International gestational surrogacy in the United States, 2014–2020
To describe characteristics, trends, and outcomes of international gestational surrogacy cycles in the United States (US). Retrospective cohort study. All assisted reproductive technology cycles in the US reported to the Society for Assisted Reproductive Technology Clinic Outcome Reporting Systems t...
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Published in | Fertility and sterility Vol. 121; no. 4; pp. 622 - 630 |
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Main Authors | , , , , |
Format | Journal Article |
Language | English |
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United States
Elsevier Inc
01.04.2024
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Abstract | To describe characteristics, trends, and outcomes of international gestational surrogacy cycles in the United States (US).
Retrospective cohort study.
All assisted reproductive technology cycles in the US reported to the Society for Assisted Reproductive Technology Clinic Outcome Reporting Systems that included an embryo transfer to a gestational carrier from 2014 to 2020.
International vs. US intended parents.
Cycle characteristics, geographic distributions, and obstetrical outcomes.
Of 40,177 embryo transfers to a gestational carrier from 2014 to 2020, 32% were for international intended parents. The number and percent of international intended parents’ gestational carrier cycles increased each year from 2014 (n = 2758, 22.0%) to 2019 (n = 4905, 39.8%) with a decrease in 2020 (n = 4713, 31.8%). Compared with cycles for US intended parents, there was a larger decrease in gestational carrier cycles between 2019 and 2020 for international intended parents (3.9% vs. 32.2%). International intended parents were more likely to be male sex (41.3% vs. 19.6%), older than 42 years (33.9% vs. 26.2%) and identify as Asian race (65.6% vs. 16.5%). International intended parents were largely from China (41.7%), followed by France (9.2%) and Spain (8.5%). Gestational carriers for international intended parents were more commonly younger than 30 years (42.8% vs. 29.1%) and identified as Hispanic race (28.6% vs. 11.7%) compared with gestational carriers for US intended parents. Cycles with international intended parents were more likely to use donor eggs (67.1% vs. 43.5%), intracytoplasmic sperm injection (72.8% vs. 55.4%), and preimplantation genetic testing (79.0% vs. 55.8%). Cycles with international and US intended parents had similar obstetrical outcomes, including live birth (adjusted risk ratio 1.01, 95% confidence interval 1.00–1.03) and multiple pregnancy (adjusted risk ratio 1.00, 95% confidence interval 0.94–1.06) rates.
An increasing number of international intended parents are utilizing gestational surrogacy in the US and more frequently using cost-enhancing specialized treatment techniques. This increase is potentially because of restrictive international commercial surrogacy laws and the increased availability of reproductive medical expertise. Given this growing demographic, continued examination of the volume of cross-border reproductive treatment, as well as the legal and ethical considerations, is warranted.
Gestación subrogada internacional en los Estados Unidos entre 2014 y 2020.
Describir las características, tendencias y resultados de los ciclos de gestación subrogada de extranjeros en los Estados Unidos (EE. UU.)
Estudio de cohorte retrospectivo
Todos los ciclos de tecnología de reproducción asistida en los Estados Unidos reportados al Sistema de Informes de Resultados de Clínicas de Tecnología de Reproducción Asistida que incluyen una transferencia de embrión a una gestante subrogada desde 2014 hasta 2020
Internacionales vs padres designados a EEUU
Características del ciclo, distribuciones geográficas y resultados obstétricos.
