What is surrogacy?
Surrogacy is an assisted reproduction method in which a woman carries and gives birth to a child for intended parents who cannot do so themselves.
Meaning and definition of surrogacy
Surrogacy is rarely a first choice. Couples come to it when pregnancy is not possible naturally or through IVF – most often when the intended mother has no uterus or it has been damaged by adhesions or tumours, after repeated miscarriages, or following premature ovarian failure.
Who can take part is decided by the country where the program runs, not by the clinic. Some countries limit programs to married heterosexual couples with a documented medical indication; others are open to unmarried couples, single parents and same-sex couples. That difference, together with how parentage is established in each jurisdiction, is what determines whether a program abroad will hold up when you return home.
Where surrogacy is practised on a commercial basis, the intended parents, the surrogate and the agency sign a contract that sets out the rights and obligations of each side, the compensation and the payment schedule. Where only the altruistic form exists, compensation is ruled out and the surrogate is reimbursed for her expenses alone.
Two types of surrogacy
Gestational surrogacy — the surrogate has no genetic connection with the child. In outline, the process looks like this:
- The intended parents provide their gametes — eggs and sperm.
- The embryologist fertilises the egg and cultures the embryo.
- The doctor transfers the embryo to the surrogate’s uterus.
- The surrogate carries the pregnancy and gives birth; she has no parental claim to the child.
- The child is registered in the names of the intended parents.
Traditional surrogacy — the surrogate is also the genetic mother, conceiving through intrauterine insemination or using her own egg. This form is no longer used in practice. The surrogate’s role is to carry a child for someone else, and a genetic link makes that role far harder to bear; for the same reason most jurisdictions that regulate surrogacy rule it out entirely. Everything described below refers to gestational surrogacy.
Which genetic material can be used
In the countries where surrogacy is regulated, the child must be genetically related to at least one of the intended parents. That leaves three combinations:
- Both intended parents’ own gametes — the ideal scenario.
- Donor eggs and the intended father’s sperm, when the intended mother has no eggs of her own or their quality is too low. We work with a database of screened egg donors, with selection based on your own criteria.
- The intended mother’s eggs and donor sperm, when the father’s sperm cannot be used.
Donor eggs and donor sperm are not combined within one program, since the child would then have no genetic link to either parent. A donor is an outside person with no genetic connection to the intended parents or to the surrogate.
The eggs are fertilised, the embryos are cultured and monitored, and at the blastocyst stage one, two or three are selected for transfer. The remaining embryos are cryopreserved, so a couple can go through a further program later using their frozen embryos.
In practice donor sperm is rarely needed: almost any form of male infertility still allows healthy sperm to be obtained. For this we use PESA, TESA, TESE and MESA — procedures in which sperm is retrieved with a needle directly from the testicle or the epididymis.
Where to start
We run programs in three countries and work with couples from all over the world. Three things usually decide which route fits:
If you are considering a program abroad, start with a free consultation: tell us where you are in your journey and we will set out the options that apply to your situation.