What is Surrogacy? – Process & Basic Concepts

Surrogacy is an infertility treatment that involves a surrogate, commonly referred to as surrogate mother, who carries a child for someone else who receives the name of intended parents or commissioning parents.

In the majority of cases, the embryos are created by means of in vitro fertilization (IVF using the eggs and the sperm cells of the intended parents, although donor gametes can be used as well). Once created, the resulting embryos are transferred to the surrogate’s womb.

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Family building through surrogacy

Surrogacy is an option for all family types – both opposite- and same-sex couples, as well as single males and females. In short, it allows those families who could not become parents naturally to have a baby.

As long as it is possible, the eggs and the sperm from the intended parents will be used for the creation of the embryo(s). Should you have no alternative but to use donor eggs, the donor and the surrogate or gestational carrier should not be the same person. The goal is to avoid the creation of an affectional bond between her and the baby, or at least to minimize it as much as possible.

In fact, many countries have forbidden this practice, which is a type of surrogacy known as traditional surrogacy, genetic surrogacy, partial surrogacy, or straight surrogacy.

Understanding the terminology

Surrogacy is the most commonly used term as well as the most appropriate and neutral one when it comes to referring to this infertility treatment. The word is a noun that was born after the union of surrogate + -cy, so we have to look into the meaning of the word surrogate to understand its use. The term surrogate comes from Latin surrogatus and literally means “put in another’s place, substitute”. It started to be used with the meaning of “woman pregnant with the fertilized egg or another woman” in 1978 approximately.

Taking into account the original meaning of the word surrogate, we would like to clarify which terms are considered correct, and which ones are incorrect or even offensive. Terms such as “womb for rent”, “womb to rent”, “womb on rent”, “rent-a-womb”, and similar phrases are rude forms that should be avoided. Firstly, because the verb rent means, according to Merriam-Webster Dictionary:

To grant the possession and enjoyment of in exchange for rent.

The intended parent or parents do not possess the womb of the surrogate: she decides to enter into an agreement with the fundamental motivation of helping a couple that would not be able to have children by their own means. These forms are considered offensive and using them to make reference to this treatment is totally unadvisable.

On the other side of the coin, there exist various forms which use is much more neutral and non-offensive for any of the parts involved. Aside from surrogacy, which has been explained earlier and is the general name given to this technique, we should learn to distinguish between a surrogate and a gestational carrier, two terms that are often used interchangeably but actually do not mean the same. What follows is the definition of each:

Surrogate
Someone who donates her egg and subsequently carries the child. In other words, she is genetically linked to the baby. It should be used only if you enter into a partial or traditional surrogacy arrangement (i.e. surrogacy using IUI).
Gestational carrier
Someone who carries the pregnancy but is in no way biologically related to the baby she is carrying. Instead, eggs and sperm from the intended parents or donors are used (i.e. surrogacy using IVF).

So, even though both are correct, we should use them appropriately depending on the type of surrogacy we opt for. However, despite the widespread use of the term surrogacy, perhaps we should refer to it as gestational surrogacy to ensure that everyone understands that she will not be the genetic mother of the child. In this sense, we recommend to take into account the definition offered by the World Health Organization (WHO) back in 2001:

A gestational carrier is a woman in whom a pregnancy resulted from fertilization with third-party sperm and oocytes. She carries the pregnancy with the intention or agreement that the offspring will be parented by one or both of the persons that produced the gametes.”

Our classification includes a third group: those forms that are actually incorrect, that is to say, mistakenly used. Examples include surrogate mother, surrogate motherhood, surrogate mom, and so on. The problem of these terms lies with the concept of motherhood, which actually means something different from that we are making reference to. Motherhood is not what is being substituted or replaced, but the pregnancy. Because we believe that the concept of mother goes beyond the mere fact of giving birth — it involves rearing and taking care of a child.

What are the reasons people might opt for surrogacy?

In the case of male same-sex couples and single males, surrogacy is the only option to have a child for obvious anatomic reasons. As for heterosexual couples, lesbian couples or single women, the reasons often are related to health problems that prevent a pregnancy, including:

  • Absent uterus, either congenital (Mayer-Rokitansky-Küster-Hauser syndrome, also known as MRKH syndrome) or acquired (hysterectomy).
  • Severe uterine abnormalities: severe endometriosis, uncorrectable Asherman’s syndrome, or severe adenomyosis.
  • Uterine malformations that would be incompatible with a pregnancy
  • Previous IVF failure
  • Pre-existing medical conditions that might become worse during pregnancy, or even cause death if the woman gets pregnant, including autoimmune diseases, cardiovascular diseases (CVD), and certain types of cancer.
  • Medications that could lead to complications during pregnancy, or might have teratogenic effects (drugs that can cause abnormal fetal development). If the intake of these medications cannot be stopped, pregnancy is not possible.

Information for parents from the UK and USA

Gestational surrogacy arrangements are legal in both the United Kingdom and the United States of America. However, the regulations governing this treatment in each country are markedly different. In fact, it is common for British intended parents to travel to the USA to have their child via surrogacy. As for people from the USA, the main reason why they decide to pursue surrogacy abroad is related to the considerable costs associated there.

