Surrogacy Agencies Research Articles

Navigating the gestational surrogacy seas: the legalities and complexities of gestational carrier services.

This paper offers a comprehensive review of the gestational surrogacy process in the US, as well as internationally, focusing on the legal and ethical challenges that gestational carriers, intended parents, fertility providers, and OB/GYNs may face. The objective of this review article is to serve as an overview and provide information on legal, cultural, and ethical aspects of the decisions to pursue gestational surrogacy both for intended parents and gestational carriers in the US and globally. By understanding the surrogacy landscape and the obstacles, the surrogacy agencies and other involved parties can improve the surrogacy process to better serve all parties involved.

LAW AND ECONOMICS IN SURROGACY MARKETS

The concept of reproductive justice can offer a framework for complex and nuanced analyses of surrogacy, taking into account the agency of surrogates and potential vulnerability of intended parents. When we define surrogacy contracts, we mean the situation in which the fertilized egg of a married couple is inserted into the uterus of a surrogate mother and carried to term by a woman who has no genetic connection with the fetus. Surrogacy contracts offer a way to supply a genetic connection that adoption contracts cannot provide. This paper argues that surrogacy with heavy regulation is a step forward into the future because it incorporates the best legal solution to custody disputes while also attaining the most economically efficient solution. This paper argues the same about surrogacy markets becoming a standard and prudent practice because calling babies a Pareto-efficient exchange that benefits everyone at the expense of no one. Surrogacy can be an excellent option for a set of biological parents who desire a child but cannot carry a pregnancy for health reasons, with potential framework for the psychological and sociological effects of mental health and abortion. The status of surrogacy agencies within the United States allows for heavy legal and economic regulation of surrogacy markets. When the law of contracts and property are incorporated into surrogacy markets, it is easier and more “efficient” for couples to make bargains with surrogate gestational carriers.

Trends in engagement in surrogacy by nationality 2018–2020: a survey of surrogacy agencies

Introduction: Global reproductive destinations are constantly changing, and so is the cross-border reproductive movement of both gametes and intended parents seeking to build families. Quantifying the use of cross-border surrogacy is difficult given no reliable data exists on the global patterns of use of CBRC generally or surrogacy in particular. Methods: Approximately 150 surrogacy agencies in countries offering surrogacy to foreigners were invited to provide consolidated data on the number of commissioning singles and couples who signed with their agency for surrogacy services over the 2018–2020 calendar years, by nationality of the biological intended parent(s). Twenty-four agencies (16%) reported on 5968 clients. Results: Other than the United States, agencies were involved predominately in arrangements for foreigners. In the United States, other than the large domestic market, France, Australia, and Israel were large source countries. Australia and France were also large source countries for Canada. China was overwhelmingly the largest source country engaging in Ukraine. In Georgia, other than Georgian nationals, China, Israel, and the United States were the largest foreign source countries. In Greece, apart from locals, the largest source countries were Italy and Australia. Colombia reported a wide spread of foreign clientele with Israel, the United States, and Canada as the largest. COVID-19 had a significant impact on enrolments in Georgia and Ukraine—each experienced large declines in enrolments when comparing 2019–2020. In contrast, despite travel bans in 2020, agencies in 3 of 4 unregulated countries continued to report increases in enrolments. Conclusions: The global cross-border surrogacy market remains highly volatile, experiencing rapid growth and decline, especially in newer destinations. Source countries providing surrogacy clients are based partly on proximity and cultural ties, but more so on affordability. Further research is required to monitor the effects of engagement in newer destinations with fewer protections.

Postpartum Depression Among Gay Fathers With Children Born Through Surrogacy: A Cross-sectional Study.

