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WHO NEEDS SURROGACY?
Unfortunately, many couples are unable to have their own
children. Up
until the last couple of decades, those couples had only two
alternatives: adopt or remain childless. Today, due to advances
in reproductive
technology, couples now have medical means to have children.
Reproductive
techniques such as artificial insemination, in vitro
fertilization/pre-embryo transfer (IVF/ET, also known as
test-tube babies) and other Advanced Reproductive Technologies
(ART) allow otherwise infertile couples a chance to have
children.
However, there are still some couples for whom these techniques
are not
successful and for whom adoption is not an attractive or viable
option.
These couples may still wish to have children who are their
genetic
offspring. Often the mother cannot give birth for reasons that
may include
lack of a uterus or where pregnancy would be medically risky.
For these
or other reasons, the only way to have genetic offspring is to
have
another woman carry and give birth to their child: a Surrogate
Mother. The
couple wishing to obtain a child through a surrogacy arrangement
are often referred to in the law as "Commissioning Couple" or
"Intended Parents."
HOW DOES A SURROGACY WORK?
There are two types of surrogacy. 1). A genetic surrogate is
where the
surrogate mother is also the biological mother. This is where
surrogate's eggs are and inseminated (usually artificially) with
the intended
father's sperm. 2). A gestational surrogate is where both the
egg and
sperm of the intended parents are joined and the pre-embryo(s)
are placed
into the surrogate who will carry and deliver the child. The
gestational surrogate has no genetic link to that child.
The medical technique for gestational surrogacy most commonly
used is
IVF/ET and/or its variations. Details of this procedure, along
with its
risks, should be discussed with a qualifies Reproductive
Endocrinologist who performs such procedures.
WHO CAN BE A SURROGATE?
This is basically a medical question and the Reproductive
Endocrinologist is the person who evaluates the surrogate's
medical qualifications.
Generally, the surrogate should be a healthy woman who is
capable of a
safe pregnancy and delivery.
WHERE DOES ONE FIND A
SURROGATE?
Since a surrogate cannot be paid a fee for being a surrogate,
she will
be someone who is motivated by something other than money: i.e.
a
relative or close friend of the intended parents. Surrogates
cannot be
obtained through or by some other paid intermediary. Thus the
intended
parents will usually find the surrogate. Some Reproductive
Endocrinologists
keep lists of women who may consider being a surrogate.
WHAT CAN A SURROGATE BE
PAID?
She can be reimbursed for any expenses or losses due to the
surrogacy
such as all medical and psychological care costs, living costs,
prenatal
care, maternity clothes, transportation costs and possibly lost
wages
directly resulting from her role as a surrogate.
HOW IS THE PREGNANCY MANAGED AND WHO MAKES THE DECISIONS?
After pregnancy is achieved, the surrogate's care is managed by
an
obstetrician of the surrogate's choosing. While the intended
parents
usually pay for the OB and may be involved in the surrogate's
care,
ultimately the surrogate has final control over her care.
WHAT ABOUT AMNIOCENTESIS
AND ABORTION?
These decisions are also made solely by the surrogate. It is
expected
that prior to entering into a surrogacy arrangement, the
surrogate and
intended parents will discuss these matters in detail. An
amniocentesis
may be advisable even if the surrogate is young since the eggs
and
sperm may be from an older couple. Issues such as abortion if
the fetus has
genetic defects should be thoroughly discussed in advance
between the
parties so that if any when a decision is required the decision
made by
the surrogate will be one everyone agrees with.
WHAT IF THE CHILD IS BORN
WITH BIRTH DEFECTS?
As with a traditional pregnancy and birth, the responsibility
and care
will be with the intended parents. The surrogate will have no
responsibility after birth even if the birth defect(s) may have
been caused by
some activity or behavior of the surrogate.
WHAT IF IT IS DISCOVERED
THAT THE CHILD IS GENETICALLY THE SURROGATE'S?
