Neurology, Neuropsychiatry, Psychosomatics

Advanced search

Assisted reproductive technologies: psychoneurological, moral-ethical, and socio-cultural aspects

Full Text:


The paper provides a definition of sexual and reproductive health and infertility and also reflects modern ideas about ways to overcome infertility using assisted reproductive technologies, such as in vitro fertilization (IVF) and surrogacy. It shows the specificity of the impact of an IVF procedure on the mental health of a potential mother. The features of the neonatal health status, as well as neuropsychiatric disorders in babies born using the IVF procedure are described. The authors present two types of surrogacy (traditional and gestational ones) and the features of their use in different countries according to governmental legislative regulation, socioeconomic and religious factors, and cultural traditions in society. They unveil the features of a psychological relationship between the mother (surrogate and presumed one) and the fetus. The consequences of surrogacy for a surrogate mother, genetic parents, and a child himself/herself are noted to be little studied. It is shown that the development of assisted reproductive technologies (IVF and surrogacy), on the one hand, helps fight infertility and, on the other hand, entails a number of problems (moral and ethical, legal, cultural and religious, socioeconomic, and neuropsychiatric ones) that need to be solved in order to prevent psychological, neurological, and mental abnormalities in all the participants (a surrogate mother, an unborn child, and potential parents) in the assisted reproductive process:

About the Authors

N. A. Tyuvina
I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
Russian Federation

Nina A. Tyuvina

11, Rossolimo St., Moscow 119021

A. O. Nikolaevskaya
Kursk State Medical University, Ministry of Health of Russia
Russian Federation

3, K. Marx St., Kursk 305041


1. Ombelet W. Global access to infertility care in developing countries: a case of human rights, equity and social justice. Facts Views Vis Obgyn. 2011;3(4):257-66.

2. United Nations. Report of the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health. Commission on Human Rights, Sixty-second session, Item 10 of the provisional agenda. New York: United Nations; 2006.

3. World Health Organization. Accelerating progress towards the attainment of international reproductive health goals. A framework for implementing the WHO global reproductive health strategy. Geneva: WHO; 2006.

4. ICMART and WHO Revised Glossary on ART Terminology; 2009.

5. Isupova OG. Assisted reproductive technologies: new opportunities. Demograficheskoe obozrenie. 2017;4(1):35-64 (In Russ.).

6. Milazzo A, Mnatzaganian G, Elshaug AG, et al. Depression and Anxiety Outcomes Associated with Failed Assisted Reproductive Technologies: A Systematic Review and MetaAnalysis. PLoS One. 2016 Nov 11;11(11):e0165805. doi: 10.1371/journal.pone.0165805. eCollection 2016.

7. Zivaridelavar M, Kazemi A, Kheirabadi GR. The effect of assisted reproduction treatment on mental health in fertile women. J Educ Health Promot. 2016 Jun 23;5:9. doi: 10.4103/2277-9531.184552. eCollection 2016.

8. Hodgetts K, Elshaug AG, Hiller JE. What counts and how to count it: physicians' constructions of evidence in a disinvestment context. Soc Sci Med. 2012 Dec;75(12):2191-9. doi: 10.1016/j.socscimed.2012.08.016. Epub 2012 Aug 27.

9. Utian WH, Sheean L, Goldfarb JM, Kiwi R. Successful pregnancy after in vitro fertilization and embryo transfer from an infertile woman to a surrogate. N Engl J Med. 1985 Nov 21;313(21):1351-2. doi: 10.1056/nejm198511213132112

10. Shenfield F, Pennings G, Cohen J, et al. ESHRE Task Force on Ethics and Law 10: surrogacy. Hum Reprod. 2005 Oct;20(10):2705-7. doi: 10.1093/humrep/dei147. Epub 2005 Jun 24.

11. Söderström-Anttila V, Wennerholm U-B, Loft A, et al. Surrogacy: outcomes for surrogate mothers, children and the resulting families – a systematic review. Hum Reproduct Update. 2016 Mar-Apr;22(2):260-76.

12. Nifantova RV, Krivenko NV. Reproductive technologies as social innovations in the system of public health. Zhurnal Ekonomika regiona. 2014;(3):191-7 (In Russ.).

13. Savel'yev DB. Soglasheniye v semeynoy sfere: Uchebnoye posobiye [Family Agreement: A Study Guide]. Moscow; 2017. P. 95 (In Russ.).

14. Bryukhina ER, Tryastsyna OS. Surrogate motherhood: «For» and «Against». Problematic issues of normative regulation. Vestnik PGGPU. 2017;(3):164-74 (In Russ.).

15. Burdo EP. Concept of substitute motherhood and its legal regulation. Probely v Rossiiskom zakonodatel'stve. 2014;(4):54-6 (In Russ.).

