Surrogate Mothers: What They Are and How Surrogacy Works

1. What Is Surrogacy?
2. Who Are Surrogates? Types of Surrogacy
3. How Does a Surrogate Mother Participate in a Program?
4. Who Uses Surrogacy?
5. The Surrogacy Process and Medical Screening
6. Cost of Surrogacy
7. Legal Aspects of Surrogacy
8. Surrogacy Agreements and Parental Rights
9. Traditional Surrogacy
10. Gestational Surrogacy
11. How to Find a Surrogate Mother
12. Requirements for a Surrogate Mother

In gestational surrogacy, the surrogate does not provide her own egg and therefore has no genetic relationship with the child. The embryo is created through IVF using eggs from the intended mother or an egg donor and sperm from the intended father or, where applicable, a sperm donor.

How legal parentage is established depends on the applicable law and can vary significantly from one country to another.

Surrogacy can provide a path to parenthood when carrying a pregnancy is impossible or would pose a serious health risk. In certain circumstances, it also allows intended parents to have a child who is genetically related to one or both of them.

To better understand the process, we explain what surrogacy is, who surrogate mothers are, the different types of surrogacy, how a gestational carrier participates in a program, and the medical and legal considerations intended parents should take into account.

What Is Surrogacy?

Surrogacy is a medical, legal, and reproductive arrangement in which a woman agrees to carry a pregnancy for another person or couple who intend to become the child’s parent or parents.

Depending on the jurisdiction, the arrangement may be altruistic, with reimbursement of permitted pregnancy-related expenses, or may allow compensation for the surrogate within the limits established by applicable law.

Surrogacy laws differ considerably between jurisdictions. For international programs in particular, both the medical process and the rules governing the establishment and recognition of legal parentage should be considered before treatment begins.

Who Are Surrogates? Types of Surrogacy

Surrogate mothers, also known as surrogates or gestational carriers depending on the type of arrangement, are women who agree to carry a pregnancy for another person or couple.

Depending on whose egg is used to create the embryo, there are two main types of surrogacy: traditional surrogacy and gestational surrogacy.

Traditional Surrogacy

In traditional surrogacy, the woman who carries the pregnancy also provides her own egg. The egg is fertilized using sperm from the intended father or a sperm donor.

As a result, the surrogate is genetically related to the child.

Traditional surrogacy raises different legal, ethical, and psychological considerations from gestational surrogacy and is used much less frequently in professionally organized surrogacy programs today.

The legality of traditional surrogacy and the procedures required to establish parentage depend on the relevant jurisdiction.

Gestational Surrogacy

In gestational surrogacy, the gestational carrier does not provide her own egg and therefore has no genetic relationship with the child.

The egg is provided by the intended mother or an egg donor, while the sperm may come from the intended father or, where permitted by applicable law and the structure of the program, a sperm donor.

Gestational surrogacy is the model most commonly used in modern surrogacy programs organized by fertility clinics and specialized agencies, including programs offered by Feskov Human Reproduction Group.

However, the absence of a genetic relationship between the gestational carrier and the child does not mean that legal parentage is automatically established in favor of the intended parents in every jurisdiction.

In some countries, the woman who gives birth may initially be recognized as the child’s legal mother even if she has no genetic relationship with the child. Establishing or transferring parentage to the intended parents may then require specific administrative or judicial procedures.

For this reason, choosing the appropriate jurisdiction is an essential part of planning an international surrogacy program.

Feskov Human Reproduction Group offers programs in different jurisdictions. The appropriate option depends on factors such as the intended parents’ nationality, marital status, country of residence, and individual circumstances.

How Does a Surrogate Mother Participate in a Program?

A gestational surrogacy program may include the following stages:

1. Matching: A candidate is selected based on the medical, psychological, and legal requirements of the program, as well as relevant preferences of the intended parents.
2. Screening and approval: The prospective gestational carrier undergoes the required medical and psychological assessments to determine whether she is suitable for the program.
3. Preparation for embryo transfer: The gestational carrier follows a medical protocol designed to prepare the endometrium for embryo transfer.
4. Embryo creation and transfer: An embryo is created through IVF using an egg from the intended mother or an egg donor. When medically indicated, embryos may undergo preimplantation genetic testing (PGT). An embryo considered suitable for transfer is then selected based on the available clinical and embryological information. Feskov Human Reproduction Group follows a single-embryo transfer approach where appropriate, in accordance with ESHRE recommendations.
5. Pregnancy testing: After the transfer, appropriate testing is performed to determine whether pregnancy has occurred. If pregnancy is not achieved, the medical team determines the next steps.
6. Pregnancy monitoring: Once pregnancy is confirmed, the gestational carrier receives medical care and monitoring throughout the pregnancy.
7. Birth: The child is born in the country specified by the program. In certain international programs, the gestational carrier may travel to the country of birth before delivery.
8. Documentation and parentage: After birth, the necessary procedures are completed to register the child and establish or recognize legal parentage in accordance with applicable law.

In programs where compensation is permitted, the gestational carrier receives the compensation specified in the contract and allowed under applicable law.

Any relationship between the gestational carrier and the intended parents after the program depends on the arrangements agreed between the parties.

Who Uses Surrogacy?

People may consider surrogacy for a range of medical and personal reasons, including:

• absence of the uterus following hysterectomy or due to congenital conditions;
• certain structural abnormalities of the uterus;
• scarring of the uterine cavity, including Asherman syndrome;
• medical conditions in which pregnancy would pose a serious risk to the woman’s health or life;
• recurrent pregnancy loss in certain clinical circumstances;
• repeated unsuccessful IVF attempts when medical evaluation indicates that carrying a pregnancy may not be viable;
• single intended parents and same-sex couples where surrogacy is permitted under the law of the relevant jurisdiction.

