Rajiv Gandhi University of Health Science, Karnataka, Bangalore

PERFORMA SYNOPSIS FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1. Name of the Candidate and Address Mrs. N. DEEPA,

1st YEAR M.Sc. NURSING,

ROYAL COLLEGE OF NURSING,

7th MAIN ROAD, 1st BLOCK,

UTTARAHALLI,

BANGALORE- 560 061.

2. Name of the Institution Royal College of Nursing

3. Course of study and subject 1st year M. Sc Nursing,

Obstetrics And Gynecological Nursing.

4. Date of admission to course

30-06-2008

5. Title of the Topic

“A Study to Assess the Knowledge and Attitude Regarding Surrogacy

Among Adults who are Attending Outpatient Department of Selected Infertility

Clinics in Bangalore, with a view to develop an Information Booklet”.

6. BRIEF RESUME OF THE INTENDED WORK

INTRODUCTION

“I Will Be A Wonderful Mother”.

- George Washington Carver.

What is the goal of the human race? Science tells us, the goal of the human race is

essentially the same as that of a basic human cell. Survival! If the ultimate goal of humanity is

survival, then this necessarily means reproduction. Humans can only survive if they continue to

reproduce. However, should this reproduction be through only "natural" means? What about

couples who are not able to reproduce? That is, either the male or the female is sterile? Is that the

end of the story for them? In an instant, a couple's dreams of having a family, raising children

and having someone to take care of them when they get older, can be shattered, not through any

fault of their own. Is this fair? Under these circumstances, the couples who want to have children

have only a few options. They can choose not to have children, they can adopt, or they can take

advantage of reproductive technology and have a child through assisted reproductive methods.

The legal, moral and religious implications of undertaking such a task are many. 

First, some argue that the Constitution implicitly provides a right to procreate. Others

claim that where this right is not explicit, it should not extend to reproductive technology.

Furthermore, the law often cannot adequately deal with questions such as what constitutes a

"parent” that have traditionally been defined in biological terms. Cases over the past ten years

have forced the courts to address the issue whereas courts are reluctant to "make law" and prefer

to leave such decisions to the legislatures. Consequently, legislatures have had to face the

challenge of regulation and about one-half have not adequately addressed the issue.

This "altering" of nature has given rise to moral and religious questions as well. Is it

against the laws of nature to produce a child in a laboratory? Most of the reproductive techniques

involve means other than traditional procreation. Also, is commercial surrogacy the "selling of

babies?" From a conservative social perspective, assisted reproductive techniques involve the

commoditization of babies, since gestational surrogate contracts usually involve payment to the

gestational surrogate in exchange for carrying the child for an infertile couple. 

From the religious perspective, some religions do not permit reproduction through means

other than natural procreation because a child is seen as “gift” from God rather than a fulfillment

of a couple’s psychological needs. Others allow assisted reproduction methods as a last resort for

infertile couples and still others encourage such means in order to benefit the population of its

adherents.

Next, assuming a couple chooses assisted reproductive methods to have a child; problems

may arise if the arrangement between the parties, in a surrogacy contract, for example, goes

awry. Who is legally entitled to keep the child? Who is the mother? Who is the father? What

rights does each possess? Further, assuming the parties have no contractual conflicts but the

child is born with some birth defect. Should the surrogate mother by liable for tort? Should it

matter whether she abused drugs during her pregnancy? Should the child have a tort claim

against the surrogate? Legislation addressing these issues seems to be lacking in most states.

The author relates the experience of slaves in early American history as comparable to

surrogacy. She writes that "southern black mothers were in a sense surrogate mothers because

they knowingly gave birth to children understanding that those children would be owned by

others." The author compares the struggle of black mothers to keep their children to the Baby M

case, in which the surrogate mother fought for custody of the child. Also, she addresses the

unusual case in which an African-American surrogate mother gave birth to the child of European

and Philippine ancestry. The article suggests that "affluent white women's infertility, sterility,

preferences and power threaten to turn poor African-American women into a "surrogate class."