16. Gnatik EN. Geneticheskaya inzheneriya cheloveka: vyzovy, problemy, riski [Human genetic engineering: challenges, problems, risks]. Moscow: Knizhnyi dom «Librokom»; 2009. P. 219-29 (In Russ.)

17. Savvina OV, Lapshin IE. Impact of assisted reproductive technologies on modern society (on the example of India). In: Materialy konferentsii «Chelovek i obshchestvo v kontekste sovremennosti». Filosofskiye chteniya pamyati professora P.K. Grechko [Proceedings of the conference «Man and Society in the Context of Modernity.» Philosophical readings in memory of professor P.K. Grechko]. Moscow, RUDN University, June 14. Vol. 1. Moscow; 2017. P. 303-17 (In Russ.).

18. Bakhtiarova VO. Sostoyaniye zdorov'ya detey, rodivshikhsya v rezul'tate ektrakorporal'nogo oplodotvoreniya i iskusstvennoy inseminatsii: Diss. … kand. med. nauk [The state of health of children born as a result of in vitro fertilization and artificial insemination: Diss. ... cand. medy. sci.]. Moscow; 1993 (In Russ.).

19. Atlasov VO, Dolgov GV, Kulikova NA, et al. Delivery and neonatal state characteristics of newborns after IVF. Zhurnal akusherstva i zhenskikh boleznei. 2004;52:37-41 (In Russ.).

20. Kuznetsova VS, Loginova IN, Korotkikh NN. Features of adaptation in the early neonatal period of newborns born to women with a history of infertility after cycles of in vitro fertilization. Zhurnal teoreticheskoy i prakticheskoy meditsiny. 2004;2(1):59-62 (In Russ.).

21. Kiseleva MA. Health value of children born full-term after assisted reproductive technologies. Kurskii nauchno-prakticheskii vestnik «Chelovek i ego zdorov'e» = Kursk Scientific and Practical Bulletin «Man and His Health». 2016;(1):32-6 (In Russ.).

22. Savvina OV. Discourse on moral justification and regulation of medical biotechnology (on the example of in vitro fertilization). Eticheskaya mysl'. 2019;19(1):104-17 (In Russ.).

23. Zuradzki T. A situation of ethical limbo and preimplantation genetic diagnosis. J Med Ethics. 2014 Nov;40(11):780-1. doi: 10.1136/medethics-2014-102278. Epub 2014 Sep 3.

24. Klitzman R. Infertility Providers' and Patients' Views and Experiences Concerning Doctor Shopping in the USA. Hum Fertil (Camb). 2019 Dec;22(4):238-45. doi: 10.1080/14647273.2017.1406155. Epub 2017 Nov 26.

25. Fischer S, Gillman I. Surrogate motherhood: attachment, attitudes and social support. Psychiatry. 1991 Feb; 54(1):13-20. doi: 10.1080/00332747.1991.11024527

26. Cranley MS. Development of a tool for the measurement of maternal attachment during pregnancy. Nurs Res. 1981 Sep-Oct;30(5):281- 4. doi: 10.1097/00006199-198109000-00008

27. Van den Akker OB. Psychosocial aspects of surrogate motherhood. Hum Reprod Update. Jan-Feb 2007;13(1):53-62. doi: 10.1093/humupd/dml039. Epub 2006 Aug 26.

28. Lorenceau ES, Mazzucca L, Tisseron S, Pizitz TD. A cross-cultural study on surrogate mother's empathy and maternal-foetal attachment. Women Birth. 2015 Jun;28(2):154-9. doi: 10.1016/j.wombi.2014.11.006. Epub 2014 Dec 3.

29. Jadva V, Golombok S, Scott R, et al. Surrogacy: issues, concerns and complexities In: Regulating Reproductive Donation. Cambridge, UK: Cambridge University Press; 2016.

30. Ragone H. Surrogate Motherhood: Conception in the Heart. Boulder: Westview Press; 1994. 215 p.

31. Jadva V, Murray C, Lycett E, et al. Surrogacy: the experiences of surrogate mothers. Hum Reprod. 2003 Oct;18(10):2196-204. doi: 10.1093/humrep/deg397

32. Jadva V, Blake L, Casey P, Golombok S. Surrogacy families 10 years on: relationship with the surrogate, decisions over disclosure and children's understanding of their surrogacy origins. Hum Reprod. 2012 Oct;27(10):3008-14. doi: 10.1093/humrep/des273. Epub 2012 Jul 18.

33. Van den Akker O. Genetic and gestational surrogate mothers' experience of surrogacy. J Reprod Infant Psychol. 2003;21:145-61. doi: 10.1080/0264683031000124091

34. Imrie S, Jadva V. The long-term experiences of surrogates: relationships and contact with surrogacy families in genetic and gestational surrogacy arrangements. Reprod Biomed Online. 2014 Oct;29(4):424-35. doi: 10.1016/j.rbmo.2014.06.004. Epub 2014 Jul 5.

