The use of surrogacy as a family building technique dates back to the Bible itself. Modern surrogacy, however, is different than in the ancient story of Abraham, Sarah and Hagar. Current references to surrogacy, so commonly discussed in today’s media, refer specifically to gestational surrogacy. This treatment involves nothing particularly new in assisted reproduction, but is rather a new way of looking at creation of a family. In gestational surrogacy, IVF is done for the intended parents (the “IP”) using standard techniques, but the resulting embryo is transferred to the uterus of a gestational carrier (the “GC”), a woman who is usually unrelated to the IP. When successful, the GC conceives and carries the pregnancy to term. After delivery, the baby is given back to the IP, who are the true biological parents.
Gestational surrogacy was developed initially as treatment for women who were either born with an abnormal uterus, or no uterus at all, or who had undergone hysterectomy. Most of these women are otherwise fertile, meaning that their ovaries and egg reserve are completely normal; they simply lack a proper organ in which to gestate their embryo. Today, the indications for surrogacy have expanded to include women in whom pregnancy would be dangerous due to medical conditions and women who suffer from recurrent pregnancy loss due either to immunological disorders or for other reasons and who do not respond to more traditional interventions. Some women also use donor eggs to establish pregnancy in the GC, but in gestational surrogacy the egg donor and the GC are never the same person (due to the legal and ethical quandaries that might ensue from such an arrangement). This is also the case for same-sex male couples who wish to start a family and who need both a donor to provide the egg as well as a GC to carry their child. Clearly there are some single women and men who have also had children in this way.
As mentioned, the techniques involved in surrogacy are standard and well-established. The issues surrounding surrogacy are mainly ethical and legal. Most surrogacy arrangements involve payment to the GC for legal and medical expenses and also to compensate them for the time they take to go to doctors, which may cause them to miss work. Payment also is meant to compensate them for the risks and discomfort of pregnancy. Some feel that surrogacy for pay exploits women and may coerce them to accept the physical risks (of pregnancy) in exchange for payment. This is not, however, the way most GCs describe their experience. Although they generally are paid for the time and risks they take, many if not most describe the overwhelming joy they feel for giving someone else a gift that is ultimately priceless. At GENESIS, we believe that all women should have autonomy over the medical decisions they make, including the choice to become a GC. We note that many in our society accept payment for risks of their employment (police officers, firefighters, flight attendants would be a few examples). In the case of the GC, we believe that NOT paying would be exploitative and unethical.
Currently in New York State, gestational surrogacy is not considered unethical and is allowable by law. However, for historical reasons any surrogacy arrangement for pay is considered illegal. This has caused much pain and inconvenience to many couples who, without surrogacy, cannot have a family. Leaving the state for such services is not only expensive and inconvenient but poses many legal obstacles once the baby returns to his or her IP. Currently in New York State, a child born as a result of paid surrogacy in another state must be legally adopted in order to be recognized as the legal child of his or her true biological parents. This situation will hopefully change with passage of the Child-Parent Security Act. The physicians at GENESIS have been working hard with the patient advocacy group RESOLVE to raise awareness about this pending legislation in Albany.
Pending passage of new legislation, we at GENESIS will honor requests to commence surrogacy treatment provided that it is done within the current legal boundaries, i.e. with an altruistic (unpaid) gestational carrier. These arrangements also require involvement of an attorney for both parties. Therefore, as part of the surrogacy treatment process we require that all patients requiring surrogacy consult with an experienced reproductive attorney.