Surrogacy: What It Is and What to Consider

Surrogacy is a way for individuals or couples to have a child when there are problems or limitations that prevent it from being achieved by natural means. However, this method remains controversial.

Surrogacy is a method of assisted reproduction in which the woman who carries a baby doesn’t act as the baby’s mother. This may be the most general definition, which is also known as surrogacy or surrogate motherhood.

This method has been around since the 1970s, but has become more popular in the last decade. However, there are a number of controversies surrounding surrogacy – not so much for biological reasons, but for the social and ethical implications.

Recently, the debate was brought back into the public spotlight by the case of Gammy, a baby with Down syndrome who was born in Thailand through surrogacy. Her biological parents abandoned her because of her condition.

What is surrogacy?

Surrogacy is a reproductive practice in which a woman lends her uterus to receive and gestate the embryo conceived by another person or couple. The baby resulting from this pregnancy is legally the child of the person who provided the embryo.

This method of assisted reproduction is used by individuals or couples who have problems conceiving or carrying a pregnancy to term. The woman who lends her womb is known as the gestational carrier or surrogate mother, while those who contract with her are known as the intended parents.

This practice is prohibited in most countries, while in others, it has become a source of income for some people. It breaks with the usual idea of what a family is and sometimes gives rise to ethical and legal controversies.

How is it performed?

Surrogacy involves a process composed of four basic steps:

1. A medical diagnosis: The specialist makes an assessment of the situation from a medical point of view and establishes whether a person or a couple is suitable for this method of assisted reproduction.
2. A legal evaluation: Whether the practice is legal in the place where it is going to be performed is established and studied. If not, it involves finding a country and a medical center where it can be done legally. It also involves signing a contract.
3. The evaluation of the surrogate: There’s a detailed review of the woman who is going to lend her uterus through multiple examinations and medical tests.
4. Gestation and delivery: includes the pregnancy as such and its follow-up, as well as the delivery of the baby at the end of the pregnancy.

Types of surrogacy

There are several types of surrogacy, depending on the way it is carried out and the motivation of the surrogate. Thus, there are three main categories.

Surrogacy by genetic link

Depending on the way in which the pregnancy is achieved, surrogacy can occur in two different ways:

• Traditional or partial: The woman who lends her womb also provides the egg. This is fertilized with the sperm of the future father by artificial insemination. Thus, there’s a genetic link between the pregnant woman and the baby.
• Gestational or complete: In this case, the pregnant woman does not provide her eggs. They come from the mother-to-be or from a donor. In this case, there’s no genetic link between the mother and the baby.

Surrogacy by family relationship

The surrogate may or may not have a bond with the intended parents. From this point of view, there are two varieties:

• Intrafamilial surrogacy: The gestational carrier is a relative of one of the two intended parents. This is not common, since there may be medical consanguinity problems.
• Extrafamilial surrogacy: This occurs if the pregnant woman has no family ties with the parents.

Surrogacy for economic reasons

There are commercial reasons for surrogacy and altruistic reasons for surrogacy. In the first case, the surrogate carries out the process in exchange for financial remuneration. In the second, the surrogate carries out the gestation voluntarily, without compensation.

When can surrogacy be used?

Surrogacy is an option for heterosexual couples who have problems conceiving or carrying a pregnancy to term. It’s also an option for homosexual couples who wish to have a child or for single-parent families – i.e. a person without a partner who wishes to become a mother or father.

The two usual medical reasons for surrogacy are the absence of a uterus or uterine malformation. Also, surrogacy may become an option when pregnancy is contraindicated for medical reasons:

• Repeated abortions
• Diseases that prevent gestation
• Conditions that pose a risk to the health of the mother or the baby
• Repeated failures in the processes of in vitro fertilization (IVF)
• Pulmonary hypertension of the mother
• Uterine cancer

Other information to be taken into account

The risks that surrogacy may generate are legal and ethical. In most countries, surrogacy is prohibited, and any surrogacy contracts are considered null and void.

This leads to problems in establishing legal maternity. As a general rule, this is determined on the basis of childbirth – that is, the woman who gives birth is logically the mother of the baby, regardless of other circumstances.

There may also be conflicts of nationality in the case of surrogate children. Often, this involves time-consuming paperwork, which is not always effective.

In addition to the legal implications of surrogacy, there may also be other consequences. When the surrogate has a genetic link to the baby, she may be hesitant to fulfill the contract, and in this case, the law protects her as the mother.

Surrogacy is a costly procedure that includes medical expenses and the consideration required by the surrogate. The countries that currently have legalized this practice are the United States, India, Thailand, Ukraine, Russia, Mexico, Nepal, Poland, and Georgia.