Surrogacy

Surrogacy is an assisted reproduction method in which a woman, the surrogate agrees to carry a pregnancy and give birth to a child on behalf of another person or couple who wants to start or grow their families when they cannot do so on their own.

The surrogate mother is a woman who agrees to carry a pregnancy and give birth to a baby for another person or a couple. Parents of a baby born through surrogacy are called intended or commissioning parents.

Surrogacy is indicated in the following conditions.

• Congenital or acquired uterine abnormalities
• Absence of uterus like in Mayer-Rokitansky-Kuster-Hauser syndrome (a disorder with the absence of uterus at birth)
• History of hysterectomy (surgical removal of the uterus) for some medical indications such as endometrial cancer or cervical cancer
• Women with multiple fibroids with failed fertility treatment attempts
• Severe medical conditions like heart or renal diseases make pregnancy risky and are contraindication of pregnancy
• Women with repeated miscarriage
• Women with recurrent implantation failure
• Biological impossibility to conceive
• Other Medical Problems with the uterus

Surrogacies are mainly of two types:   

•  Traditional surrogacy: In traditional surrogacy, a surrogate carries a pregnancy achieved through artificial insemination wherein the surrogate mother’s egg is fertilized with the intended father's sperm, making her and the intended father, genetic parents.
•   Gestational surrogacy: In gestational surrogacy, a surrogate carries a pregnancy achieved through in vitro fertilization (IVF), wherein an embryo from the intended parent or a donated egg or sperm is transferred to the surrogate uterus. A surrogate has no genetic connection to the child in gestational surrogacy.

• ​​​​​​Age- A surrogate should be at least 21 years old, generally between the ages of 23–35 years old.
• Reproductive background- A surrogate should have already given birth to at least one healthy baby of her own. The child should be a minimum of 3 years old and there should not be a <2 years gap between the two deliveries.  This helps them understand the medical risks associated with pregnancy and childbirth and the emotional issues of bonding with a newborn.
• Medical conditions- A surrogate should not have any severe medical disorders or concomitant issues. The surrogate should have a history of regular menstrual cycles.
• Medical Tests- A surrogate should undergo routine blood tests along with tests for infectious diseases such as syphilis, gonorrhea, cytomegalovirus, human immunodeficiency virus, hepatitis B virus surface antigen, and hepatitis C virus along with the genetic tests. In addition, electrocardiogram, Pap smear, and mammogram are also recommended. Surrogates should also get medical tests to ensure they have immunity to Measles, Rubella, and chickenpox. She should also undergo a thorough pelvic and abdominal ultrasound to rule out any anatomical abnormality.
• Psychological screening- A surrogate should have passed a psychological screening process that involves an extensive psychological assessment. This will help uncover any issues with giving up the baby after birth. A thorough criminal and financial background check is mandatory.
• Habits- A surrogate should not have any bad personal habits of consuming alcohol, smoking, substance, or drugs.
• Healthy environment- A surrogate should be in a stable marriage and a family environment that would support the treatment.
• Consent- Consent and willingness of the surrogate's spouse are mandatory for her to become a surrogate mother. The spouse should understand the responsibilities and implications.

There are several ways to find a surrogate mother-

• Friends, family, or relatives: Some people find a friend, a family member, or a relative who is willing to serve as a surrogate/ gestational carrier. This is somewhat controversial. But because of the high cost of surrogacy and the complex legal issues, it raises about parental rights, a tried-and-tested family relationship can be simpler to manage. The American Society for Reproductive Medicine accepts certain family ties as acceptable for surrogates. It generally discourages surrogacy, though, if the child would carry the same genes as a child born of incest between close relatives.
• A surrogacy agency: Many people use agencies to arrange a gestational surrogate. They act as go-betweens. An agency helps you find a surrogate and decide. Agencies first get the screening done for the candidates to ensure they meet the criteria associated with the surrogacy process. Then, the crossmatch client's wants/needs to find the best situation for their families. The agency also collects any fees passed between intended parents and the surrogate, such as paying for their medical expenses.

• An intended parent and a surrogate need to have a legal contract to avoid any legal issues after the child’s birth. Each party should have an attorney to ensure its legal interests are represented and protected. Contracts are signed, and the medical process can begin once everyone agrees to the terms of the agreement and each lawyer has had a chance to review and approve it. It also includes the surrogate’s role and responsibilities in the pregnancy, such as prenatal care. Informed consent is taken from the surrogate and commissioning couples.
• Documents required from the surrogate and the intended couple/single parent are Identity and address proof, marriage certificate, if a surrogate is divorced, then divorce certificate, and if widow then death certificate of the spouse is required. In the case of a single parent, only identity and address proof are required.

There are different risks and complications associated with surrogacy.

• The major risk associated with surrogacy is obstetrics complication and multiple order pregnancy being the most common. Recently, a lot of recommendations are being made by health committees for single embryo transfer, but only 15%–20% of clinics follow single embryo transfer norms.  However, more and more clinics are accepting the policy/norms.
• Pregnancy, birth, and the postpartum period include complications such as urinary tract infections, preeclampsia and eclampsia, stress incontinence, and gestational diabetes, and rare complications, but these risks are associated with pregnancy in general and not specific to surrogacy.
• Apart from physical risk, a surrogate may have a risk of developing psychopathology.
• Surrogacy may be the reason for the emotional trauma that many surrogate mothers face emotional problems in handing over the baby and after giving away the baby to intended parents. Although, these feelings tend to lessen during the weeks following the birth.