Studies on postpartum depression (PPD) in gay fathers are scarce. The goals of this study were to examine the prevalence of PPD among Israeli gay fathers with children born through surrogacy and to identify characteristics associated with PPD in this population. In this descriptive cross-sectional study, we sent surveys to gay fathers who had children who were 0 to 12 months of age and were born through surrogacy. Surveys were sent through 3 major surrogacy agencies in Israel and through the media. Data were collected concerning sociodemographic, medical, and lifestyle factors as well as concerning satisfaction with partners, family, and social support. Each respondent completed the Edinburgh Postnatal Depression Scale, which screens for PPD. Characteristics of fathers with and without probable PPD were compared. Between July 2018 and December 2019, 66 men answered our questionnaire. The respondents, mean age of 37.5 years, were mostly first-time fathers (82%), with high rates of twin pregnancies (42%). Eight respondents (12%) were classified as having depressive symptoms (95% CI: 5.4%-22.5%), and 16 respondents (25%) reported current or past use of antidepressant medications. A negative association was observed between satisfaction with family support and report of depressive symptoms (χ22=6.53, P=0.038) and Spearman correlation test (rs=-0.34, P=0.005). The incidence of probable PPD among gay fathers was 12% compared with 8.8% reported in fathers in the general population. High satisfaction with family support was associated with a lower incidence of probable PPD among gay fathers. Increased awareness of the potential for PPD in gay fathers can improve early diagnosis and treatment.

Global Trends in Surrogacy Uptake by Destination and Nationality 2018–2020

Background: Cross-border surrogacy arrangements are an increasingly common means to family building globally amongst gay male singles and couples, as well as infertile heterosexual singles and couples who do not have significant access to other routes to parenthood. Research has shown that when regulation or affordability in a home state is too restrictive people will travel across borders for surrogacy extensively. Establishing patterns of use has always been difficult. Accurate data is stymied by lack of documentation of international third-party reproductive care available to authorities. In addition, surrogacy destinations have been in a state of flux for some years. Estimating the trends in source and destination countries will improve understanding of the populations whose reproductive care needs cannot be met in their home country. Such data can assist regulators, policymakers and professionals to understand these trends and provide education and policy to minimise risk. Aim: Provide a quantitative estimate of the trends in relation to intended parents engaging in surrogacy arrangements per destination country, in the three calendar years 2018, 2019 and 2020, by country of residence. Method: Surrogacy agencies in Canada, Colombia, Cyprus, Georgia, Guatemala, Kenya, Mexico, Thailand, Ukraine and USA were asked to complete an anonymised online survey providing aggregate data on the number of commissioning singles and couples who contracted for surrogacy services during each year by nationality of the biological parent(s). Results: Over thirty agencies across eight nations reported on a total of 6550 clients commencing over these three calendar years. Clients from 96 source countries were represented. Results showed stark differences in the largest user nations of domestic and international surrogacy per capita, the most commonly used ‘destination’ countries and changes in patterns of engagement over time. Conclusion: Some source countries showed far higher rates of update of domestic or international surrogacy than others. Differences are likely associated with varying access to alternative family building pathways, differences in kinship norms, average incomes and the lack of availability of surrogates in their own country due to obstructive laws and/or cultural norms.

Individual responsibility or trust in the state: A comparison of surrogates’ legal consciousness

Drawing on ethnographic research in the United States and Israel, two countries that have long-term experience with surrogacy, we compare surrogates’ understanding of, approaches to, and expectations about regulation. Women who become surrogates in these two countries hold opposite views about regulation. US surrogates formulate their rejection of standardized regulation—including standardized screening and contracts—by emphasizing their own responsibility for the legal, relational, and medical aspects of surrogate pregnancy. They want more oversight of fertility clinics and surrogacy agencies but ultimately argue for individual accountability. Israeli surrogates, conversely, support centralized government regulation of the practice and even defend Israel’s centralized regulation of surrogacy; many advocate for the extension of the law and the state to assume more responsibility for these arrangements. We discuss these differing formations of legal consciousness in terms of Engel’s conceptualization of “individualism emphasizing personal responsibility” versus “rights-oriented individualism.”

Examining pre-term birth and cesarean section rates in gestational carrier pregnancies.