Situation in the UK

Surrogacy has been regulated in the UK for over 20 years after the Surrogacy Arrangements Act 1985 entered into force. The Human Fertilisation and Embryology Act 1990 added further regulation as regards the creation of the parental order mechanism, though. Even though surrogacy arrangements are legal in the UK, it involves a lot of complicated legal issues that should be considered beforehand:

  • The surrogate (and her husband, if she is married) is considered the legal mother of the child until the intended parents get a Parental Order, which can be applied for within 6 months after the child’s birth and no earlier.
  • Once intended parents get a Parental Order, the surrogate (and her husband, if she is married) has no further obligations or rights to the child.
  • If the surrogate is married or in a civil relationship, her partner will be automatically considered the legal parent unless it can be shown that her partner did not consent. However, it is possible for surrogates to nominate a second legal parent before the embryo transfer under certain circumstances.
  • If the surrogate is single, then the man providing the sperm will automatically be the second legal parent at birth, provided that he agrees.
  • In UK law, surrogacy is treated as an altruistic act. This means that paying a surrogate anything more than reasonable expenses is illegal.

The fact that you need a Parental Order to become the legal parents of the child means that the surrogate can change her mind about the arrangement at any time, and the intended parents would have no right to claim for parentage. In other words, surrogacy agreements are not binding in the UK even though it is a legal procedure.

This is the reason why many UK hopeful intended parents decide to travel to an overseas destination in order to enter surrogacy arrangements for the birth of their child. If you are a British intended parent considering surrogacy in a foreign country, you should take into account that even if you are named on a foreign birth certificate as the legal parents of your child, you still have to apply for a Parental Order when you return to the UK.

Situation in the USA

Surrogacy and its legality fall under state jurisdiction, which means that the legal situation of this treatment in the USA varies greatly from state to state. While some states have written legislation, others have developed common law regimes, and others refuse or even penalize this type of arrangements. According to this, we can classify them into 3 groups:

Permissive states
including Nevada, California, Texas, Arkansas, Illinois, Virginia, Florida, New Hampshire, Delaware, New Jersey, Tennessee, and Washington.
Surrogacy-friendly states
including Alaska, Oregon, Colorado, Georgia, Idaho, North Carolina, Minnesota, Maryland, Wyoming, North Dakota, New Mexico, Montana, and Rhode Island.
Prohibitive states
including, Michigan, New York, Indiana, Kansas, and Nebraska.

Moreover, it is important to put emphasis on the fact that traditional or partial surrogacy arrangements are forbidden, that is, by no means can the surrogate be biologically linked to the child. In the USA, thus, when we talk about surrogates, we are actually referring to gestational carriers.

While the main advantage of undergoing surrogacy in the USA is that those states which allow or are favorable to surrogacy grant a pre- or post-birth order to guarantee that the intended parents will be the legal parents of the baby, the main disadvantage is related to its great cost — from USD $90,000 to USD $280,000.

For this reason, and with the purpose of reducing the costs of the treatment, many US intended parents decide to pursue surrogacy overseas. However, they must make sure that at least one of them is the genetic parent of the child. Otherwise, the child will not obtain US citizenship at birth.

Surrogacy in the world: destination countries

Despite surrogacy is allowed in a number of foreign countries, one should be aware of the fact that not all of them are valid for British and American citizens, especially depending on the family type. Moreover, one should not keep in mind the law of the destination country, but also the regulations in the home country.

In general, the following are the most recommendable options for intended parents from the UK and the USA pursuing surrogacy abroad:

  • Canada
  • Greece
  • Russia
  • Ukraine
  • Georgia

The requirements to be met according to the law in each country should be considered as well. Being married or providing a medical certificate to prove that there exists a medical condition that prevents pregnancy in the intended mother are common requirements in various countries.

In the case of same-sex couples, Canada and the United States are the only possible destinations for them, as the law in the rest expressly excludes them from entering into surrogacy agreements there.

Surrogacy professionals involved

Several professionals are involved throughout the entire process to ensure that everything is done as it should, and to avoid potential mishaps:

Consultants
Normally, surrogacy consultants work from the country of origin. They provide information to intended parents about the steps involved in the process, put patients in contact with the rest of professionals involved, and coordinate the procedure. They travel with you during your trips to the destination country, and help you overcome any potential linguistic barrier.
Surrogacy and egg donation agency
They find the most appropriate woman to carry the pregnancy, and the egg and/or sperm donors, if necessary.
Fertility clinic
It is the place where the in vitro fertilization (IVF) cycle to achieve a pregnancy in the gestational carrier takes place.
Attorneys
Their function is to review the surrogacy contract to make sure that every formality required to ensure that the baby is able to enter your country of origin without legal complications is done properly.
Escrow account manager
It is strongly recommendable to hire the services of a escrow account manager to supervise all the transactions that are made during the process.

Intelligent Virtual Assistant

At the beginning, it is normally for those who need a gestational carrier to become parents to feel overwhelmed and, more often than not, they do not know anything about the different companies and destinations that would be more suitable for their family structure. For this reason, at Surrofair we have developed a system that helps you overcome these obstacles.

We recommend that you chat with Lucy, our intelligent virtual assistant, who will clarify as many doubts possible. She has been programmed to tell you what is the most suitable destination country for you, and which companies would be able to help you there.

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