Surrogacy is an arrangement in which a woman carries and delivers a child for another couple or person. Surrogacy is otherwise called as third party parenting, wherein women not having proper gestational environment for a pregnancy can utilize some other woman’s uterus for the duration of pregnancy. Most importatntly,the surrogate is genetically unrelated to the child (called gestational surrogacy and not the biological mother. A gestational surrogacy requires the transfer of a previously created embryo, and for this reason the process always takes place in a clinical setting. In India, ICMR has laid strict rules and regulations for surrogacy services to abide and has made the process more organized, streamlined and surely of a benefit to the childless couples.
What is surrogacy?
Surrogacy is when another woman carries and gives birth to a baby for the couple who want to have a child.
There are two types of Surrogacy — traditional surrogacy and gestational surrogacy.
In Traditional surrogacy, a surrogate mother is artificially inseminated, either by the intended father or an anonymous donor, and carries the baby to term. The child is thereby genetically related to both the surrogate mother, who provides the egg,and the intended father or anonymous donor.
In Gestational surrogacy, an egg is removed from the intended mother or an anonymous donor and fertilized with the sperm of the intended father or anonymous donor. The fertilized egg, or embryo, is then transferred to a surrogate who carries the baby to term. So surrogate is not biological mother of the child.
Finding a Surrogate –
Sometimes a family member or friend offers to be a surrogate ( Altruistic surrogacy). This can greatly reduce the cost of surrogacy. However, because not everyone knows a woman in a position to volunteer to be a surrogate, one may find a surrogate through other means. There are many full-service agencies/firms that will match intended parents to surrogates.
Recruitment: Surrogates are recruited by an authorized professionals in Assisted Reproductive Technology bank(ART Bank).
Selection of surrogate mother is to be based on her medical, physical and psychological fitness as per ICMR guidelines. All necessary background checks are done there in the bank with the help of concerned authorities. Medical- Psychological checks , ruling out sexually transmitted diseases, advanced blood tests including a chromosomal analysis, hormonal assays to name some. Her resolve to be a surrogate mother should be supported by her husband and family members or guardian in undertaking this noble cause.It is important to ascertain that she has no criminal record. She should be healthy, emotionally stable, responsible, having at least one successful pregnancy with one living healthy child which proves her fertility and experience of carrying the pregnancy. ICMR recommends that a psychological assessment of the surrogate should be done to restrict the likelihood of any psychological injury hence psychological screening of surrogate is done by the professional psychologist( IQ testing) There after they undergo trans-vaginal scan to assess their own fertility and detailed counseling takes place.
Classification of surrogacy
Partial surrogacy (also known Straight or Traditional) – Partial surrogacy involves sperm from the intended father and an egg from the surrogate. Here fertilization is (usually) done by artificial insemination or intrauterine insemination (IUI). In traditional surrogacy, the surrogate’s egg is used to create the embryo of the child she is going to carry (either through intrauterine insemination or in vitro fertilization.)
In gestational surrogacy, the intended parents create an embryo using their own egg and sperm or using donated egg or sperm. Full surrogacy (also known as Host or Gestational) – Full surrogacy involves the implantation of an embryo created using either:
• the eggs and sperm of the intended parents
• a donated egg fertilized with sperm from the intended father
• an embryo created using donor eggs and sperm.
While traditional surrogacy was the only way to complete a surrogacy throughout most of history, over the past 30 years, gestational surrogacy has become the more popular of the two types of surrogacy. Not only does it allow both parents of a heterosexual couple to be biologically related to their child, but it also helps eliminate some of the legal and emotional struggles that come with a surrogate being genetically related to the child she’s carrying.
Another factor that creates different types of surrogacy is the compensation that a surrogate is paid to carry the intended parents’ child.
When a surrogate is given base payment for carrying the child (beyond reimbursement for pregnancy-related expenses), this is known as compensated surrogacy. If a surrogate does not receive any additional payments, she will complete an altruistic surrogacy, usually through the means of a friend or family member.
Documentation / Legal formalities / Paperwork involved
Agency ensures that the information the surrogate has given is true by obtaining the related documents to verify their personal identity, age, marital status, number of children etc. Also a thorough counselling before the surrogate proceeds for recruitment takes place. Since, it is ethically a voluntary contribution, it is our honest duty to inform, educate, communicate and make them (surrogate, her husband or guardian) aware about surrogacy process, medical and legal necessities, its consequences and complications involved in the whole process considering the legal issues involved. The legal adviser explains about her nil rights over the child, obligations under the contract, repercussions of failing to meet any clause, in language surrogate and her husband best understands. The agreement is signed in two languages, English and her own language, for her understanding. The confidentiality of the details of the parents as well of the surrogate mother’s is well maintained.
What are the risks of surrogacy?
These are rarely found, especially when quality checks happen strictly, confidentiality & process are closely maintained, monitored & the regulations are properly obeyed.
The risks associated with surrogacy depend on the type of surrogacy (full or partial) undertaken. Generally, the risks associated with full surrogacy are similar to those for IVF, in case of intended parents or egg donor.
There is also a risk of transferring HIV and hepatitis, and so screening of everyone involved in surrogacy is recommended. If a registered donor at a licensed clinic is used, the donor will automatically be screened, in case of donor egg and surrogacy option.
Usually ailments & complications if any of pregnancy can also take place in a surrogate.
Current Indian perspective
Many countries have strict laws regulating this process. Indian surrogacy has long been a popular option for international intended parents but, like most international surrogacies today, has recently gone through major legislative reform.
In 2015, the Indian government passed new regulations on the surrogacy process. Today, Indian surrogacy laws make it illegal for foreign intended parents to complete a surrogacy in India. The only people who can complete a commercial surrogacy in India today are Indian intended parents who have been married for at least five years. The ban on foreign intended parents in 2015 was only the start of legislation regulating surrogacy. In December 2018, after almost two years of debate, an Indian surrogacy regulation bill of 2016 was passed in Lok Sabha that :
Made commercial surrogacy illegal, Only allows altruistic surrogacy for needy, infertile Indian couples. Requires intended parents to be married for five years and have a doctor’s certificate of their infertility
Restricts women to being surrogates only once, and only if they are a close relative of the intended parents, are married and have a biological child
Bans single parents, homosexuals and live-in couples from surrogacy
There are multiple initiatives from government as well as medical professional bodies to bring firmer regulation to the surrogacy process and discussions are still underway