Born via surrogate

What It Is and How Does Surrogacy Work

Written by Rebecca Buffum Taylor

Medically Reviewed by Jennifer Robinson, MD on November 04, 2021

There's still some controversy about using a surrogate mother to have a baby. The legal process is also tricky because it varies from state to state. Even so, whether it's because of fertility problems or other reasons, surrogacy is an option for you and your partner. Find out how it works and see if it's right for you.

What Is a Surrogate Mother?

There are two kinds:

Traditional surrogate. It's a woman who gets artificially inseminated with the father's sperm. They then carry the baby and deliver it for you and your partner to raise.

A traditional surrogate is the baby's biological mother. That's because it was their egg that was fertilized by the father's sperm. Donor sperm can also be used.

Gestational surrogates. A technique called "in vitro fertilization" (IVF) now makes it possible to gather eggs from the mother (or an egg donor), fertilize them with sperm from the father (or a sperm donor), and place the embryo into the uterus of a gestational surrogate.

The surrogate then carries the baby until birth. They don't have any genetic ties to the child because it wasn't their egg that was used.

A gestational surrogate is called the "birth mother." The biological mother, though, is still the woman whose egg was fertilized.

In the U.S., gestational surrogacy is less complex legally. That's because both intended parents have genetic ties to the baby. As a result, gestational surrogacy has become more common than a traditional surrogate. About 750 babies are born each year using gestational surrogacy.

Who Uses Surrogates?

If you're a woman, you may consider a surrogate for several reasons:

Medical problems with your uterus
You had a hysterectomy that removed your uterus
Conditions that make pregnancy impossible or risky for you, such as severe heart disease

You may want to think about surrogacy if you tried but couldn't get pregnant with a variety of assisted-reproduction techniques, such as IVF.

Surrogates have also made parenthood an option for people who might not be able to adopt a child, perhaps because of their age or marital status.

If gay men decide to use a traditional surrogate, one of them uses their sperm to fertilize the surrogate's egg through artificial insemination. The surrogate then carries the baby and gives birth.

A gay couple might also choose an egg donor, fertilize that donated egg, and then have the embryo implanted in a gestational surrogate to carry until birth.

Finding a Surrogate

There are several ways you can find a surrogate mother:

Friends or family. Sometimes you can ask a friend or relative to be a surrogate for you. It's somewhat controversial. But because of the high cost of surrogacy and the complex legal issues it raises about parental rights, a tried-and-tested family relationship can be simpler to manage.

The American Society for Reproductive Medicine accepts certain family ties as acceptable for surrogates. It generally discourages surrogacy, though, if the child would carry the same genes as a child born of incest between close relatives.

A surrogacy agency. Most people use one to arrange a gestational surrogate. There are about 100 agencies now operating in the U.S. They act as go-betweens.

An agency helps you find a surrogate and make arrangements. It also collects any fees that get passed between you and the surrogate, such as paying for their medical expenses.

How to Choose a Surrogate

Right now there aren't any regulations about who can be a surrogate mother. But experts agree on a few points about how to select one.

You should choose surrogates who:

Are at least 21 years old
Have already given birth to at least one healthy baby so they understand firsthand the medical risks of pregnancy and childbirth and the emotional issues of bonding with a newborn
Have passed a psychological screening by a mental health professional to uncover any issues with giving up the baby after birth
Sign a contract about their role and responsibilities in the pregnancy, such as prenatal care and agreeing to give you the baby after birth

Using a Surrogate

The American Society for Reproductive Medicine says surrogates should get a medical exam to check that they are likely to have a healthy, full-term pregnancy. The organization suggests they get tests that check for infectious diseases such as syphilis, gonorrhea, chlamydia, HIV, cytomegalovirus, and hepatitis B and C.

Surrogates should get tests to make sure they have immunity to measles, rubella (German measles), and chickenpox. Also, you may want to ask that they get a medical procedure to visually "map" the uterus, which can help the doctor check their potential to carry a pregnancy. Surrogate mothers should have their own doctor during pregnancy rather than use yours.

