Gestational surrogacy. Medical, psychological and legal aspects: 9 years of experience in Mexico.

study questionWhat are the medical, psychological and legal aspects involved in running a gestational surrogacy (GS) program in Mexico? SUMMARY ANSWER: The correct and complete implementation of a medical protocol, adherence to legality and psychological screening are key elements for the success of a GS program. WHAT IS KNOWN ALREADY: To our knowledge, this is the first reported GS case series in Mexico. STUDY DESIGN SIZE DURATION: This was a retrospective, descriptive study of 135 cycles performed between 2007 and 2016 at a fertility center in Villahermosa, Tabasco, Mexico. PARTICIPANTS/MATERIALS SETTING

methodWe analyzed data from 135 GS cycles, 57 intended parents (IP) and 63 gestational carriers (GC). MAIN RESULTS AND THE ROLE OF CHANCE: GS in Mexico is only allowed in its altruistic mode. The legal requirements for the GCs are age 25-35 years and a complete medical examination that certifies no pregnancy during the last 365 days before embryo transfer and excludes infectious and chronic diseases. The IPs must be aged 25-40 years of age, have Mexican citizenship, and provide life insurance and medical expenses for the GCs. The GC recruitment was carried out by word of mouth. Of the 150+ women that requested information, 89 were identified as possible candidates. In total, 77 underwent the psychological evaluation protocol and nine were rejected owing to behavior and emotional alterations, giving 68 who began the medical selection protocol. Five women were not accepted as they were positive for human papilloma virus, or had experienced endometrial polyposis or recurrent pregnancy loss. Finally, 63 women entered the IVF protocol as GCs. The indications for GS were: hysterectomy 32%, implantation failure 21%, single fathers 14%, maternal medical condition 14%, recurrent pregnancy loss 11%, previous pregnancy complication 5% and uterine pathologies 3%. The mean age of intended mothers was 38.8 years. The average number of embryos transferred per cycle was 1.9, with 22.2% of cycles resulting in pregnancies. The live-birth rate per IP was 33.3%, 18.5% of cycles resulted in live births, with 24% of live births being twins. LIMITATIONS REASONS FOR CAUTION: Owing to the retrospective nature of this study conclusions must be drawn accordingly. WIDER IMPLICATIONS OF THE

findingsAs the first article addressing GS in Latin America, it may serve as a reference for future practice and publications. The results demonstrate the importance of having an assisted reproduction program in the form of GS. STUDY FUNDING/COMPETING INTERESTS: There was no external funding used and there are no conflicts to report.