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Infertility, same-sex couples, and single parents
Infertility is the inability to become pregnant after a year or longer of unprotected sex; cases have been on the rise in the past few decades. Infertility can be caused by the absence of a uterus or certain health problems. Other problems that may cause a couple to be unable to conceive include: “significant structural abnormalities, an inoperably scarred uterus or repeated miscarriages” [3]. Surrogacy has become a very helpful option for couples trying to conceive, for same-sex couples, and for single individuals who are not able to have children themselves.
What is surrogacy?
Surrogacy is when “a woman becomes pregnant and gives birth to a child with the intention of giving away this child to another person or couple” [3]. This means that when a couple or person who is infertile wants to have a baby, they will consult a woman (whether this is a family friend, sibling, or stranger) who will carry a child for 9 months, and when those nine months are over, the baby is given to the couple or individual. This method of conceiving came around during the 1980s and has become more popular today. The surrogate, or the woman who carries and births the child, can take on this task commercially or altruistically. Commercial surrogacy is when the surrogate “receives a financial award for her pregnancy,” which means that she will be paid after bearing the child [3]. Sometimes, this means getting hired by an agency that will pay for the medical costs. An altruistic surrogate goes through the process without expecting any form of payment. Most surrogates are said to be altruistic, wanting to help the couple to conceive without any compensation. Either way, there must be a legal contract between the surrogate and the intended parent or parents. This involves an attorney for each party to “ensure that their legal interests are represented and protected” [1].
There are two types of surrogacies that can be performed, and they are usually chosen by the individual or couple intending to raise the child. These forms of surrogacy include:
1. Traditional (or genetic) surrogacy- when the father or donor’s sperm is “naturally or artificially employed to inseminate the surrogate’s oocyte” [2]. In simpler terms, the male of choice’s sperm fertilizes the egg of the surrogate, making the surrogate the biological mother.
2. Gestational (also called host, partial, or full) surrogacy- when both the sperm and the egg of the parents are planted inside of the surrogate’s uterus. This makes the couple the biological parents, and the surrogate will have no genetic relationship with the baby.
Some countries are not welcoming of the process of surrogacy. It is completely banned in certain countries, while there are rules against commercial surrogacy in others. It is not allowed at all in “Austria, Bulgaria, Denmark, Finland, France, Germany, Italy, Malta, Norway, Portugal, Spain and Sweden” to perform surrogacy [3]. Commercial surrogacy is still allowed in “Georgia, Israel, Ukraine, Russia, India and California, USA” [3], while altruistic surrogacy is practiced within Australia, Canada, New Zealand, and most of the U.S.
Common concerns relating to surrogacy arrangements
Although surrogacy can be beneficial to couples who cannot conceive, it does come with both physical and emotional risks for the surrogate and the unborn child. Many surrogates do have to go through several medical exams, as well as, psychological assessments before being considered for the process. Most surrogates will be between the ages of 21 and 45 years old, a healthy age to bear children. However, the same as any woman giving birth, surrogates have to go through the symptoms of pregnancy and childbirth. This includes the risk of “miscarriage, ectopic pregnancy, and common obstetric complications” if they are not careful when carrying the baby to term [3]. Surrogacy can also include: “complications such as preeclampsia and eclampsia, urinary tract infections, stress incontinence, and gestational diabetes and rare complications such as amniotic fluid embolism and the possibility of postpartum hemorrhage,” which are all common symptoms of normal pregnancies [1]. On top of all these things, surrogates can also have multiple pregnancies, the same as when a couple ends up with twins, and can lead to more “medical risks associated with surrogacy practice” [1].
Additionally, surrogates go through psychological problems that regular mothers do not go through. Stress is common for mothers during pregnancy, and some stressful behaviors can affect how the fetus develops. For surrogates, knowing that the baby is not their own to raise can add additional stress, and they can also form an emotional attachment to the child after they are born. Postpartum depression can result from this, as well as a period of anger or guilt toward the situation, especially if they are ostracized from the community for taking part in surrogacy. It is shown that “increased stress hormones in maternal blood, such as adrenalin, penetrate the placenta and invade fetal blood, causing fetal rapid heartbeat or breathing acceleration” [2]. This means that when a mother or surrogate is stressed during their pregnancy, the stress hormones can transfer to the baby and cause their heartbeat and breathing to quicken.
Stress can also affect how the child develops after birth, where some children “were categorized as antisocial and with low frustration threshold” [2]. Children born from surrogates can also have health problems. For example, the children are more prone to developing “cardiovascular diseases, presenting with higher systolic and diastolic blood pressure, obesity resulting from insulin resistance and the impaired glucose metabolism, and thyroid dysfunction with high levels of thyroid-stimulating hormone (TSH)” [2]. If, during gestational surrogacy, there is the development of multiple embryos, that could lead to “preterm labor and delivery,” as well as “speech delays and developmental handicaps” [2].
Even the intended mothers go through troubles during the process of surrogacy. For example, the surrogate mother gets to make the decisions when she is pregnant because it is her body producing the child. This can cause the intended mother stress. The intended mother can also experience difficulties when it comes to “quality of life, parent psychological status, parent–child relationship, quality of parenting, marital quality and stability, relationship with surrogate mother, motivation, experience of surrogacy, disclosure to the child” [3]. The genetic parents are already stressed about not being able to conceive, and they may worry about “potential psychological risk to the child,” the possibility of “a child being born with any abnormality,” and “the practical difficulty and cost of treatment” if it is commercial surrogacy [1].
So, is surrogacy safe?
Although surrogacy has been proven to have great results and help couples and individuals begin their journey of starting a family, it also comes with its own risks. The surrogate can develop health and psychological problems; the child can also produce these same problems, and the intended parent/parents can go through stress during the pregnancy period. There are normal health complications associated with surrogacy, but the psychological impacts are much more significant. It is always recommended to talk to your doctor about being infertile and what steps to take in order to start a family. It is also important to see if surrogacy is legal wherever you reside.
References:
1. Patel, N. H., Jadeja, Y. D., Bhadarka, H. K., Patel, M. N., Patel, N. H., & Sodagar, N. R. (2018). Insight into Different Aspects of Surrogacy Practices. Journal of human reproductive sciences, 11(3), 212–218. https://doi.org/10.4103/jhrs.JHRS_138_17
2. Simopoulou, M., Sfakianoudis, K., Tsioulou, P., Rapani, A., Anifandis, G., Pantou, A., Bolaris, S., Bakas, P., Deligeoroglou, E., Pantos, K., & Koutsilieris, M. (2018). Risks in Surrogacy Considering the Embryo: From the Preimplantation to the Gestational and Neonatal Period. BioMed Research International, 2018, 1–9. https://doi.org/10.1155/2018/6287507
3. Söderström-Anttila, V., Wennerholm, U. B., Loft, A., Pinborg, A., Aittomäki, K., Romundstad, L. B., & Bergh, C. (2015). Surrogacy: outcomes for surrogate mothers, children, and the resulting families—a systematic review. Human Reproduction Update, dmv046. https://doi.org/10.1093/humupd/dmv046
Contributors:
Author: Kayjah Taylor
Editor: Lauryn Agron and Terin Buckley
Health scientist: Dora Sow