The cost of surrogacy can range from $80,000 to $120,000. A lot of different things go into the price, such as whether the surrogates have their own medical insurance or whether you need to buy a surrogacy-pregnancy policy for them.

Legal Issues With Surrogates

Parental rights aren't guaranteed after a surrogate pregnancy. The law continues to change as reproductive technology and the very definition of a "parent" changes.

There isn't a federal law on surrogacy and state laws vary. After a surrogate pregnancy in some states, you may still have to pass adoption proceedings to gain legal custody of the child. In other states, a "declaration of parentage" before birth lets you avoid having to "adopt" the baby.

To protect your rights as parents-to-be -- and the rights of the child you're hoping to have -- hire an attorney who specializes in reproductive law in your state. They can write a surrogacy contract that clearly spells out what everyone needs to do.

A contract like that may help if legal issues come up after birth. It can also outline agreements about a variety of possible scenarios with the pregnancy, such as what happens if there are twins or triplets.

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Surrogacy > Fact Sheets > Yale Medicine

Overview

For some, welcoming a child into the world is among life’s top priorities. If a woman is unable to carry a pregnancy to term, gestational surrogacy may be the best option. Also called a surrogate, a gestational carrier is a woman who carries and delivers a child for a couple or individual.

Surrogate mothers are impregnated through the use of in vitro fertilization (IVF). In this process, doctors create an embryo by fertilizing eggs from the intended mother or an egg donor with sperm from the intended father or a sperm donor. Because the gestational carrier doesn’t provide the egg, she is not genetically related to the child.

Yale Fertility Center’s Third Party Reproductive Program has achieved successful results for couples from around the country and all over the world for more than 20 years.

“Gestational surrogacy is a great option for people who really want to be parents but have faced long odds.” says Emre Seli, MD, a reproductive endocrinologist and infertility specialist. “Gestational surrogacy alone or in combination with egg donation is used with great success at the Yale Fertility Center. ”

Who may benefit from gestational surrogacy?

After a comprehensive medical evaluation, our experts will determine if you need a gestational carrier. A carrier may be recommended for the following patients:

Women without a functioning uterus
Women who have acquired disorders that make their uterus unsuitable for pregnancy, such as extensive fibroids or scarring of the uterine cavity
Women who have a medical condition that puts them at significant medical risk if they become pregnant
Women who have a history of recurrent pregnancy loss

Gestational surrogacy is also an excellent option for male same-sex couples who want to have children.

What steps are involved in finding a surrogate carrier?

At the Yale Fertility Center, the first step in learning more about gestational surrogacy is a consultation with a program counselor. At this appointment you will learn about all that is involved, including education about the process of finding a gestational carrier, the types of screening required, treatment protocols and program costs. Our program counselor will also discuss the social and psychological aspects of gestational surrogacy.

Following that meeting, the next step for potential parents is to see a Yale Fertility Center physician for a medical consultation (generally the same day). This meeting includes a comprehensive description of the surrogacy process, as well as a thorough evaluation and review of the intended parents’ medical history, a medical examination and a discussion of possible side effects and medical complications.

How do I find a gestational carrier?

Gestational surrogacy can be complicated, so we require that couples choosing a gestational carrier work with an agency and provide a signed contract to us prior to the start of treatment medications. The agency’s role, typically, involves identifying a potential carrier and establishing legal agreements between the parties. We provide interested parties with an agency referral list.

According to program counselor Dorothy Greenfeld, MSW, “Most surrogates want the intended parents to be involved in the pregnancy. ” Therefore, she says, “I always tell intended parents that they should be clear about their geographical restrictions and how far they are willing to travel.”

Though they are paid for their services, most gestational surrogates have altruistic motivations and enjoy being pregnant, she adds. “In the contract, there is a line about the surrogates’ expectations in terms of contact after the baby is born,” Greenfeld says. “Often, they just want an occasional holiday card or something simple like that.”

How is the gestational carrier screened?

