Conscious Surrogacy – Making the Best Decisions For Your Family

Is there such a thing as conscious surrogacy? Yes, and those considering surrogacy will be confronted with some serious ethical questions.

Conscious surrogacy is a process. It is critical to understand some of the questions, and dilemmas, that you will face if you choose surrogacy to help you have your family.  If you are prepared to answer these questions before your surrogacy journey, and if you are comfortable with your answers, then you are ready to have these conversations with a potential surrogate mother.

What are some of the questions that you will face on your conscious surrogacy journey?

Do I want a single embryo or double embryo transfer? Do I want twins?  One of the first questions you will have to consider is whether you want to try and have twins with your surrogate mother.  Many choose this option for economic reasons.  If you know that you want more than one child, consecutive surrogacy journeys may not be an option.  But there is much more to consider.

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Twin pregnancies are much harder on the surrogate mother.  It can mean doctor ordered bed rest for your surrogate and more doctors’ visits, particularly in the third trimester.  Twin pregnancies also bring a higher risk of complications for the surrogate, such as preterm labor, and hypertension.

Twins arrive earlier. A normal singleton pregnancy is 40 weeks.  Most twins arrive early, at or before 36 weeks, which means that one or both of the children may require an extended hospital stay in the NICU (neonatal intensive care unit.)  Some doctors state that in 50% of twin pregnancies, a NICU stay is required.  This by itself may give parents pause about choosing a double embryo transfer.  Studies show that consecutive singleton births result in better medical outcomes than a single twin birth.  With all the information, you can make a conscious decision.

Do I want PGD or PGS? Preimplantation genetic diagnosis or screening is now being offered by most IVF facilities.  PGD or PGS allows a parent to view the genetic material of their child before an embryo is implanted in a surrogate mother’s womb.  PGD/S can show whether a child has any genetic disorders, the sex of the child and other genetic traits that may complicate a pregnancy.  While infertile couples who use IVF (in vitro fertilization), or anyone with a preexisting genetic condition,  may be familiar with PGD/S, couples or individuals who have their families with the assistance of a surrogate mother will most definitely be asked whether they want the information that PGD/S provides.

Knowing whether there is a genetic complication prior to embryo implantation may be in the best interests of all parties, however, choosing the sex of your child before it is born ventures into an ethical quagmire. Most families do not have this information and, while the technology exists, you must ask whether you want the information that it can provide.  The mental and physical health of your surrogate mother must be a priority in making this decision.

Do I want to selectively reduce if complications arise? Perhaps the most important questions you will confront is whether or not to selectively reduce, or abort, an embryo or fetus if there is a danger to the surrogate mother or to the child.  In reality, no state will enforce a gestational carrier contract which requires selective reduction.  The surrogate mother will always have the final say.  But you must know what you want first before you can discuss it with your surrogate.

While abortion is one of the most controversial topics in American society, it is routinely a part of conversations that intended parents have with their surrogate mothers. Surrogacy agreements attempt to cover all possible outcomes and obstacles that can arise during a surrogate pregnancy.  The most important aspect of this topic is being able to communicate your beliefs and desires with your surrogate.

There are many more issues that intended parents will face. Conscious surrogacy is about understanding the major decisions surrounding these issues and being able to come to a place of peace with each one, first with yourself, then with your surrogate mother.  Respecting her autonomy during the pregnancy will take you a long way toward reaching this goal.  Maintaining open and honest communication with your surrogate mother will also help to ensure that the journey is successful for all involved.

For more information about surrogacy, please visit https://timeforfamilies.com or email me at Anthony@timeforfamilies.com.

in Ethics / Featured Articles / IVF / Surrogacy  by Anthony Brown 3 comments

Ethical Surrogacy – Making the Right Choices

Ethical surrogacy is, and must be, the goal of an intended parent (IP) who is looking to have a family with the assistance of a surrogate mother.

Because of the different parties involved and the roles that they play, there must be a guiding, ethical roadmap for intended parents to follow to ensure that everyone has a successful and positive experience, an ethical surrogacy. Up until very recently, no such roadmap existed for intended parents.  Doctors have such guidelines in the ASRM (American Society of Reproductive Medicine) Recommendations for Practices Utilizing Gestational Carriers.  Attorneys also have such guidance in numerous articles and section committees dedicated to issues surrounding surrogacy.

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Now there is a place where intended parents can go to review best practices and baseline protocols for ethical surrogacy, ensuring that each IP has the tools to create an ethical journey. Men Having Babies (MHB), a non-profit organization of which I am the board chairperson, recently introduced A Framework for Ethical Surrogacy for Intended Parents, available online in English, French, German, Spanish, Italian and Hebrew.  This comprehensive document is supported by several LGBT organizations in America and abroad.

What is Ethical Surrogacy?

MHB’s ethical surrogacy framework revolves around the notion that surrogacy can be a wonderful and fulfilling experience for all parties involved, even if the surrogate is compensated for her efforts, risk and inconvenience. While compensation is part of the process, the act itself is not commercial because the IPs are not buying anything, particularly a child, which is a claim made by some anti-surrogacy activists.  A surrogate efforts should be compensated, even if the journey does not result in a pregnancy or in the case of a miscarriage.

