In medical aspect, gestational surrogacy (GS) is a solution to involuntary childlessness.

The process of GS
always operates against a background of in vitro fertilization and entails a woman agreeing to become
pregnant (via embryo transfer) and then carrying the pregnancy to term with the intent to relinquish
custody of that child on its birth to the couple with whom she has made the contract.1 The primary reason
for the GS is where the woman has a non-functional uterus or has a recurrent pregnancy loss. As with all
Assisted Reproduction Technologies (ART), the ultimate aim of GS is a singleton delivery of a healthy full-
term baby. But advanced maternal age is the most critical determinant for the success rate with IVF, even
for GS cases. The embryo implantation failure rate due to aneuploidy likely exceeds 50 percent when the
female is older than 38 years of age.2 From maternal, neonatal, social, and economic perspectives, the
Single Embryo Transfer (SET) is unquestionably the overall best strategy to prevent multiple gestation and
preterm birth.3

Gestational Surrogacy is being practiced in Argentina, Australia, Japan, Malaysia and others. In Argentina,
filiation through Assisted Reproduction Technologies (ART) are recognized in their Civil Code. However
there is no specific legislation for surrogacy, and cases are increasing respectively. Some surrogacy cases
are handled by court. Nevertheless, intended parents become parents at any price, lawyers are
occasionally involved in contracts of surrogacy. Surrogates proposes informal arrangements in the
internet via social media for sum of money.

In Australia, Gestational and Altruistic Surrogacy is permitted and regulated throughout the country, the
procedural aspect is highly regulated. Altruistic Surrogacy is permitted and commercial surrogacy is
prohibited. However, the Northern Territory is the only part of Australia that has specific legislation on
the matter. It has also different legislative scheme by which the parentage can be transferred from the
birth mother and her partner to the intended parents.

In Japan, infertility is a common issue to the individuals who marry at later age and delay child bearing
which led to the increased demand for assisted reproductive technology (ART). This access is limited to
heterosexual couples only. Surrogacy is not permitted except for uterus transplantation. Moreover, uterus
transplantation faces medical, ethical, legal and social issues at present.

In Malaysia, infertility issues in the country were treated either by medication or surgery. Medication was
used to correct hormonal deficiency, and surgery was arranged to correct anatomic defects. These
methods are not controversial in their view. The ART changed it dramatically which involved a third party
in the process which challenges religious, ethical and legal concepts. At present, surrogacy is unregulated,
just as in nearby India and many other countries. The law of reproductive surrogacy depends on whether
the participating parties are Muslim or non-Muslim. These have been mostly noncontroversial from
ethical and religious points of view.

1
Sheean LA, Goldfarb JM, et al. In vitro fertilization (IVF)-surrogacy: application of IVF to women without functional
uteri. J In Vitro Fert Embryo Transf 1989; 6:1347.
2
Franasiak JM, Forman EJ, Hong KH et al. The nature of aneuploidy with increasing age of the female partner: a
review of 15,169 consecutive trophectoderm biopsies evaluated with comprehensive chromosomal screening.
Fertil Steril 2014; 101:65663.
3
Sills ES. An evidence-based policy for the provision of subsidised fertility treatment in California: integration of
array comparative genomic hybridisation with IVF and mandatory single embryo transfer to lower multiple
gestation and preterm birth rates. Ph.D. thesis, University of Westminster-London, 2012 (British Library EthOS
uk.bl.ethos.576982).
In the Philippines surrogacy is not yet introduced. Although some attempt to propose but failed. Medical
factors should be considered in selecting surrogates, ideally, the surrogate should be physically and
mentally healthy. It must include the past obstetric and gynecological history; must undergo cervical
screening test up to date. A comprehensive family, social, and medical history should be obtained from
the prospective surrogate. Accordingly, she is nonsmoker and have a healthy lifestyle with no history of
alcohol or drug misuse. It should be also obtained the sexual history of the surrogate inheritable
conditions (such as thrombophilia), her marital status. The surrogate should also be a good communicator,
demonstrate emotional intelligence and altruistic, can handle change and manage emotions.

The surrogate and the intending parents should be routinely offered counseling and medical and legal
advice at the outset. This will promote greater understanding and more transparency and clarity, prevent
coercion and exploitation, and ensure that informed choices are made by both sides. The intending
parents must be protected because they may be vulnerable and desperate for a child, whereas the
surrogate also must be protected, especially if she is less affluent. Both parties need support and
protection.4

Psychological screening is recommended for potential surrogates to identify psychopathology, unresolved

trauma, or any other issues that would increase the likelihood of psychological or emotional risks to the
surrogate and preclude her participation.5 Screening of the Intended Parents includes an assessment of
their current and past mental health and psychological status, along with their marital stability.6

4
Celia Burrell and Leroy C. Edozien: The Ideal Surrogate
5
Practice Committee of the American Society for Reproductive Medicine and Practice Committee of the Society for
Assisted Reproductive Technology. Recommendations for practices utilizing gestational carriers: a committee
opinion. Fertil Steril 2015; 103:18.
6
H. Hanafin. Surrogacy and gestational carrier participants. In S. N. Covington and L. Hammer Burns, eds., Infertility
Counseling: A Comprehensive Handbook for Clinicians (New York: Cambridge University Press, 2006), pp. 37086.