fertility treatments

Surrogacy Process: All You Need to know

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Medically Reviewed by Dr. Deepika Tiwari - MBBS on 25 Mar 2019 - Written by Dr. Neha Gupta - MBBS - Grammatically Approved by Dr. Kavita Jaggi Agrawal - MBBS

Surrogacy is basically an arrangement, which is supported by a legal agreement. In surrogacy, a woman called as surrogate agrees to become pregnant for a couple who cannot carry a pregnancy themselves. The intended parents ultimately become legal parents of the child or children born from surrogacy.

Surrogacy is a significant method of Assisted Reproductive Technology (ART). In a surrogacy arrangement, a woman agrees to bear a child for another woman or couple who are not able to have their own child and surrender it to the intended parents at birth. Surrogates are special, selfless women with a passion for helping others and bringing joy in their lives. The couple who are in hope of a child resulting from a surrogate pregnancy is referred to as the ‘intended parents'. (1)

In this article, we will look at:

1. What are the types of surrogacy?

There are mainly two main types of surrogacy: gestational surrogacy and traditional surrogacy. 

Traditional Surrogacy: When the intended father's sperms are used in insemination, the resulting child is genetically related to the intended father and genetically related to the surrogate. If donor sperm is used, the resulting child is not genetically related to either the intended parent and is genetically related to the surrogate only.

Gestational Surrogacy:Gestational surrogacy takes place when an embryo created by In Vitro Fertilization (IVF) technology is transferred in a surrogate. These surrogates are called gestational carrier. Here, the resulting child is genetically unrelated to the surrogate.

  • If the embryo is created using the intended father's sperms and the intended mother's eggs, the resulting child is genetically related to both the intended parents.
  • If the embryo is created using the intended father's sperms and a donor egg, the resulting child is genetically related to the intended father only.
  • If an embryo is created using the intended mother's egg and donor sperm, the resulting child is genetically related to the intended mother only.
  • If a donor embryo is implanted in a surrogate, resulting child is genetically unrelated to both the intended parents and the surrogate as well.

Traditional and gestational surrogacy can also be of two types:

  • Commercial Surrogacy:When the commissioning parents compensate the surrogate, it is called commercial surrogacy. This type of surrogacy is illegal in most countries including India and the UK.
     
  • Altruistic Surrogacy:When the surrogate chooses to carry the child for reasons other than financial gain, it is called as altruistic surrogacy. (2)

2. When is Surrogacy Required?

Surrogacy is considered as the best treatment during the following conditions:

  • Medical problems with the uterus of the intended mother
  • A woman is unable to become pregnant or carry a pregnancy because she has had a hysterectomy or is missing part of her uterus, ovaries or other parts of the genital tract
  • A woman has a health condition that makes pregnancy dangerous
  • A single man wishes to have a child using his sperm
  • When pregnancy is impossible or risky for the intended mother, such as severe heart disease.
  • A woman who has frozen embryos in storage dies and her male partner wishes to use the embryos to have a child.
  • If the couple has tried but couldn't get pregnant with a variety of Assisted Reproduction Techniques, (ART), such as IVF.
  • Surrogacy is also an option for people who might not be able to adopt a child, possibly because of their age or marital status.
  • Surrogacy is a popular option for gay men. If a gay couple decides to go for surrogacy, one of the partners can use his sperms to fertilize the surrogate's egg through artificial insemination. (3)

3. How to find a surrogate mother?

Sometimes a family member or friend offers to be a surrogate for the intended parents. This greatly reduces the cost of surrogacy. This is not the case always because everyone does not know a woman in a position to volunteer to be a surrogate mother. So, most people find a surrogate through other means. There are many full-service agencies that match intended parents to surrogate mothers. While choosing an agency, it is very important to research the agency’s history. 

Here are two ways you may consider:

  • Asking Someone You Know:If intended parents prefer their surrogate to be someone they already know, it can be potentially awkward to ask them directly. If the person is not comfortable with surrogacy, this may affect their future relationship with them. Rather than directly asking someone to help, it may be preferable to let it be known that they have been advised by their fertility specialist to consider surrogacy and that they are looking for a potential surrogate. Then wait to see who offers. If they have been private about their journey towards creating a family, this may seem very challenging. Discussing their situation with others can help them feel more comfortable. Potential surrogates are everywhere. It helps intended parents to be more proactive and step outside their comfort zone. 
     
