The perinatal outcome of pregnancies (both single and multiple) established after in-vitro fertilization (IVF)-surrogacy was evaluated and compared to the outcome of pregnancies that resulted from standard IVF. Analysis of medical records and a telephone interview with physicians, IVF-surrogates, and commissioning mothers were conducted to assess prenatal follow up and delivery care in several hospitals. 95 IVF-surrogates delivered 128 liveborn (65 singletons, 27 sets of twins and two sets of triplets). The commissioning mothers and the IVF-surrogates average ages were 37.7 +/- 5.0 and 30.4 +/- 4.7 years old respectively. IVF-surrogates carrying twin and triplet gestations delivered substantially earlier than those who gestated singleton pregnancies (36.2 +/- 0.4 versus 35.5 versus 38.7 +/- 0.3 weeks gestation respectively; P < 0.001). Twin newborns were significantly lighter than singleton infants born through IVF-surrogacy (2.7 +/- 0.06 versus 3.5 +/- 0.07 kg; P < 0.001). The incidence of low birth weight infants rose from 3.3% in the single births to 29.6% (P < 0.01) in the twins and to 33.3% in the triplets born through IVF-surrogacy. The incidence of prematurity was significantly greater in both twins delivered by IVF-surrogates (20.4%) and infertile IVF patients (58%). The occurrence of pregnancy-induced hypertension and bleeding in the third trimester was four to five times lower in the IVF-surrogates, independently of whether they were carrying multiples. The incidence of Caesarean section was 21.3% for singleton gestations, while two times higher in the IVF-surrogates carrying multiples (56.3%). Postpartum complications occurred in 6.3% of patients and the incidence of malformation was similar to those reported for the general population. The results provide general reassurance regarding perinatal outcome to couples who wish to pursue IVF-surrogacy.

Little has been written about psychoanalytic psychotherapy with people who suffer from medical conditions such as cancer and as distinct from the well-established literature describing psychoanalytic theories and clinical work with those who have medical conditions which may be considered to have a psychologically-influenced causal basis.In this paper, I will explore the nature and experience of cancer, its psychological impact upon the patient and also the therapist, and the patient's relation to the disease inside. I think about cancer as an unboundaried invader within the body which may temporarily dislocate the patient's ego, resulting in the 'I' of the patient feeling overwhelmed or threatened. The subject of this paper is the 'I' which perceives and relates to the cancer within. The aim of the paper is to work towards describing the principles and practice of a model of ego-supportive psychotherapy with cancer patients, its goal being to help the patient to strengthen, relocate or reinstate his/her vulnerable ego.

In this paper, I explore the emotional experiences of patients who are nursed in physical isolation in a specialist general hospital. I begin with a description of a subjective experience that occurred while I was in a session with a patient. My own inner psychic state led me to think about what the patient might be feeling and it became the basis for the subject of this paper.With reference to the work of Daniel Stern, Thomas Ogden and others I discuss the possible effects of a serious physical illness and its treatment on the patient's sense of self and bodily continuity. Insight into the mental, physical and emotional processes that may affect these patients can help the counsellor to work with the kinds of anxieties that arise and provide the emotional containment needed. The patients written about in the three clinical examples were all in-patients being treated for leukaemia. The ideas explored here can also apply more broadly to include other seriously ill patients needing intensive medical treatment in hospital.

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