Past Issue

Volume 10, Number 1, Apr-Jun 2016, Pages: 113-119

Development and Validation of Attitude toward Gestational Surrogacy Scale in Iranian Infertile Couples

Fatemeh Rahimi Kian, M.Sc, 1, Afsaneh Zandi, M.Sc, 1, *, Reza Omani Samani, M.D, 2, *, Saman Maroufizadeh, M.Sc, 2, Abbas Mehran, M.Sc, 1,
Faculty Member of Nursing and Midwifery Care Research Center, Tehran University of Medical Sciences, Tehran, Iran
Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
*Corresponding Addresses: P.O.Box: 6459 Faculty Member of Nursing and Midwifery Care Research Center Tehran University of Medical Sciences Tehran Iran P.O.Box: 16635-148 Department of Epidemiology and Reproductive Health Reproductive Epidemiology Research Center Royan Institute for Reproductive Biomedicine ACECR Tehran Iran,



Surrogacy is one of the most challenging infertility treatments engaging ethical, psychological and social issues. Attitudes survey plays an important role to disclosure variant aspects of surrogacy, to help meeting legislative gaps and ambiguities, and to convert controversial dimensions surrounding surrogacy to a normative concept that eliminates stigma. The aim of this study is to develop a comprehensive scale for gestational surrogacy attitudes.

Materials and Methods

Development process of gestational surrogacy attitudes scale (GSAS) performed based on a descriptive cross-sectional study and included a rich data pool gathered from literature reviews, a qualitative pilot study on 15 infertile couples (n=30), use of expert advisory panel (EAP) consisting of 20 members, as well as use of content validity through qualitative and quantitative study by the means of content validity ratio (CVR) and content validity index (CVI). Also internal consistence using Cronbach’s alpha and test-retest reliability using intracalss correlation coefficient (ICC) were evaluated. Application of GSAS was tested in a cross-sectional study that was conducted on 200 infertile couples (n=400) at Royan Institute, Tehran, Iran, during 2014.


Final version of GSAS had 30 items within five subscales including "acceptance of surrogacy", "Surrogacy and public attitudes", "Child born through surrogacy", "Surrogate mother", and "Intentional attitude and surrogacy future attempt". Content validity was represented with values of CVR=0.73 and CVI =0.98. Cronbach’s alpha value was 0.91 for the overall scale, while ICC value due to test-retest responses was 0.89.


Acceptable level of competency and capability of GSAS is significantly indicated; therefore, it seems to be an appropriate tool for the evaluation of gestational surrogacy attitudes in Iranian infertile couples.