Eligibility requirements vary by country.

Some jurisdictions require specific medical indications, while others apply different criteria based on the intended parents’ personal or family circumstances.

How to Find a Surrogate Mother

There are several ways to find a surrogate:

• Through relatives or people you know. This option may be considered when there is already an established relationship of trust. However, the ASRM notes the importance of independent evaluation and appropriate medical, psychological, and legal counseling.
• Online. Specialized forums, groups, and communities may connect intended parents with potential surrogates. However, a candidate found independently should still undergo appropriate medical and psychological screening before being accepted into a program.
• Through a specialized clinic or agency. The organization may provide access to previously screened candidates and coordinate the medical, psychological, administrative, and legal aspects of the program.

Feskov Human Reproduction Group maintains a database of candidates who have already completed certain stages of the screening process, which can reduce the time required to identify a suitable gestational carrier.

Requirements for a Surrogate Mother

According to ASRM recommendations, prospective gestational carriers should be assessed according to relevant medical and psychosocial criteria.

In general, a candidate should:

• be within an age range considered medically appropriate;
• have previously completed at least one pregnancy;
• have an obstetric history compatible with another pregnancy;
• be in good overall health;
• be medically suitable to carry a pregnancy;
• undergo psychological evaluation;
• have an appropriate and stable support system.

The exact criteria may vary depending on the country, clinic, agency, and individual circumstances.

The screening process is intended to reduce medical and psychological risks and ensure that the prospective gestational carrier fully understands the implications of participating in the program.

Feskov Human Reproduction Group provides intended parents with candidates who have already undergone the screening required by the relevant program. Additional checks regarding personal and social circumstances may also be carried out in accordance with applicable internal procedures.

The Surrogacy Process and Medical Screening

Before a program begins, the gestational carrier and the individuals whose gametes will be used to create the embryo undergo the assessments required under the relevant clinical protocols.

According to ASRM recommendations, evaluation of a prospective gestational carrier may include a review of her general and reproductive health, psychological assessment, and testing for relevant infectious diseases and other factors that could affect pregnancy.

A gynecological evaluation is also performed to assess whether the uterus is suitable for embryo transfer and pregnancy.

Where appropriate, genetic screening is performed for the individuals whose gametes will be used to create the embryo — the intended parents and/or egg or sperm donors.

The complete screening process may take several weeks. The results help determine whether the candidate can participate in the program and whether any additional medical procedures or evaluations are required.

Cost of Surrogacy

The cost of a surrogacy program can vary considerably depending on the country, clinic, services included, and complexity of the program.

Potential costs may include:

• IVF procedures;
• donor gametes, where required;
• compensation or reimbursement of the gestational carrier’s expenses, where permitted;
• pregnancy monitoring;
• childbirth;
• program coordination;
• legal services;
• procedures required to establish parentage and obtain the child’s documents.

In the United States, a complete surrogacy program can be expensive and, in some cases, may exceed $150,000-$200,000. Costs may be lower in other jurisdictions.

The actual amount depends on the selected program and the services included.

Feskov Human Reproduction Group offers surrogacy programs in Europe, Ukraine, and the United States, with services and financial terms defined contractually.

Depending on the selected program, the price may include specified IVF procedures, gestational carrier services, and legal support throughout different stages of the process.

Legal Aspects of Surrogacy

Surrogacy laws vary considerably from one country to another.

Commercial surrogacy is prohibited in some jurisdictions. Others allow surrogacy only under specific conditions or for certain categories of intended parents.

In the United Kingdom, for example, surrogacy operates within a non-commercial legal framework, and intended parents may need to obtain a parental order to establish legal parentage.

The United States does not have a uniform federal surrogacy law; rules vary by state. In certain jurisdictions, it may be possible to obtain a court order relating to parentage before birth, such as a pre-birth order, while other states follow different procedures.

Some international surrogacy programs may involve medical treatment in one country and childbirth in another jurisdiction selected according to the intended parents’ circumstances and the applicable legal framework.

Certain programs offered by Feskov Human Reproduction Group may be structured in this way: embryo creation, IVF, and some stages of medical care may take place in Ukraine, while the child may be born in another country depending on the structure of the program and the legal advice provided.

The specific arrangement should be assessed individually, taking into account both the laws of the country of birth and those of the intended parents’ country of nationality or residence.

Surrogacy Agreements and Parental Rights

Legal parentage following surrogacy is not established in the same way in every jurisdiction.

A surrogacy agreement may address issues such as:

• the gestational carrier’s obligations during pregnancy;
• arrangements for medical monitoring;
• reimbursement of expenses and any compensation permitted by law;
• procedures for unexpected circumstances and complex medical decisions;
• communication between the gestational carrier and the intended parents;
• mechanisms for resolving disputes;
• actions and declarations required to establish or recognize legal parentage.

This list is not exhaustive.

A comprehensive agreement should be tailored to the law of the relevant jurisdiction and the specific circumstances of the program.

Involving lawyers experienced in reproductive law can help all parties understand their rights and obligations and reduce legal risks before medical treatment begins.

For this reason, the choice of program and jurisdiction should be made after an individual assessment of the intended parents’ circumstances.

Feskov Human Reproduction Group offers consultations to explain the available options and develop a medical, organizational, and legal plan for the proposed program.