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    surrogacy

    Surrogacy - Types, Complications and Techniques

    • 12479 views
    • 4.8   (3 Votes)
    Medically Reviewed by Dr. Deepika Tiwari - MS, MBBS on 29 Mar 2019 - Written by Dr. Sheetal Pandey Tejwani - Fellowship, MS, MBBS - Grammatically Approved by Dr. Kavita Jaggi Agrawal - MS, MBBS

    Surrogacy is an arrangement, which is often supported by a legal contract between a surrogate and intended parents. A woman (surrogate) agrees to carry the pregnancy of a child for another person or couple. Surrogacy techniques come with some complications and there are two types of surrogacy.

    A surrogate is a woman who agrees to carry a pregnancy to due term for another couple who will be the ultimate parents of the resulting child. She may use her own eggs in case of traditional surrogacy in which she is artificially inseminated. (6) Surrogacy, which is also called as third party reproduction - is opted by couples when pregnancy is medically impossible or when a single individual wishes to have a child. (7)

    With the above-discussed parameters, let us get more information about:

    1. Surrogacy Types

    Pregnancy is achieved in surrogate mother through IVF during which embryo prepared from the gametes of intended parents is transfered into her uterus.  The resulting baby is the genetic offspring of the intended parents. There may be legal control over these surrogacy arrangements, particularly financial arrangements. (5) Surrogacy process entails using fertility treatments or procedures in order to place the fertilized egg into the surrogate's uterus. There are two primary types of surrogacy namely gestational and traditional surrogacy, and each works in a somewhat different fashion.

    a) Gestational Surrogacy: Gestational surrogacy is a treatment option available to women who have been diagnosed with certain medical problems, usually an absent uterus, to help them have their own genetically related child. It involves In Vitro Fertilization (IVF), which allows the creation of embryos from the gametes of the intended parents and subsequent transfer of the prepared embryos to the uterus of a surrogate host. The process of Gamete Intrafallopian Transfer (GIFT) - transfers the egg to the surrogate mother. This is done along with the husband’s sperm or the egg is fertilized in the woman’s uterus using IVF treatment with her husband’s sperm. The indications for gestational surrogacy may include absent uterus, repeated failure of IVF, recurrent miscarriage, and certain medical conditions. (1) The surrogate mother carries the commissioning or the intended parent's genetic child conceived via IVF treatments. For this treatment, the infertile woman should still have working ovaries. (3) Altruistic surrogacy comes under the category or type of gestational surrogacy, wherein a woman (surrogate) becomes pregnant without being compensated for her services. In altruistic surrogacy, the surrogate is usually known to the intended parents such as a family member or close friend and is likely to receive the reimbursement for medical expenses. (10)

    b) Traditional Surrogacy: In this type of surrogacy, a surrogate mother is artificially inseminated, either by the intended father or an anonymous donor and carries the pregnancy to the term. The resulting baby is genetically related to both the surrogate mother, who provides the egg and the intended father or anonymous donor. (2) Here, the infertile woman will have no genetic and biological relationship to the newborn baby. In traditional surrogacy, surrogate mother’s eggs are fertilized with the intended father’s sperm by artificial insemination method using a syringe. (3)

    2. Risks / Complications Associated with Surrogacy

    When it comes to legal aspects associated with surrogacy, there are complications related to legal and medical issues such as financial arrangements and social requirements and other medical problems related to surrogacy.

    Legal Complications- The legal rights or laws related to surrogacy differs widely from one jurisdiction to another. There are certain legal formalities done prior to embryo transfer in surrogacy where the surrogate and intended parents work with their own attorney to prepare and negotiate a legal contract. (8) Over the years, surrogacy has received quite a lot of bad press recently, especially when the contract goes sour and there is a dispute over the baby between the commissioning parents and the surrogate mother. The Courts then need to have the Wisdom of Solomon to assign the rights of the ‘genetic’ mother, the ‘birth’ mother, and the ‘social or rearing’ mother. Legal issues associated with surrogacy can be related to:

    1. Financial arrangements: The compensation of the surrogate related to medical arrangements and other maternity services is negotiated between the surrogate and intended parents. The contract also includes additional compensation in case of any pregnancy-related complications occur in later stages.
       