  • Finding Someone You Don’t Know:Intended parents cannot advertise or publish a statement or notice that they are seeking a surrogate. They need to be careful in making public statements, even on some wide circulation social media. If in doubt, seek professional advice. Parents may find a surrogate through their networks, through word-of-mouth or other means. It maybe that a friend of a friend has been considering acting as a surrogate for some time and offers when she hears of one’s experience. Many people find it helpful to join a support group for advice and emotional support. There are many online forum and face-to-face social meetings. (4)

4. What are the qualifications of a surrogate mother?

An ideal surrogate should have the following qualifications:

  • Good physical and mental health    
  • Have carried and delivered at least one child
  • Had pregnancies that were complication free and full-term
  • Be less than 43 years of age 
  • Be in a stable living situation
  • Should not have a habit of smoking and should not be an alcoholic. (5)

5. What is the process of surrogacy?

  • The Surrogacy Decision:While adoption seems like an easier and better option there are several reasons why surrogacy is better than adoption. Intended parents are able to choose the surrogate mother and review the background before agreeing to the process. Surrogacy can also be a good option for couples who are not capable of conceiving a child. This process can put an end to unsuccessful infertility treatment. When there are no other options, having the benefit of letting you participate in your baby’s gestation and birth. (6) Surrogacy is also a viable option with the assistance of the SPAR program (Special Program of Assisted Reproduction) if the male parent or parents are HIV positive. Often times when people consider surrogacy, they ponder what kind of women carry children as surrogates, and what are their motives. Do they just carry for the money? Most women opt to become surrogates because becoming pregnant and carrying a pregnancy is something their bodies can do easily, and they are empowered by this altruistic ability that their body can do this for someone else’s benefit. (7)
     
  • Initial Consultation With The Surrogate And Intended Parents:Fertility counselors traditionally meet separately with the intended parents, separately with the gestational carrier for psychological assessment and consultation and finally with both the intended parents and gestational carrier in a group session. Each of these sessions has different purposes and goals, yet all are components in building, planning, and navigating the family-building process with a gestational carrier. A significant goal of preconception counseling with a potential gestational carrier is helping her decide if being a carrier will serve a positive purpose or have a negative impact on her life. Being a gestational carrier involves ambiguity and potentially emotionally stressful situations, and assessing how a carrier will respond to and resolve such issues as a key to protecting her and all parties involved. She needs to be able to provide informed consent, be able to relinquish the child, and, along with her family, exit the experience whole and unharmed.  More specifically, these publications highlight the importance of psychological counseling, assessment, education and support by a qualified mental health professional of all participants. They also provide for rejection or denial of participants. Counseling becomes an important part of medical care and should occur before treatment begins. (8)
     
  • Find a Match/ Selection of a Surrogate: The choice of a surrogate mother is of the highest importance for the successful outcome of the treatment. She might be a member of the family, such as a sister or a mother, or an anonymous or known unrelated person. A gestational carrier should preferably be between the ages of 21 and 45 years and she should have at least one child. Her previous pregnancies should have been full-term and uncomplicated. Ideally, the carrier should not have had more than a total of five previous deliveries and three deliveries via Caesarean section. The autonomy of the surrogate mother should be respected at all stages, including any decision about her pregnancy, which may conflict with the commissioning couple’s interest. (9)
     
  • Surrogacy Contract & Legal Agreements: Whether a surrogacy contract is valid depends on the resolution of a number of issues. First, courts must decide whether such a contract is void as against public policy or voidable by the birth mother. If the contract is valid, then the proper remedy for the breach of the agreement must be determined. Some courts may order the mother to hand over the child, whereas other courts will only allow monetary damages. If couples are seeking to enter into a surrogacy agreement or if a woman is planning to become a surrogate, it may be helpful to contact an experienced family law lawyer. A family attorney can help understand how the state's laws affect the surrogacy contract and the legal requirements. (10)
     
