Surrogacy is a process in which a woman, known as a “surrogate mother,” takes on the pregnancy and carrying of a fetus for another individual or couple who are unable to conceive or carry a pregnancy themselves. This method allows families and individuals who, due to medical issues such as infertility or specific life circumstances, cannot have children themselves, to utilize this technique and fulfill their wish for parenthood.
Surrogacy is presented as a modern and effective solution for infertile couples and single individuals who cannot experience pregnancy. This process helps individuals bring their child into the world without needing to endure the pregnancy themselves by collaborating with a surrogate mother. This method, which has received increasing attention in recent years, not only creates an opportunity for the intended parents but also enables the surrogate women to assist families in achieving their dreams.
What is Surrogacy?
Surrogacy is when another person carries and gives birth to a child for another couple or individual. The person who carries the pregnancy is called the surrogate or gestational carrier. The intended parents are the couple or individuals intending to raise the child.
Most surrogacy pregnancies are achieved via in vitro fertilization (IVF). In this method, the embryo is created in a laboratory using the egg and sperm of the intended parents or an egg and/or sperm donor. The embryo is then transferred to the carrier’s uterus. Since the gestational carrier does not provide the egg, there is no genetic link between the carrier and the child.
What is the difference between a Surrogate Mother and a Gestational Carrier?
Gestational Surrogacy is a type of Surrogacy in which the surrogate (or gestational carrier) is not genetically related to the fetus because she did not provide the egg used for fertilization. In this type of pregnancy, the egg of the intended parent or a donated egg is used. The gestational carrier carries the pregnancy and gives birth to the baby. This is the most common type of Surrogacy. In most cases, at least one of the intended parents is genetically related to the child, but the carrier is not. This makes the process less legally complicated.
Traditional Surrogacy is when the gestational carrier is genetically related to the fetus. Her eggs create the pregnancy, and she carries and gives birth to the baby. As the child’s biological parent, she must then relinquish her parental rights to the intended parents.
Who chooses Surrogacy?
Many individuals or couples use a gestational carrier to grow their family. A gestational carrier may be necessary when:
- The intended parents are infertile due to an issue with the uterus.
- The intended parents cannot safely become pregnant or give birth due to a serious medical or psychological condition that would put them or the fetus at risk.
- An individual has had a hysterectomy and does not have a uterus, or has a uterine abnormality.
- The intended parents are not biologically capable of getting pregnant or having children, such as a single individual or a gay couple.
What is the process of using a Surrogate?
In Surrogacy, the embryo is created through IVF (In Vitro Fertilization) using the egg and sperm of the intended parents (or donors). The embryo is then transferred to the surrogate, the gestational carrier. The process begins with selecting a carrier.
Next, the carrier and the intended parents sign legal contracts and undergo various medical and psychological screenings. Once these steps are finalized, the IVF treatment begins.
Finding a Surrogate
Most individuals interested in Surrogacy meet with a surrogacy agency to discuss the process and the costs of treatment. This agency helps you find a gestational carrier. The agency assists in creating the legal agreements (contracts) between the intended parents and the carrier. Agencies act as an intermediary between the carrier and the intended parents. Some couples or individuals choose family members or friends as their gestational carrier. This is generally acceptable. However, there may be more emotional complexities involved in choosing someone you know.
According to the American Society for Reproductive Medicine (ASRM), an ideal gestational carrier is an individual who:
- Is a healthy person between 21 and 45 years old (preferably under 35).
- Is someone who has had at least one, but no more than five, full-term pregnancies and deliveries without complications.
- Is someone who has had no more than three Cesarean section deliveries.
- Has a healthy weight.
Medical Screenings for Surrogacy
The intended parents and the carrier must undergo a psychological evaluation, including screening for mental health conditions like depression, by meeting with a psychologist.
