Surrogacy: the hope and the challenges

Tales of surrogacy can often be among the most heart-warming of all fertility journeys: incredible gifts of parenthood from women prepared to give so much of themselves to help another couple become a family. The London Women’s Clinic describes the challenges of this increasingly common treatment method.

Surrogacy is becoming more common

Surrogacy offers hope to couples who have experienced sustained unsuccessful fertility treatment, to women who cannot carry a pregnancy, and to gay couples seeking a family of their own. With celebrities like Sarah-Jessica Parker and Kelsey Grammer building their families in this way, and the law in the UK being updated to embrace gay and unmarried couples, surrogacy is becoming more common and more accepted as a form of fertility treatment.

Legal and ethical issues

Surrogacy arrangements - in which an embryo is transferred to a third-party mother for the duration of the pregnancy - do pose some of the greatest challenges of all fertility treatment, and ethical concerns (particularly about the potential commercialisation of surrogacy) continue to mean that surrogacy is carefully restricted in the UK.

Clinics are barred by law from recruiting surrogate mothers and this makes surrogacy, first and foremost, a challenge for patients, who need to find a surrogate mother willing to help them. Some patients are lucky enough to have a relative or close friend volunteer to carry their child; others have to work harder.

Finding a surrogate is not an easy task, since it is against the law for patients to advertise and there are no professional surrogacy agencies in the UK which can be paid a commercial fee to help. Many patients without a ready volunteer work with one of the UK’s non-profit making surrogacy agencies (including COTS and Surrogacy UK), which are able to introduce intended parents to surrogates because they do not work on a profit-making basis.

Organising fertility treatment once a surrogate is found

Once a surrogate is found, the next step is arranging appropriate fertility treatment. Surrogacy arrangements typically encompass a range of possible options and handling them well requires medical expertise and sophisticated care of all involved. Treatment options might include IVF or frozen embryo transfer with the intended parents’ embryo, treatment using donor eggs or donor sperm, or treatment with the intended father's sperm through IUI (in straight surrogacy arrangements).

Care is taken to ensure that good quality counselling is provided to all those involved in the arrangement (including the intended parents, the surrogate and her partner) and legal advice is also recommended.

The legal position of the surrogate mother

If all goes well and a pregnancy is achieved, this is just the start of the journey. However, those involved have to continue to work together during pregnancy and birth, and after the birth will need to go through a legal process to complete the surrogacy. The law treats the surrogate mother as the child’s mother (regardless of whether she is the biological mother) and often her partner is treated as the child’s other parent, which means that, once the child is born, the intended parents must ask the court to make them the parents instead.

Applying to become parents after surrogacy

The process of applying to become parents after surrogacy has recently been opened by Parliament to gay and unmarried couples (where previously you had to be a heterosexual married couple to qualify), and this is one example of the increasing public acceptance of surrogacy. As a result, the UK’s non-profit surrogacy agencies are also now helping gay men and unmarried couples to make contact with potential surrogate mothers, and this makes UK surrogacy a real option for more people than ever before.

Despite its challenges, surrogacy is an increasingly important form of fertility treatment. For many patients, including those who have reached the end of the line with IVF and those who need the loan of a womb to get started at all, surrogacy offers the only hope they may have of a much wanted family.

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