  • Medical Process Step By Step:The surrogacy process involves a number of medical procedures. Initially, the clinic reviews the medical records; conduct a physical exam of the woman/women whose eggs and/or uterus may be used, and conduct prescreening testing. After this, the fertility doctor performs a mock embryo transfer. If the intended mother is using her own eggs, she needs to take hormone injections. The woman is monitored directly in the office approximately 7-8 times. These appointments usually include vaginal ultrasounds and bloodwork. Once the doctor has determined the follicles are of the right size, a final shot is injected to prepare the eggs for retrieval. Once the eggs have been retrieved, the prepared semen at the clinic – is used to fertilize it. When the intended parent’s semen is being used but is determined to be of poor quality, the clinic can attempt fertilization through (intracytoplasmic sperm injection) ICSI. The fertilized egg will be monitored for three to five days to check its development. At the blastocyst stage, the fertilized egg will be transferred to the surrogate mother’s uterus. The egg transfer is a quick and painless procedure that can be completed less than fifteen minutes. (11)
     
  • Pregnancy & Birth: Once the baby is born, it is crucial that parents pay attention to all the necessary documents that they must complete and file to ensure that parental rights are properly established.

6. What are the risks associated with surrogacy treatment?

There are also some risks associated with surrogacy treatment. The major risk is that of obstetrics complication and multiple order pregnancy. Pregnancy, birth, and the postpartum period include complications such as urinary tract infections, preeclampsia and eclampsia, stress incontinence, and gestational diabetes and rare complications such as amniotic fluid embolism and the possibility of postpartum hemorrhage. However, these risks are associated with pregnancy in general and are not associated with surrogacy only. (10)

7. What are the legal laws related to surrogacy in India?

India had been a popular destination for international intended parents. In 2015 the Indian government passed new regulations on the surrogacy treatment. According to that law, it became illegal for foreign intended parents to complete a surrogacy in India. The 2015 surrogacy ban was only the start of legislation regulating surrogacy. After almost two years in December 2018, an Indian surrogacy law was passed and made the following changes:

  • Made commercial surrogacy illegal in India
  • Only altruistic surrogacy in allowed for needy, infertile Indian couples
  • It is necessary for Indian parents to be married for five years and have a doctor’s certificate of their infertility
  • Women can become surrogates only for once, that too if they are a close relative of the intended parents, are married and have their own child
  • Homosexuals couples, single parents and live-in couples cannot go for surrogacy

These changes reflect a new era of surrogacy in India. Other countries like Nepal and Thailand have recently implemented surrogacy bans, as well. (11)

Although surrogacy is the most expensive treatment, it is also the most successful one too. After reading the article, if you still have any doubts, you can consult Ela experts. Get more information about the top surrogacy centers in India. Feel free to call on the given number to discuss the process of surrogacy and to book an appointment with the best surrogacy doctors: +917899912611.

Dr. Neha Gupta

Written by

Infertility Specialist, IVF Specialist
Gurgaon

Dr. Neha Gupta is an Obstetrician and Gynaecologist in Gurgaon. She has been practicing for many years now. Her rich experience in Normal Vaginal Delivery, Intrauterine Insemination (IUI), In-Vitro Fertilization (IVF), Hysterectomy and Tubectomy makes her the most preferred names in Gurgaon. She has acquired MBBS in 2004, DNB from National Board of Examinations in 2009 and MS - Obstetrics and Gynaecology from Maulana Azad Medical College in 2009. She is a member of the Royal College of Obstetricians and Gynaecologists, London. Dr. Neha Gupta has an expertise in Intrauterine Insemination and is practicing at Fortis Memorial Research Institute in Gurgaon. You can get the contact details of Dr. Neha Gupta at elawoman.com

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5 Comments

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Deepak Roy

I am looking for a surrogate mother. Can you help me with some qualities to look for in a surrogate mother.

Sept. 15, 2018, 5:25 p.m. 4.5

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Nidhi Verma

I think having an agreement signed before insemination is better to reduce any future complications.

Sept. 3, 2018, 2:28 p.m. 4.5

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Aditi Singh

I have a friend looking for surrogacy. Will ask them to read it to know more on the legal aspects of surrogacy.

Aug. 24, 2017, 4:46 p.m. 5.0

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Trishna Sahpathi

Check from your side if the surrogate mother is not infected with AIDS, Zika Virus, Ebola, Rubella because the infection can reach fetus and can cause certain birth defects.

Aug. 24, 2017, 4:45 p.m. 5.0

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Lipika Saha

Surrogacy is legal but it's a complex treatment. The mother offering surrogacy can also have certain complications. Complete health check up is advised.

Aug. 24, 2017, 4:06 p.m. 4.5

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