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Friday, March 29, 2024

Surrogacy commission asked to consider health implications

Bridget Ryder

Editor’s note: This is the fourth story in a series on surrogacy, which a Minnesota State Legislature commission is studying as it prepares to make public policy recommendations on the practice.

Does commercial surrogacy ask too much of women? Opponents of the practice say “yes.” Surrogacy logo black

While any pregnancy is inherently risky, those risks increase in a surrogacy pregnancy — a fact opponents hoped was underscored in testimony before the Minnesota Legislative Commission on Surrogacy, which is studying the issue and plans to release a report next month. Minnesota does not legally recognize commercial surrogacy arrangements.

Public policy should protect women from surrogacy’s dangers, surrogacy opponents say, rather than create an industry that would submit them to serious potential health risks.

“A surrogacy pregnancy is not the same as a natural pregnancy, because these women have to mimic pregnancy to prepare a woman’s uterus to receive an embryo,” Jennifer Lahl, president of the California-based Center for Bioethics and Culture, told legislators at the commission’s September hearing.

Unnatural pregnancy

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Inducing a pregnancy typically requires a surrogate to take a mix of hormones and steroids for at least four months, and the pregnancy includes triple the normal risk for hypertension and preeclampsia, said Lahl, a pediatric critical care nurse.

About a month before the embryo transfer, the surrogate mother’s menstrual cycle is brought under medical control, often by first suppressing it with the synthetic hormone Lupron. According to Lahl and testimony by fertility industry representatives, the drug is not FDA-approved for use in artificial reproduction. It was developed to treat endometriosis and prostate cancer, and is a Category X drug, meaning if a woman gets pregnant while taking it, the drug can cause damage to the developing fetus.

After Lupron, estrogen and progesterone are administered to thicken and prepare the uterine lining. Doses of the two female hormones can last another two months to prevent miscarriage.

The side effects of these drugs include bloating, depression and loss of bone density. Because the fertility industry is largely unregulated, there is little follow-up with surrogates and egg donors, and no studies on the long-term effects of the drug and hormone regimen in vitro fertilization requires.

One surrogate whose case was cited in the Journal of Neuro-Ophthalmology in 2013 developed pounding headaches from intracranial hypertension.

Many pregnant surrogates also take steroids to suppress their immune systems and prevent their bodies from rejecting babies who don’t share their genes. According to Lahl, because the baby is genetically unrelated, some women experience symptoms similar to those of a donated organ rejection.

Surrogacy pregnancies are also at risk for early labor, and babies are usually delivered by cesarean section, compounding potential complications and risks.

Pregnancy not a ‘job’ to be outsourced

Although many surrogate mothers who have testified before the commission reported no complications, other surrogates have had negative experiences. Obstetrician Matthew Anderson, who practices at AALFA Family Clinic in White Bear Lake, submitted written testimony about a surrogate mother in his care who developed a condition that required her to stop working and go on bed rest. According to Anderson’s testimony, she was a single mother and the intended parents offered her no additional support when she was unable to work.

Other cases have made national headlines. Lahl pointed to the death of surrogate mother Brooke Brown of Idaho, who died in October 2015 from placental abruption just days before a planned cesarean delivery of the twins she was carrying.

Brown, who was married and a mother to three boys, had been a surrogate three times. Like Brown, all surrogates are already mothers, as they are required to have proven their ability to bring a pregnancy to term.

The twins Brown was carrying also died. Their intended parents were Spanish; American women often serve as surrogates for European couples because the practice is banned in Europe as exploitative of women.

Dr. Michael Feinman, a fertility doctor in California, wrote about Brown’s death last year on his blog, remarking, “Dying from a pregnancy-related complication is so rare in the U.S. that many people take it for granted and feel it is acceptable to transfer the risks of pregnancy to another woman.”

For opponents of surrogacy, Brown’s death and the instances of other women who have suffered severe health consequences during high-risk surrogacy pregnancies demonstrate that pregnancy is not a “job” that can simply be outsourced and regulated through public policy.

“You’re not going to be able to take away the health risks,” Lahl warned the commission.

Lahl and surrogacy opponents hope Minnesota’s surrogacy proponents look at the facts and have a reality check.

Lahl asked the commission: “As matter of public policy, is it ethical to ask a young woman — and surrogates in this country are overwhelmingly young mothers — to compromise their own health?”

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