[Surrogate pregnancy with regard to marriage between persons of the same sex].

After first defining surrogacy, distinguishing between cases in which the pregnancy results from the surrogate's own egg or a donor egg, and examining the different configurations of male homosexual families, the authors outline French and foreign legislation and provide a summary of the literature and of French working group hearings. Arguments for and against lifting the ban on surrogacy for gay couples are examined. The main arguments for lifting the ban are the following: 1) the same-sex couple's desire to start a family from their own gene pool, 2) current obstacles to adoption, 3) the notion of equality between heterosexual and homosexual couples, 4) frequent recourse to surrogacy abroad, which is not only very costly but also leaves the child in a state of legal limbo on its return to France, and 5) the lack of access to therapeutic alternatives. Some arguments against lifting the ban are of a medical nature: (1) physical and psychological risks for the surrogate, 2) the fact that exchanges between the mother and fetus during pregnancy are more complex than previously thought (microchimerism, epigenetics) and never negligible, and 3) the physical and psychological risks for the child. Other arguments are of an ethical nature: 1) surrogacy may undermine the status of motherhood, 2) surrogacy is becoming a societal rather than a medical issue, implying a profound bioethical upheaval, 3) the increasing commercialization of the human body, 4) subjugation of women to men's desires, 5) the risks for the surrogate's own couple and children, and for the host couple, 6) unavoidable financial aspects, and (7) the risk of abuse. The aim of this study is to bring together all the factors potentially influencing the health consequences of surrogacy, for both the mother and the child, especially if surrogacy were to be legalized for male homosexual couples. Surrogacy raises issues far beyond purely medical considerations and is primarily a societal issue that must be settled by the legislator: Short-term and especially long-term physical and psychological risks, particularly for the child, are poorly documented. If it is decided to legalize surrogacy, then a rigorous, objective and strictly regulated program must be set up to assess the related risks.