Surrogate motherhood is a very important and controversial subject which can be contemplated from very different angles.

When there is some news about reproduction, the media usually call me to discuss about them. Sometimes I read material that I have written ten years ago and I am surprised at how my opinion has changed. I’ve gone from believing that surrogacy was horrible, even a way to use the body of a woman in a situation of need, to help doing it to whom asks me to. This evolution comes after learning about different situations (like the one about a girl whose son died in childbirth and whose uterus had to be removed due to an hemorrhage), and also after seeing the dedication and love attitude of women pregnant thanks to surrogacy. In my opinion, many of the comments are applicable to egg donation.

Where is it allowed?

Legally, in Europe the parenthood of the child is determined by birth; the law forbids to rent a womb.

As an exception, England allows it only if there is a family connection between the two women, if there is no financial arrangement and if both of them are English. Following the same law, in South Africa, a 48 years old woman could give birth to her daughter’s triplets.

It is also allowed in some states of the USA, Canada, Russia and Ukraine. Most treatments are made in these countries.

Until recently many cases were made in India , Thailand and Mexico but the law changed and were discontinued .

Who may need to rent a womb?

We constantly take care of people who would like to have some information about how and where to do it.

On the one hand, it is requested by couples or single women presenting a medical inability to carry a pregnancy (because their uterus has been removed, because they were born with uterine malformations, because they are taking medications that are incompatible with a pregnancy or because they suffer from conditions where a pregnancy is contraindicated). Also women that have done multiple failed IVF treatments.

On the other hand, it is requested by gay men, singles or couples, as well as by heterosexual single males. Increasingly, men claim their rights to single parenthood; you all know celebrity cases which have used it.

Why is a woman willing to be a surrogate mother?

What kind of women are capable to go through a fertility treatment, a pregnancy and a birth and then deliver the newborn to other people?

A study presented in an international congress stated that surrogate mothers have no psychological consequences and that the reasons why they do it are in 91% of the cases to help, although it is actually to help their children. An 8% does it for the pleasure of being pregnant (our experience as gynaecologists says that being pregnant is not a pleasure, indeed, in most cases it’s just the opposite: the pleasure lies in having a child) and only 1% says that they do it exclusively for the money.

From what I’ve seen over the years, most surrogate mothers do it to get resources to support their children. They are proud of it and live it as “I’ll help you raise your child and you help me raise mine.”

A child conceived this way can have three mothers, the biological mother, (who provided the eggs), the gestational mother (who carried the pregnancy), and the legal mother, who will look after the child forever. It may also be that there is a legal father.

The woman who carries the pregnancy is the gestational mother but usually not the biological mother. The oocytes are either from the legal mother or from an egg donor; moreover they always have their own children, among other things to avoid the risk of becoming sterile because of a complication during birth.

What kind of relationship is created between the woman and the child’s parents?

The relationship between the legal parents and the surrogate mother is very different depending on the countries and cultures.

In the USA and Canada, they can meet and have the relationship that they have decided to establish. Online communication is very frequent, even visits and occasional gifts, but they can also remain anonymous. In these countries, the woman who is going to act as the surrogate mother sets the rules. She can even be the one who selects the legal parents.

After the birth, a fast trial is done in which the three parts are present and where the end of the contract they had made as a ‘temporary adoptive mother” is signed, that is, as someone who cares about the child during a period in which the legal parents are unable to do it: pregnancy. I know patients that, after this trial, a week after birth, went all together to a barbecue at the gestational mother’s house.

Emotional support is necessary in these cases and, in these countries, both the surrogacy agencies and the legal parents provide it.

In Ukraine and Russia the centre takes care of everything, usually there is no contact with the legal parents. After birth, there is some administrative formalities in court and with the police department. In many occasions they leave the country with the baby still being registered as the son/daughter of the surrogate mother and the male, and once in Europe the woman adopts the baby.

Economic aspects

A surrogacy process is payable in stages; there are fees for each part of the process to be paid according to the evolution of it, with a price list for extras such as amniocentesis, twin pregnancy, etc.

The amount paid to the surrogate mother is much less than you think. Most of the money goes to lawyers, agencies, medical expenses for the fertility treatment and pregnancy, childbirth and the incubator if needed, insurance and trips. A process of surrogacy, if everything goes well on the first try, can cost around 60,000 Euros in Ukraine, nearly the double in the USA and intermediate prices in other countries.

Obviously, there are many people who, despite a whole-hearted desire to have a child, can not afford it economically.

What must be taken into account?

It’s necessary to have an attorney specialized in this area in the parents’ country of residence. It’s also very desirable to have a specialist in reproductive medicine who has handled many cases and is up to date with the clinics’ medical aspects. I know of many patients who have privately organized the whole process through the Internet and have suffered a fraud.

I’ve been able to see and share all kind of experiences with the patients that I have accompanied through this adventure: negative experiences because of repeated failures or, for example, after arriving to India to start the process and noticing a rejection’s attitude of the centre’s staff because the husband is in a wheelchair (in their culture, it’s still widespread to conceive illness as a divine punishment), as well as fantastic experiences because of finally having that child in their arms.

Questions for the debate

Without a doubt, the scientific and medical progresses such as surrogacy create a social, cultural and legal debate. It’s quite clear that not everything that is technically possible is morally acceptable.

What do you think, on an ethical level, about surrogacy?

Do you think that the trouble and risks of pregnancy can be paid with money? Or instead, should it be seen as a help exchange?

How would you write the law in your country? Would you allow surrogacy in all cases, in just a few or never? Would you be a surrogate mother for your sister?

Once I had a little argument with Carmen Garijo, a very successful women and deputy director of Glamour magazine: she was saying that famous models and artists choose surrogacy in order to avoid the physical effects of pregnancy, and she also mentioned that people are afraid that Assisted Reproduction centres are offering “children à la carte” choosing the parents depending on certain characteristics. All this is a myth. The reality is that all women who want to have a baby want to feel the child inside their body, and they all ask for the same thing: to have a healthy baby as soon as possible. Maybe it seems that they are superficial but they are not, at least when it come to this matter.

In relation to the comment that we are “making designer babies”, the truth is that I don’t know what they are talking about. We are professionals dedicating our life to people who want to become parents –we don’t do estrange things in the lab.