The ideal surrogate falls within the guidelines of the American Society for Reproductive Medicine (ASRM). She should be a healthy woman between the ages of 21 and 42 (preferably younger than 35), with a history of a normal pregnancy and full-term delivery without complication.

The Yale Fertility Center also requires gestational carriers to have a body mass index (BMI) less than 30 (preferably less than 27), and not to have had more than two caesarean section deliveries in the past.

Can a friend or family member be the gestational carrier?

Yes, if she meets our screening criteria.

What is the medical process?

Once you identify a potential gestational carrier, we will provide the evaluation and medical treatment. Evaluation includes a thorough medical and psychological screening by our staff, and a consultation with our colleagues in Maternal-Fetal Medicine. The gestational carrier will also undergo a mock (or trial) cycle that mimics the medication protocol followed during the embryo transfer cycle. The purpose of the mock cycle is to evaluate the response of her uterine lining to the medications, which helps prepare the uterus for the implantation of an embryo.

Depending on the individual’s or couple’s medical condition, eggs will either be donated by the intended mother or by someone else. Similarly, sperm may come from the intended father or from a donation. Fertilization of the eggs by the sperm will occur via IVF to produce embryos.

The gestational surrogate’s cycle will be synchronized with the ovulation induction (or stimulation of ovulation using medication) of the intended mother in order to create the best possible environment for the embryo. The embryo is then transferred to the carrier, who will deliver the baby.

“After the transfer, which we do in our offices, we follow the surrogate for 10 weeks until we can hear the baby’s heartbeat. At that point, she can return to care from her own obstetrician-gynecologist,” Greenfeld explains.

Is a legal contract necessary?

Yes, a legal contract is required for both parties, intended parents and their gestational carrier, before proceeding with medical treatment.

What are the program costs?

Total costs vary, depending on whether you and your partner have insurance coverage for testing and medications. You will meet with a financial coordinator at the time of your initial visit for a complete review of the fee schedule.

What stands out about Yale Medicine’s approach to gestational surrogacy?

The Yale Fertility Center’s Third Party Reproductive Program offers state-of-the art treatment and has successfully helped many through assisted reproduction.

“Our patient-centered approach is aimed at making this medically complex procedure a smooth and easy one for our patients,” Dr. Seli says.

Apina, Malikov and other stars who became parents thanks to surrogate mothers

Philip Kirkorov

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On November 26, 2011, during the Golden Gramophone music ceremony, Philip Kirkorov announced that he had become a father for the first time. And a few days later, the People's Artist of Russia commented on the rumors that a surrogate mother gave birth to his daughter Alla-Victoria. Kirkorov said on Andrey Malakhov's show that he wanted to "show everyone that single people who want to have children can solve their problem" by his own example. Seven months later, the artist became a father for the second time - his son Martin-Christine was born. nine0005

In 2017, in an interview with the New Russian Sensations program on the NTV channel, Kirkorov said that in the civilized world, families who want to be 100% happy (by 100% family happiness, Philip means children), "solve this issue." The singer does not consider himself a “discoverer”:

“It’s just that in our country, he openly said this, was not shy, did not hide behind various legends about supermodels who gave birth to your child, and then disappeared somewhere, leaving the child to you on care. I am not a supporter of lies. It's easier to always tell the truth, because you never lie. Then someday you will need to tell something to your children. And it will be necessary to somehow lie. Why?" nine0005

Kirkorov practically does not speak about the mother of his heirs, limiting himself to general phrases. “Our mother is a serious, non-public person and does not strive for publicity, does not want to be in sight. Maybe the time will come when she wants to go out, I don't know. But for now, this is it. Everything is fine with us, Alla-Victoria and Martin have both a father and a mother, ”the singer said in an interview with HELLO!

Alla Pugacheva and Maxim Galkin (recognized as a foreign agent in the Russian Federation)

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In December 2011, at the premiere of the film Vysotsky. Thank you for being alive ”Alla Pugacheva commented on the news about the paternity of her ex-husband. “Surrogacy is now very common among single people and is therefore welcome all over the world! If this brings happiness to Kirkorov, I will only be happy! - Alla Pugacheva said in an interview with Komsomolskaya Pravda.

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After 1.5 years, the People's Artist of the USSR became a mother of many children - in September 2013, Alla Pugacheva and her husband Maxim Galkin had twins Lisa and Harry (Pugacheva has an older daughter, Kristina Orbakaite - "Gazeta. Ru"). As it turned out, the artist froze her eggs at the age of 52. And she told her husband about it only after the wedding. The comedian spoke about this in an interview with Boris Korchevnikov on the Russia 1 TV channel in October 2013.

The couple did not know that they would have a boy and a girl. nine0005

“In general, people who are familiar with the procedure of surrogacy and implantation of a fertilized egg know that two are usually implanted. Because no one knows which will survive. And it often happens that in such cases there is a possibility of twins. When we were told about it, we replied that we would be happy about it. But the fact that there will be a boy and a girl was not foreseen in advance, ”said Galkin.

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As Sergei Lazarev admitted in 2019 to Lera Kudryavtseva in the Secret for a Million program, several years ago he visited a psychologist and spoke with a specialist about his desire to become a father. “I closed my eyes to the question “Who do you have?” - answered that I have a boy and a girl, ”Lazarev recalled. nine0005

The singer did not want to wait for the moment when he would meet “the one and only”. And he took responsibility. In 2014, the artist had a son, Nikita, and 4 years later, a daughter, Anna.

Lazarev kept the fact of his son's birth a secret for 2.5 years, and told about his daughter a year after her birth.

As it turned out, the artist used the services of a surrogate mother. “Nikita and Anna are full-fledged brother and sister by both parents and copies of each other. One hundred percent relationship. Anya is a copy of Nikita. Nikita and Anya have the same biological mother, but different surrogate mothers bore my children, ”Sergey told TV presenter Lera Kudryavtseva. nine0005

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Alena Apina went to motherhood for ten years. As the singer admitted in an interview with Boris Korchevnikov for the program “The Fate of a Man”, she had several unsuccessful attempts to get pregnant and bear a child: “I lost a child nine times. This is my personal inner kitchen. I experienced it hard and in different ways.

Apina failed to get pregnant with the help of the IVF procedure. After that, the attending physician suggested that she use the services of a surrogate mother. “The only thing I feared was that nothing would come of it,” the artist recalled in an interview with Arguments and Facts. nine0005

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But everything worked out. Ksenia was born in December 2002. And Alena became one of the first Russian celebrities who spoke publicly about surrogacy.

“I understood that my daughter would grow up and understand everything. I didn’t really want to start our life with deceit,” Apina said in the program “The Fate of a Man”,

Yana Rudkovskaya and Evgeni Plushenko

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Married to Maria Ermak, Nikolai is the son of Yana from Viktor Baturin, Andrey (his biological mother is the ex-wife of Baturin - Gazeta. Ru), Alexander is the common heir of Yana and Evgeny. As Rudkovskaya said in an interview with Vogue, wanting to become a mother again, she underwent eight stimulations (the first stage in the in vitro fertilization procedure, IVF - Gazeta.Ru). But in the end, the family resorted to the help of a surrogate mother. The embryo took root and the pregnancy ended with the birth of a child only for the third time. nine0005

At the end of September 2020, Arseniy was born in one of the clinics in St. Petersburg. In an interview, Yana admitted that only two weeks later she began to realize that this was her child and this was forever: “I say this honestly, without hiding, it seems to me that it is important to admit this. When you give birth on your own, when they put a baby on your chest, when you press it, these are completely different sensations. I have had the good fortune to experience them twice. But for some, this is not given by fate, and then surrogate motherhood is a chance.”

Elena and Dmitry Malikov

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In 2016, in the Secret for a Million program, Dmitry Malikov admitted that he really wants a son. The People's Artist of Russia did not disclose details, but explained that he and his wife Elena were "actively working on this." Already in January 2018, the son of the Malikovs was born in one of the maternity hospitals in St. Petersburg (at that time, the People's Artist of Russia was 47 years old, and his wife was 54 years old).

