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Surrogacy refers to an arrangement when one woman carries a baby or babies for another woman/couple and hands over the baby after birth. This is called renting the womb. The couple who want the baby and start this arrangement are called the commissioning couple. The woman who carries the baby is called the surrogate or host.

Who will benefit from surrogacy treatment?

  • Women born without a uterus
  • Women who have undergone a hysterectomy or removal of the uterus
  • Women with damaged uterine lining, including Asherman’s syndrome where the uterine cavity is obliterated due to adhesions as a result of severe scraping of the womb.
  • Women with recurrent miscarriages
  • Repeated failure of IVF treatment in spite of good quality embryos
  • Severe medical conditions incompatible with pregnancy

Host surrogacy (also knows as gestational surrogacy)

The eggs are from the commissioning mother and the sperm are from the commissioning father. They are fertilised by IVF treatment and the resulting embryos are placed inside the womb of the surrogate host. The resulting baby is not genetically related to the surrogate host. In this arrangement, the commissioning couple literally rent the womb of the surrogate host.

The sperm from the commissioning father is usually frozen for six months (he has screening for HIV, HTLV, hepatitis B and hepatitis C at the time of freezing the sperm and again at the end of six month period). The commissioning mother undergoes ovarian stimulation for IVF and her eggs are collected and fertilised with the frozen-thawed sperm of her husband. The resulting embryos are used fresh for transfer into the host and the surplus embryos are frozen. The host can have embryos transferred in a natural cycle or a hormonally prepared cycle.


Straight surrogacy (also known as partial or natural surrogacy)

Here the surrogate not only carries the baby but also acts as an egg donor. The resulting baby is genetically her baby.

In this situation, the treatment required is usually intra-uterine insemination which is simpler compared to IVF. Intra-uterine insemination can be performed on a natural cycle or a drug controlled cycle (please see info). Occasionally IVF may be required in straight surrogacy also, if IUI attempts are not successful. Then the surrogate undergoes the whole IVF treatment.


Third scenario

There is a third scenario, where the commissioning mother’s eggs are not available or suitable for the treatment, but the commissioning couple does not wish to use the surrogate’s eggs. They can use eggs from another woman who will act as an egg donor. The egg donor can be known or anonymous to the commissioning couple.

This arrangement involves three parties:

  • The commissioning couple who want the baby
  • The surrogate host who carries the baby
  • The egg donor who provides the eggs

Some commissioning couples feel that this arrangement may make it easier for the surrogate to hand over the baby at the end if the baby is not genetically related to her. In some cases, the surrogate may share this feeling too.

Preparation for surrogacy treatment

The commissioning couple is advised to find the surrogate host. It may be a close member of the family, such as a sister, or a close friend. They may be able to find a surrogate through an agency or support group. One such support group in the UK is called Childlessness Overcome Through Surrogacy (COTS) which is set up to help couples seeking hosts and potential hosts seeking couples to help.

The commissioning couple and host have a detailed medical consultation and screening. Both the parties are advised to attend counselling. Their treatment should be approved by the ethics committee of the clinic.


Screening test for commissioning couple

  • Mother
    • HIV, HTLV
    • Hepatitis B
    • Hepatitis C
    • VDRL
    • CMV
    • Blood group
  • Father
    • HIV, HTLV
    • Hepatitis B
    • Hepatitis C
    • (All the above to be repeated after six months)
    • Blood group
    • CMV
  • Host
    • Haemoglobin
    • HIV, HTLV
    • Hepatitis B
    • Hepatitis C
    • VDRL
    • CMV
    • Blood group
    • Rubella

Potential problems in surrogacy treatment

  • The surrogate may fail to handover the baby at the end and keep the baby.
  • The surrogate may demand more money when she gets pregnant.
  • Commissioning couple may reject the baby if the baby is abnormal.
  • In view of the above problems, it is better to have a legal contract drawn between the parties with a solicitor.
  • Some countries ban surrogacy treatment completely.
  • Some religions do not accept surrogacy treatment.
  • Breast feeding by commissioning mother.

A question commonly asked by coupes is whether the commissioning mother can breast feed the baby after it is handed over by the host.

The answer is: yes, it is possible and the commissioning mother can be prepared for this with medications.