Surrogacy is one of the most complex methods of assisted reproduction. It involves a woman – the surrogate mother – who carries and delivers a child for another couple or individual who cannot carry a pregnancy themselves. Although this practice has brought hope to thousands of families worldwide, it remains the subject of numerous legal, ethical, and medical debates.
What is surrogacy?
Today, when we talk about surrogacy, we usually mean gestational surrogacy. In this approach, the surrogate mother carries an embryo created through in vitro fertilization (IVF) using the eggs and sperm of the intended parents or donors. The surrogate has no genetic link to the child. This form of surrogacy is the standard practice worldwide, as it avoids many legal and ethical complications associated with older forms of surrogacy.
Why choose surrogacy?
Surrogacy is an option for couples and individuals facing:
• Medical contraindications to pregnancy (e.g., severe congenital or acquired uterine diseases, heart conditions)
• Recurrent miscarriages
• Previous failed attempts at IVF
• Same-sex couples or single men who want a biological child
Medical aspects
The medical procedures involved in surrogacy are the same as in standard IVF. The embryo is created from the intended parents’ (or donors’) gametes and transferred to the surrogate’s uterus.
Key challenges include:
• Medical risks for the surrogate (as with any pregnancy – preeclampsia, gestational diabetes, cesarean section)
• Psychological preparation and support
• Ensuring quality prenatal and postnatal care
Legal frameworks
The legal regulation of surrogacy varies significantly between countries:
• In some countries (e.g., Ukraine, Georgia, certain U.S. states) surrogacy is legal and regulated.
• In others (e.g., Germany, France, Austria) it is completely prohibited.
This creates so-called ‘reproductive tourism’ – couples travel to countries where surrogacy is legal but later face complicated procedures to establish parenthood in their home country.
Ethical dilemmas
Surrogacy raises numerous ethical questions:
• Are surrogate mothers economically exploited?
• How are the rights of the surrogate mother and the child protected?
• Is it justified to commercialize reproduction?
International organizations such as ESHRE (European Society of Human Reproduction and Embryology) highlight the importance of ethical standards, transparency, and the protection of all participants in the process.
Conclusion
Surrogacy offers hope to many families who would otherwise have no possibility of having a biological child. However, the legal and ethical challenges make it one of the most controversial issues in modern reproductive medicine. The future of surrogacy depends on global efforts to balance the rights of intended parents, surrogate mothers, and the best interests of the child.
References
Brinsden, P. R. (2003). Gestational surrogacy. Human Reproduction Update, 9(5), 483–491. https://doi.org/10.1093/humupd/dmg029
Pennings, G. (2016). International surrogacy: Between prohibition and regulation. Reproductive BioMedicine Online, 32(6), 593–601. https://doi.org/10.1016/j.rbmo.2016.03.003
Shenfield, F., Pennings, G., Cohen, J., Devroey, P., de Wert, G., & Tarlatzis, B. (2005). ESHRE Task Force on Ethics and Law 10: Surrogacy. Human Reproduction, 20(10), 2705–2707. https://doi.org/10.1093/humrep/dei147
Teman, E. (2010). Birthing a mother: The surrogate body and the pregnant self. University of California Press.
Zegers-Hochschild, F., et al. (2017). The International Glossary on Infertility and Fertility Care, 2017. Human Reproduction, 32(9), 1786–1801. https://doi.org/10.1093/humrep/dex234