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The Surrogate



Jess agrees to be a surrogate for her close friends Josh and Aaron. When they find out that the fetus has Down's Syndrome, they disagree about what to do about the pregnancy. Josh and Aaron want her to have an abortion, and Jess wants to continue the pregnancy. In a conversation with her mother, Jess shares that she's had a past abortion, and her mother shares that she's had one too. The movie ends with Jess making an appointment for an abortion after realizing she does not want to be tied to Josh for the rest of her life.




The Surrogate



This surrogate endpoint table includes surrogate endpoints that sponsors have used as primary efficacy clinical trial endpoints for approval of new drug applications (NDAs) or biologics license applications (BLAs). The table also includes surrogate endpoints that may be appropriate for use as a primary efficacy clinical trial endpoint for drug or biologic approval, although they have not yet been used to support an approved NDA or BLA. We believe that this list should facilitate consideration of potential surrogate endpoints when developers are designing their drug development programs.


The agency anticipates that this surrogate endpoint could be appropriate for use as a primary efficacy clinical trial endpoint for drug or biologic approval, although it has not yet been used to support an approved NDA or BLA.


Please include the following information in an e-mail, and send it to Marian Domanski and Tim Straub, or ssc_surrogates@simon.er.usgs.gov (see User Group section for more information on subscribing to the ssc_surrogates mailing list)


The USGS, Office of Surface Water (OSW) maintains a mailing list and the forum relating to the application of surrogate instruments and methods for measurement of suspended-sediment concentration in rivers and estuaries. The mailing list and forum are used to share information about instruments, including policies, procedures, techniques, and new developments within the USGS and other agencies.


The SSC_surrogates mailing list is the primary means for disseminating up-to-date information regarding USGS policies, training classes, workshops, and new developments. A searchable archive of email messages sent to the acoustics mailing list is kept. This archive can be viewed chronologically or by author or subject.


In order to post to the acoustics mailing list, it is necessary to first subscribe to the list. Send an email to ssc_surrogates-request@simon.er.usgs.gov with the words "subscribe" and "end" on separate lines in the body of the email. A confirmation email will be sent to you once you are subscribed. Email postings to the list should then be addressed to ssc_surrogates@simon.er.usgs.gov


The forum is maintained by the USGS, OSW for sharing information regarding the application of surrogates to the measurement of suspended- sediment concentration. The forum is a USGS resource to educate, learn, and facilitate the exchange of information about applications involving a variety of instruments including acoustics, turbidity, laser diffraction, and other technologies. The forum is also used by the USGS to disseminate important information regarding quality assurance practices, training, and other matters.


Therefore, these aspects of surrogacy are still the most controversial and challenging issues in reproductive processes in most countries. Although, this method has many advantages but has raised a lot of social- ethical questions and issues that requires comprehensive assessment in all its positive and negative aspects (12, 14). Review of literature shows that researchers have not paid serious attention to emotional experiences in surrogate mothers in limited researches conducted in this field. Phenomenology is an efficient approach for profound research on personal meanings, live experiences and a deep understanding of a phenomenon including communications, expectations, attitudes and beliefs (15).


The participants included 8 uterus-donor women who referred to Fertility and Infertility Center of Isfahan. The interviews were conducted after delivery. Inclusion criteria were: ability to express their experiences and having complete surrogate pregnancy. Sampling was purpose based and continued up to 8 samples that data saturation or repetition of previously collected data occurred. All participants were selected based on a common experience (surrogacy). At the onset of research, objectives of the study were explained to participants and they were assured of privacy of information.


At the fifth step, all themes merged for an exhaustive description and constitution of whole structure of the phenomenon "the emotional experiences of surrogate mother". At the sixth step, to describe the fundamental structure of the phenomenon obviously. Thereafter, the researcher sought an expert researcher who reviewed the findings in terms of richness and completeness to provide sufficient description and to confirm that the exhaustive description reflected the experience of surrogate mothers. Finally, the seventh step aimed to validate study findings using "member checking" technique. It was performed through returning the research findings to the participants and discussing the results with them. Participants' views on the results of the study were obtained directly. Eventually, all participants approved that the results reflected their feelings and experience entirely and accurately.


