Surrogacy is an arrangement between a woman and a couple or individual to carry and deliver a baby. The surrogate mother is also known as a gestational carrier. Women or couples who choose surrogacy often do so because they are unable to conceive due to a missing or abnormal uterus, have experienced multiple pregnancy losses, or have had multiple in vitro fertilization attempts that have failed. The advantage of gestational surrogacy to the parents is that the embryo is created from the woman’s egg and the man’s sperm, so it is biologically theirs. Surrogacy is often one of the only ways for a couple to have a biological child, and it can also allow the surrogate to greatly help someone in need (Altruistic surrogacy). If the pregnant woman received compensation for carrying and delivering the child (besides medical and other reasonable expenses) the arrangement is called a commercial surrogacy.
Types of Surrogacy
Gestational Surrogacy: Full surrogacy involves the implantation of an embryo created using both the eggs and sperm of the intended parents or a donated egg fertilized with sperm from the intended father or an embryo created using donor eggs and sperm. In gestational surrogacy, the embryo is implanted in the surrogate through in vitro fertilization. The surrogate carries the baby to term, then gives up the child and signs over parental rights at birth.
Traditional/ Partial Surrogacy: This involves sperm from the intended father and an egg from the surrogate mother. Here fertilization is usually done by artificial insemination or intrauterine insemination (IUI).
Is Surrogacy Right for You?
For some couples opting for surrogacy is a very straight forward decision, while, for others there are lots of things to be considered and thought about before taking the decision. There are lots of complex issues involved. It is an emotional roller coaster ride for the couple, the families and friends. It is a decision where the 'right' and the 'wrong' are very individual things. An infertility specialist or a counselor can help the couple seeing things in the right perspective. Other options such as, adoption or further infertility treatment can also be considered.
Candidates for Surrogacy
A "perfect" surrogate is a woman under 30 years old who is in a stable monogamous relationship. She should have her own children. A surrogate should have a history of pregnancies without complications and vaginal deliveries.
Candidates for traditional surrogacy should be between the ages of 21 and 36. For gestational surrogacy, candidates should be between the ages of 21 and 42.
Surrogates can be women who the couple has a relationship with beforehand or who are obtained from a surrogacy agency. A sister or friend who serves as a surrogate is usually a better choice if such a person is available.
Some of these recommendations are to maximize the chances for delivery of a healthy child. Some of the recommendations are to lessen the risks of having a problem with a surrogate such as one who refuses to give the baby to the couple for whom she carried the baby.
Steps to Surrogacy
Intended parents locate a surrogate and, working with their lawyers and fertility specialists, make decisions about traditional or gestational surrogacy, determine compatibility, etc.
Most surrogacy arrangements do involve a written agreement; however, not all states have surrogacy laws, and not all states with laws recognize these agreements or treat them the same way if they are challenged.
In some states and under some circumstances, an adoption will follow the child's birth.
Artificial insemination is a treatment for infertility, when a couple cannot conceive a baby. It involves directly inserting sperm into a woman’s womb. It is performed when the man has mild fertility problems, when the woman has mild endometriosis or when the couple has unexplained fertility problems. Women without a male partner, such as women in same-sex partnerships, have also used artificial insemination to become pregnant.
There are several techniques used in Artificial Insemination which includes Intrauterine insemination, Intravaginal insemination, Intracervical insemination, and Intratubal insemination.
In Vitro Fertilization (IVF)
This involves surgical removal of an egg from the woman's ovaries and fertilization with sperm in a laboratory. The fertilized egg, or embryo, is then placed back into the woman's womb to grow and develop. The success rate of IVF is determined to a large degree by the age of the woman undergoing the treatment. Younger women tend to have healthier eggs, which increases the chances of success.
Surrogacy treatment requires thorough screening and preparation.
The intended parents must undergo a clinical examination and provide a full medical history to highlight any possible implications for the treatment. This includes factors such as infectious diseases that could affect the surrogate mother or the baby.
The ethical and legal issues are also discussed with the commissioning parents as part of the process.
The surrogate mother is also screened and tested. These tests include chromosomal karyotyping and fibrosis, which are required for both the egg and sperm providers.
Just like the intended parents, the surrogate host undergoes a full clinical examination and screening to check for conditions that could be passed to the baby or affect the surrogate host’s pregnancy.
Possible risks and procedures are discussed at length with the surrogate mother and they are also made aware of any potential psychological and emotional issues.
A blood test is taken for the surrogate mother as well as urine, hemoglobin, syphilis, hepatitis, and HIV screening.
Since the incubation time for HIV infection is quite long, the frozen sperm is kept in storage until the provider has undergone an HIV test six months after supplying the sample.
Benefits of Surrogacy
The success rate of surrogacy is dependent on many factors. The concept of surrogate motherhood is becoming widely known, as infertile couples are accepting this concept whole-heartedly. Surrogacy is more safe and successful than other techniques. In the past decade the success rate was only 40% but now with the advancement of IVF technology, the success rate has reached up to 70 to 90%. Surrogacy has a number of practical and medical advantages. When egg and/or sperm from the intended parents are used, there can be an actual genetic relationship to the child. In gestational surrogacy, embryos are created outside the womb through in vitro fertilization (IVF). Surrogacy can allow the surrogate to make some extra income.
Issues with Surrogacy
Legal Issues: There is no legal standard for surrogacy. However, it is almost always certain that any dispute will be heard in the jurisdiction where birth occurs.
Moral and Ethical Issues: Surrogacy is related to moral and ethical issues of embryo creation, fees that some see as baby-buying (or baby-selling).
Change of Mind: As in traditional adoption, surrogates can have a change of mind and decide they do not want to relinquish the baby. Depending on state law, whether there's an agreement, and how it's interpreted by the court, the outcome isn't necessarily certain.
Cost: Surrogacy is very expensive in most of the developed country. Total costs and expenses may include the surrogate's fee and possible expenses, lawyers' fees, fertility specialists' fees, and fees connected with an adoption.
Surrogacy in India
Commercial surrogacy has been recognized by the Supreme Court of India in 2002 which means, In India, surrogacy is legally accepted. India is emerging as a leader in international surrogacy and a destination in surrogacy-related fertility tourism. The citizenship of the child born through this process will have the citizenship of its surrogate mother according to the Indian law.
Cities in India offering Surrogacy by various infertility hospitals, clinics and agencies are as follows;
Cost of Surrogacy in India
Indian surrogates have been increasingly popular with infertile couples in industrialized nations because of the relatively low cost. Indian clinics and hospitals are well equipped with advanced technology. Surrogacy is considered to be very expensive in most of the countries; however in India the arrangement is highly cost effective. The total cost of the complete package which includes fertilization, the surrogate mother’s fee, and delivery of the baby at a hospital, travel and accommodation, etc is comparatively low.
Cost Comparison of Surrogacy
Some of the common countries from which patients travel to India for surgery are: