Types of Surrogacy

Traditional

When a woman donates her egg to be fertilized by sperm—from intended father or sperm donor—through artificial insemination or IVF. The woman is the biological, genetic, and gestational mother. Upon delivery, she relinquishes all parental rights to the intended parents.

Gestational

Egg from intended mother or egg donor is fertilized by sperm from intended father or sperm donor and implanted in the carrier through in vitro fertilization. The carrier has no genetic or biologic link to the fetus and relinquishes all parental rights to the intended parents upon delivery.

History

• 1978—First successful IVF baby born.
• 1983—First baby from egg donation was born.
• 1985—Emergence of gestational surrogacy and first successful pregnancy.
• 1986—Baby M Case.
• 1999—Special Program of Assisted Reproduction (SPAR) formed.
• 2011-Oldest surrogate (61) carried her grandchild.

Indications

• Absent uterus.
• Uterine anomaly.
• Severe heart or renal disease.
• Biological inability to conceive—single male, homosexual male couple.
• Hysterectomy for carcinoma or hemorrhage.
• Unidentified endometrial factor.
• Multiple unexplained IVF failures.
• Recurrent miscarriage.

Steps to Surrogacy

1. Choose surrogacy.
2. Psychosocial Education/Counseling.
3. Screening and testing of genetic parents.
4. Complete Physical Examination.
5. Laboratory Testing.
6. Legal Counsel.

1. Choose to become a surrogate.
2. Psychosocial evaluation and counseling.
3. Screening and testing of gestational carrier.
4. Complete medical evaluation.
5. Laboratory Testing.
6. Legal Counsel.

Surrogate Qualifications

• Good physical and mental health.
• Carried and delivered at least one child (Sometimes preferred surrogate has completed own family.)
• Past pregnancies free of complications and full-term.
• <43 years old.
• Stable living situation.
• Solid support system.
• No smoking or alcohol abuse.

Benefits

Intended Parents

Allows those who cannot have children to have children.

Genetic connection to their child(ren).

Surrogate Mother

Feeling of worth/meaning.

Financial compensation and health care benefits.

Emotional connection.

Risks

Intended Parents

Frustration.

Guilt.

Jealousy.

Surrogate Mother

Emotional Attachment.

Familial Distress.

Post delivery depression.

Main Questions to Consider:

1. Surrogacy agreements enforceable or prohibited?
2. Commercial or Altruistic?
3. Traditional or gestational?
4. Post-birth adoption or pre/post-birth parentage order?

Surrogacy in the United States

International Surrogacy

India

• Leader in international surrogacy.
• Surrogacy agreements are enforceable.
• Commercial surrogacy is legal.
• Surrogacy related fertility tourism.
• $10,000-$28,000 for complete package.

Nursing Implications

1. Be prepared to educate all parties on ALL available resources--counseling, antenatal care, labor and delivery, and postnatal care.
2. Educate participating parties on associated risks involved with assisted reproductive therapy.
3. Understand the surrogacy policy for your state, or place of practice.
4. Provide the best possible care for their patient.

**This is new territory all around.

Questions

1. What is the difference between traditional and gestational surrogacy?
2. What other nursing implications might be applicable to a surrogate mother/family?
3. Do you think that creating a business out of surrogacy, such as in India, is sustainable? ethical?
4. Do you think using gestational surrogacy as a means of creating a child without interrupting your career or social life is ethical?

Sources