The recent survey of gestational surrogacy stated: “… it is not related to the treatment of the parties involved in (gestational) surrogacy process that is complex, but their preparation with a proper counseling: legal and medical, also careful selection of a suitable host”. This statement reflects the interacting aspects of gestational surrogacy and demonstrates how the latter cannot be seen outside the context of other aspects. A bit later, it is fair to say that the preparation of the intended parents remains complicated.
Surrogacy is a procedure where the functions of traditional motherhood/parenthood are fragmented. In surrogacy procedure in Ukraine, one woman –surrogate mother – is pregnant through assisted reproductive technologies (ART), carries, and then delivers a surrogate child for infertile couple who cannot achieve pregnancy themselves – the intended parents. The surrogate child is immediately handed over to the intended parents or soon after childbirth, who then raises one as their own.
Two types of surrogacy are widely practiced: gestational surrogacy and traditional surrogacy. Gestational surrogacy is absolutely legitimized and regulated by specific legislative acts of Ukraine, while traditional surrogacy is absolutely prohibited in Ukraine. Within two broad types of gestational and traditional surrogacy, there are many options, so we will be briefly discussing some of them.
Gestational surrogacy is a more complex, more time-consuming and more expensive option requiring the involvement of the IVF clinic and the creation of an embryo (-s) ex vivo (that is, outside the uterus) using IVF (in the tube). This process requires medical intervention, and the resulting surrogate child cannot exist without the explicit choice of gametes, the IVF process, and the embryo transfer (ET). Surrogate mother is not genetically linked to this fetus / the surrogate child. In the gestational surrogate procedure in all cases, the intended parents are completely genetically linked to the surrogate child, the intended mothers’ oocytes (eggs) and the intended fathers’ sperm. However, patients can also use donor eggs or sperm. Donated gametes (oocytes or spermatozoa) can be left by other patients, also can be donated by anonymous donors.
In all such cases, surrogate mother remains genetically unlinked to the resulting surrogate child, while the intended mother or the intended father or both of them are genetically linked. The intended parents do not participate in its gestation. The intended parents in gestational surrogacy are three steps away from the natural conception, because: a) they miss sexual intercourse to conceive, b) they miss a nine-month pregnancy, and c) they miss the subsequent delivery and delivery of the surrogate child. In addition, when the intended parents contribute to the embryo, they need to retrieve the oocytes and do the IVF for the fertilization of the egg.
After this long and complex process involving third parties, they become the only legitimate parents of the newborn surrogate child. Surrogate mother is also involved in the medical and technological concept as far as possible from the natural concept, and in reality it is only three steps away from traditional childbearing because a) she does not perceive traditionally, b) the surrogate child is not genetically linked with her, and c) she relinquishes the surrogate child she gave birth too.
Traditional surrogacy that is absolutely prohibited in Ukraine is associated with a process that mimics the natural conception. Because of one prohibition in Ukraine, we will be briefly discussing this method. Here, surrogate mother is artificially inseminated with the sperm of the intended father (or sperm donor) through intrauterine insemination (IUI) in the IVF clinic, although it can be made much more expensive through IVF for the fertilization of her egg. She gave birth to the surrogate child, similar to her own children, and after birth she gives the surrogate child carrying her own genetic material to the intended parents.
The intended parents here take home the surrogate child that is partially (or not) genetically linked to them and was not taken by them. Here the intended parents are only one-step away from adoption, but far from the natural conception, where neither the full genetic link nor the pregnancy was part of the family creating process. However, for surrogate mother, she is close to the natural conception, pregnancy and childbirth, same if it was a pregnancy planned for her own family creating purposes.
The surrogate child in this case is still genetically linked to surrogate mother, but is not genetically linked to one or both intended parents who will be needed to pass the legal process of taking the surrogate child as theirs own or seek the parental rights after the birth.
People, for medical or social reasons, can use any type of surrogacy. In practice, altruistic surrogacy usually relies on the availability of commercial surrogacy. Whereas altruistic surrogacy tends to be used when there is a medical need to use surrogate mother if it is available and legal in the country where it is required.
Different types of surrogate mothers will be discussed in the later blogs. Expectations of women who become surrogate mothers – for the intended parents, who have either social or medical reasons to use surrogacy, may be different.