She supports this contention by the court's ruling in favor of the genetic parents, over the

gestator; in direct contravention of a California state statute that expressly provided that birth

mothers are the natural and legal parents of their offspring.

The decision was based mainly, if not entirely, on race. However, the court dealt with

several concerns, including perhaps, but not limited to race. Ultimately, its decision was based on

the child's emotional well being in being in not being awarded to two mothers.

6.1 NEED FOR THE STUDY

“The future belongs to those who give the next generation reason for hope”. 

-Pierre Teilhard de Chardin

Although younger people are accepting the concept of surrogate motherhood, but the

term remains a social stigma. Previous stigmatization of surrogate mothers in the media had

added to the reluctance to undertake this treatment option.

A study was done on the present attitudes to surrogacy among 187 women from the

general population, in the state of Washington. Out of which they found that only 8 out of the

187 were willing to become genetic surrogate mothers and 9 gestational surrogates. However,

younger women were more willing to become surrogate mothers. Women who were unsure

about the idea of surrogacy were less likely to have had children, whereas those who were

potentially willing and those who were unwilling were more likely to have had them.” Women

who were potentially willing to become surrogates were more likely to say that they would be

happy to be identified as the surrogate to the couple and the child. Those who thought that

parenthood was very important were also more likely to be willing to help others to become

parents like themselves.

In 2006, 290 surrogacy cases were reported compared to 158 in 2005. In 2004, there were

50-odd cases, according to data collected from 116 fertility centres in a study which will be

released in Mumbai on September 20. A copy of the findings of the National ART (artificial

reproductive techniques) Registry of India (NARI) survey, conducted by the Federation of

Obstetrics and Gynaecological Societies of India (FOGSI) and the Indian Society for Assisted

Reproduction.

Doctors say that besides affluent Indian couples, non-resident Indians and foreigners are heading

for India.

Fears about the impact of surrogacy on the well-being of children and families appear to

be unfounded, according to findings from the world’s first controlled, systematic investigation of

surrogate families, the annual conference of the European Society of Human Reproduction and

Embryology heard on Monday 1 July. In fact, the mothers of children born via a surrogacy

arrangement show more warmth towards their babies and are more emotionally involved than is

the case in families where the child is conceived naturally. Both the mother and father have

better parenting skills than do the parents in non-surrogate families, and the babies themselves

show no differences in their temperament and behaviors when compared with non-surrogate

babies. Nor do they seem to be problems when the surrogate mothers hand over the babies to the

mothers who have commissioned the surrogacy. These factors are likely to influence the reports

of stigma associated with surrogacy, and it is possible that this could be overcome by linking

alternative means of becoming a family to positive (rather than negative) family values.

A recent small pilot survey of fertile people’s opinions of the acceptability of different

methods of overcoming involuntary childlessness which they would either use themselves or

find acceptable for use by others has shown that those practicing a religion were less accepting

of surrogacy, particularly as a hypothetical option for themselves. Unfortunately, any general

population survey on surrogacy is likely to be heavily influenced by the prevailing negative

cases portrayed in the media (Appleton, 2001 ). More importantly, normal populations have not

been subjected to a need to redefine the concept of parenthood.

Researcher would like to narrate an experience that researchers own sister-in-law is

facing in her day to day life. She is 36yrs now, got married 8yrs before and not yet got pregnant

still. She has got Poly cystic Ovarian Disease and cervical stricture; she is on treatment for it.

More than 8 yrs of treatment it could not serve her the purpose of getting pregnant. At last when

they opted for surrogacy, but there is no one to help her in the family, it’s because of the social

stigma and etc and not giving importance to the feelings of the couple and as a medical

practitioner in this field researcher could understand the pain of the mother. This made the

researcher to do this study.

“Society also believe that, as surrogacy becomes less stigmatized, families who have

children born in this way will be more likely to disclose the means of conception, not just to their

children, but also to their family and friends, leaving them in better psychological health.