“... this is a long-awaited child, which was given to us for a long time and difficult. I can only say that even taking into account the colossal progress in medicine, it is impossible to guess the sex of the child at the time of his conception. But Dima wanted a boy for a very long time, for many years - and now God heard his prayers, ”Elena commented on the news about the birth of Mark in an interview with Wday.ru. nine0005

Stefania, the couple's daughter, on the air of the show "Hi, Andrey!" she said that she found out about her brother five days before his birth: “Dad told me that another child would soon appear in the house. Of course, I was very surprised. Mom was afraid to tell me, she was afraid of my reaction. However, I was very happy."

First child under the full surrogacy program

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January 4, 1985 in a London clinic was born a girl who became the world's first surrogate child under the gestational motherhood program. The embryo of the biological parents was carried by Mrs. Cotton. This event gave hope to many families with infertility.

Surrogacy is the process of carrying and giving birth to a child for other people. There are traditional and gestational surrogacy. In the first case, a man's sperm is taken and the egg of a surrogate mother is artificially fertilized, which also acts as a biological one. In the second, the egg is fertilized in the laboratory, and the embryo is placed in the uterine cavity of the surrogate mother chosen by the couple. nine0005

The method is used when pregnancy and childbirth threaten the woman's life, or when a single man or a homosexual couple is planning to have a child. In different countries, the attitude towards surrogate motherhood is different. Somewhere it is an assisted reproductive technology, fixed legally, and somewhere it is prohibited by law and is equated with human trafficking.

The practice of surrogate motherhood existed in ancient Rome. Men for money gave their wives to families where the woman was barren. "Hired mothers" carried a baby who was considered the legitimate child of an infertile couple. And the ancient Jews continued offspring at the expense of slaves, who were used if the wife was childless. A similar story is described in the Book of Genesis. In order for a family to have the right to a child, the spouse had to be the first to take him in her arms. This was also enshrined in the Code of Laws of King Hammurabi in Sumerian Mesopotamia in the mid-18th century. BC. nine0005

The ancient work of Plutarch “On the Valor of Women” also describes surrogate motherhood: “Stratonika, realizing that her husband needs to have legitimate children in order to inherit his royal power and without giving birth herself, convinced him to have children with another woman and allow her , Stratonic, take them as their own. Deyotar, admiring her selflessness, gave her freedom of action, and she, having chosen a beautiful girl named Electra from among the captives, brought her together with Deyotar, and raised the children born from this union as her lawful ones, with love and magnificent generosity. nine0005

And among the Kikuyu people living in Kenya, there is a custom that in order to receive the property of a deceased spouse, a woman must have a child. To do this, she can conceive him from another man or ask another woman to give birth to an heir.

Today, surrogacy is possible thanks to artificial insemination and IVF. In 2001, the World Health Organization adopted a wording that calls a surrogate mother a "gestational courier". It is explained that pregnancy occurs due to the fertilization of oocytes by spermatozoa of third parties, to whom the child will be transferred after childbirth. nine0005

In Russia, surrogate motherhood is permitted by law, but a surrogate mother cannot be genetic at the same time; egg donor. The Federal Law “On the Basics of Protecting the Health of Citizens in the Russian Federation” defines surrogate motherhood as “carrying and giving birth to a child (including premature birth) under an agreement concluded between a surrogate mother (a woman who carries a fetus after transfer of a donor embryo) and potential parents, whose germ cells were used for fertilization, or a single woman for whom the bearing and birth of a child is impossible for medical reasons. nine0005

Photo sources: avatars.mds.yandex.net, avatars.mds.yandex.net/get-zen_doc

Author Olga Skibina

artificial insemination motherhood childbirth

Source: rus.team, surrogacy.ru, ru.wikipedia.org

Information provided by the Information Agency "Scientific Russia". Mass media registration certificate: IA No. ФС77-62580, issued Federal Service for Supervision of Communications, Information Technology and Mass Communications on July 31, 2015. nine0005

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