Surrogacy as an infertility treatment

Surrogacy is the involvement of a third party in the infertility treatment process; a couple asks another woman to carry and give birth to a baby for them, because the female partner is unable to have a normal pregnancy. There are several ways of approaching surrogacy but this is not an easy process, either emotionally or ethically.

If you are a woman who is unable to carry a child, due to problems with conception or potential problems with pregnancy, labour or delivery, then a surrogate mother can carry your child on your behalf. Surrogacy has also been used by older couples, unable to conceive naturally, and by homosexual male partners who want to have a child that has been conceived with one partner’s sperm and the surrogate’s own eggs, or donor eggs.

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Where is surrogacy allowed?

The regulations that govern surrogacy, and whether it is allowed to take place at all, differ across countries of the world. Some countries, such as Spain, the UK, China, Canada and Australia will allow altruistic surrogacy (see below), but will not allow any form of commercial arrangement to take place. Other countries ban surrogacy completely, and include Germany, Italy and France. India, which has no laws at all regulating surrogacy, has become a popular destination for couples seeking surrogate mothers in recent years. The USA is plagued by different regulations in different states, and many American couples travel abroad to make arrangements.

Religious groups generally look unfavourably on all types of surrogacy; the Catholic Church does not allow it and it is not acceptable to people who are Jewish or Muslim. Some Christian groups also oppose it.

Types of surrogacy

The differences stem from the origin of the gametes and the financial arrangements with your surrogate:

• Host or gestational surrogacy: the woman acting as the surrogate is not genetically related to the child. The embryo may be created, using IVF , from the eggs and sperm of the commissioning parents combined with either donor eggs or sperm.
• Traditional or partial surrogacy: the surrogate is the genetic mother of the child. Sperm from the male of the commissioning couple is used to artificially inseminate the surrogate using IUI.
• Altruistic surrogacy: the surrogate receives no more than allowable expenses and so does not benefit financially from the surrogacy arrangement.
• Commercial surrogacy: a fee is paid to the surrogate, on top of allowable expenses, as payment for the service.

Surrogacy vs adoption

Surrogacy has many advantages over traditional adoption, especially since you are able to contribute your own sperm, eggs, or both to the process, making the child genetically related to at least one partner in the relationship.

While surrogacy is regulated differently across the world, with some countries outlawing it altogether, and others allowing it as a commercial enterprise, it rarely involves the extensive and expensive processes that adoption can often entail. In most cases, you do not need to ‘qualify’ for surrogacy in the way you do for adoption. Neither are there background checks on your domestic arrangements or suitability as parents, although some countries may not allow surrogacy for same sex couples on religious grounds.

What does surrogacy cost?

The cost of surrogacy varies from country to country and will depend on the nature of the arrangement. The costs can include:

• Your own infertility treatment to create the embryo, such as IVF and ICSI.
• Embryo implantation into the surrogate or artificial insemination of the surrogate.
• Costs for donor sperm or eggs.
• Expenses of the surrogate.

The cost of using a surrogate will inevitably be greater than the cost of infertility treatment where you carry the child yourself. You may also need to travel abroad more often to form a bond with your surrogate and check for progress of the pregnancy.

Given the complex legal nature of surrogacy there will also be significant legal costs involved, both in drawing up a contract between you and your surrogate and in registering your legal claim to the child, or formally adopting it on your return home. In some cases, you may even have to pay for a visa for a child born abroad to enter your home country, until your legal rights as parents have been clarified.

Is surrogacy fair?

One of the biggest surrogacy issues is whether it is fair to the surrogate mother. It is generally assumed that she will become attached to the child she is carrying, even if it is not genetically her own, and that it is in some way cruel to take it from her, even if that is the established agreement.

However, studies have shown that surrogate mothers rarely change their minds and want to keep the child. Surrogate mothers adopt a range of techniques to maintain an appropriate relationship with the baby they are carrying, including bonding with the commissioning couple, and this helps to prevent attachment. Most surrogate mothers are proud of the job they are doing and feel positive about being able to help a childless couple to start the family they want so much.

Legal issues with surrogacy

There are many complex legal issues surrounding surrogacy, and these are discussed in depth in our related article. It is vitally important that you understand both the laws of the country that you travel to for treatment, and the laws of your home country regarding surrogacy contracts, before you begin the surrogacy process.

Expert legal advice is highly recommended to ensure that any contract you enter into overseas is enforceable, and that it will be recognised on your return home. Even though such advice is not cheap, it is a small price to pay to ensure everything runs smoothly and that you become the legal parents of your surrogate child.