6.2 REVIEW OF LITERATURE

A Study conducted by the department of Histology and Embryology, Gulhane Military

Medical Academy, Turkey, regarding the opinion of infertile Turkish women on gamete

donation and gestational surrogacy. Objective of the study was to determine the approval levels

of infertile Turkish women concerning gamete donation and gestational surrogacy. Design

adopted was Opinion Survey and the setting was assisted reproductive treatment center at

Gulhane. 368 women were taken for the study, who had applied for infertility treatment. The

patients were asked to answer a questionnaire that included questions about the patients’ socio-

demographic status, previous medical history with infertility treatment, and opinions on gamete

donation and gestational surrogacy. The results shows some patients approve for gamete

donation out of which 23.3% accepts for oocytes and 3.4% accepting for sperm and gestational

surrogacy is 15.5% . It concludes by donation and surrogacy are alternate treatments for the

serious condition called infertility and each of these patients should have the right to try any of

them.

A cross sectional study to identify the gender differences in attitude towards surrogacy

after providing information on this technique was done by the Department of Health Sciences,

University of Yamanashi, Japan. Design was opinion survey and the sample includes 3647

people out of which 1564 people received only the questionnaire and 2083 people received the

questionnaire and a brochure containing information about assisted reproductive technology. The

result showed that the men in the brochure group could not clearly express their opinions when

compared with those in the no-brochure group (odds ratio OR: 0.69; 95% confidence interval CI;

0.53-0.89%. in contrast, with regard to donor insemination, women in the brochure group could

clearly express their opinions when compared with those in the brochure group (OR, 1.24; CI,

1.02 -1.52). Therefore it concludes by that there were gender differences in attitude towards the

technology.

A study to investigate people’s intentions to receive or to donate sperm, oocyte or uterus

and to identify possible motivational patterns explaining their intentions in Technological

education, Institute at Greece. The sample size was 365 men and women of reproductive age 18-

45 yrs conducted on stratified random sampling to select the men and women for interview. The

results obtained shows approximately 50% of the surveys participants would be prepared to

receive or donate sperm and oocyte, from multiple regression analysis gender role is positively

associated with the intention to use gamete donation and surrogacy. On the contrary, ‘confidence

in emotional relationship is negatively associated with the intention to use gamete donation and

surrogacy and men are more likely than women to report, ‘the intention to use gamete donation

and surrogacy. The conclusion suggest the specific motivational patterns of the population need

to be thoroughly analyzed and taken into consideration in order that appropriate counseling to be

given to the individuals and couples.

A study conducted on perception of risk and benefits of invitro fertilization among

gamete engineering and biotechnology, by the Institute of Biological Sciences, University of

Tsukaba at Ibrarabi, Japan. The samples of public 551, high school biology teachers 222,

scientists 555 and nurses 301. Japanese have a very high awareness of biotechnology 97%

saying that they had heard of the word. They also have a high level of awareness of in vitro

fertilization and genetic engineering.

A study to determine public attitudes toward the use and possible limitation of assisted

reproductive technology in university of health sciences, Canada. The total sample of 602

edmonton residents aged 16 yrs or more reached by telephone agreed to participate. The result

overall 66% and 63% respective of the respondents would donate an egg or sperm to a sibling;

the corresponding rates for donation to a stranger were 41% and 44%. Selective fetal reduction

was supported by 47% of the respondents, although only 24% would support fetal embryo

freezing should be permitted by law. A total of 74% agreed with surrogacy if done for medical

reasons, but 85% opposed its use for reasons of convenience. Overall, 72% of the respondents

thought that ART should be regulated. A total of 58% felt that physicians should be primarily

responsible for determining the allowable limits of this technology, and 38% felt that the public

should be primarily responsible. Only 21% agreed with public funding of ART. Religious

affiliation strongly influenced attitudes toward ART. The result of this survey should help

physicians and governing bodies make informed decisions about the future directions of ART in

Canada.

