The different types of surrogacy

It is possible to distinguish between two types of surrogacy based on the origin of the eggs (oocytes) used during the assisted reproduction treatment. Therefore, depending on the case, we will speak of traditional or gestational surrogacy.  These are both medico-legal procedures used when the parents cannot procreate naturally.

On the other hand, commercial type and altruistic type differ in that the surrogate receives payment in the commercial case, but not in the other.

Intended parents are those who want to have a child through surrogacy.

Most often, heterosexual couples resort to this solution because of infertility or sterility problems. Pregnancy is either physically impossible or it poses a serious risk to the woman’s health.

In the case of gay couples or single men, the absence of a partner of the opposite sex leads them to turn to surrogacy to have a biological child.

In either case, this is a complex procedure into which third parties enter.

For this reason, the traditional concept of surrogacy becomes polyform, giving rise to the various types of path which can cause ethical questions and difficulties in understanding the content of the dynamic.

Before advances in reproductive medicine, the concept of motherhood was concentrated on a single figure, that of the mother.

This was the person who provided the “genetic inheritance,” carried the pregnancy to term, and finally assumed the responsibility of motherhood from a social and legal point of view.

With the advancement of assisted reproduction, the concept of motherhood itself has become more complex, leading to three different concepts:  genetic charge, the transmission of DNA through gametes (eggs); gestation, the carrying the child in the womb; and that of legal responsibility. The latter is perhaps the most important because it refers to the figure of the woman who is going to educate and care for the child, becoming legally responsible until he or she comes of age.

In the surrogacy vision, the legally responsible mother will be the intended mother, that is, the woman who expresses a desire and willingness to have a child and initiate a surrogacy journey.

Should she have the capacity to provide the eggs, she may also be the biological mother, but it is not mandatory.

Among the different types of surrogacy, we can distinguish between two types of surrogacy by considering the type of genetic charge. The distinction is based on the link to the oocytes used.

In traditional (or partial) surrogacy the pregnant woman provides the oocytes. Thus, she is both the biological and surrogate mother.

In gestational (or total) surrogacy the surrogate mother has no biological link to the child because the eggs come from the commissioning mother (or intended mother): failing that, from a donor.

In the case of the traditional method, artificial insemination is usually sufficient. In contrast, in the gestational method, in vitro fertilization is necessary.

The traditional or partial mode has existed for centuries, hence the origin of the same name. Mention of this practice has been discovered in the Bible and in the remains of Mesopotamia. History shows us that this is early model of surrogacy, although it is used less and less. The future father had sexual relations with the surrogate mother in order to have offspring.

Currently, traditional surrogacy is listed under assisted reproductive techniques. In fact, artificial insemination is sufficient.

From a technical point of view, the procedure is simple. Insemination can be performed in a natural cycle or with ovarian stimulation treatment (to control the ovarian cycle) then ovulation time. When ovulation is about to occur, sperm from the intended father or a donor is deposited in the uterus of the surrogate mother so that fertilization occurs naturally within her body.

This assisted-reproduction technique is less complex and less expensive than in vitro fertilization. Despite this apparent advantage, the traditional mode is being used less and less because of the fact that the surrogate mother also has a genetic bond with the child. This makes the procedure illegal in most countries. Also to be considered is the strong emotional bond of the surrogate mother passing on her DNA to the child.

Of course, in the event that the intended mother has functioning ovaries, she will want to be the biological mother in order to pass on her DNA to her child (gestational surrogacy).

Gestational, or full surrogacy is more technically complex because it necessarily involves more manipulation of the gametes. However, this modality is increasingly practiced because there is no genetic link between the gestational surrogate and the child and is in fact legal in many states countries in today’s jurisdictions.

Since the gestational surrogate does not provide her own eggs, her role is limited to pregnancy and delivery.

The technique used is necessarily in vitro fertilization, either conventional or ICSI (injection of sperm into the egg).

If the intended mother ovulates, she will undergo hormone stimulation treatment in order to extract several mature eggs through follicular puncture.

The eggs of a donor (a third person) will be used In the case of a homosexual couple of two men or a single man or if the intended mother does not have the capacity to provide her own eggs.

The eggs are fertilized in the laboratory with sperm from the designated father or a donor. After a few days of culture, the resulting embryos can be transferred to the surrogate.

From a technical point of view, the procedure follows the same steps as in vitro fertilization. The difference is in the transfer: instead of being transferred to the uterus of the biological mother, the embryo is transferred to the uterus of the gestational surrogate.

Regardless of the origin of the eggs (biological mother or donor) surrogacy arrangements can also be divided into two other categories within the different types of surrogacy, depending on whether or not there is any remuneration or financial compensation for the surrogate mother.

Intended parents are not free to choose for themselves because arrangements depend on the legal framework governing surrogacy in each country.

The gestational surrogate does not receive any kind of financial compensation when the type of surrogacy is altruistic.

However, the expenses generated by the pregnancy are the responsibility of the intended parents. They must cover all legal and medical expenses, as well as those related to the pregnancy itself and to the surrogate mother’s well-being during this period, such as maternity clothing, food, etc.

Pregnancy is a state that involves physical and emotional changes which in some cases are accompanied by even more serious problems.

For this reason, it is more common for the altruistic mode to be adopted in an intra-family context (in those countries where this alternative exists such as Canada) where the woman who offers to carry the pregnancy does so for a relative or close friends. Indeed, a woman who belongs to the circle of friends or family of the prospective parents tends to feel a higher level of empathy about the fertility issue.

In the case of a commercial surrogacy contract, the surrogate mother receives financial compensation for the physical and emotional effort involved in the pregnancy.

Being pregnant is a time of great transformation in a woman’s life. This state presupposes a great deal of effort, since one has to adjust one’s love life and nutrition and modify physical and work activities from the end of the pregnancy until the birth of the baby.

Therefore, even when it comes to commercial surrogacy, we do not talk about a salary or compensation for the pregnancy itself, but rather an allowance or compensation.

In the ideal scenario, the compensation is not the only motivation for surrogate mothers: rather, it represents a reward for their solidarity and desire to help others.

In countries that allow and regulate this alternative such as the United States, compensation can be subject to negotiation since the cost of living between states varies greatly. The amount of compensation also varies depending on other factors such as dependent offspring, termination of employment, and state of residence.

There are different types of surrogacy, but the important thing to understand is how they can influence the intended parents’ choice.

The truth is that although it is important to know about these alternatives, prospective parents cannot choose which type or path to take, since circumstances (type of infertility or gender identity) or the law of the country in which they intend to begin the process will decide for them.

Knowledge remains the best means of protection, always.