What is Surrogacy?

The word surrogate is rooted in Latin SUBROGARE (to substitute) that is “appointed to act in place of”. Surrogacy implies that a woman becomes pregnant and gives birth to a child with the intention of giving away this child to another person or couple, commonly referred to as “intended” or “commissioning” couple.

The earliest known description of surrogacy is claimed to be the servant Hagar begetting a child for the childless Sarah through her husband Abraham, described in the biblical book of genesis.

In Hindu mythology, despite taking birth from the womb of Rohini, Balram is regarded as the son of mother Devaki.

There are two main kinds of surrogacy, Traditional and Gestational.

Traditional Surrogacy

Traditional Surrogacy is also commonly known as Genetic Surrogacy, Partial Surrogacy, or Straight Surrogacy.

It is the result of artificial insemination of the surrogate mother with the intended father’s sperm which means the surrogate mother’s eggs are used, making her a genetic parent along with the intended father. In view of the genetic involvement of traditional surrogate, this is no longer practiced worldwide.

According to an International Federation Of Gynecology and Obstetrics (FIGO) committee and Indian Council of Medical Research (ICMR) report, only gestational surrogacy is nowadays acceptable.

Gestational Surrogacy

Gestational Surrogacy is also commonly known as IVF Surrogacy, Host Surrogacy, or Full Surrogacy.

It is defined as an arrangement in which an embryo from the intended parents is transferred to the surrogate’s uterus. The surrogate here has no genetic connection to the child.

The first successful IVF surrogacy was reported in 1985 in the USA.

Surrogacy can be commercial or altruistic depending upon whether the surrogate receives a financial reward for her pregnancy. If she receives money for the surrogacy arrangement it’s considered Commercial Surgery and if she receives no compensation beyond reimbursement of her medical and other pregnancy-related expenses along with the insurance coverage for her, it is Altruistic Surrogacy.

When Surrogacy May Be an Option

Congenital absence of uterus e.g. Mayer Rokitansky Kuster Hauser (MRKH) Syndrome
Loss of uterus following serious obstetrical complications such as intra and postpartum haemorrhages or rupture uterus.
Repeated miscarriages
Severe medical conditions, (for example heart and renal diseases) in whom pregnancy would be life-threatening. However, their long term prospect for health is good.
After removal of the uterus (Hysterectomy) for any reason like cancer in the cervix etc.
Repeated unexplained IVF failures despite the retrieval of good quality embryos.
Persistent thin endometrium.
Inoperable Asherman Syndrome (Uterine Synechiae)
High risk of Uterine rupture (e.g. after multiple Cesarean deliveries)
Severe Adenomyosis.
Single men who are fertile and wish to have children of their own using sperm.
Women with disorders that prevent conception or causes miscarriage e.g. Women with Auto-Immune disorders, blood clotting disorders like Factor V Leiden, etc.

Surrogacy: Guidelines To Follow

Surrogacy can be done only by the ART clinic that is registered under the National Registry of ART Clinic & Banks, ICMR.
Sex selection at any stage after fertilization or abortion of foetus of any particular sex is not permitted, except to avoid the risk of transmission of a genetic abnormality assessed through genetic testing of biological parents or through pre-implantation genetic testing (PGT)
No more than three embryos are placed in a woman during any one treatment cycle, regardless of the procedure used, excepting under exceptional circumstances {such as elderly women (above 37 years), poor embryo quality}.
Single mothers or single fathers can commission surrogacy provided they can provide their reproductive gametes and are resident Indian Nationals. They will have full rights on the child born through surrogacy agreement. (Assisted Reproductive Technology Act 2008 under Sec 32).
In the case of single-parent surrogacy issuing birth certificates is slightly complicated and time taking, due to the absence of any definite law in India. Single parents should submit an affidavit that the child was conceived using an egg/sperm donor, to the local municipal authorities who will approach the registrar of birth. The registrar will issue the appropriate birth certificate in the name of the Single Parent.
The only “couples” eligible for ART shall be those “having a sexual relationship that is legal in India.”
Same-sex couples are not eligible.
In case either of the intended mother or intended father is unable to produce gamete, an egg donor or sperm donor may be used. But both the gametes from the donor (Embryo Donation) are not allowed.
The third-party donor of sperm or eggs is always informed that the offspring will not know his/her identity.
A surrogate mother cannot act as an egg donor.
An egg donor cannot act as a surrogate mother for the couple to whom the egg is being donated.
A third party egg/sperm donor and a surrogate mother must relinquish in writing all parental rights concerning the offspring and vice versa.
The intended parents will not know the identity of the sperm/egg donor. Intended parents will be provided the following information regarding the donor: height, weight, skin color, educational qualification, profession, family background, freedom from any known disease or carrier status (such as hepatitis B or AIDS), ethnic origin, before accepting the donor.
Foreigners cannot avail surrogacy services in India. ( Annexure I & Annexure II)