A cross-sectional study to clarify the factors affecting the attitude of the Japanese toward

gestational surrogacy at University of Yamanashi, Japan. The participants included 2568 and

3647 people from the general public surveyed in 1979 and 2003, respectively (1564 people

received only the questionnaire , and 2083 people received a questionnaire and brochure about

assisted reproductive technologies (ART). the result 20-30% disapproved the procedure, and

only half the respondents approved for gestational surrogacy. People with high socio-economic

status clearly expressed their opinion on this issue. The conclusion suggests that socio-economic

status affects peoples in expressing their opinion regarding this issue while attitude towards this

procedure influenced the individual belief.

A study was done by the Department of Medical Psychology and Medical Sociology,

Germany regarding egg donation, surrogate mothering, and cloning: attitudes of men and women

based on a representative survey. The objective was to determine opinions and attitudes of the

general population toward the treatment methods of reproductive medicine: egg donation,

surrogate mothering, and reproductive cloning. The design was representative survey in general

population. Which would be face-to-face interviews at home with 2,110 persons, aged 18-50

years? The outcome was approval and disapproval of treatment methods of reproductive

medicine and preimplantation genetic diagnosis were assessed by questionnaires regarding

medical, age, reasons, or general. Overall, the diverse treatment methods of reproductive

medicine found comparable rates of approval and disapproval. Legalization of egg donation was

approved by a slight majority (50.8%), particularly for medical reasons (35.9%). Surrogate

mothering found lower overall rates of approval (43.7%), 28.5% supported an admission for

medical reasons. Reproductive cloning was rejected by the vast majority (82.9%). Balancing the

individual’s right to a reproductive autonomy and choice and ethical standards will constitute a

future challenge for society.

A study was conducted by the IVF and infertility Unit at Israel, regarding successful

pregnancy after 24 consecutive fetal losses: lessons learned from surrogacy. The objective of the

study is to offer surrogacy as a treatment option to patients in whom maternal rather than fetal

factors are responsible for high-order unexplained habitual abortions. It is designed as a Case

report at university Hospital. A 36-year-old woman with 24 consecutive abortions over 11 years,

were a regular IVF procedure in the aborting woman and transfer of two good quality embryos to

the surrogate mother, who had previously received hormones. The end result showed that the

transfer of two embryos to the surrogate mother led to a clinical pregnancy, which was

uneventful until term. Therefore it concluded saying that surrogacy can be offered as a treatment

option to patients in whom maternal rather than fetal factors are responsible for high-order

unexplained habitual abortions.

A study conducted by Pennsylvania Reproductive Associates, Philadelphia, USA,

regarding a comparison of oocyte donors and gestational carriers/surrogates attitudes towards

third party reproduction. This study was designed to compare the levels of satisfaction for ovum

donors and gestational carriers/surrogates (GCS), investigate attitudes and explore beliefs about

the role genetics, gestation and environment play in various characteristics. It was designed at an

east coast IVF center and two California-based agencies recruited donor and GCS candidates.

Were the participants received questionnaires that included sections on demographics, attitudes,

and beliefs? The result showed that both groups were highly satisfied with their participation,

were donors were not willing to be GCS, and GCS were not willing to be donors. GCS thought

about and disclosed their participation, felt children should be told about GCS, and desired future

contact with the child more than did donors (p<0.002). Donors did not indicate a preference

about disclosure. Contact with recipients did not correlate with satisfaction. It concluded that

women who chose to donate eggs or to be GCS hold distinct and different beliefs about the role

of gestation and genetics.

A study conducted by Bruce Rappaport, Faculty of Medicine, Israel, regarding the

ethical issues in gestational surrogacy. The objective is to distinguish between the genetic

mother- the donor of the egg; and the gestational mother—she who bears and gives birth to the

baby; the social mother—the woman who raises the child. It raises the questions regarding

medical ethical aspects of surrogacy and the obligations of the physicians to the parties involved.

The right to be a parent although not constitutional is intuitive and deeply rooted. Therefore it

concluded by finally raising the following provocative question to society: In the interim period

between today’s limited technology and tomorrow’s extra-corporeal gestation technology

(ectogenesis), should utilizing females in PVS for gestational surrogacy be socially

acceptable/permissible---provided they left permission in writing?

