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Surrogacy: Medicine, Law and Ethics Explained

Surrogacy is an arrangement in which a woman carries and gives birth to a child for another person or couple. It involves medical, legal, and ethical considerations.

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Things worth knowing about "Surrogacy"

Surrogacy is an arrangement in which a woman carries and gives birth to a child for another person or couple. It involves medical, legal, and ethical considerations.

What is Surrogacy?

Surrogacy is an arrangement in which a woman – known as the surrogate mother – carries a pregnancy on behalf of another person or couple, referred to as the intended parents, and relinquishes the child after birth. Surrogacy is a multifaceted topic that encompasses medical, legal, ethical, and psychological dimensions.

Types of Surrogacy

Traditional Surrogacy

In traditional surrogacy, the surrogate is artificially inseminated with sperm from the intended father or a donor. The surrogate is therefore genetically related to the child. This form is less commonly practiced today due to ethical and legal concerns.

Gestational Surrogacy

In gestational surrogacy, an embryo created through in vitro fertilization (IVF) is transferred into the uterus of the surrogate. The embryo is derived from the eggs and sperm of the intended parents or donors. The surrogate has no genetic connection to the child.

Medical Process

The medical process of gestational surrogacy involves several steps:

Hormonal stimulation of the egg donor to retrieve eggs
Fertilization of the eggs in a laboratory setting (IVF)
Hormonal preparation of the surrogate's uterus for embryo transfer
Transfer of the embryo into the surrogate's uterus
Medical monitoring and care throughout the pregnancy until birth

Legal Situation

The legal status of surrogacy varies significantly around the world:

Prohibited in Germany, Austria, and Switzerland
Permitted or tolerated in certain US states, Canada, the United Kingdom (altruistic surrogacy only), Ukraine, and other countries
In Germany, surrogacy is prohibited under the Embryo Protection Act (Embryonenschutzgesetz) and the Adoption Mediation Act

Intended parents from Germany who pursue surrogacy abroad often face significant legal challenges upon their return, particularly regarding the legal recognition of parenthood.

Ethical Considerations

Surrogacy raises a number of important ethical questions:

Protection of the surrogate's bodily autonomy
Risk of exploitation, particularly in low-income countries (commercial surrogacy)
Psychological impact on the surrogate after birth and handover of the child
The rights of the child regarding identity and welfare
The distinction between altruistic (unpaid) and commercial (paid) surrogacy

Medical Risks

As with any pregnancy, surrogacy carries health risks for the surrogate mother:

Risks associated with hormonal stimulation, such as ovarian hyperstimulation syndrome (OHSS)
Pregnancy complications including preeclampsia, multiple pregnancies, or premature birth
Psychological burden related to relinquishing the child after birth

Psychological Support

Comprehensive psychological support for all parties involved – the surrogate, the intended parents, and eventually the child – is considered essential by medical societies. Open communication and clear agreements contribute to the emotional stability of all parties.

References

European Society of Human Reproduction and Embryology (ESHRE): Surrogacy: A Guide to Good Clinical Practice. ESHRE Guidelines 2023.
Jadva, V. et al. (2012): Surrogacy families 10 years on: relationship with the surrogate, decisions over disclosure and children's understanding of their surrogacy origins. Human Reproduction, 27(10), 3008–3014.
World Health Organization (WHO): Infertility prevalence estimates, 1990–2021. WHO, Geneva, 2023.

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