What is Surrogacy? Definition, Procedures, Risks, Emotional Side of Surrogacy

What is Surrogacy?

Surrogacy is a legal arrangement where a woman agrees to carry a pregnancy on behalf of another couple or person, who will become the child's parent(s) after birth.

This may be sought when a couple cannot carry a pregnancy themselves, when pregnancy is medically impossible when pregnancy risks are dangerous for the intended mother, or when a single man or a male same-sex couple wishes to have a child.

Who Uses Surrogacy?

Individuals or couples who are unable to conceive or carry a pregnancy to term on their use of surrogacy.

This can include:

Couples facing infertility: Some couples may face infertility due to medical conditions or reproductive issues

Same-sex couples: Surrogacy enables same-sex couples to have a biological child using one partner's sperm or eggs with the assistance of a surrogate.

Individuals without a partner: Individuals who want to have a child can choose surrogacy and use their genetic material.

Individuals with medical conditions: Some medical conditions or health issues may prevent individuals from being able to carry a pregnancy. In these cases, surrogacy can be an option.

Women with recurrent pregnancy loss: Women who have had multiple miscarriages or pregnancy complications may opt for surrogacy to reduce health risks or guarantee the successful birth of a child.

Surrogacy Terminology

Various terms are used in surrogacy which include:

Intended Parents (IPs): The couple or individual who wishes to have a child through surrogacy.

Surrogate Mother/Carrier: The woman who carries the pregnancy for the IPs. Also referred to as a gestational surrogate.

Egg Donor: A woman who donates her eggs for the IVF process.

Sperm Donor: A man who donates his sperm for the IVF process.

Who Uses Surrogacy?

​Individuals or couples who are unable to conceive or carry a pregnancy to term on their use of surrogacy. This can include:

• Couples facing infertility: Some couples may face infertility due to medical conditions or reproductive issues
• Same-sex couples: Surrogacy enables same-sex couples to have a biological child using one partner's sperm or eggs with the assistance of a surrogate.
• Individuals without a partner: Individuals who want to have a child can choose surrogacy and use their genetic material.
• Individuals with medical conditions: Some medical conditions or health issues may prevent individuals from being able to carry a pregnancy. In these cases, surrogacy can be an option.
• Women with recurrent pregnancy loss: Women who have had multiple miscarriages or pregnancy complications may opt for surrogacy to reduce health risks or guarantee the successful birth of a child.
  

Surrogacy Terminology

​Various terms are used in surrogacy, which include:

• Intended Parents (IPs): The couple or individual who wishes to have a child through surrogacy.
• Surrogate Mother/Carrier: The woman who carries the pregnancy for the IPs. Also referred to as a gestational surrogate.
• Egg Donor: A woman who donates her eggs for the IVF process.
• Sperm donor: A man who donates his sperm for the IVF process.
  

Types of Surrogacy

​Surrogacy is primarily categorized as traditional surrogacy and gestational surrogacy.

Traditional Surrogacy: Traditional surrogacy involves the surrogate mother using her egg to create the embryo, with the sperm coming from the intended father or a donor.

The surrogate mother carries the child and gives birth to it, after which the intended parents become the legal parents of the child.

Gestational Surrogacy: Gestational surrogacy is a form of surrogacy where the surrogate mother does not use her egg to create the embryo.

The embryo is formed through in vitro fertilization (IVF) using the egg and sperm of the intended parents or with donor eggs and sperm.

The embryo is then implanted in the surrogate mother's uterus, and she becomes pregnant with the child. Following the birth, the intended parents assume legal parenthood of the child.

Who Is Involved In The Surrogacy Process?

​The surrogacy process involves several people:

1. A surrogate/Carrier
2. The intended parent(s)
3. Egg or sperm donors
4. Surrogacy agency
5. Fertility center
6. Lawyers or legal counsel
7. Pregnancy care providers, like obstetricians or midwives
8. Mental health providers
9. Genetic counselors
   

Steps of the Surrogacy Process

​Surrogacy is a wonderful and intricate process that helps intended parents have their own family through the assistance of a gestational surrogate. Though the exact process may differ depending on the location and specific situations, there are typically six main steps involved

Step 1: Decide if Surrogacy is Right for You

This step is the most crucial one when it comes to surrogacy. It involves a significant emotional, financial, and legal commitment. Before making a decision, intended parents and potential surrogates need to consider all aspects of the process carefully. It's important to have access to resources, support systems, and open communication throughout the journey

Step 2: A Perfect Surrogate

A healthy woman aged 21–45 (preferably under 35). Has had 1–5 uncomplicated full-term pregnancies. Has not undergone more than 3 C-section deliveries.Maintains a healthy weight.
Meets additional requirements from the surrogacy agency.