De 40,177 transferencias de embriones a una gestante subrogada realizadas entre 2014 y 2020, el 32% correspondió a padres designados extranjeros. El número y el porcentaje de ciclos de gestantes subrogadas para padres designados extranjeros aumentaron cada año desde 2014 (n = 2758, 22.0%) hasta 2019 (n = 4905, 39.8%), con una disminución en 2020 (n = 4713, 31.8%). En comparación con los ciclos para padres designados de los Estados Unidos, hubo una disminución más significativa en los ciclos de gestantes subrogadas entre 2019 y 2020 para los padres designados extranjeros (3.9% vs. 32.2%). Los padres designados extranjeros tenían más probabilidades de ser de sexo masculino (41.3% vs. 19.6%), mayores de 42 años (33.9% vs. 26.2%) e identificarse como de raza asiática (65.6% vs. 16.5%). Los padres designados extranjeros eran en su mayoría de China (41.7%), seguidos por Francia (9.2%) y España (8.5%). Las gestantes subrogadas para padres designados extranjeros eran más comúnmente menores de 30 años (42.8% vs. 29.1%) e identificadas como de raza hispana (28.6% vs. 11.7%) en comparación con las gestantes subrogadas para padres designados de los Estados Unidos. Los ciclos con padres designados extranjeros tenían más probabilidades de utilizar óvulos de donante (67.1% vs. 43.5%), inyección intracitoplasmática de espermatozoides (72.8% vs. 55.4%) y pruebas genéticas preimplantatorias (79.0% vs. 55.8%). Los ciclos con padres designados extranjeros y de los Estados Unidos tuvieron resultados obstétricos similares, incluyendo tasas de nacimientos vivos (cociente de riesgos ajustado 1.01, intervalo de confianza del 95% 1.00–1.03) y de embarazos múltiples (cociente de riesgos ajustado 1.00, intervalo de confianza del 95% 0.94–1.06).
Un número creciente de padres designados extranjeros están utilizando la gestación subrogada en los Estados Unidos y, con mayor frecuencia, recurren a técnicas de tratamiento especializadas que aumentan los costos. Este incremento se debe posiblemente a leyes restrictivas de gestación subrogada comercial a nivel internacional y a la mayor disponibilidad de experiencia médica en reproducción. Dada esta creciente demografía, se justifica continuar examinando el volumen de tratamientos reproductivos transfronterizos, así como las consideraciones legales y éticas asociadas. |
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AbstractList | To describe characteristics, trends, and outcomes of international gestational surrogacy cycles in the United States (US).
Retrospective cohort study.
All assisted reproductive technology cycles in the US reported to the Society for Assisted Reproductive Technology Clinic Outcome Reporting Systems that included an embryo transfer to a gestational carrier from 2014 to 2020.
International vs. US intended parents.
Cycle characteristics, geographic distributions, and obstetrical outcomes.
Of 40,177 embryo transfers to a gestational carrier from 2014 to 2020, 32% were for international intended parents. The number and percent of international intended parents' gestational carrier cycles increased each year from 2014 (n = 2758, 22.0%) to 2019 (n = 4905, 39.8%) with a decrease in 2020 (n = 4713, 31.8%). Compared with cycles for US intended parents, there was a larger decrease in gestational carrier cycles between 2019 and 2020 for international intended parents (3.9% vs. 32.2%). International intended parents were more likely to be male sex (41.3% vs. 19.6%), older than 42 years (33.9% vs. 26.2%) and identify as Asian race (65.6% vs. 16.5%). International intended parents were largely from China (41.7%), followed by France (9.2%) and Spain (8.5%). Gestational carriers for international intended parents were more commonly younger than 30 years (42.8% vs. 29.1%) and identified as Hispanic race (28.6% vs. 11.7%) compared with gestational carriers for US intended parents. Cycles with international intended parents were more likely to use donor eggs (67.1% vs. 43.5%), intracytoplasmic sperm injection (72.8% vs. 55.4%), and preimplantation genetic testing (79.0% vs. 55.8%). Cycles with international and US intended parents had similar obstetrical outcomes, including live birth (adjusted risk ratio 1.01, 95% confidence interval 1.00-1.03) and multiple pregnancy (adjusted risk ratio 1.00, 95% confidence interval 0.94-1.06) rates.
