Dados do Trabalho

Title

Surrogacy: a 20-year experience in a reproductive medicine clinic in Brazil.

Objective

To demonstrate through numbers the main indications of surrogacy, multidisciplinary approach and the outcomes in the treatments of surrogacy.

Methods

Retrospective analysis of the psychological follow-up of patients who sought an in vitro fertilization treatment with surrogacy, highlighting aspects related to medical indication, psychological assessment and ethics discussion.

Results

A total of 88 patients had the indication of surrogate between April 2003 and April 2023 in a private reproductive medicine clinic in Belo Horizonte/Brazil. The average age of people who underwent treatment was 36 years. The main medical indications for surrogacy were following hysterectomized women for benign diseases in 24 cases (27,3%); serious medical conditions in 19 (21,6%); 16 (18,2%) homosexual patients; 2 (2,3%) single men; congenital absence of uterus in 11 cases (12,5%); cancer surgery in 8 patients (9%); recurrent miscarriage in 6 cases (6,8%) and repeated IVF failures in 2 cases (2,3%). 37 (42%) couples/patients underwent treatment, we had incomplete data from 9 (10,2%) patients, 4 patients (4,5%) underwent oocyte cryopreservation for future treatment and another 38 (43,3%) did not undergo treatments after the indication. Of the 37 (42%) couples/patients underwent treatment, 3 (8,1%) are pregnancy and 14 (37,8%) had a live birth;13 (35,2%) were negative results; 5 (13,5%) progressed to abortion and 2 (5,4%) had a canceled cycle. Of the 38 (43,3%) patients/couple did not undergo treatments after the indication, the main reasons were: 21 (55,3%) had a first medical and psychological evaluation, but chose not to undergo the treatment; 10 (26,3%) was considered unfit by the doctor; 4 (10,6%) were considered psychologically unfit; 1 (2,6%) gave up the treatment, due to the couple broke-up; 1 (2,6%) would have to use donated eggs with surrogacy and this was not authorized in CFM Resolution number 2.013/2013 and 1 (2,6%) was not authorized by the CRM/MG, as the patient was a single man and there was no inclusion of single people in chapter VII of Substitute gestation at CFM Resolution no. 2.121/2015. In these 20 years, we have offered systematic psychological listening – whether individual, couple or in groups – that allows us pay attention to the unique dimension of the experience of people who experience surrogacy treatment. Thus, we can evaluate and follow up the patient/genetic couple, as well as the surrogate and their family, to identify the affective bonds and possible psychological factors that may predispose to treatment, in addition to optimize the conditions of the family environment that will receive the unborn child. In Brazil, the CFM, in its resolution no. 2.320/2022, determines that the patient's medical record must contain a medical report, with a psychological profile, attesting the clinical and emotional adequacy of all those involved, and this has been the practice at our clinic since the first case of surrogacy in 2003.

Conclusion

The surrogacy is an alternative treatment that gives patients, unable to conceive, a chance to get a biological child, on the condition that everyone involved in the process must be well evaluated from a medical, psychological and ethical point of view.

Keywords

surrogacy, medical indication, psychological assessment, ethics discussion.

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