What Is the Difference Between a Baby Conceived Through IVF and a Baby Born Through Surrogacy?

1. What Is IVF?
2. What Is Surrogacy?
3. Differences Between IVF and Surrogacy
4. IVF Without a Gestational Carrier
5. IVF With a Gestational Carrier
6. Parenthood: Surrogacy vs. IVF
7. Cost Comparison: IVF vs. Surrogacy

In the first case, the embryo is transferred to the intended mother’s uterus, and she carries the pregnancy and gives birth. In gestational surrogacy, the embryo is transferred to a gestational carrier, who carries the pregnancy without having a genetic relationship with the child.

In both cases, the child’s genetic relationship to the intended parents depends on whose gametes are used to create the embryo. The intended mother may be genetically related to the child if her own eggs are used, or she may have no genetic relationship if donor eggs are used. Similarly, the intended father may be genetically related to the child if his sperm is used, or not genetically related if donor sperm is used.

Therefore, the fundamental difference between IVF without a gestational carrier and IVF within a gestational surrogacy program is who carries the pregnancy.

If the intended mother has difficulty conceiving but is medically able to carry a pregnancy, IVF may allow her to become pregnant, carry the baby, and give birth herself. If she cannot safely carry a pregnancy, gestational surrogacy may be considered.

Below, we take a closer look at how these two paths work, how they differ, and what implications they may have for establishing legal parentage.

What Is IVF?

In vitro fertilization (IVF) is an assisted reproductive technology in which an egg is fertilized with sperm in a laboratory. The resulting embryo is then transferred to the uterus of the woman who will carry the pregnancy — either the intended mother or, in a surrogacy program, a gestational carrier.

After ovarian stimulation of the intended mother or an egg donor, eggs are retrieved and fertilized in the laboratory using sperm from the intended father or, where applicable, a sperm donor.

In surrogacy programs, requirements concerning a genetic relationship between the child and one or both intended parents depend on the laws of the relevant jurisdiction.

Eligibility requirements may also differ for couples, single women, and single men.

After several days of embryo culture, preimplantation genetic testing (PGT) may be performed when medically indicated to assess certain chromosomal or genetic conditions.

An embryo considered suitable for transfer is then selected based on the available information and relevant clinical and embryological criteria.

If the transfer results in pregnancy, the pregnancy then follows the same fundamental biological processes as other pregnancies. The principal difference from natural conception is that fertilization takes place in a laboratory before the embryo is transferred to the uterus.

What Is Surrogacy?

Surrogacy is a reproductive arrangement in which a woman other than the intended mother carries the pregnancy.

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

The embryo may be created using the intended mother’s eggs or donor eggs and the intended father’s sperm or, where permitted under the program and applicable law, donor sperm.

This distinguishes gestational surrogacy from traditional surrogacy, in which the woman carrying the pregnancy also provides her own egg and is therefore genetically related to the child.

Today, gestational surrogacy is the model most commonly used in programs organized by specialized fertility clinics and surrogacy agencies.

Differences Between IVF and Surrogacy

IVF and surrogacy are not two alternative procedures of the same type.

IVF is an assisted reproductive technology used to create embryos in a laboratory.

Surrogacy, by contrast, is an arrangement in which a woman other than the intended mother carries the pregnancy.

IVF can therefore be performed without surrogacy, while gestational surrogacy generally involves creating an embryo through IVF before transferring it to the gestational carrier’s uterus.

Another difference concerns preparation of the endometrium for embryo transfer.

When an embryo is transferred to the intended mother, her endometrium is prepared to receive it. In a gestational surrogacy program, the gestational carrier’s endometrium is prepared instead.

The specific medical protocol depends on the individual case and is determined by the medical team.

IVF Without a Gestational Carrier

This is a common scenario.

The intended mother’s eggs — or donor eggs when necessary — are fertilized in the laboratory. An embryo is then transferred to the intended mother’s uterus, and she carries the pregnancy and gives birth.

No gestational carrier is involved.

This option may be appropriate when the fertility issue can be treated with IVF and the intended mother is medically able to carry a pregnancy.

IVF With a Gestational Carrier

In a gestational surrogacy program, the IVF process may include the following stages:

1. The intended mother’s or donor’s eggs are fertilized in the laboratory using sperm from the intended father or, where applicable, a sperm donor.
2. The resulting embryos are cultured in the laboratory for several days.
3. When medically indicated, embryos may undergo PGT. An embryo considered suitable for transfer is then selected based on the available information and relevant embryological criteria, including morphology. Other embryos suitable for future use may be cryopreserved.
4. The gestational carrier follows the prescribed medical protocol to prepare the endometrium for embryo transfer.
5. At the time determined by the reproductive medicine specialist, embryo transfer is performed.
6. After the transfer, appropriate testing is carried out to determine whether pregnancy has occurred. If pregnancy is not achieved, the medical team determines the next steps and whether another embryo transfer should be performed.

The number of attempts included in a program and any potential additional costs vary depending on the clinic and the terms of the specific program.

Feskov Human Reproduction Group offers fixed-price programs, with the included services and applicable terms defined in the contract.

Parenthood: Surrogacy vs. IVF

It is important to distinguish between genetic parentage and legal parentage.

With IVF without surrogacy, when the intended mother carries the pregnancy and gives birth, legal motherhood is determined under the laws of the relevant jurisdiction, including in cases where donor eggs are used.

In gestational surrogacy, establishing legal parentage can be more complex and may vary considerably between jurisdictions.

In some countries, the woman who gives birth may initially be recognized as the legal mother even though she has no genetic relationship with the child. Recognition of the intended parents may then require specific administrative or judicial procedures.

The United Kingdom, Belgium, Canada, and Greece, for example, apply different legal frameworks to surrogacy and the establishment of parentage.

International surrogacy programs must also take into account both the laws of the country where the child is born and those of the intended parents’ country of residence or nationality.

Countries such as Germany, Spain, and France may have specific procedures for recognizing the parentage of children born abroad through surrogacy.

For this reason, an individualized legal assessment should be carried out before beginning an international surrogacy program.

Cost Comparison: IVF vs. Surrogacy

The cost of IVF and the cost of a complete surrogacy program can differ substantially.

IVF costs depend on numerous factors, including the country, clinic, medications, required testing, use of donor gametes, PGT, and the number of treatment attempts.

A surrogacy program may include additional expenses beyond assisted reproductive treatment, such as:

• screening and support of the gestational carrier;
• pregnancy monitoring;
• childbirth and related medical care;
• compensation or reimbursement of the gestational carrier’s expenses where legally permitted;
• program coordination;
• legal services;
• procedures required to establish or recognize parentage.

For these reasons, a complete surrogacy program generally costs considerably more than IVF without a gestational carrier.

IVF and gestational surrogacy are therefore different but closely related concepts. IVF is the medical procedure used to create the embryo, while in gestational surrogacy that embryo is subsequently transferred to a gestational carrier.

The appropriate approach depends primarily on the individual medical circumstances. If the intended mother is medically able to carry a pregnancy, IVF without surrogacy may be considered. If she cannot carry a pregnancy or doing so would pose significant medical risks, a gestational surrogacy program may be an option.

Before starting a surrogacy program, a comprehensive medical assessment is important.

Feskov Human Reproduction Group offers consultations to review medical history, discuss available reproductive options, and determine which approach may be appropriate for each individual situation.