35. Snowdon C. What makes a mother? Interviews with women involved in egg donation and surrogacy. Birth. 1994 Jun;21(2):71-84. doi: 10.1111/j.1523-536X.1994.tb00239.x

36. Baslington H. The social organization of surrogacy: relinquishing a baby and the role of payment in the psychological detachment process. J Health Psychol. 2002 Jan;7(1):57-71. doi: 10.1177/1359105302007001652

37. Pande A. It may be her eggs, but it's my blood: surrogates and everyday forms of kinship in India. Qual Sociol. 2009;32:379-97. doi: 10.1007/s11133-009-9138-0

38. Crockin SL Growing families in a shrinking world: legal and ethical challenges in cross-border surrogacy. Reprod Biomed Online. 2013 Dec;27(6):733-41. doi: 10.1016/j.rbmo.2013.06.006. Epub 2013 Jun 22.

39. Ciocca DR, Delgado G. The reality of scientific research in Latin America; an insider's perspective. Cell Stress Chaperones. 2017 Nov; 22(6):847-52. doi: 10.1007/s12192-017-0815-8

40. Patel NH, Jadeja YD, Bhadarka HK, et al. Insight into Different Aspects of Surrogacy Practices. J Hum Reprod Sci. 2018 JulSep;11(3):212-8. doi: 10.4103/jhrs.JHRS_138_17

41. Pande A. Commercial surrogacy in India: manufacturing the perfect mother-worker. Signs Women Cult Soc. 2010;35:969-92. doi: 10.1086/651043

42. Pande A. Transnational commercial surrogacy in India: gifts for global sisters? Reprod Biomed Online. 2011 Nov;23(5):618-25. doi: 10.1016/j.rbmo.2011.07.007. Epub 2011 Jul 23

43. Vora K. Experimental sociality and gestational surrogacy in the Indian ART clinic. Ethnos. 2014;79:63-83. doi: 10.1080/00141844.2013.770774

44. Rudrappa S. Discounted Life: The Price of Global Surrogacy in India. New York: NYU Press; 2015.

45. Smerdon UR. Crossing bodies, crossing borders: international surrogacy between the United States and India. Cumberland Law Rev. 2008;39:15.

46. Karandikar S, Gezinski LB, Carter JR, Kaloga M. Economic necessity or noble cause? A qualitative study exploring motivations for gestational surrogacy in Gujarat, India. Affilia. 2014;29(2):224-36. doi: 10.1177/0886109913516455

47. Moorti S. 'Womb Farms' in India: Orientalism in Scientific Garb. Political Science; 2011.

48. Roberts EF. God's Laboratory: Assisted Reproduction in the Andes. California: University of California Press; 2012.

49. Deonandan R, Green S, van Beinum A. Ethical concerns for maternal surrogacy and reproductive tourism. J Med Ethics. 2012 Dec;38(12):742-5. doi: 10.1136/medethics2012-100551. Epub 2012 Oct 9.

50. Pande A. Not an 'angel', not a 'whore'. Indian J Gend Stud. 2009;16:141-73. doi: 10.1177/097152150901600201

51. Markowitz FE. The effects of stigma on the psychological well-being and life satisfaction of persons with mental illness. J Health Soc Behav. 1998 Dec;39(4):335-47. doi: 10.2307/2676342

52. Schmitt MT, Branscombe NR, Postmes T, Garcia A. The consequences of perceived discrimination for psychological well-being: a meta-analytic review. Psychol Bull. 2014 Jul;140(4):921-48. doi: 10.1037/a0035754. Epub 2014 Feb 17.

53. Palattiyil G, Blyth E, Sidhva D, Balakrishnan G. Globalization and cross-border reproductive services: ethical implications of surrogacy in India for social work. Int Soc Work. 2010;5:686-700. doi: 10.1177/0020872810372157

54. Dasgupta S, DasGupta S. Globalization and Transnational Surrogacy in India: Outsourcing Life. UK: Lexington Books; 2014.

55. Baumhofer E. Commodifying the Female Body: Outsourcing Surrogacy in a Global Market. California: UCLA Center for the Study of Women; 2012.

56. Pennings G, de Wert G, Shenfield F, et al. ESHRE task force on ethics and law 15: cross-border reproductive care. Hum Reprod. 2008 Oct;23(10):2182-4. doi: 10.1093/humrep/den184. Epub 2008 Jul 8.

57. Sibal K. Unequal by law. The Indian Express [Internet]. 2016. Available from:


For citations:

Tyuvina N.A., Nikolaevskaya A.O. Assisted reproductive technologies: psychoneurological, moral-ethical, and socio-cultural aspects. Neurology, Neuropsychiatry, Psychosomatics. 2020;12(5):104-110.

Views: 423

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.

ISSN 2074-2711 (Print)
ISSN 2310-1342 (Online)