What is surrogacy?
Surrogacy is an arrangement by which one woman (the surrogate mother) bears a child for another woman or a couple (the intended parents or commissioning couple) and surrenders it at birth.
Indications for surrogacy
Surrogacy may be considered in instances of:
- damaged lining of the womb – Asherman’s Syndrome
- recurrent miscarriage, in spite of all possible treatment
- repeated failure of IVF treatment, in spite of the creation of good quality embryos
- women who have had a hysterectomy, or have an absent or markedly abnormal uterus
- same-sex couples who require a host in order to conceive
Types of surrogacy treatment
Treatment can be carried out either by using:
- embryos that genetically do not belong to the host (this is called ‘full’ or ‘host’ surrogacy)
- embryos that the surrogate has contributed herself (this is called ‘partial’ or ‘straight’ surrogacy).
In the second option, the surrogate mother is both the genetic and carrying mother of the resulting child.
Recruiting a surrogate mother
The centre cannot be involved in recruiting surrogate mothers. The Human Fertilisation and Embryology Authority Act 2008 bans licensed centres from advertising for a surrogate mother. It also prohibits any third party on a commercial basis. The patient is responsible for the recruitment of her own surrogate, either personally or through a charitable organisation such as COTS or Surrogacy UK.
Screening and preparing for surrogacy treatment
The intended (commissioning) parents will undergo the following investigations:
- Full history and clinical examination to establish the indications for treatment and exclude infectious diseases that might adversely affect the surrogate mother or the potential child.
- Counselling to discuss emotional and psychological issues and the implications of this treatment.
Screening blood tests for the intended (commissioning) mother and father, and for the surrogate host in partial surrogacy arrangements, include:
- HIV 1 and 2
- HTLV-1 and 2
- hepatitis B, hepatitis B Core and hepatitis C
- CMV IgG and IgM
- syphilis
- chlamydia
- gonorrhoea
- full blood count
- blood group and antibody screen
- cystic fibrosis and chromosomal karyotyping will also be performed
These screening tests are required for the egg and sperm providers in a surrogacy arrangement as the embryos are being transferred into a third party, the host. Therefore the egg and sperm providers are considered and treated as known egg and sperm donors.The surrogate (host) will undergo the following:Full history and clinical examination to exclude infectious diseases that could be passed to the baby and conditions that might make pregnancy a particular risk for the surrogate mother. Emotional and psychological issues will be discussed in detail and implications counselling will be required for the surrogate host.
Screening blood test for the surrogate host in full surrogacy arrangements include:
- HIV 1 and 2
- hepatitis B, hepatitis B Core and hepatitis C
- rubella status
- CMV IgG and IgM
- full blood count
- blood group and antibody screen
- chlamydia (urine)
Quarantine of the sperm
Sperm is required to be frozen and quarantined in storage until 180 days (six months) after producing the sample, when the intended father must repeat the infectious disease screening. We advise the patients to agree on storage of the sperm at the time of the initial consultation as this will save time when the treatment is to commence.
Counselling
If the commissioning couple and the host have been counselled by COTS or Surrogacy UK, you may not be required to receive implications counselling at LFC. However, if you have not been counselled, the commissioning couple and host will be required to receive implications counselling at LFC. Supportive counselling is available during and after your treatment cycle for both the commissioning couple and host – the first two sessions are complimentary.
Procedures
Full surrogacy
We need to synchronise the cycles of both women so that when the intended mother produces the eggs, the surrogate’s womb will be receptive for the created embryos. The protocol of treatment of the intended mother will differ depending on several factors including age, weight, follicle stimulating hormone (FSH) level, regularity of her cycles and whether she has had a hysterectomy. The treatment for the commissioning mother will include hormone injections, ultrasound monitoring scans and blood tests. The treatment for the host will include medication to boost the lining of the womb and monitoring ultrasound scans. It usually takes 12-14 days for both women to be ready.
Once both women are ready, the commissioning mother will undergo an egg collection procedure and the eggs will be fertilised with the commissioning father’s sperm, once released from quarantine.
The host will then have embryo transfer the timing of which depends on the development of the embryos. Please refer to our IVF Patient Information Sheet for more information about the egg collection and embryo transfer procedures.
Partial (straight) surrogacy
The protocol of treatment for the surrogate host will differ depending on several factors including age, weight, follicle stimulating hormone (FSH) level, and regularity of her cycles. The treatment for the host will include hormone injections, ultrasound monitoring scans and blood tests. It usually takes 12-14 days for the host to be ready for egg collection.
Once ready, the host will undergo an egg collection procedure and the eggs will be fertilised with the commissioning father’s sperm, once released from quarantine.
The host will then have embryo transfer the timing of which depends on the development of the embryos. Please refer to the IVF Patient Information Sheet for more information about the egg collection and embryo transfer procedures.
Legal issues
No third party should be involved in surrogacy on a commercial basis. Payment from the intended parents to the surrogate mother is allowed only to cover expenses. Advertising for a surrogate is prohibited by the Surrogacy Arrangement Act 1985. Intending parents are strongly advised to seek specialist legal advice.
Legal parentage
The surrogate (host) mother is the legal mother of the baby. If she is married and her husband agreed to the treatment he is then the legal father. The intended (commissioning) parents can only become the legal parents through legal procedures when the intended parents legally adopt the child through a parental order.
The surrogacy journey can take considerable time, and involves assessment of the suitability of the intended parents. Since 1 November 1994, intended parents can apply for a parental order (HFEA Act 1990). This is much simpler and quicker than adoption. Rules in force from 6 April 2010 now enable unmarried and same-sex couples to apply for Parental Orders in addition to married couples. LFC’s team have carefully considered the implications of the new rules and are pleased to be able to offer surrogacy treatment to a wider population of patients in a range of relationships. Intending parents are strongly advised to seek specialist legal advice.
Storage of residual embryos
The Human Fertilisation and Embryology Authority Act 2008 allows for the storage of embryos created for use in surrogacy arrangements to have an initial statutory storage period of 10 years. Patients are advised to seek their own independent legal advice if they are considering surrogacy treatment.
Other considerations
Intended parents and the surrogate mother (couple) should agree on:
- number of embryos to be replaced/risk of a multiple pregnancy
- selective fetal reduction (ie, termination of one fetus) in case of triplet or higher order pregnancy
- screening tests for chromosomal abnormalities and neural tube defects, possibly using amniocentesis
- termination/continuation of pregnancy if there is an abnormality with the baby
- whether the surrogate or the intended mother will keep the baby if there is any congenital abnormality not detected antenatally
- the intended parents and the surrogate mother (couple) should build up a relationship of trust and care before embarking upon any treatment
- life insurance on the surrogate mother in favour of her family
- change of will of the intended parents in favour of the unborn baby