What is Surrogacy? The Terms to Know
Surrogacy is a fertility treatment in which a woman carries and delivers a pregnancy for an infertile couple. As part of the Surrogacy agreement, she waives all her parental rights and agrees to give the baby to the Intended Parents immediately upon delivery.
Surrogacy has been around since biblical times, when Sarah and Abraham famously conceived a child using their servant Hagar as the surrogate. But surrogacy has only recently become a practical treatment option since the 1970s with the first successful in-vitro fertilization process and the transfer of embryos conceived in a clinic laboratory.
If you are considering a surrogacy “journey”, then you will encounter all of the terms listed below. Before beginning, you should be familiar with the meanings of these terms.
Surrogate (a.k.a. Gestational Carrier)
A woman who has agreed to carry a pregnancy for another couple. As part of the arrangement the surrogate agrees to give custody and full parentage to the Intended Parents. The surrogate, may also provide the eggs (as in the case of traditional surrogacy) or she may simply carry the baby conceived with another woman’s eggs (called gestational surrogacy).
Surrogates may be compensated financially (as in the case of Commercial Surrogacy) or volunteer for the purpose of helping a childless couple conceive a family (as in the case of Altruistic Surrogacy).
The person(s) who will eventually become the legal parents of a child born through a surrogacy arrangement. In most cases, the Intended Father is also the sperm donor and legal father upon the child’s birth. The legal status of the Intended Mother is often less certain. In countries without specific legislation, the Birth Mother is named on the child’s birth certificate, and she becomes the legal mother by default. In this case the Intended Mother may have to complete a court process (Adoption or “Parental Order” for example) to guarantee her parental rights and remove the surrogate as the legal mother.
(IVF): A clinical procedure whereby a human ovum (egg) is fertilized in a lab and allowed to develop into an embryo. Embryos conceived through IVF may be used right away, but are more often frozen and stored for use as part of a future fertility procedure (including Gestational Surrogacy).
The transfer of a human embryo (conceived by an IVF cycle) into the uterus of a woman in the hope of producing a pregnancy. The woman may be the biological mother or a surrogate. The embryo may be conceived using the egg & sperm of the Intended parents or those of a donor (if the intended parents suffers from infertility).
Single or Double Embryo Transfer The number of embryos transferred during an Embryo Transfer procedure. If one embryo is transferred, the procedure is known as a Single Embryo Transfer (SET) as opposed to a Double Embryo Transfer (DET). Some couples mistakenly believe that the likelihood of a pregnancy is greater in a Double Embryo transfer, although statistics do not support this assumption. Some couples request Double Embryo Transfer because they hope to have a twins pregnancy. ASRM Guidelines instruct IVF clinics to avoid Double Embryo Transfers because the chances of premature birth and serious complications are much higher.
Commercial Surrogacy (a.k.a. Paid Surrogacy)
A surrogacy agreement in which one or more parties may benefit financially. For example, commercial surrogacy agreements often include significant compensation for the surrogate. Also as part of a commercial agreement, surrogacy agents can provide professional services such as recruiting surrogates, providing professional oversight during the pregnancy, or managing the clinic appointments. Many countries with explicit surrogacy laws prohibit commercial surrogacy on ethical grounds. Commercial surrogacy is legal in the United States, Ukraine, Greece, and some eastern European countries.
Altruistic Surrogacy (a.k.a. Unpaid Surrogacy)
A surrogacy agreement where no party makes a profit. For example, in altruistic surrogacy agreements the surrogate is not compensated more than her own out-of-pocket expenses. Also commercial activities like advertising for surrogates or providing professional care and oversight are not allowed. As a result of the limitations of altruistic surrogacy, it is often takes a long time to find qualified surrogates, and once found the Intended Parents must perform much of the logistics that would be manged by a commercial Surrogacy Agent. Countries with altruistic surrogacy laws include the United Kingdom, Canada, Belgium, the Netherlands and parts of Australia.
A surrogacy arrangement where the surrogate is directly impregnated by the Intended Father. The surrogate may be impregnated through sexual intercourse or by intrauterine insemination (the injection of sperm into the woman’s uterus). Once the baby is born the surrogate agrees in principle to give the child to the intended parents and to waive all of her own parental rights. However in traditional surrogacy the surrogate is the genetic mother of the baby as well as the birth mother, and this is risky from a legal perspective as the Intended Mother has no biological connection to the baby or parental rights in most jurisdictions.
