Introduction

Bringing a new life into this world is a profound and precious experience, yet some who embark on parenthood may encounter unexpected challenges.

In recent years, surrogacy has emerged as a ray of hope, offering a pathway to parenthood for individuals and couples facing obstacles in conceiving or carrying a child.

The choice to consider surrogacy is deeply personal and characterized by a mix of emotions—hope, uncertainty, and, at times, a hint of apprehension.

This guide aims to explain the different parts of surrogacy, whether you're thinking about becoming a surrogate, the intended parents need more information, or you're just interested in the idea.

It will be a complete guide to explain the process, answer common questions, and give you a full picture of this life-changing journey.

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.

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:

• A surrogate/Carrier
• The intended parent(s)
• Egg or sperm donors
• Surrogacy agency
• Fertility center
• Lawyers or legal counsel
• Pregnancy care providers, like obstetricians or midwives
• Mental health providers
• Genetic counselors

Steps of the Surrogacy Process

Surrogacy is a wonderful and intricate process that helps intended parents have their own families 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

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

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

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.

The Legal Process for Surrogacy

Legal contracts must be completed before IVF can begin. 

The agreement covers the following details:

• 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

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.

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 full-term.
• Risks of fertility treatment and medical procedures to the intended parents or carrier.
• Financial risk associated with IVF, medical procedures, legalities, and compensation.
• Emotional risk of miscarriage, complications, and other health conditions.
• Frustration over 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.

FAQs

Whose egg is used in surrogacy?

Surrogate mothers are impregnated through in vitro fertilization (IVF). In this process, doctors create an embryo by fertilizing eggs from the intended mother or an egg donor with sperm from the intended father or a sperm donor.

Who is the biological mother of a surrogate child?

 It depends on the surrogacy method. Traditionally, it's the surrogate mother. In Gestational Surrogacy, the intended parent or donor providing genetic material is considered the biological mother/ parent.

How is sperm transferred to the surrogate mother?

The egg is fertilized by injecting the sperm into it or by mixing it with the egg in a petri dish. The embryo develops in the lab for two to five days, and then it is transferred back to a surrogate mother at a fertility clinic.

Will the baby look like the surrogate mother?

If the surrogate is a traditional surrogate (meaning she contributed the egg and carried the baby), then yes, the baby will look like her. If the surrogate is a gestational surrogate (meaning another woman's egg was used to create the embryo), then the baby will not look like the surrogate.

Is a surrogate pregnancy a high-risk pregnancy?

Surrogate pregnancies may involve more risks than traditional pregnancies due to unique medical procedures like In vitro fertilization (IVF) and embryo transfer. Surrogates may also undergo hormonal treatments, which can pose health risks.

Conclusion

Surrogacy presents challenges and complexities, but it also brings hope, compassion, and the incredible power to bring new life into the world.

It offers a beautiful opportunity for individuals to embark on the incredible journey of parenthood, even if they may not have initially thought it possible.

Surrogacy nurtures connections between surrogates and intended parents, founded on trust, empathy, and a common aspiration for the happiness and welfare of the child.

Ultimately, surrogacy shines brightly with the deeply human desire to create and nurture life, igniting a powerful light of hope and endless possibilities for individuals or couples who long to embrace the joys of parenthood.

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)