A surrogate woman is one who carries a pregnancy for another couple or woman.
Surrogacy is medically and emotionally complex process requiring evaluation by medical and legal professionals to ensure that procedure is beneficial to both intended parents and Surrogate.
History of Surrogacy dates to Old Testament of Holy Bible, when Biblical Sarah was unable to conceive and was helped by the maid, Hagar who was impregnated by Sarah’s Husband.
First Baby born by Gestational surrogacy is from the USA in 1985.
Surrogacy is in practice in India since 2002.
Definitions as per ICMR guidelines
Surrogacy means an arrangement in which a woman agrees to pregnancy, achieved through assisted reproductive technology (ART), in which neither of the gametes belongs to her or her husband, with the intention to carry it and hand over the child to the person or persons for whom she is acting as a surrogate.
Surrogate mother means a woman who is citizen of India and is resident in India, who agrees to have an embryo generated from the sperm of a man who is not her husband and the oocyte of another woman, implanted in her to carry the pregnancy to viability and deliver the baby to the couple / individual that had asked for surrogacy.
Surrogacy Agreement means a contract between the person(s) availing of assisted reproductive technology and the surrogate mother.
Types of Surrogacy Agreements
Traditional surrogacy (Natural or partial surrogacy) is not accepted by Law.
Gestational or IVF or Full surrogacy: in which surrogate carries a pregnancy created by transferring an embryo created by sperm and egg of intended parents (donor sperm or egg can be used ) in IVF lab. The gestational surrogate has no genetic relationship with the child.
Commercial surrogacy: In this, the surrogate is paid over and above the necessary medical expenses.
Altruistic Surrogacy: Surrogate is paid only the necessary pregnancy-related expenses. Generally, this agreement requires surrogate related to the couple.
Indications for Gestational Surrogacy
Women having naturally functioning ovaries but lack uterus Congenital absence of uterus Prior hysterectomy due to benign or malignant conditions or due to postpartum haemorrhage.
Women with a history of repeated pregnancy loss or repeated IVF failures.
Women with untreatable Asherman syndrome.
Women with medical contraindications to pregnancy.
ICMR Guidelines:
Couple
A person or persons availing surrogacy services is legally bound to accept the custody of child or children irrespective of any abnormality that child or children may have
The couple should have at least one gamete of their own in the creation of embryos
The couple cannot have services of more than one surrogate at any given point of time
The couple cannot have a simultaneous transfer of embryos in woman and surrogate both
The commissioning parents have to ensure that the surrogate and the child or children that she delivers are appropriately ensured until the time of handing them over to the commissioning parents or another person as per the agreement and till the surrogate is free of health complications arising out of surrogacy
Selection of Surrogate
The gestational carrier should be between 21 and 35 years of age but can be taken to 45 years.
Surrogate should have a stable social environment and have delivered a live born child at term.
Severe medical disorder or a personal habit like smoking, alcohol, drug abuse is ruled out.
Women should satisfy all testable criteria to go through a successful term pregnancy.
Evaluation of the uterine cavity is done.
The woman is screened for infectious diseases and should have not received blood or blood products in the last 6 months.
Psychological assessment of surrogate is done.
Consent of the spouse is a must.
No woman can act as a surrogate for more than five successful live births in her life including her own children.
In the case of a relative acting as a surrogate woman should belong to the same generation as that of a surrogate.
Maximum three embryo transfers from the same couple are permitted the same surrogate
Surrogate cannot act as an egg donor for the same couple.
Should not engage in any act harmful to the foetus.
