What Is a Surrogate?

Understanding the Different Kinds of Surrogates

Pregnant woman's belly with a blue ribbon around it
Acting as a surrogate for a couple who can't have a baby otherwise is an amazing gift. It is not, however, risk free. Daniel Grill / Getty Images

Surrogate is a general term that refers to a woman who carries a pregnancy for another person. The commissioning person or couple who is trying to have a baby with a surrogate's help is known as the intended parent or parents.

While the surrogate carries the pregnancy and gives birth, the intended parents raise the child and are listed on the birth certificate as the actual parents. 

What is a Traditional Surrogate?

A traditional surrogate is someone who is genetically related to the child she is carrying. In other words, the surrogate's eggs will help conceive the child. A traditional surrogate may also be called a partial surrogate, traditional surrogate mother, natural surrogate or just surrogate.

The procedure is also sometimes known as straight surrogacy.

The surrogate's eggs are fertilized via an insemination procedure, so IVF is not required. The insemination may be via intrauterine insemination (IUI), where specially washed sperm cells are transferred directly to the uterus via a catheter, or another form of artificial insemination may be used. Alternative options to IUI are intracervical insemination and intravaginal insemination. 

Usually, the male intended parent provides a semen sample to the fertility clinic. There it is cleaned and prepared by a fertility clinic. In other cases, a sperm donor is used. If a sperm donor is used in traditional surrogacy, there is an increased risk of legal complications. This is because the child is not related to the intended father or mother, but is genetically related to the surrogate. In this case, an adoption procedure may be required to establish parenthood for the intended parents.

Traditional surrogacy is generally riskier from a legal standpoint. Since the baby is genetically related to the surrogate, and she is giving birth to the baby, surrogacy contracts may be questioned if the surrogate changes her mind about giving the baby to the intended parents as originally planned. This may occur regardless of what papers are signed beforehand. 

Due to legal complications, traditional surrogacy is not used or recommended as often as gestational surrogacy.

What Is a Gestational Surrogate?

A gestational surrogate (or gestational carrier) is not genetically related to the child she carries. Gestational surrogacy is also called IVF surrogacy, host surrogacy or full surrogacy.

In gestational surrogacy, the egg and sperm are usually taken from the intended parents, as in an IVF procedure, and any resulting embryo is transferred to the gestational surrogate. But this is not always the case. 

Other possibilities include...

  • the intended mother's egg along with a sperm donor
  • the use of an egg donor with an intended male parent's sperm
  • an egg donor with a sperm donor
  • an embryo donation

In some states and countries, a surrogacy arrangement can only take place if the baby is genetically related to at least one of the intended parents. In other places, this is not a problem. In places where this is a problem, using both an egg and sperm donor, or using an embryo donor, may cause legal issues. 

Commercial vs Compassionate Surrogacy

The term commercial surrogacy refers to an arrangement where the surrogate receives financial compensation above and beyond expenses. This is a legal arrangement in some states and countries.

In some places, commercial surrogacy is illegal. The intended parents may pay for medical costs, legal costs, lost work or other "reasonable expenses," but they cannot pay the surrogate purely for her role as a surrogate.

Surrogacy arrangements where there is no additional financial compensation beyond "reasonable expenses" is called "compassionate" surrogacy. 

There are also places where any form of surrogacy is illegal, and contracts declaring the intended parents as the true parents are not recognized, valid or enforceable. Surrogacy contracts may not be enforceable even in states or countries where surrogacy is technically legal, while other states and countries do enforce surrogacy contracts.

Due to the complexity of surrogacy arrangements, getting legal advice and consulting with an experienced psychologist about surrogacy is very important. Also, doing as much up-front research on surrogacy and other family-building options is essential to avoid potential problems or costly (emotional or financial) mistakes. 

Unfortunately, there are scammers out there looking to steal money from people looking for a surrogate. If an arrangement sounds too good to be true, or the parties involved insist you forgo finding your own lawyer, walk away.

Who May Need a Surrogate?

There are a variety of reasons why an intended parent (or parents) may need or want a surrogate to have a baby. Some of those reasons include:

  • the intended mother is missing her uterus (from birth or after removal for medical reasons)
  • uterine malformations
  • medical conditions that may endanger the mother or baby's life if she were pregnant
  • previous pregnancy or birth complications that may endanger the mother or child
  • repeated unexplained IVF implantation failure
  • repeated pregnancy loss not resolve with other treatments
  • male gay couple who wishes to have a child
  • single man who wishes to have a child

Who Can Be a Surrogate?

Before you volunteer to be a surrogate to a friend or family member, be sure you understand everything you're getting into. Surrogacy is a beautiful gift you can give to someone you know or a stranger. However, it is also an highly involved process, medically and physically invasive, and emotionally trying. 

Here's a short list of just some of the requirements to be a surrogate:

  • Be in good overall health, including being at a good weight.
  • Have had at least one healthy pregnancy and birth in the past.
  • Not have given up a child to adoption in the past.
  • Be older than 21 but younger than 35 (some exceptions may be made for a known surrogate).
  • Have health and life insurance.
  • Live in a surrogacy friendly state or country.
  • Be available and willing to attend many doctor appointments.
  • Be prepared to have vaginal ultrasounds and insemination (or embryo transfer) procedures.
  • Be willing to attend counseling, psychological and legal, before and possibly during surrogacy arrangement.

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