Infertility is one of the problems that has a deep impact on the marital relationships of infertile couples and also on their social and family relationships, and it is considered the third leading cause of divorce in Iran, which leads to the need to use technologies such as assisted reproductive technologies (ART).
One of the assisted reproductive methods in Iran is the surrogate uterus, which involves a third-party intervention in artificial human reproduction and has become possible through scientific advancements and the use of surrogate mothers, leading to new jurisprudential, ethical, legal, and social issues, especially regarding family rights, and without addressing and understanding these issues, it is not possible to take the necessary steps to initiate the process.
A surrogate motherhood in Iran means an agreement with a woman who has a healthy uterus and declares her willingness to become pregnant for an infertile couple, in a way that after childbirth, the newborn is handed over to the infertile couple. The woman who carries the pregnancy is considered the surrogate motherhood in Iran, and the infertile couple is considered the child’s biological parents.
The gestational mother’s situation is divided into three categories based on the genetic relationship between the gestational mother and the intended parents.
The egg and sperm of the infertile couple are converted into an embryo using the in-vitro fertilization method, and depending on the reproductive cycle of the woman with the uterus, the resulting embryo is transferred to the surrogate mother’s uterus. In this method, the surrogate mother carries the fetus in her womb until delivery. Genetically, the resulting baby has no genetic connection with the surrogate mother, and the infertile couple is considered the biological parents of the baby. This method is called full surrogacy.
Pregnancy of the woman with the uterus, resulting from in-vitro fertilization of the mother’s egg with the sperm of the infertile couple, or direct fertilization. In this method, the woman with the uterus has a genetic relationship with the child and is considered the biological mother of the fetus, which is called relative surrogacy.
The embryo resulting from the sperm of the biological father and a donated egg is implanted in the surrogate mother’s uterus. In this case, the surrogate mother also has no genetic connection to the embryo, but the legal father has a connection with the newborn.
This method is called pregnancy with a donated embryo, which is implanted in the surrogate mother’s uterus.
The necessity of using a surrogate mother in Iran is for couples who have infertility problems and use it to preserve the family foundation and prevent its disintegration. It includes the following cases:
* Congenital absence of the uterus due to Mullerian duct development disorder during fetal development (Rokitansky syndrome), uterine adhesions following curettage (Asherman’s syndrome), suffering from infectious disease and uterine tuberculosis.
* Secondary absence of the uterus in the mother’s body due to hysterectomy, cancer, etc.
* Heart or kidney failure, autoimmune diseases.
* Recurrent miscarriages that have caused infertility and termination of pregnancy.
* Failure in infertility treatment using in vitro fertilization (at least 6 to 8 unsuccessful transfers).
The word “surrogate” is derived from the Latin word “surrogacy,” meaning substitute, which was first mentioned in the Holy Book: Sarah, the wife of Prophet Abraham (PBUH), suggested to her husband that this problem be solved through her maidservant, Hagar.
The law of surrogacy in Iran, based on the “Procedure for Donating Embryos to Infertile Couples” law, permits infertility treatment through the transfer of embryos formed from the sperm and egg of legal and religious couples outside the uterus under specific conditions. All specialized infertility treatment centers will be permitted, in compliance with Sharia regulations and the conditions stipulated in the law, to transfer embryos resulting from the in vitro fertilization of legal and religious couples, after obtaining written consent from the couple who own the embryos, to the uterus of women who, after marriage and undergoing medical procedures, have been proven to be infertile.
The aforementioned centers can proceed with infertility treatment if they obtain written consent from the donating couple and receive a permit to receive embryos from the family court for the requesting husband and wife.
a) Medical consultation: Infertile couples applying for surrogacy must be evaluated in various aspects before using this method. The need for laparoscopy in cases of congenital absence of the uterus, assessment of the health and function of the testes and ovaries through sperm analysis and hormonal tests, ovarian ultrasound, testing for sexually transmitted diseases such as AIDS, hepatitis B and C, and determining blood group (in cases where the surrogate mother has a negative blood group).
Since the possibility of the infertile couple being infected with AIDS is important for the health of the surrogate mother and the resulting child, it is recommended that the sperm or embryos obtained from the infertile couple’s gametes be frozen, and after six months the infertile couple should be re‑tested for AIDS, and if the test results are negative, the frozen sperm or embryos should be transferred to the surrogate uterus.
b) Psychological consultation: Evaluating the mental health of infertile couples applying for surrogacy is highly important, and efforts are made to assess the psychological well‑being of the couple and the stability of their marriage. The presence of personality disorders such as severe depression and schizophrenia, intellectual disability, obsessive‑compulsive disorder, antisocial behavior, and addiction to alcohol consumption are among the factors that prevent the couple’s names from being included in the treatment applicants list.
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