What can go wrong with surrogacy?

I think it’s a very, very important consideration that all couples who wish to go through a surrogacy arrangement should consider before they actually make a firm decision to go down this route. The most important consideration would be where to have your treatment.

Any surrogacy arrangement you have in an unlicensed setting will not give you the legal right to be the parent of a child. So when choosing a clinical, you’ll need to ensure in the UK you have a treatment with an HFEA licensed clinic so that you can ensure you can be the legal parent of the child at the end of the arrangement.

If you’re choosing clinics abroad, as part of the International Surrogacy, you need to ensure a few aspects.

1. One of them is if surrogacy is legal in the country in which you wish to have the treatment.
2. Number two is if you have the treatment there, whether there is an arrangement that if you can legally bring the child and this arrangement will be acceptable by the family court in the United Kingdom.

These are some of the important things you need to consider when you’re just choosing a clinic or a setting where you wish to have your treatment.

The other important considerations would be that there is a remote, but a very real possibility, that the host surrogate may decide not to hand over the child at the end. This is probably at the top of the mind for most of the patients going through it, “What if I do not have my child?”

The other consideration, while I may say it’s minor, but still extremely important to consider, would be is when doing is a surrogacy arrangement to ensure that you have a candid discussion with the host surrogate because if there were to be any obstetric complications, your views and the host surrogate’s views should be in concurrence. For example, if there is a congenital abnormality or birth defect of a child you may wish not to have the child, but the surrogate might not want to go through a termination because of the psychological consequences. You have to understand that the responsibility of the obstetric team or the fetal medicine team in such situation lies with the host surrogate and not with yourself.

For example, if there is a congenital abnormality or birth defect of a child you may wish not to have the child, but the surrogate might not want to go through a termination because of the psychological consequences. You have to understand that the responsibility of the obstetric team or the fetal medicine team in such a situation lies with the host surrogate and not with yourself.

That is something you need to consider when you are putting in place a surrogacy arrangement. The other one important consideration, if during the course of the surrogacy arrangement or during the course the pregnancy, if the surrogate where to have a life-threatening complication or for some reason lead to an unexpected adverse event, there is an exposure to yourself.

So you should put in place adequate insurances and life insurance, not only for yourself but also for the surrogate’s family. These are some important consideration you should consider ways in which surrogacy can go wrong.

How does surrogacy work?

Surrogacy is an assisted conception treatment option that is of relevance to a certain subgroup of patients. First of all, to consider how the surrogacy works it is important to understand who needs this treatment. Patients who have had a hysterectomy either for benign causes or for malignant

Patients who have had a hysterectomy either for benign causes or for malignant causes are the ones who should bear in mind that they might need this, especially when they had not completed their family by the time the hysterectomy was performed.

The other group of patients would be those who have been through cancer treatments or who have been exposed to chemoradiotherapy and us as part of this treatment the pelvis could not be protected and that has damaged the lining the womb where the implantation of the embryo is unlikely or hasn’t happened after a few treatments; then surrogacy is something they want to have to consider.

The other group of patients could be those who have medical illnesses and some of these illnesses could worsen. Or, on some occasions, these diseases can be life-threatening and then the carrying of the pregnancy can be life-threatening. Then for such patients surrogacy should be considered, which will give them an option to have their family without increasing the morbidity from their medical illness or even making it life-threatening.

Surrogacy also gives a family building option to male gay couples who want to have families.

After seeing who actually needs surrogacy, the first step is involved is you need to see a fertility specialist to understand the complexities of surrogacy. This area tends to be more complex – more from a non clinical point of view rather than from a clinical point of view.

Once you’ve seen the consultant or fertility specialist and you feel that this is still the way that he want to go then the next step probably for you would be to identify suitable surrogate.

Once you’ve identified the surrogate, then as a commissioning couple, you will be going through the screening test for infections because when we are creating these embryos and replacing them back, you’re effectively acting as an embryo donor or the gamete donor.

So in order to minimise the risk of exposure to the host surrogate, you are screened for a range of conditions. You may also be advised to quarantine either the sperms or the embryos based on what you prefer for a certain period of time, so the possibility of transmitting infectious diseases can also be minimised.

Once you have quarantined the sperms your case will also be considered usually by the clinic and ethical committee, and once all these have been considered and the arrangement has been approved then you would actually start the process of the treatment.

Once you start the process, then based on the arrangement that’s in place as to

• who the gamete providers will be,
• who the surrogate is,
• whether the surrogate wishes to have a frozen embryo transfer, or
• it would be a fresh transfer.

We will synchronise all the cycles together and then take you through the treatment.

The overall processes can take from the very first step to actually having an embryo transfer into the surrogate can take from to three to six months. Sometimes it may take longer. The important points during this course you also need to consider taking the advice of a family solicitor to ensure that you would be eligible for the parental order application, that would give you the right to be the legal parent of a child.

These are briefly some of the considerations that you need to consider in mind before going for a surrogacy arrangement. Obviously, many of these can be discussed in detail at your consultation.