The American Society for Reproductive Medicine (ASRM) states that carriers must undergo a comprehensive medical examination to ensure their health for pregnancy. The organization also suggests that they undergo blood tests to screen for the following:
- Syphilis
- Gonorrhea
- Chlamydia
- HIV
- Hepatitis B and C
Carriers should also have received vaccinations such as measles, mumps, rubella (MMR), and Tdap (Tetanus, Diphtheria, and Pertussis). COVID-19 vaccination is sometimes required. The intended parents (or egg/sperm donors) undergo genetic screening to assess the risk of the child having congenital disabilities like Down syndrome.
How does a Gestational Carrier become Pregnant?
Your healthcare provider collects your eggs and fertilizes them with your partner’s sperm in a laboratory. In some cases, donated eggs or donated sperm are used. If the intended parent uses their own eggs, they take fertility medications to produce as many eggs as possible for fertilization. The embryo is formed after the sperm fertilizes one or more eggs.
The gestational carrier takes fertility medications to prepare the uterus for the embryo. Once the embryo is formed, they are implanted into the gestational carrier’s uterus.
What are the risks of using a Gestational Carrier?
There are risks for couples or individuals who use a gestational carrier. Some of the most common risks include:
- There is no guarantee that the pregnancy will be successful or carried to term.
- Risks associated with fertility treatments and medical procedures for the intended parents or the carrier.
- The financial risk is associated with IVF, medical procedures, legal matters, and compensation.
- The emotional risk of miscarriage, complications, and other health conditions.
- Frustration stemming from a lack of control over the carrier, the pregnancy, and other factors.
There are also risks for the carrier. They must receive routine prenatal care throughout the pregnancy. Carriers inherit all the risks of pregnancy complications such as high blood pressure, diabetes, and infections. Carrying someone else’s pregnancy can be emotionally draining, time-consuming, and challenging for the carrier’s spouse or children. While most carriers are happy to help a couple or an individual become parents, they can still become attached to the baby after delivery.
The bottom line
Surrogacy is when the surrogate mother is not genetically related to the child she is carrying. This is the most common type of Surrogacy today. This method helps thousands of people grow their families when they are not biologically or physically capable of forming a family. The process involves finding a carrier, completing legal agreements and documentation, and transferring the embryo to the selected carrier. Although this is a long and challenging process, it is often the only way for some individuals to experience parenthood.
Additional questions
- What is a surrogacy embryo transfer cycle’s success rate (probability of live birth)?
The success rate for each surrogacy embryo transfer cycle is, on average, about 75%, although various factors, including the age of the egg donor and the expertise of the fertility clinic, affect this statistic.
- Aside from uterine issues or infertility, what are the main reasons for failure of an IVF cycle in a surrogacy process?
The main reasons for failure include poor egg quality (especially if the intended mother is older), chromosomal abnormalities in the embryo that prevent implantation or growth, hormonal imbalances in the carrier’s body, or minor uterine abnormalities that may affect success despite the carrier’s overall health.
- What is the optimal thickness of the Endometrial Lining in a carrier to maximize the success rate of embryo transfer?
The thickness of the uterine lining (endometrium) on the day of embryo transfer should ideally be between 8 and 14 millimeters (mm). A thickness less than 7–8 mm is associated with lower implantation and pregnancy rates, although some successful pregnancies have been reported with thinner linings.
- What is the main role of the hormone Progesterone in a gestational carrier’s treatment protocol after embryo transfer?
Progesterone plays a vital role in maintaining and thickening the uterine lining (endometrium) and preparing it for embryo acceptance (implantation). After the transfer, progesterone prevents uterine contractions that could lead to miscarriage and helps stabilize the pregnancy in its early weeks.
- Besides diabetes and high blood pressure, what common placental complications are more frequently seen in surrogacy pregnancies (resulting from IVF)?
IVF pregnancies, including surrogacy pregnancies, may be associated with a higher risk of Placenta Previa (the placenta covering the cervix) and Placenta Accreta (the placenta growing too deeply into the uterine wall), both of which can lead to severe hemorrhage (bleeding).
References
https://my.clevelandclinic.org/health/articles/23186-gestational-surrogacy
https://www.webmd.com/infertility-and-reproduction/using-surrogate-mother
https://tfp-fertility.com/en-gb/donation/surrogacy