If it turns out that the child is genetically the child of the
surrogate (in a gestational surrogacy), then the surrogate has
the
responsibility for the child after birth (as does the intended
father if he is the
biological father). If the intended parents still wish to have
the
child, they must go through an adoption.
WHAT HAPPENS IF PREGNANCY
IS NOT ACHIEVED OR THERE IS A MISCARRIAGE?
If pregnancy is not achieved or there is a miscarriage, the
parties can
try again as often as they agree.
ARE THERE ANY MEDICAL RISKS
TO THE INTENDED PARENTS OR SURROGATE AND SHOULD ADDITIONAL
INSURANCE BE OBTAINED?
Any and all risks should be thoroughly discussed with the
Reproductive
Endocrinologist. The medical risks to the intended parents are
generally very low (though in a gestational surrogacy there may
be some related
to egg retrieval). The risks to the surrogate are normally those
associated with any pregnancy and delivery. All parties should
attempt to
have applicable medical and hospitalization insurance in place,
including
maternity coverage, to cover all anticipated medical
contingencies.
WHAT ARE THE COSTS AND WHO
WILL PAY THEM?
The costs can be extensive and will vary depending upon the
circumstances involved in each surrogacy. Typically they involve
the following:
medical costs of evaluation, both medically and psychologically;
costs of
the procedure in getting pregnant; prenatal care and delivery;
legal
fees; and, reimbursements to the surrogate. The total costs will
usually
be no less than $15,000.00 and average around $21,000.00 in
gestational
surrogacies. For genetic surrogacies, the costs are considerably
lower
since the medical techniques to achieve the pregnancy are much
lower.
These costs are the responsibility of the intended parents.
Insurance
coverage should be used or obtained, to mitigate these costs.
WHAT GUARANTIES AND
SAFEGUARDS ARE THERE?
As for the medical certainty of getting a child, only a
Reproductive
Endocrinologist can answer that for each case. As for legal and
monetary
safeguards, a written contract should be prepared by an
attorney.
In a gestational surrogacy the intended parents take custody of
the
child immediately after delivery. They immediately petition the
Court for
approval of the agreement and notify all persons interested
including
the surrogate and Reproductive Endocrinologist. The Court will
examine
the agreement and the facts of the case and, barring unforeseen
difficulties, confirm the parentage of the intended parents as
the legal
parents.
In a genetic surrogacy the intended parents go through a
modified
adoption procedure. A consent (after delivery of the child) is
obtained from
the genetic surrogate. Then a petition is filed for adoption
naming all
appropriate parties including the intended parents, the genetic
surrogate and the surrogate's spouse (if any). In some instances
HRS is
notified in advance to do a home study, though often after
delivery they
treat the adoption as a step-parent adoption (since the intended
father is
the biological father) and thus bow out of further involvement.
The
Court reviews the case and if approved, names the intended
parents as the
legal parents and orders the issuance of a new birth
certificate. This
procedure is more involved and takes longer than that involved
in a
gestational surrogacy. Furthermore, the home study and
background
investigation by HRS or other approved agencies must be
completed prior to the
child going home with the intended parents. Thus this should be
done in
advance of delivery. If it in not, the attorney involved with
the
procedure must procure temporary housing for the child.
HOW WOULD I GET INVOLVED IN
A SURROGACY ARRANGEMENT?
If you are reading this, you may have already taken the first
step
which is to see a Reproductive Endocrinologist to determine if
surrogacy is
a viable medical option. If so, a surrogate must be obtained.
During
the medical and psychological evaluation the intended parents
and
surrogate should seek the counsel of independent attorneys
knowledgeable in
this area of the law to discuss the legal requirements and
ramifications
of surrogacy and draw up the appropriate documents.
Surrogacy involves a great deal of emotional, physical and
financial
commitment over a long period of time. Before entering into such
an
arrangement, all parties should examine the consequences.
Communication is
very important to determine if everyone's philosophy and goals
are the
same, especially between the intended parents and surrogate.
Therefore,
no question is too dumb or embarrassing to ask.
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