The constant presence of the question: "what constitutes the essence of surrogate mothers experience?" in the whole process of the study led to extraction of themes and their interpretations. In this study, distinguishing the main themes allowed the researcher to expand the narrative description of emotional experience of surrogate mothers. In a phenomenology study, the researcher is not going to test a hypothesis but to extract the concepts of a phenomenon through clarification of related and involved individuals by referring them to their experience. To determine the validity and reliability of findings of present study the criteria of Lincoln and Guba were used: Credibility, transferability, dependability, and conformability (21). To improve the validity of findings in this study peer debriefing (external checking) and member checking was accomplished. The researchers were engaged in the study for a long time, around 10 months, and immersed themselves in the data. Transferability shows whether findings are utilizable and applicable to other settings and groups or not. We tried to introduce and explain the process of our study in detail and precisely so that other researchers could repeat it. To achieve dependability and conformability, in addition to in detail explanation of the process of study, inquiry audit was applied.


To analysis the data, the Colaizzi seven-step method was used. The Colaizzi method of phenomenology uses Husserlian phenomenology to describe the essential structure of a phenomenon in its analysis. It was used to investigate the real-life experience of nurses who gave spiritual care (21, 22). This data analysis method appeared to be an appropriate methodology for the present study because it focused on finding the essence and meaning of the experiences of surrogate mothers (23). Prior to describing the analytical procedure of dataset, a brief description of data collection and transcripts formation are summarized as follow:


Coercion to have no fooling to baby is the first code of the first sub-theme (feelings toward pregnancy) of the first main theme (experiences acquired in pregnancy). It seems that the separation from the newborn and handing the child over to the commissioning couple will be a distressing and painful experience for a surrogate mother. However; there is inconsistent and conflicting evidence about the emotional effects of uterus donation process on surrogate mothers. For example, in a study by Ciccarelli, fourteen surrogate mothers were asked to report their feelings or concerns about relinquishing the child. One mother reported emotional distress over the relinquishment and two others reported a strong instinctual urge to bond with the child. The remaining eleven did not feel bonded with the child, which may seem to indicate that for the majority of surrogates the issue of having to relinquish the child did not appear to be a problem (25). Ber concluded that pregnancy can be painful for surrogate mothers as much as infertile mothers (26).


Some evidence shows that baby transfer may lead to considerable distress and emotional problems in uterus of donor mothers. On the other hand, there is a concern that lack of maternal attachment to the baby during the surrogacy process may be challenging for the health of both the mother and the baby (7). The important bond between mother and child, which derives from both biological and cognitive/psychological aspects of human nature, begins during pregnancy and continues after birth. Surrogacy ruptures this significant bond (10, 25). The study accomplished in England by Jadva showed that all of the surrogate mothers in postpartum period, with no doubt, delivered the babies according to previous agreement. The follow up of those women showed that 32% of women had emotional and psychological problems for several weeks after losing the babies. After a few months, this rate decreased to 15% and continued until 1 year only in 6% of cases (27).


Fear of husband reactions in marital relationship is the first code of the second sub-theme (relationship with family, relatives and the commissioning couples) of the first main theme (experiences acquired in pregnancy). In the present study most of the women were concerned about their sexual relationships during the pregnancy and eventually disruption of family relationship. There were a few surrogate mothers that complained about an insignificant decrease in libido. Jadva in a study on marital satisfaction of women found that 16% of the surrogate mothers had low marital satisfaction, 4% had severe problems in marital relationship with their spouse, and 80% had moderate or high marital satisfaction (27). So we can say that the surrogacy phenomenon have no significantly negative impact on the marital relationships of couples. This difference may be related to cultural or religious differences between the Iranian and England communities. 041b061a72


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