An increasing number of international intended parents are utilizing gestational surrogacy in the US and more frequently using cost-enhancing specialized treatment techniques. This increase is potentially because of restrictive international commercial surrogacy laws and the increased availability of reproductive medical expertise. Given this growing demographic, continued examination of the volume of cross-border reproductive treatment, as well as the legal and ethical considerations, is warranted. To describe characteristics, trends, and outcomes of international gestational surrogacy cycles in the United States (US). Retrospective cohort study. All assisted reproductive technology cycles in the US reported to the Society for Assisted Reproductive Technology Clinic Outcome Reporting Systems that included an embryo transfer to a gestational carrier from 2014 to 2020. International vs. US intended parents. Cycle characteristics, geographic distributions, and obstetrical outcomes. Of 40,177 embryo transfers to a gestational carrier from 2014 to 2020, 32% were for international intended parents. The number and percent of international intended parents’ gestational carrier cycles increased each year from 2014 (n = 2758, 22.0%) to 2019 (n = 4905, 39.8%) with a decrease in 2020 (n = 4713, 31.8%). Compared with cycles for US intended parents, there was a larger decrease in gestational carrier cycles between 2019 and 2020 for international intended parents (3.9% vs. 32.2%). International intended parents were more likely to be male sex (41.3% vs. 19.6%), older than 42 years (33.9% vs. 26.2%) and identify as Asian race (65.6% vs. 16.5%). International intended parents were largely from China (41.7%), followed by France (9.2%) and Spain (8.5%). Gestational carriers for international intended parents were more commonly younger than 30 years (42.8% vs. 29.1%) and identified as Hispanic race (28.6% vs. 11.7%) compared with gestational carriers for US intended parents. Cycles with international intended parents were more likely to use donor eggs (67.1% vs. 43.5%), intracytoplasmic sperm injection (72.8% vs. 55.4%), and preimplantation genetic testing (79.0% vs. 55.8%). Cycles with international and US intended parents had similar obstetrical outcomes, including live birth (adjusted risk ratio 1.01, 95% confidence interval 1.00–1.03) and multiple pregnancy (adjusted risk ratio 1.00, 95% confidence interval 0.94–1.06) rates. An increasing number of international intended parents are utilizing gestational surrogacy in the US and more frequently using cost-enhancing specialized treatment techniques. This increase is potentially because of restrictive international commercial surrogacy laws and the increased availability of reproductive medical expertise. Given this growing demographic, continued examination of the volume of cross-border reproductive treatment, as well as the legal and ethical considerations, is warranted. Gestación subrogada internacional en los Estados Unidos entre 2014 y 2020. Describir las características, tendencias y resultados de los ciclos de gestación subrogada de extranjeros en los Estados Unidos (EE. UU.) Estudio de cohorte retrospectivo Todos los ciclos de tecnología de reproducción asistida en los Estados Unidos reportados al Sistema de Informes de Resultados de Clínicas de Tecnología de Reproducción Asistida que incluyen una transferencia de embrión a una gestante subrogada desde 2014 hasta 2020 Internacionales vs padres designados a EEUU Características del ciclo, distribuciones geográficas y resultados obstétricos. De 40,177 transferencias de embriones a una gestante subrogada realizadas entre 2014 y 2020, el 32% correspondió a padres designados extranjeros. El número y el porcentaje de ciclos de gestantes subrogadas para padres designados extranjeros aumentaron cada año desde 2014 (n = 2758, 22.0%) hasta 2019 (n = 4905, 39.8%), con una disminución en 2020 (n = 4713, 31.8%). En comparación con los ciclos para padres designados de los Estados Unidos, hubo una disminución más significativa en los ciclos de gestantes subrogadas entre 2019 y 2020 para los padres designados extranjeros (3.9% vs. 32.2%). Los padres designados extranjeros tenían más probabilidades de ser de sexo masculino (41.3% vs. 19.6%), mayores de 42 años (33.9% vs. 26.2%) e identificarse como de raza asiática (65.6% vs. 16.5%). Los padres designados extranjeros eran en su mayoría de China (41.7%), seguidos por Francia (9.2%) y España (8.5%). Las gestantes subrogadas para padres designados extranjeros eran más comúnmente menores de 30 años (42.8% vs. 29.1%) e identificadas como de raza hispana (28.6% vs. 11.7%) en comparación con las gestantes subrogadas para padres designados de los Estados Unidos. Los ciclos con padres designados extranjeros tenían más probabilidades de utilizar óvulos de donante (67.1% vs. 43.5%), inyección