Who Can Use Surrogacy Services?

1. Eligibility Criteria for Intended Parents
2. Medical Indications for Surrogacy
3. Health Conditions That May Prevent Pregnancy
4. Surrogacy for Same-Sex Couples
5. Infertility as a Reason for Considering Surrogacy

Intended parents facing infertility often want to know who is eligible for surrogacy. There is no universal set of criteria: eligibility depends on the country, the clinic, and applicable local law. For example, in the United States, international intended parents may be able to access surrogacy programs depending on the state, while in Ukraine surrogacy is available to married heterosexual couples who meet the applicable legal and medical requirements. One common medical reason for considering surrogacy is the inability to safely carry a pregnancy.

Surrogacy may be considered by people for whom pregnancy is physically impossible or would pose a significant health risk, as well as by people who cannot carry a pregnancy because of their family structure.

Those who may consider surrogacy generally include:

• women with medical contraindications to pregnancy;
• couples facing infertility after multiple unsuccessful treatment attempts;
• male same-sex couples who want to have a child;
• single women and men who want to become parents without a partner.

There is no single criterion that determines whether someone is eligible for surrogacy. Each case must be assessed individually, taking into account medical history and the requirements of the relevant jurisdiction, as surrogacy laws vary considerably from country to country.

Eligibility Criteria for Intended Parents

In addition to the underlying reason for considering surrogacy, clinics and agencies may assess several factors when determining whether intended parents can participate in a program:

• the health and age of the intended parents;
• citizenship, residency, and marital status;
• whether their own eggs and/or sperm can be used or whether egg and/or sperm donors are required;
• psychological readiness for the program;
• budget;
• individual needs and preferences.

After the preliminary assessment, legal consultation is an essential part of planning a surrogacy program. In the United States, for example, the intended parents and the gestational carrier should have independent legal counsel. Independent legal representation helps protect the interests of all parties and clarifies their respective rights and obligations.

At this stage, the cost and appropriate jurisdiction for the program can also be assessed. For international intended parents, the legal strategy should take into account not only the country where the child will be born but also the requirements for establishing or recognizing parentage in the parents’ country of nationality or residence.

Medical examinations also help determine whose gametes can be used to create the embryo. Whether a genetic relationship with one or both intended parents is legally required depends on the jurisdiction and the structure of the particular program.

Medical Indications for Surrogacy

Medical reasons for considering surrogacy may include:

• congenital absence or abnormalities of the uterus, or absence of the uterus following surgery;
• recurrent pregnancy loss in certain clinical circumstances;
• multiple unsuccessful IVF attempts where further medical evaluation supports considering surrogacy;
• serious chronic conditions in which pregnancy would pose a significant risk to the woman’s health or life, including certain severe heart conditions.

The exact medical indications and eligibility requirements vary by country and should be assessed by a reproductive medicine specialist.

Infertility as a Reason for Considering Surrogacy

In clinical practice, surrogacy is generally not the first step in infertility treatment. Depending on the patient’s medical circumstances, the fertility treatment pathway may include:

• attempting natural conception for an appropriate period based on age and medical history;
• less invasive fertility treatments, such as intrauterine insemination (IUI), where appropriate;
• in vitro fertilization using the intended mother’s own eggs or donor eggs.

Surrogacy may be considered when previous treatment has been unsuccessful or when a physician determines that carrying a pregnancy is not possible or would pose a serious risk to the intended mother’s health. Importantly, infertility alone does not necessarily mean that surrogacy is medically indicated. The appropriate treatment depends on the cause of infertility and the individual clinical situation.

Health Conditions That May Prevent Pregnancy

In addition to structural abnormalities of the uterus, certain health conditions may make pregnancy medically contraindicated or exceptionally high-risk.

These may include severe heart, kidney, or lung disease, certain autoimmune conditions, and some medical circumstances following chemotherapy or radiation therapy.

In such cases, the decision should be made individually by a reproductive medicine specialist together with the relevant medical specialist — such as a cardiologist, nephrologist, oncologist, or another physician — depending on the diagnosis and its severity.

The objective is to determine whether carrying a pregnancy would present an unacceptable medical risk and whether gestational surrogacy may be an appropriate alternative.

Surrogacy for Same-Sex Couples

For a female same-sex couple, gestational surrogacy may be considered when neither partner can carry a pregnancy or when there are other medical circumstances that make pregnancy unsuitable. Depending on the program, an embryo may be created using the egg of one partner and donor sperm.

For male same-sex couples, gestational surrogacy provides a route to having a child genetically related to one of the partners. These programs generally involve donor eggs and sperm from one of the intended fathers. Depending on the program and applicable law, embryos may be created using sperm from both partners.

Legal parentage requires particular attention in surrogacy programs for same-sex couples. The procedures for recognizing both intended parents vary significantly between jurisdictions. Depending on the country or state, parentage may be established through a court order, adoption, registration procedure, or another legal mechanism.

It is therefore important to plan the legal establishment and recognition of parentage before beginning the program, particularly in international arrangements. A surrogacy arrangement that is permitted and legally recognized in one jurisdiction may be treated differently in another. The laws of both the country where the child is born and the intended parents’ home country should therefore be considered in advance.

If you would like to determine whether you are eligible for surrogacy and which program and jurisdiction may be appropriate for your circumstances, you can request a free consultation with Feskov Human Reproduction Group. You will receive information about available programs in jurisdictions that may be suitable for your situation, including their structure and fixed-price options. Depending on the selected program, services may include a gestational carrier, an egg donor where required, medical coordination, and support with the procedures necessary to establish or recognize the child’s legal status in the country of birth and the intended parents’ home country.