A study was conducted by Warwick Medical School, UK, regarding British women’s

attitudes to surrogacy. It is done on public opinion using components of the theory of planned

behaviour. Questionnaires on attitudes to surrogacy and reasons for parenthood were completed

by 187 women from the general public. The results showed to significant socio-demographic

differences were found between who were possibly willing (n=76) and those who were unwilling

(n=111) to become surrogate mothers. General attitudes to surrogacy also differed between

groups (P=0.000). this study supported the predictive utility of components of the TPB, and

differentiated adequately between groups on attitudes to recruitment for surrogacy (P=0.000), the

consequences of surrogacy (P=0.000), factors that induce people to become surrogates

(P=0.000), social support (P=0.000), having personal control (P=0.002) and reasons for

parenthood (P=0.000). Age (P=0.000), attitudes to advertising (P=0.02) and the consequences of

surrogacy (P=0.05) predicted (un)willingness to become a potential surrogate mother. It

concluded by saying further research is needed with larger sample sizes of potentiate surrogates

to determine whether the predictive attitudes reported here translate to actual behaviours. The

negative attitudes reported by the majority of the population and are likely to be influenced by

reports of stigma associated with surrogacy.

A prospective longitudinal study was done to assess the psychological trait and state

characteristics, social support and attitudes to the surrogate pregnancy and baby in the

Department of Psychology, Aston University, UK. The objective of the study was to explore the

psychological functioning in surrogate mothers (SMs) who gestate and relinquish and intended

mothers (IMs). SMs and IMs (n=81:61 surrogate, 20 intended) undergoing genetic or gestational

surrogacy (4groups) were assessed by using questionnaire. The results showed that there was no

significant difference between or within SM and IM groups on personality characteristics. Social

support, marital harmony and state anxiety differed significantly (to P, 0.01) between SMs and

IMs at different stages of the arrangement. Differences in attitudes towards the pregnancy and

the baby were also observed between groups during pregnancy (to P,0.001), but there was no

evidence os post-natal depression amongst the groups studied. The result demonstrates

psychological effects on the surrogate mothers are notable and occur over an extended period of

time. The study was concluded saying that psychological screening and support prior to, during

and following surrogacy is indicated.

OBJECTIVES OF STUDY

1. To assess the knowledge of adults regarding surrogacy.

2. To assess the attitude of adults regarding surrogacy.

3. To find out the association between the knowledge of adults’ regarding surrogacy and

selected demographic variables.

4. To find out the association between the attitude of adults’ regarding surrogacy and

selected demographic variables.

5. To develop an information booklet regarding surrogacy based on the knowledge of

adults.

6.4 OPERATIONAL DEFINITIONS

1. Assessment: Assessment refers to the critical analysis and valuation or judgment of the

status or quality of a particular condition or situation.

2. Knowledge: It is the adults’ ability to answer for the questions related to surrogacy.

3. Attitude: refers to the opinion or way of thinking of adults.

4. Surrogacy: It is a method of reproduction whereby a woman agrees to become pregnant

and deliver a child for a contracted party. She may be the child's genetic mother (the

more traditional form of surrogacy), or she may, as a gestational carrier, carry the

pregnancy to delivery after having been implanted with an embryo.

5. Adults: a person, male or female who belongs to the age group of 21 to 45 yrs. an adult

is someone over 18 yrs old.

6. Out patient Department: A patient who receives treatment in the hospital but is not

admitted to a bed in the hospital ward.

7. Infertility clinic: It is places were the infertile adults come in for treatment. Infertility is

the failure of a couple to conceive a pregnancy after trying to do so for at least one full

year.

8. Information booklet: an unbound printed work, which can provide information about

surrogacy.

HYPOTHESIS OF THE STUDY

H1 There will be a statistically significant association between adults’ knowledge regarding

surrogacy and educational status.

H2 There will be a statistically significant association between adults’ knowledge regarding

surrogacy and age.

H3 There will be a statistically significant association between adults’ attitude regarding

surrogacy and religion.

H4 There will be a statistically significant association between adults’ attitude regarding

surrogacy and occupation.