Guidelines To Follow for Intended Parents

The intended parent(s) will have to enter into an agreement with the surrogate mother.
The intended parent(s) will bear all expenditure incurred on medical tests and treatment, food, health insurance, compensation, and other requirements of the surrogate mother, from the date of the agreement, during the period of pregnancy and after delivery as per medical advice and till the child is ready to be delivered as per medical advice, to the biological parents.
The intended parent(s) will also provide monetary compensation to the surrogate for carrying out surrogacy.
There is always a possibility of multiple pregnancies. If the intended parents don’t want it, there is an option of elective Single Embryo Transfer (eSET) which will reduce the chances of multiple pregnancies significantly.
The birth certificate of the child shall bear the names of the intended parents even if an egg/sperm donor was used.
The Indian Law makes it mandatory for the intended parents to take the responsibility of the child thus born and parents have to accept the child irrespective of any abnormality and a refusal to do so would constitute an offence.

Surrogacy at IHR Kolkata

At IHR we try to make the whole surrogacy program seamless and safe. The first surrogacy consultation will involve discussing in detail the procedure involved in surrogacy. Our consultants will address all your concerns and queries in relation to surrogacy. The consultant will explain the legalities, administrative formalities, program highlights, and the payment structure for the surrogacy program. At the end of this consultation, you will get a fair idea about:

Treatment plans and treatment costs
Stages in the treatment plan
Time required for each procedure
What are the procedures in which you will be required to be present and for how long?
What are the procedures that are included in the package?
What are the procedures for which you have to pay additionally?

Stages of Surrogacy at IHR Kolkata

Searching of surrogate

Selection of surrogate

Counseling of surrogate

Investigation of surrogate

1. Searching of Surrogate:

They are selected via surrogacy agencies. These agencies employ an agent who searchs for potential surrogate mothers and counsels them about the process of surrogacy. These agencies screen the family background of the surrogate mother and make sure there is no criminal history. A medical social worker (MSW) is appointed for each surrogate. This MSW acts as a chaperone to the surrogate and provides support and guidance to the surrogate through the surrogacy process. This process of searching may require 1- 4 months.

Or intended parents can also bring their own surrogate who can also be a relative. This can save a lot of time and expense. In the case of a relative acting as a surrogate, the relative should belong to the same generation as the woman desiring the surrogate.

2. Selection of Surrogate

Should be between the ages of 25-35 years.
Should be married (marriage certificate as a proof is essential)
Should have at least one biological child from her marriage
Previous pregnancy should be full-term and uncomplicated.
A surrogate cannot have more than 4 children including her biological children and children born through surrogacy.
Husband’s consent is necessary.
If husband passed away, a death certificate is necessary. Also, the consent of a guardian is necessary.
They should be of a height of 4 feet 10 inches minimum.

3. Counselling of Surrogate

Implication of IVF & surrogacy.
Possibility of multiple pregnancies
Social implications.
Psychological risks.
Sense of bereavement while giving away baby.
Consent in giving up all parental rights over the child.
Possibilities of complications or side effects that may occur during the treatment procedure and pregnancy.

4. Investigations of the Surrogate:

General physical examination: Height, Weight, Pulse, Blood pressure, Temperature, Respiratory System, Cardiovascular System, Per abdominal examination, Per speculum examination, Per vaginal examination
Blood Investigation: CBC, Hb typing to rule out Thalassemia, ABO & Rh typing, Random Blood Sugar, LFT, RFT, Serology (HIV, HCV, HbsAg, VDRL), Thyroid, Prolactin
Others: Urine routine, HSG, ECG, Chest X-Ray, Hysteroscopy, Ultrasound whole abdomen, and 3D TVS.

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