Independent Surrogacy (a.k.a. Private Surrogacy)
Independent Surrogacy is when an Intended Parent enters into a surrogacy agreement without the aid of an “Agent”. Instead of the agent, the Intended Parents work directly with their surrogate to manage her medical and legal processes, fertility treatments, and pregnancy. Independent Surrogacy is significantly less expensive than typical Agent Programs because they forgo professional services and avoid exorbitant agency fees. Also without an agency, Intended Parents can be more lax on the requirements for their surrogate — they can pay less for surrogates who are not as medically fit or who would be rejected by stringent agency standards. Parents may also decide to forgo some valuable but costly details, like a health insurance, psychiatric evaluation, background checks or even an executed surrogacy contract. These omissions can have serious consequences.
For more info, visit the article on Indy Surrogacy in the Guide.
A surrogacy arrangement in which the embryo is conceived through in-vitro fertilization and then transplanted into a surrogate. The surrogate will then carry and deliver the pregnancy. In most cases of gestational surrogacy, the embryos are conceived using the egg and sperm of the Intended Parents, and so they share a true genetic bond with the baby. In some cases an egg donor may be used, but it is rare that a sperm donor is used in gestational surrogacy cases. To avoid any genetic relationship between the surrogate and the baby, the surrogate’s eggs are never used to conceive embryos in cases of Gestational Surrogacy.
With Gestational Surrogacy, the child born is genetically related to its parents and the surrogate has no genetic relation. The surrogate carries the baby to term, then gives up the child and waives any parental rights at birth.
A professional service that arranges and oversees surrogacy procedures. A surrogacy agency will provide full services, including recruiting and evaluating potential surrogates, arranging clinical procedures, overseeing the surrogate during the pregnancy, arranging legal services in support of the surrogacy process, and providing support and counseling to the Intended Parents. In some cases surrogacy agencies are owned and operated by large Surrogacy Clinics, and thus have financial incentives to provide clinical services for their patron clinic. More reputable agencies are independent, work with multiple clinics, and receive no financial incentives to sell unnecessary or unwanted treatments.
In many cases the future mother is unable to donate her own eggs for medical reasons. In these instances a donated egg may be used. Donated eggs are available through many international agencies, or the couple may ask a friend or family member to provide a donated egg. Donation agencies are a very reliable alternative, although the selection of an egg donor is best managed with an experienced consultant.
Known Donor vs Anonymous Donor An egg donor who’s identity is known to the Intended Parents is a “known donor”. A Known Donor may be a friend of the parents or someone introduced casually by an agency. Known donors may allow future contact with the family, or she may prefer privacy after the IVF cycle is complete. Many states and countries prohibit known donation, and they require only “Anonymous Donation” where the donor’s identity is withheld from the parents. (In an Anonymous Donation, the donor’s agency still has all pertinent medical and personal information on the donor to ensure safety and health of the baby).
Donor Cycle (IVF with donated eggs)
A donor cycle assumes the Intended Father father will donate the sperm for the IVF, but the eggs will be supplied by a independent egg donor.
To prepare an egg donor requires 6 to 8 weeks of fertility treatments. Stimulation treatment is designed to force the maturation of multiple eggs in the woman’s ovaries for retrieval and fertilization. During a woman’s natural cycle only one egg matures each month, a stimulation cycle can force the maturation of 15 to 20 eggs, making them suitable for fertilization. Once the donor has been properly prepared, she undergoes extraction using a large needle that harvests the eggs directly from the ovaries.
Self-Cycle (Surrogacy with the intended mother’s eggs)
A self-cycle assumes the intended parents will provide both the sperm and eggs for the IVF cycle.
Women who will use their own eggs for the surrogacy process should expect to undergo about 15 days of daily fertility treatments before retrieving her eggs. Intended Mothers need to be in the clinic a few days prior to their menses so that the clinic can run some tests along with a physical examination. Stimulation of the woman’s ovaries (Gonadotropin Injections) will then be started at the beginning of her menses (determined after doing a blood hormonal test).
The mother will be required to take daily injections for about 14 days, during which multiple mature eggs will have formed in both ovaries. The Ovum collection will be around day 15, and the fertilization immediately after. The resulting embryos are typically frozen and the Embryo Transfer may happen at any point in the future.
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