Figure 1. The current legal status of surrogacy around the world (1).

The latest advances in assisted reproduction technologies have managed to make incredible things come true. Current advances are changing the lives of millions of people, giving them the opportunity to form their own family. One of the options that have opened new possibilities for parenthood is surrogacy. Perhaps, this is not as common as others, but it certainly hits the media every now and then. However, what have you heard about it? The following points are the main aspects everyone should know about this option:

A) Who may need surrogacy? Prospective parents are individuals who seek a surrogate mother because:

1. There is actually a medical condition that makes it impossible or dangerous for the woman to get pregnant and/or to enter labour.
2. He is a single man who wants to become a father (2).
3. They are a gay men couple who want to form a family with a genetic link (3).

B) Who is the surrogate mother, and how does the entire process usually take place? The surrogate mother is a woman who carries out pregnancy as a donation in order to help form a new life. This process can take place with or without her own eggs. If it is her eggs that are used, the process is referred to as traditional surrogacy; otherwise, it is called full or gestational surrogacy. If this is the case, embryos can be derived from three different sources (4):

1. Eggs and sperm that belong to the intended parents.
2. Donor eggs fertilized by the sperm of the intended father.
3. Both eggs and sperm obtained from donors.

C) Whether surrogacy entails remuneration depends on the country. If the surrogate mother does not receive a payment (although prospective parents may provide reimbursement for medical care), the arrangement is known as non-commercial surrogacy, which is common between family members or friends. On the contrary, if the surrogate mother does receive compensation, the term used for the arrangement is commercial surrogacy (5).

D) Where this procedure may be carried out depending on local regulations. As shown above (Fig. 1), surrogacy is only allowed in certain countries, each one with its own legal regulations. For instance, some of them only permit the altruistic form, in others surrogacy is available just for resident citizens, and in some others, this option is only allowed for heterosexual couples. Therefore, it is essential to know which country/countries present the appropriate legislation in each particular case, the reason why before choosing a destination it is important to find out some key aspects, such as (6):

  • Legal protections (if any) that local jurisdiction offers to intended parents and surrogates.
  • Possibility of transfer or legal parentage.
  • Eligibility criteria for surrogacy (being a local citizen, availability for single men, gay couples, unmarried heterosexual couples…).
  • Exit requirements post birth.
  • Surrogate compensation (if allowed).
  • Availability of health insurance for the surrogate (also considering any post-birth complications).
  • Are contracts enforceable by law?
  • Neo-natal intensive care facilities available.
  • Cost of intensive care facilities.
  • Is it possible for the intended parent(s) to be present at birth?
  • Possibility to update the medical history of the surrogates or the children in a medical registry.
  • Registry for the surrogate and children to exchange information once the child reaches maturity.

E) Perhaps the first question to ask actually is: “does this option feel right for me?” Every single person and situation are unique, and so you may end up wondering whether this is the right path to form your family. Regarding such a delicate topic you should first question yourself, and carefully take your time to consider all ethical issues you may encounter within the process.

It is important to consider that there exist multiple support groups and agencies that can help you resolve all your technical and ethical doubts with respect to this process. Therefore, it is advisable to first gather all available information in order to answer every question. Only then would it be safe to achieve your dream of starting a family the way you decide.

REFERENCES

  1. Surrogacy. In: Wikipedia [Internet]. 2017. Available from: https://en.wikipedia.org/w/index.php?title=Surrogacy&oldid=810900302.
  2. Carone N, Baiocco R, Lingiardi V. Single fathers by choice using surrogacy: why men decide to have a child as a single parent. Hum Reprod Oxf Engl. 2017 Sep 1;32(9):1871–9.
  3. Blake L, Carone N, Raffanello E, Slutsky J, Ehrhardt AA, Golombok S. Gay fathers’ motivations for and feelings about surrogacy as a path to parenthood. Hum Reprod Oxf Engl. 2017 01;32(4):860–7.
  4. Humbyrd C. Fair trade international surrogacy. Dev World Bioeth. 2009 Dec;9(3):111–8.
  5. Raposo VL. The new Portuguese law on surrogacy – The story of how a promising law does not really regulate surrogacy arrangements. JBRA Assist Reprod. 2017 Sep 1;21(3):230–9.
  6. Families through Surrogacy. Available from: http://www.familiesthrusurrogacy.com/