intracitoplasmática de espermatozoides (72.8% vs. 55.4%) y pruebas genéticas preimplantatorias (79.0% vs. 55.8%). Los ciclos con padres designados extranjeros y de los Estados Unidos tuvieron resultados obstétricos similares, incluyendo tasas de nacimientos vivos (cociente de riesgos ajustado 1.01, intervalo de confianza del 95% 1.00–1.03) y de embarazos múltiples (cociente de riesgos ajustado 1.00, intervalo de confianza del 95% 0.94–1.06). Un número creciente de padres designados extranjeros están utilizando la gestación subrogada en los Estados Unidos y, con mayor frecuencia, recurren a técnicas de tratamiento especializadas que aumentan los costos. Este incremento se debe posiblemente a leyes restrictivas de gestación subrogada comercial a nivel internacional y a la mayor disponibilidad de experiencia médica en reproducción. Dada esta creciente demografía, se justifica continuar examinando el volumen de tratamientos reproductivos transfronterizos, así como las consideraciones legales y éticas asociadas. OBJECTIVETo describe characteristics, trends, and outcomes of international gestational surrogacy cycles in the United States (US).DESIGNRetrospective cohort study.SETTINGAll assisted reproductive technology cycles in the US reported to the Society for Assisted Reproductive Technology Clinic Outcome Reporting Systems that included an embryo transfer to a gestational carrier from 2014 to 2020.PATIENTSInternational vs. US intended parents.MAIN OUTCOME MEASURESCycle characteristics, geographic distributions, and obstetrical outcomes.RESULTSOf 40,177 embryo transfers to a gestational carrier from 2014 to 2020, 32% were for international intended parents. The number and percent of international intended parents' gestational carrier cycles increased each year from 2014 (n = 2758, 22.0%) to 2019 (n = 4905, 39.8%) with a decrease in 2020 (n = 4713, 31.8%). Compared with cycles for US intended parents, there was a larger decrease in gestational carrier cycles between 2019 and 2020 for international intended parents (3.9% vs. 32.2%). International intended parents were more likely to be male sex (41.3% vs. 19.6%), older than 42 years (33.9% vs. 26.2%) and identify as Asian race (65.6% vs. 16.5%). International intended parents were largely from China (41.7%), followed by France (9.2%) and Spain (8.5%). Gestational carriers for international intended parents were more commonly younger than 30 years (42.8% vs. 29.1%) and identified as Hispanic race (28.6% vs. 11.7%) compared with gestational carriers for US intended parents. Cycles with international intended parents were more likely to use donor eggs (67.1% vs. 43.5%), intracytoplasmic sperm injection (72.8% vs. 55.4%), and preimplantation genetic testing (79.0% vs. 55.8%). Cycles with international and US intended parents had similar obstetrical outcomes, including live birth (adjusted risk ratio 1.01, 95% confidence interval 1.00-1.03) and multiple pregnancy (adjusted risk ratio 1.00, 95% confidence interval 0.94-1.06) rates.CONCLUSIONAn increasing number of international intended parents are utilizing gestational surrogacy in the US and more frequently using cost-enhancing specialized treatment techniques. This increase is potentially because of restrictive international commercial surrogacy laws and the increased availability of reproductive medical expertise. Given this growing demographic, continued examination of the volume of cross-border reproductive treatment, as well as the legal and ethical considerations, is warranted. |
Author | Shandley, Lisa M. Kawwass, Jennifer F. Herweck, Alexandra DeSantis, Carol Hipp, Heather S. |
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Cites_doi | 10.1080/09649069.2012.750478 10.1016/j.fertnstert.2009.12.008 10.1037/dev0000372 10.1016/j.rbms.2020.09.003 10.1016/j.fertnstert.2013.02.042 10.1177/00258172211060192 10.1001/jama.2022.1892 10.2147/RMHP.S63862 10.1016/j.rbmo.2011.03.010 10.1093/humrep/den184 10.1016/j.rbms.2018.10.019 10.1016/j.fertnstert.2010.01.046 10.1016/j.fertnstert.2019.07.1346 10.1177/0020872820940008 10.1016/j.fertnstert.2020.05.032 10.1016/j.fertnstert.2017.07.1168 10.3390/medicina57010047 10.1016/j.fertnstert.2016.03.050 10.1080/14647273.2018.1540801 10.1016/j.fertnstert.2022.01.012 10.1097/AOG.0000000000004712 10.1097/AOG.0000000000003698 10.1016/j.fertnstert.2016.11.007 |
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Copyright | 2024 American Society for Reproductive Medicine Copyright © 2024 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved. |
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Keywords | third party reproduction preimplantation genetic testing cross-border reproductive care Gestational carrier in vitro fertilization surrogacy |
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Retrospective cohort study.
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