Step 3: Medical Screenings for Surrogacy

The intended parents and the carrier must undergo a medical evaluation, which includes screening for psychological conditions such as depression through consultations with a psychologist. Some blood tests are performed for:

Syphilis,

Gonorrhea,

Chlamydia,

HIV

Hepatitis B and C.

Carriers should also be vaccinated for measles, mumps, rubella (MMR), and Tdap (diphtheria, tetanus, and pertussis). The COVID vaccination may also be necessary. Intended parents (or egg or sperm donors) will undergo genetic screening to evaluate the child's risk for congenital disabilities like Down syndrome.

Step 4: The Legal Process for Surrogacy

Legal contracts must be completed before IVF can begin. The agreement covers the details like:

The surrogate will give the baby to the intended parents after birth.

The carrier’s role and responsibilities during the pregnancy include things like attending prenatal appointments, not using drugs or alcohol during pregnancy, and more.

Compensation and payment.

Sensitive issues like termination of the pregnancy, death of the fetus, and more.

All risks and liabilities associated with IVF, pregnancy, and childbirth.

There are many other scenarios and possible outcomes that may have legal implications.

 Step 5: Medical Procedure

The healthcare provider collects your eggs and fertilizes them with your partner's sperm in a laboratory. In certain situations, donor eggs or sperm may be utilized. If the intended parent uses her eggs, she will undergo fertility treatment to produce as many eggs as possible for fertilization. An embryo is created when the sperm fertilizes one or more eggs. The gestational carrier undergoes fertility treatment to prepare the uterus for the embryo. Once the embryos are formed, they are implanted into the gestational carrier's uterus.

Step 6: Postpartum Care

After a successful and healthy pregnancy, the intended parents joyfully welcome their child home. The role of the surrogate in the child's life depends on the agreement and preferences of both parties involved. Emotional support and guidance are provided to both the surrogate and the intended parents during this significant transition to parenthood.

What Are The Risks Of Using A Surrogate Mother?

​There are risks for couples or individuals who use a gestational carrier. Some of the most common risks are:

• There is no guarantee of a successful pregnancy or a full-term pregnancy.
• Risks of fertility treatment and medical procedures to the intended parents or carriers.
• Financial risk is associated with IVF, medical procedures, legalities, and compensation.
• Emotional risk of miscarriage, complications, and other health conditions.
• Frustration over a lack of control over the carrier, the pregnancy, and other factors.

There are also risks to the carrier. They must get routine prenatal care throughout the pregnancy. Carriers inherit all the risks of pregnancy complications like high blood pressure, diabetes, and infections.

Carrying another person’s pregnancy can be emotional, time-consuming, and challenging for the carrier’s spouse or children.

While most carriers are happy to help a couple or person become parents, they can still become attached to the baby after delivery.

The Emotional Side of Surrogacy

​Surrogacy is a transformative experience for all parties. It can bring immense joy, but it also comes with its own set of challenges.

The intended parents may feel hopeful, excited, and anxious as they await the progress of the pregnancy.

The surrogate may go through a range of emotions, from forming a bond with the baby to feeling sadness as the pregnancy comes to an end, and finally experiencing joy as the intended parents become parents.

References

• ScienceDirect (2011). Surrogacy. Available at https://www.sciencedirect.com/topics/medicine-and-dentistry/surrogacy (Accessed 30/12/2023).
  
• Cleveland Clinic (2022). Gestational Surrogacy. Available at https://my.clevelandclinic.org/health/articles/23186-gestational-surrogacy (Accessed 30/12/2023).
• National Library of Health (2018). Insight into Different Aspects of Surrogacy Practices. Shenfield F, Pennings G, Cohen J, Devroey P, de Wert G, Tarlatzis B. ESHRE Task Force on ethics and law 10: Surrogacy. Hum Reprod. 2005;20:2705–7. [PubMed] [Google Scholar]. Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6262674/#ref1 (Accessed 30/12/2023).
• Surrogacy Australia (2022). What is Surrogacy? Available at https://www.surrogacyaustralia.org/what-is-surrogacy/. (Accessed 30/12/2023).
• Family Solutions International (2022). An Overview of the Surrogacy Process. Available at https://www.3sisterssurrogacy.com/overview-of-the-surrogacy-process/ (Accessed 30/12/2023)