This study sought to report on the route and gestational age at delivery of gestational carrier (GC) pregnancies with respect to the GCs' prior obstetric history. A retrospective analysis of all GC pregnancies from one of the largest surrogacy agencies in California between 2008 and 2018 was performed. Available demographic data and obstetric history, including a history of prior cesarean section (CS) and preterm birth (PTB), were collected for each GC and correlated to outcomes of the index GC pregnancy. Primary outcomes for the index GC pregnancies included delivery route and gestational age at delivery. Eight-hundred-thirty-six GCs were included in our analysis. 319 (38.2%) delivered via CS, and 517 (61.8%) delivered vaginally. 60 (18.8%) of the CS deliveries were due to multifetal gestation. Primary CS rate in singleton GC pregnancies was 38.5%. In women without a history of CS, neither age, BMI, interpregnancy interval, prior parity, nor year of delivery impacted the primary singleton CS rate (all, P > 0.05). Of GCs with a history of a prior CS (n = 350, 41.9%), 218 (62.3%) had a vaginal delivery after CS (VBAC) and 132 (37.7%) had a repeat CS. Women who had successful VBACs were significantly younger than those who had repeat CS (mean 33.7 vs. 35.2years, P = .003). BMI was lower in patients who had a VBAC compared to those that had a repeat CS (mean BMI 24.6 vs. 25.5, P = 0.074), although this did not reach statistical significance. In GCs with a history of CS, interpregnancy interval, year of delivery, prior parity, and multiple gestation in the index GC pregnancy did not impact mode of delivery. VBAC rates did not change over the study period (P = 0.757). Overall PTB rate was 15.1%. Most PTB in GC pregnancies were in those with a history of PTB, and PTB was more likely in singletons rather than multifetal gestations (76.7% in singletons vs. 30% in multiples) in patients with history of PTB (P < 0.001). Those with no history of PTB and who carried multiples had a low rate of PTB; in fact, in this group, only 1 out of 35 patients had a PTB with multiples. Both primary CS and PTB rates in singleton GC pregnancies are higher than national averages. CS rates are independent of age, BMI, and interpregnancy interval. In GCs with a history of a CS, VBAC rates well exceed national averages and are higher in younger GCs with a lower BMI. PTB rates are impacted primarily by the GCs obstetric history. In those GCs without a history of PTB, rates of PTB are low, even in those with a multifetal gestation.

‘Surrogates All Make that Choice to Help’: Surrogacy in the Neoliberal Reproductive Market

Recent scholarships on neoliberal practices document how, in varied settings, people who would benefit from regulation embrace the neoliberal logic. Drawing on ethnographic research on the largest US online surrogacy support forum I explore surrogates’ discussions of choices and responsibilities. Surrogates maintain that infertile couples, whom they see as emotionally vulnerable, have no choice but to turn to surrogacy. Surrogates claim to be well-informed, intelligent, independent, and empathic woman who assume responsibility for the legal, relational, and medical aspects of pregnancy and reject standardization of ‘surrogacy journeys’. They want more oversight of fertility clinics and surrogacy agencies but ultimately argue for individual accountability. Surrogates’ discussions provide insights into the reasons why practitioners are, in many ways, in alignment with neoliberal ideas and practices: because they are compatible with collective definition of surrogacy as a private rather than a business relationship.

Ideology of simulation: The material-semiotic production of the surrogate in the web worldings of Russian surrogacy

This article examines the webpages of Russian reproductive clinics and surrogacy agencies that offer surrogacy to foreign clients. Theoretically and analytically, the article is anchored in the works of Donna Haraway and Jean Baudrillard. While the websites are conceptualised as worldings, context-dependent ensembles of practices and possibilities articulated via images and text, the main focus of the analysis is the material-semiotic production of the surrogate in these worldings. The analysis reveals material-semiotic eugenics that render the surrogate a simulacrum, thus challenging her status as human.

“Not my child to give away”: A qualitative analysis of gestational surrogates’ experiences

Problem/backgroundLimited empirical data are available on the experiences of women who have been a gestational surrogate. QuestionWhat are the experiences of gestational surrogates along the surrogacy pathway? MethodsAn anonymous study-specific cross-sectional survey was used to evaluate participants’ experience of being a surrogate. A total of 184 Canadian women who were recruited from Canadian surrogacy agencies and the Internet completed the online survey; 9446 words were collected from 110 participants who entered comments to one or more questions. The qualitative data were analyzed through thematic analysis. FindingsSeven main themes, and eighteen interrelated sub-themes grouped under the pre-, during, and post-surrogacy stages were identified. Many surrogates viewed surrogacy as a positive experience and as something meaningful and impactful to other people’s lives. Most surrogates had harmonious relationships with their intended parents and maintained on-going contact with the surrogacy family post birth. DiscussionSurrogacy involves deliberate efforts to establish a trustful surrogate-parent partnership through relationship building, boundary negotiation, and management of expectations. The compatibility between surrogate and intended parents, regarding aspects such as communication and pregnancy management styles, was an important contributing factor to a positive experience. ConclusionOur findings provide a deeper understanding of participants’ reasons for and motivation to be a surrogate, the relationship dynamics with their intended parents and the gestated fetus during surrogacy, and their satisfaction on personal and relationship levels post surrogacy. The findings would be useful to mental health professionals in preparing new surrogates for the potential challenges along the surrogacy pathway.