6.6 ASSUMPTIONS

1. Adult possess some knowledge regarding surrogacy.

2. Adults’ knowledge regarding surrogacy can be measured by using a structured

questionnaire.

3. Adults’ attitude regarding surrogacy can be assessed by using an attitude scale.

4. Increased knowledge of adult will show a positive attitude towards surrogacy.

6.7 DELIMITATIONS OF THE STUDY

1. The study is limited to only adults aged between 21 and 45 yrs.

2. The study is limited to adults who are attending outpatient department of selected infertility

clinics in Bangalore.

6.8 PILOT STUDY

The study will be conducted with 10 samples. The purpose to conduct pilot study is to find

out the feasibility for conducting the study and design on plan of statistical analysis.

6.9 VARIABLES

Variables are an attribute of a person or objects that is takes on different values.

Dependent variables: Knowledge and attitude of adults regarding surrogacy.

Independent variables: Age, Gender, Education status, Religion, Residential area,

Occupation and Income.

7.0 MATERIAL AND METHODS

7.1 SOURCE OF DATA

The data will be collected from the adults who are attending outpatient department of

selected infertility clinics in Bangalore.

7.1.1 RESEARCH DESIGN

Non- experimental design

The research design adopted for this study is descriptive in nature.

7.1.2 RESEARCH APPROACH

Descriptive survey approach

7.1.3 SETTING OF THE STUDY

The study will be conducted in selected infertility clinics, in Bangalore.

7.1.4 POPULATION

All Adults who are aged between 21 to 45 yrs and attending outpatient department of

selected infertility clinics in Bangalore.

7.2 METHOD OF COLLECTION OF DATA (INCLUDING SAMPLING PROCEDURE)

The data collection procedure will be carried out for a period of one month. The study

will be conducted after obtaining permission from the concerned authorities. The investigator

will collect the data from adults by using a structured questionnaire and an attitude scale

respectively to assess the knowledge and attitude on surrogacy by the data collections instrument

which consists of the following sections.

Section A: Demographic data.

Section B: Questionnaire to assess the level of knowledge of the adults regarding surrogacy.

Section C: Attitude scale to assess the attitude of adults towards surrogacy.

7.2.1 SAMPLING TECHNIQUE

Sampling technique adopted for selection of sample is non-probability convenience sampling.

7.2.2 SAMPLE SIZE

The sample consists of 100 adults aged between 21-45yrs, who are attending outpatient

department of selected infertility clinics in Bangalore.

SAMPLING CRITERIA

7.2.3 INCLUSIVE CRITERIA

1. Adults aged between 21-45 yrs.

2. Adults who are attending outpatient department of selected infertility clinics in

Bangalore.

3. Adults who are willing to participate in the study.

4. Adults who are available at the time of data collection.

7.2.4 EXCLUSIVE CRITERIA

1. Adults aged below 21 yrs and above 45 yrs.

2. Adults who are not attending the outpatient department of selected infertility clinics, in

Bangalore.

3. Adults who are not willing to participate in the study.

4. Adults who are not available at the time of data collection.

5. Adults who are selected for pilot study.

7.2.5 TOOL FOR THE DATA COLLECTION

A structured Questionnaire and an attitude scale will be used to collect the data from the

adults who are attending the outpatient department of selected infertility clinics in Bangalore.

7.2.6 DATA ANALYSIS METHODS

The data collected will be analyzed by using descriptive and inferential statistics.

Descriptive Statistics:- Frequency and percentage for analysis of demographic data and

mean, mean percentage and standard deviation will be used for assessing the level of

knowledge and attitude regarding surrogacy.

Inferential Statistics:- Chi-Square test will be used to find out the association between

knowledge and attitude of adults’ regarding surrogacy and selected demographic

variables.

7.3 DOES THE STUDY REQUIRE ANY INVESTIGATION OR INTERVENTIONS

TO BE CONDUCTED ON PATIENTS OR OTHER HUMANS OR ANIMALS?

Since the study is descriptive in nature, investigation or interventions are not required.

7.4 ETHICAL CLEARANCE

The main study will be conducted after the approval of research committee of the college.

