What is Surrogacy?
The term surrogacy is used when a woman carries a pregnancy and gives birth to a baby for another woman. Opinions on the morality of surrogacy are divided. Surrogacy is legally accepted in many countries as a treatment option for selected groups of patient. The use of surrogacy in Nigeria is steadily on the increase for the informed infertile couples.
IVF SURROGACY (GEATATIONAL CARRIER) or full surrogacy is a situation where a woman carries a pregnancy created by an egg and sperm of genetic couples. The carries is not genetically related to the child.
NATURAL SURROGACY (TRADITIONAL SURROGACY) is a situation where the surrogacy is inseminated with sperm from the male partners of an infertile couple. The child that results is genetically related to the male partner but not to the commissioning female partner.
INDICATION FOR SURROGACY: There are several groups of patients that the natural and IVF surrogacy may be advised to
IVF SURROGACY: Is advised in women whose ovaries are producing eggs but they do not have uterus. This could be because they have had hysterectomy (removal of uterus) performed due to fibroids, cancer, and severe haemorrhage or ruptured womb, they were born without a uterus.
This is the most common reasons for IVF surrogacy.
– A woman whose uterus is malformed or damaged and incapable of carrying pregnancy to term may be recommended for IVF surrogacy.
– Woman who suffer from medical problems such as severe Diabetes, heart problem, kidney disease and in whom a pregnancy may be life threatening
– Woman with repeated and investigated miscarriages may also benefit from IVF surrogacy.
TRADITIONAL SURROGACY: This is advised in women who have np functioning ovaries due to premature menopause (although egg donation is sometimes the best option for the group of women). A woman is at risk of passing on a genetic disease to her offspring may opt for traditional surrogacy. As with IVF surrogacy, women who suffer from medical conditions such as diabetes, heart and kidney diseases and in whom pregnancy could be life threatening may select traditional surrogacy if their long term prospect for health is good.
SURROGACY FOR SOCIAL REASONS SUCH AS THE INCONVENIENCE OF CARRYING A CHILD, FEAR OF PREGNANCY OR INTERUUPTING A CAREER IS NOT ACCEPTABLE.
Women who agree to become a surrogate may do so for compassionate reasons to help a sister, daughter or friend. Some women may agree to become surrogates for financial remuneration. Commercial surrogacy is not allowed in the UK. There are no laws against it in many countries including Nigeria.
PROTOCOLS AND GUIDELINE FOR MANAGING SURROGACY: Most infertility clinics that offer surrogacy have protocols and guidelines for managing surrogacy. Consultation with the fertility expert to assess
Whether the couples are medically suitable for treatment is essential. An in depth medical history from both partner and physical examination is normal. The male partner will have a semen analysis.
Assessment of the host carrier is essential. The ideal surrogacy should
-Be married or in a stable relationship and relatively young
-Should be less than 38 years old to minimize the obstetric risk to the host and her family.
-Should at least have one previous live birth without complications.
-The surrogate womb is evaluated with ultrasound scan or Hysteroscopy. A psychological evaluation of the surrogate is also essential. An independent counselling is also essential.
SCREENING BEFORE SURROGACY TREATMENT
The genetic woman, genetic couple, female host and host couple must all be screened before beginning surrogacy treatment. The genetic woman may have blood tests and ultrasound scan to assess her ovaries and ovarian function. All screening for Rhesus, HIV, and Hepatitis are also performed before treatment.
SOURCES OF SURROGATES
In the majority it is the responsibilities of the genetic couples to find their own host. The surrogate can be known or anonymous known surrogates can be relatives such as sisters or friends. Anonymous surrogates can be arranged privately by fertility clinic or agencies known to the fertility clinics
SURROGACY PROCEDURE
IVF surrogacy
This is straight forward. It involves the commissioning woman undergoing IVF treatment, fertilizing her egg with her partner’s sperm. Then the subsequent embryo transfer into the surrogate (host) uterus
TRADITIONAL SURROGACY
This involves the insemination of the male partner’s sperm into the surrogate’s uterus (IUI) using washed and prepared sperm. The costs of IVF surrogacy and traditional surrogacy varies, but legal fees are to be considered. Because of the high cost of surrogacy in Europe and USA many western women and Nigeria in Diaspora are outsourcing treatment abroad in India and Nigeria where the cost of having a surrogacy is affordable.
LEGAL ISSUES
Both couples (commissioning and host) should take legal advice. Although contracts and agreements of surrogacy are not blind in law, most infertility clinics would insist on obtaining written consent from both parties before accepting them for treatment. It is important for couples to recognize that the woman who carries the child is also a mother. Consequently a surrogate cannot be compelled to hand over the child. Similarly, if the commissioning couple decide to reject the child, it remains the responsibility of the surrogate. All couples contemplating surrogate must be aware of the small possibility of bonding between the surrogate and the child and she can change her mind. Like every pregnancy, it is impossible to predict the outcome. If a fetal abnormality is diagnosed during the pregnancy, by law, only the woman who is pregnant can give consent to termination of pregnancy. Would the genetic couples accept an abnormal child? The genetic couples have a responsibility to the surrogate (host). No pregnancy is without risk. The welfare of the surrogate and her family must be protected e.g. insurance policy. A guardian ideally should be arranged in case the commissioning couples die before the child is born. Surrogacy agreement will continue to require goodwill on both parties and the genetic couples will ideally have to seek a change in parentage through the court. After the baby is delivered.
