Surrogacy

Surrogacy is an arrangement in which a woman (the surrogate, sometimes called a gestational carrier) conceives, carries and gives birth to a child for another person or couple (the intended parent or parents), and agrees to give the child to them after the birth. Surrogacy arrangements are medically, emotionally, financially and legally complex.

For some people who were previously unable to have children, including same-sex couples and women who cannot carry a pregnancy, surrogacy offers an opportunity to have a child.

Laws on surrogacy vary widely from country to country, so it is essential to get up-to-date legal advice for the place where the arrangement will take place. The information here is general; check with a fertility clinic or legal adviser for the rules that apply where you live.

How surrogacy works#

In many places, a surrogate cannot be the genetic mother of the child she carries, which means her own egg cannot be used. Instead, the intended parents, or a donor, provide the egg and sperm to form an embryo. This embryo is then transferred to the uterus of the surrogate, who carries the pregnancy and gives birth.

In some jurisdictions only altruistic surrogacy is allowed. This means it is illegal to pay the surrogate beyond reimbursing her for medical and other reasonable expenses.

Reasons for surrogacy#

A surrogacy arrangement may be considered when, for example:

• a woman is unable to become pregnant or carry a pregnancy because she has had a hysterectomy, or is missing part of her uterus, ovaries or other parts of the reproductive tract
• a woman has a health condition that makes pregnancy dangerous
• a same-sex male couple wish to have a child using the sperm of one partner
• a single man wishes to have a child using his sperm

Things to consider#

There are many medical, emotional, financial and legal issues to consider before entering a surrogacy arrangement, as well as matters to be aware of once the surrogate gives birth and gives the child to the intended parents.

Factors that can contribute to a positive arrangement include:

• all parties being in good mental and physical health
• clear and open communication, with clear boundaries and mutual understanding between the surrogate, her family and the intended parents
• realistic expectations about the chance of a successful outcome
• a good understanding of the medical processes involved
• being realistic about the timeline, as it can take a year or more before embryo transfer occurs
• being prepared for the emotional responses and reactions that can arise during the process
• agreement between the parties on what is fair and reasonable in covering the surrogate’s expenses, and on how the pregnancy and birth will be managed
• being aware of and prepared for the financial costs involved

Legal requirements#

Laws differ greatly between countries and regions. Where altruistic surrogacy is permitted, the surrogate is reimbursed only for medical and other reasonable expenses and is not otherwise paid. In some places, specific legislation sets out the requirements for surrogacy; where there is no specific legislation, national ethical guidelines may apply. Always check the current law for your own location with a fertility clinic or legal adviser.

Common requirements in jurisdictions that permit altruistic surrogacy can include:

• the intended parents being unable to conceive or carry a baby, or facing a likely medical risk to mother or baby if they did
• the surrogate not using her own eggs in the arrangement
• a preference (though not always a legal requirement) that the surrogate has already completed her own family
• requirements that the surrogate be over a minimum age and have previously given birth to a live child
• all parties – including the intended parents, the surrogate and the surrogate’s partner (if she has one), and sometimes a donor – having received counselling and legal advice

Medical risks#

There are certain medical risks involved in surrogacy. They are similar to the risks of other assisted reproductive treatment:

• For the egg provider – fertility drugs are given to stimulate the ovaries to produce multiple eggs. There is a small risk of ovarian hyperstimulation syndrome (OHSS), a potentially serious condition that, in very rare cases, can lead to blood clots, kidney failure and death.
• For the surrogate – pregnancy and birth carry risks, including gestational diabetes, high blood pressure, bleeding, and the possible need for a caesarean section.
• For the child – if more than one embryo is transferred, this increases the chance of a multiple birth, which is associated with premature birth, low birth weight and health problems for the babies.

For more detail about the risks involved, consult your fertility specialist.

Where to get help#