What's Out There: Surrogacy ForumBook Review

What's Out There: Surrogacy ForumBook Review

A limited market: the recruitment of gay men as surrogacy clients by the infertility industry in the USA.

Gestational surrogacy via egg donation is an expensive – and sometimes ambivalently undertaken – but increasingly popular route to planned fatherhood for some gay men. The surrogacy market in the USA plays an important role for gay men with the financial resources to access these services, as it is currently the only stable, commercial market in which there are legal protections for openly gay men. While a small, ethnographic and qualitative literature on the experiences of gay fathers via surrogacy exists, less is known about the state of the surrogacy industry towards gay men as clients. Here I investigate the surrogacy industry in the USA to ask how welcome gay men are in this market. I do so via a content analysis of patient/client recruitment on infertility clinic and surrogacy agency websites. Content analysis of 547 websites indicates that the majority of infertility clinics (62%) and 42% of surrogacy agencies do not directly advertise or appear to be welcoming to gay men. A minority of gay-friendly clinics and agencies, which cluster geographically, actively recruit gay men, creating a limited but niche market. The unequal recruitment of gay men as infertility clients reflects how normative ideas about gender, sexuality and social class are reproduced in the infertility industry. This, in turn, may impact gay men's procreative consciousness and decision-making about parenting, and exacerbate inequalities around their access to intentional genetic parenthood.

Privatizing procreative liberty in the shadow of eugenics.

The late John Robertson is renowned for the theory of ‘procreative liberty’ that he expounded in his pioneering book, Children of Choice. Procreative liberty captures the ‘freedom to reproduce without sex’ above and beyond the ‘freedom to have sex without reproduction’ that are recognized by constitutional rights to abortion and birth control. Most controversial among Robertson's work on procreative liberty was its application to prenatal selection. Unless the state had very good reasons, he argued, people should be free to access reproductive medicine or technology to have a child who or would be born with particular traits. Prospective parents in the USA today face no official limits in using sperm banks, egg vendors, IVF clinics, or surrogacy agencies with an eye toward choosing for certain characteristics. But should they be protected, this essay asks, when mix-ups or misdiagnoses thwart the selection of offspring traits? The best answer to this question extends the theory of procreative liberty from government restrictions to professional negligence. It also demands sensitivity to genetic uncertainty, the limits of private law, and the history of eugenics in America. Or so I argue in this tribute to the inimitable John Robertson.

Labor of Love: Gestational Surrogacy and the Work of Making Babies. By Heather Jacobson. New Brunswick, N.J.: Rutgers University Press, 2016. Pp. x+203. $90.00 (cloth); $28.95 (paper).

<i>Labor of Love: Gestational Surrogacy and the Work of Making Babies</i>. By Heather Jacobson. New Brunswick, N.J.: Rutgers University Press, 2016. Pp. x+203. $90.00 (cloth); $28.95 (paper).

For love or money? Australian attitudes to financially compensated (commercial) surrogacy.

Australian law allows for altruistic surrogacy but prohibits compensation of surrogates beyond their expenses, or the use of professional surrogacy agencies. These restrictions limit local access to surrogacy, driving Australians overseas where they can access commercial surrogacy. To assess the Australian public's views regarding the use of gestational surrogacy under various social and medical scenarios, together with their level of support for financial compensation of surrogates and the use of professional surrogacy agencies. Online survey of 500 Australians of reproductive age (18-49 years) regarding views on surrogacy and acceptable levels of compensation, conducted during January 2016. The majority of respondents supported access to surrogacy for couples, irrespective of a couple's marital status or sexuality, with only 9% believing that surrogacy was unjustified under any circumstances. Of those who held a view on compensated surrogacy, over half (58%) believed the current ban was unjustified, with close to two-thirds (62%) also believing that Australians should be allowed to access commercial surrogacy overseas. In relation to compensation, most believed that payment should be determined by negotiation between the surrogate and commissioning parents, while also supporting additional payments for 'hardship' pregnancies. Half of the surveyed cohort supported the legalisation of professional surrogacy agencies, with only 17% being totally opposed. The majority of Australians support surrogacy, compensation for surrogates and professional surrogacy agencies. Therefore, the existing legal restrictions should be replaced with professional guidelines that protect the surrogate and commissioning parents, while also improving Australians' access to surrogacy.