How can Ethical Surrogacy be Achieved?

Regulation is the key to achieving ethical surrogacy. Having laws in place that require independent representation for all parties ( in their home languages), ensuring that all parties are vetted medically and psychologically, limiting compensation so as not to create irresistible incentives for participation and making surrogacy legal in each state and in each country so IPs and surrogate mothers do not have extraordinary distances between them, all work together to create an ethical surrogacy environment.

Reasonable and appropriate legislation should be enacted to allow perspective parents, donors and surrogates enter into legally enforceable agreements for surrogacy arrangements without having to cross state lines or country borders. This fosters more successful and fulfilling relationships between surrogate mothers and IPs.  Steps must also be taken to limit any medical risks that donors and surrogates face in the surrogacy process.

Baseline Protocols for Providers

Several baseline protocols should be implemented by service providers to ensure an ethical surrogacy experience including, but not limited to: informed consent from all parties, medical screening, social and psychological screening, independent legal representation (with language interpretation is required) before any treatments begin, medical insurance review from the surrogate mother and an agreement regarding contact during and after the surrogacy journey.

Best Practices

Best practices are suggestions for “above and beyond” thinking that is required of IPs because so much of the integrity of the journey depends on them. Among these suggestions is the creation of a long term vision about your family.  Who will be the biological parent?  How many journeys do you anticipate? What will the relationships be during and after the surrogacy?  How will you explain your family make-up to your child?  These questions are just a few of those that need to be asked and answered in the surrogacy process.

Above all, the autonomy of your surrogate mother must be respected and supported. While it may be your child that she is carrying, it is her pregnancy.  Insuring that she knows that you, as IPs, understand this distinction is critical to supporting her autonomy.  Her family and community will also play a role in her pregnancy, so getting to know her circle of support is a wonderful way of bolstering that support, making the journey a happy and healthy one for your surrogate mother.

While the MHB Framework for Ethical Surrogacy for Intended Parents goes deeper into the specifics of making your journey an ethical one, this article is designed to begin a conversation about the quality and success of your surrogacy journey.  After all, your family is worth it!  For more information, go to timeforfamilies.com or email Anthony at Anthony@timeforfamilies.com.

in Assisted Reproductive Technology / Egg Donation / Ethics / Featured Articles / IVF / Known Donor / Surrogacy  by Anthony Brown 3 comments

Why You Should Always Meet Your Gestational Carrier In Person

 Meeting your gestational carrier is a required component of the matching process. We are, after all, human beings with emotions and body language and senses and intuition.

It almost sounds a little silly as I type out those words, and I’m the one writing them.  What gives? Who doesn’t meet their gestational carrier, you might wonder.

Believe it or not, it happens.

In my early days of surrogacy, I belonged to several online support groups with surrogates and intended mothers from across the country.  Although the majority of the experiences the women brought to the group were positive, there were a few hair-raising ones as well.

One particularly unfortunate story involved an experienced surrogate carrying for a couple that maintained homes in the United States and Europe. They had an independent agreement (meaning they didn’t use an agency to find one another or negotiate their contract) and they used a US fertility center. They used donor eggs and the intended father’s sperm, and the surrogate was pregnant with their baby girl.

Throughout the contract agreement phase and the entire pregnancy, the surrogate spoke only with the intended father by phone. He told her that his wife spoke little English and they were overseas, so she had no contact with her intended mother.

When she delivered the baby, the intended father didn’t come to the birth. Within a day or so of giving birth, he revealed to her that his wife was never aware of the pregnancy and did not want the child, and therefore he didn’t want the baby either.

Shocking, right?!?

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All’s well that ends well (in theory, at least) – the surrogate was able to get temporary guardianship of the baby and placed her with adoptive parents, who no doubt were elated.   But the guy who orchestrated the pregnancy and his unsuspecting wife? Clearly all sorts of crazy.

It turns out that the surrogate never met either of the parents (and this was long before the days of Facetime or video conference calls). She’d only spoken with the intended father on the phone, and nothing more. Granted, in no way, shape or form did she deserve this to happen to her, but I have to wonder if the situation could have been avoided had she insisted on meeting both parents prior to agreeing to carry for them.

And if you follow the news, you probably already know about an unfortunate surrogacy case currently happening in California, where a gestational carrier is pregnant with triplets for a single father. He wanted to reduce the pregnancy, which she refused to do, and now it’s in question whether he wants any of the babies  at all (though they’re all his).

a face-to-face meeting is a required component of the matching process. We are, after all, human beings with emotions and body language and senses and intuition

As it turns out, she agreed to carry for him and became pregnant with his children without ever meeting him, or ever speaking with him for that matter (he is deaf, but still, there are mechanisms for people who are hearing impaired to communicate by phone, and of course there’s email).

by Susan Fuller – March 11, 2016 Surrogacy by Design

Click here to read the entire article.

in Ethics / Recently Added / Surrogacy  by Anthony Brown 0 comments