira (that means, in translation from Sanskrit, "a great hero") was the founder of Jainism, a religion which still being practiced in India, in the United States and other countries. He lived in the V century BC. And the story about his origin surprisingly anticipates one of the techniques of assisted human reproduction - the method of the surrogate motherhood.

The fact is that the Great hero decided to play a trick on the gods and to be born in the wrong estate, not in the one he was supposed to, i.e. not at highborn Kshatriya, but at the Brahmins who were not noble. On the Earth, two women got pregnant at the same time: one from Kshatriyas and another from the Brahmins. The gods could not allow the great hero to be born from a Brahmin woman. Therefore, they had to resort to their superhuman abilities, and while the two women were asleep, they changed the places of the babies. The fetus of the Kshatriya woman was put into the womb of the Brahmin one and vice versa. Thus the Great hero was born within the estate he supposed to. And both women, without knowing this, became surrogate mothers. They became pregnant on the same day, so by the time of the embryos transplantation they had the same age. It was exactly three lunar months, three lunar cycles.

But this was a legend. And the real history of mankind shows that in fact the prototype of surrogate motherhood had appeared some thousand years before the IVF treatment was invented. What else could be the purpose of the concubines, kept women, bondwomen, harems, and other similar institutions which appeared at one time? A human being is programmed by the nature to procreate, and if the simplest and the most natural way does not work, it means that another ones should be created. If a wife of some Egyptian Pharaoh was not able to have children, or could not give birth to a son, the heir, nothing and nobody, and least of all the Queen herself, could forbid the governor to take a concubine, a girl from a decent family, and to reward her generously in order she could give birth to a son for the royal couple.

So, it appears that the surrogacy has the same age as all the mankind and whose many of the best representatives were born in this way. So, how should one treat the surrogate motherhood: as something good or as an inevitable evil? Religious, moral, ethical, legal, and scientific debates concerning this topic will never cease. One thing is clear: the surrogate motherhood it’s just a fact, it exists and, apparently, there's no getting around that.

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The surrogate mother must be a young woman, less than 35 years old, and, of course, healthy. She must have her own family: the husband, and at least two children

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That’s no doubt that the conception “in vitro” and any kind of experiments with human genetic material can convert the children into some kind of goods, creating a situation, when the rich people will be able to hire women to bear their progeny.