Views of Swedish commissioning parents relating to the exploitation discourse in using transnational surrogacy.

Transnational surrogacy, when people travel abroad for reproduction with the help of a surrogate mother, is a heavily debated phenomenon. One of the most salient discourses on surrogacy is the one affirming that Westerners, in their quest for having a child, exploit poor women in countries such as India. As surrogacy within the Swedish health care system is not permitted, Swedish commissioning parents have used transnational surrogacy, and the majority has turned to India. This interview study aimed to explore how commissioning parents negotiate the present discourses on surrogacy. Findings from the study suggest that the commissioning parents’ views on using surrogacy are influenced by competing discourses on surrogacy represented by media and surrogacy agencies. The use of this reproductive method resulted, then, in some ambiguity. Although commissioning parents defy the exploitation discourse by referring to what they have learnt about the surrogate mother’s life situation and by pointing at the significant benefits for her, they still had a request for regulation of surrogacy in Sweden, to better protect all parties involved. This study, then, gives a complex view on surrogacy, where the commissioning parents simultaneously argue against the exploitation discourse but at the same time are uncertain if the surrogate mothers are well protected in the surrogacy arrangements. Their responses to the situation endorse the need for regulation both in Sweden and India.

Egg donors working with gestational surrogacy agencies: motivations and personality traits

This study investigates motivations and personality characteristics of egg donors working with gestational surrogacy agencies. The personality traits of egg donors and non-donors from a demographically matched sample of women were examined.

The Desire for Parenthood

Gay men are becoming increasingly involved in reproduction despite significant barriers limiting their access to reproductive technologies or legal parentage in many jurisdictions. Based on in-depth interviews with gay men in the United States and Australia who have become parents through surrogacy, I explore how gay men understand their desire to have children and what frames their parenthood experiences. The notion of choice is widespread in understandings of gay parenthood and family formation. Most of the men in this study did not develop a “procreative consciousness” as a result of sexual and fertility-related events. The majority also initially accepted the notion that homosexuality was synonymous with childlessness. Awareness of the possibilities for parenthood emerged over time through the promotional activities of surrogacy agencies, through media, peers, and relationship partners. Additionally, men played with the symbols of kinship to negotiate and obscure biogenetic paternity.

The changing profile of surrogacy in the UK – Implications for national and international policy and practice

Since 2007, the numbers of UK Parental Orders granted following surrogacy have markedly increased. More recently, eligibility criteria have been extended to unmarried heterosexual couples and same-sex couples rather than only married couples. Numbers seeking fertility treatments, including through surrogates, outside their country of residence have also increased. This paper presents the limited data currently available – from UK General Register Offices, Child and Family Court Advisory and Support Service for England and the UK surrogacy agencies: COTS, Surrogacy UK, British Surrogacy Centre – to consider potential reasons for the increase and to consider policy and practice implications. It charts the apparent decline in involvement of surrogacy agencies and suggests the potential for exploitation where scrutiny of arrangements and follow up are limited. It recommends improvements to data collection and argues the need for a more integrated approach to review of surrogacy arrangements both nationally and internationally.

Working at the Margins: The Views and Experiences of Court Social Workers on Parental Orders Work in Surrogacy Arrangements

Unlike many contemporary social work tasks, the work of Parental Order Reporters (PORs) in surrogacy cases in England is infrequent and unresearched. This study offers insights into how experienced social workers approach work in little-regulated but ethically complex contexts outside the mainstream. Sixteen PORs took part in telephone interviews about their experiences in providing court reports on over 135 applications. There was little evidence of controversy about surrogacy, but there were variations in approaches to the task, including that of financial scrutiny. Perceptions of risk arising from genetic difference were thought to be low in light of apparently strong parent– child bonding, commitment of commissioning parents, openness with the child about their origins and awareness of longer-term identity and contact needs. Concern about parents’ potential to achieve the latter was limited. However, concerns about the impact on surrogates’ children and PORs’ constraints of entering the process too late were high. Findings suggest a need for regulation of surrogacy agencies and improved child-focused suitability assessments and preparation of surrogates and commissioning parents, including external scrutiny. More reference to courts over financial aspects and increased use of analytic, research-informed approaches by PORs is also indicated.