Permission will be obtained from the head of the institutions. The purpose and details of

the study will be explained to the study subjects and assurance will be given regarding the

confidentiality of the data collected.

8. LIST OF REFERENCES

1. European Society for human Reproduction Embryology, van den Akker, Biomedicine.

Available from: URL:http//:www.google.com

2. Anita L. Allen, The Black Surrogate Mother: The Socio-Economic Struggle for Equality, 8

Harv. BlackLetter J.17, (Spring 1991). Available from: URL:http//:www.google.com

3. Barbara . Life and Health Sciences, Aston University, Birmingham, UK.

4. Alufiya Khan. Hindusthan Times. Available from: URL:http//.www.hindusthantimes.com

5. Baykal B, Korkmaz C, Ceyhan ST, Goktolga U, Baser I. Opinions of infertile Turkish

women on gamete donation and gestational surrogacy. Fertil Steril. 2008 Apr;89 (4):817-22.

Available from: URL:http// : www.pubmed.com

6. Minai J, Suzuki K, Takeda Y, Hoshi K, Yamagata Z. There are gender differences in

attitudes toward surrogacy when information on this technique is provided. Eur J Obstet

Gynecol Reprod Biol. 2007 Jun; 132(2): 193-9. Epub 2006 Oct 13. Available from:

URL:http// : www.pubmed.com

7. Chliaoutakis JE. A relationship between traditionally motivated patterns and gamete donation

and surrogacy in urban areas of Greece. Hum Reprod. 2002 Aug; 17(8):2187-91. Available

from: URL:http// : www.pubmed.com

8. Macer DR. Perception of risks and benefits of in vitro fertilization, genetic engineering and

biotechnology. Soc Sci Med. 1994 Jan;38 (10);23-33. Available from:

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9. Genuis SJ, Chang WC, Genuis SK. Public attitudes in Edmonton toward assisted

reproductive technology. CMAJ. 1993 Nov 1; 149 (9): 1225-6. Available from:

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10. Suzuki K, Hoshi K, Minai J, Yanaihara T, Takeda Y, Yamagata Z. Analysis of national

representative opinion surveys concerning gestational surrogacy in Japan. Eur J Obstet

Gynecol Reprod Biol. 2006 May 1, 126(1):39-47. Epub 2005 Sep 19. Available from

URL:http// : www.pubmed.com

11. Stobel-Richter Y, Goldschmidt S, Brahler E, Weidner K, Beutel M. Egg donation, surrogate

mothering, and cloning: attitudes of men and women in Germany based on a representative

survey. Fertil Steril.2008 Aug 4. Available from URL:http// : www.pubmed.com

12. Raziel A, Friedler S, Schachter M, Strassburger D, Ron-EI R. Successful pregnancy after 24

consecutive fetal losses: Lessons learned from surrogacy. Fertil Steril. 2000 Jul;74 (10):

104-6. Available from URL:http// : www.pubmed.com

13. Bravennan AM, Corson SL. A comparison of oocyte donors and gestational

carriers/surrogates attitudes towards third party reproduction. J Assist reprod Genet. 2002

Oct;19(10):462-9. Available from URL:http// : www.pubmed.com

14. Ber R. Ethical Issues in gestational surrogacy. Theor Med Bioeth. 2000;21(20):153-69.

available from: URL:http// : www.pubmed.com

15. Poote AE, van den Akker OB. British women’s attitudes to surrogacy. Hum Reprod. 2008

Sep 14. Available from: URL:http// : www.pubmed.com

16. van den Akker OB. Psychological trait and state characteristics, social support and attitudes

to the surrogate preganancy and baby. Hum Reprod. 2007 Aug; 22(8):2287-95. Available

from: URL:http// : www.pubmed.com

9. Signature of Candidate

10. Remarks of the Guide

11. Name and Designation of

11.1 Guide

11.2 Signature

11.3 Co- Guide

11.4 Signature

11.5 Head of Department

11.6 Signature

12. 12.1. Remarks of the Chairman and Principal

12.2 Signature