    2. Social Requirements: This includes the basic requirements and responsibilities expected from the surrogate such as abstaining from alcohol, drugs and smoking throughout the pregnancy. Social agreements also determine who will be present at antenatal appointments and at the time of delivery. (8)

    Medical Complications

    The major medical complications associated with surrogacy are that of obstetrics and gynecological complications with multiple order pregnancy being the most common one. Other complications or risks, which are common in both general pregnancy and surrogacy, are preeclampsia and eclampsia, stress incontinence, urinary tract infections and gestational diabetes. There are some other rare complications like amniotic fluid embolism and possibility of postpartum hemorrhage, which are associated with pregnancy in, general and not specific to surrogacy. (4)

    3. Techniques Used in Surrogacy

    Surrogacy procedures are carried with the help of Assisted Reproductive Technologies (ART) or artificial insemination. In order to conduct a possible surrogacy procedure, In Vitro Fertilization or Intrauterine Insemination treatments are necessary.

    • Intrauterine Insemination: IUI procedure consists of simple technique wherein a sample of semen is placed into the uterine cavity of the patient. The goal of the treatment is to allow sperms to reach the fallopian tube and inseminate the egg to make implantation occur.
       
    • In Vitro Fertilization: IVF procedures are technically more advanced and challenging as compared to IUI as the eggs are extracted directly from the ovaries through a process called ovum pick-up. The fertilization takes place in IVF labs. The prepared embryos are cultured for 3 to 5 days before being transferred back to the patient’s womb.

    Depending on the severity of the condition, additional techniques can be used as complementary procedures when necessary. The most common techniques used along with IVF can be egg or sperm donation, Preimplantation Genetic Diagnosis (PGD) and cryopreservation of gametes and embryos. In traditional surrogacy, IUI procedures are performed where the surrogate is artificially inseminated with intended father’s sperm or donor sperm. In gestational surrogacy, IVF or IVF along with ICSI may be used to get the surrogate pregnant. A gestational surrogate is just considered to be the birth mother of the resulting child, with no genetic linkage to the child. (9)

    Elawoman provides you with a refined list of hospitals and clinics willing to help in offering surrogacy, which can be accessed from elawoman.com. Before embarking upon the surrogacy journey, let our fertility experts assist you by resolving all the queries on +918929020600.

    Dr. Sheetal Pandey Tejwani

    Written by

    Fellowship, MS, MBBS, DNB
    Laparoscopic Surgeon, Gynecologic Surgeon
    Mumbai
    Dr. Sheetal Pandey Tejwani is an Infertility Specialist, Gynecologic Surgeon and Obstetrician, located in Mumbai and having an experience of almost a decade. Her alma mater is B J MEDICAL COLLEGE in Pune from where she completed her MBBS and MS in Obstetrics and Gynaecology in 2007 and 2009, respectively. In the following year, she pursued her DNB in Obstetrics and Gynecology. She received her Post Doctoral Fellowship in Reproductive Medicine from Krishna IVF Vizag and Nadkarni IVF Centre, Surat in 2013. She is the member of 3 different associations i.e. Indian Society of Assisted Reproduction (ISAR), Indian Medical Association (IMA), and Association of Medical Consultants. Her area of expertise includes Tubectomy/Tubal Ligation, Hysterectomy (Abdominal/Vaginal), Intrauterine Insemination (IUI), Caesarean Section and In-Vitro Fertilization (IVF). She is a consultant in Veda Fertility And Urology Care, Mira Road and is a visiting consultant in Wockhardt Hospital, Mira Road, Mumbai. You can get the contact details of Dr. Sheetal Pandey Tejwani at elawoman.com

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    3 Comments

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    Kriti Gulati

    Gestational surrogacy procedure is a useful one. It helped me and my husband become parents of healthy babies.

    June 2, 2018, 6:53 p.m. 5.0

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    Rita Agarwal

    Now, this makes me think which type of surrogacy is the best? Not the traditional one I'm sure.

    June 2, 2018, 4:52 p.m. 5.0

    user_img

    Dilip Narayan

    This Surrogacy blog is a very informative one. I found some of unread info about gestational surrogacy. Great one!

    April 17, 2018, 6:11 a.m. 4.5

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