By Cristina Mestre Ferrer BSc, MSc (embryologist) and Mark P. Trolice MD, FACOG, FACS, FACE (reproductive endocrinologist).
Last Update: 06/29/2016

Surrogacy or surrogate motherhood, mistakenly defined by many as the rental of wombs or “womb-for-rent” service, is a fertility treatment by which a woman other than the intended mother carries the pregnancy to term and gives birth to the baby.

This method involves great complexity from an ethical and emotional perspective, as it breaks with tradition to provide a new understanding of family formation.

Different types of surrogacy

Surrogacy is a fertility procedure that involves a woman who agrees to carry someone else’s baby. This woman is known as surrogate or gestational carrier, while the patients are usually called intended parents.

We can distinguish between two types of surrogacy depending on how the surrogate achieves pregnancy:

  • Traditional, partial, genetic, or straight surrogacy: In this case, the surrogate contributes an egg as well, and therefore her genetic load. In this case, surrogacy is done through intrauterine insemination with the intended father’s sperm, although IVF using the surrogate’s eggs is possible as well.
  • Gestational, host, or full surrogacy: The surrogate or gestational carrier does not contribute an egg for the creation of an embryo. In this case, the genetic material of the baby-to-be is that of the intended mother. Using donor eggs is possible as well.

It should be noted that traditional or genetic surrogacy has almost fallen into disuse nowadays, as it would mean the surrogate developing a greater emotional attachment to the unborn baby. Ideally, the intended mother should be the one contributing the egg; failing that, then egg donation could be used as alternative plan B.

The gestational, host, or full surrogacy option is commonly the only type allowed in the vast majority of countries where this fertility treatment is permitted.

On the other hand, surrogacy can be classified into two more types if we take into account the financial compensation surrogates can get in certain countries. Depending on whether she is economically compensated or not, we can distinguish between:

  • Commercial surrogacy: Surrogates are paid for carrying the pregnancy, apart from being given a compensation in recognition of the expenses derived from the process.
  • Altruistic surrogacy: Surrogates can be financially compensated in recognition of the expenses derived from the pregnancy such as maternity clothes, prenatal visits, special meals required, visits to the hospital, etc.

The total cost of the treatment will depend on the type of surrogacy chosen. For instance, commercial surrogacy, as well as the need for turning to donor eggs and/or sperm, would add to the overall costs of the treatment. In addition, surrogacy fees vary from country to country, depending on each destination’s particularities.

Why surrogacy might become necessary?

The group of patients for which surrogacy is often necessary are heterosexual or straight couples which find themselves in one of the following situations:

Also, single women and lesbian couples suffering from one of the above mentioned issues could become mothers thanks to surrogacy.

Likewise, single men and same-sex male partners often resort to surrogacy to have a baby, as it is the only way for them to have a genetic child using their reproductive cells. In these cases, surrogacy is required just because human males do not have the anatomy needed for natural embryonic and fetal development.

Surrogacy around the world

Surrogacy has always been considered to be a controversial fertility option, which boundaries between what’s ethical and what’s not are still blurred. The reason behind should be understood in legal terms: surrogacy is not allowed everywhere. That is why many patients have no alternative but to cross borders to have the chance to create a family.

On the other hand, it should be borne in mind that even countries which are in favor of surrogacy, this fertility treatment is surrounded by a number of restrictions and particularities that might make it difficult for foreign citizens to make their dream come true.

Some countries like the United States allow all types of surrogacy, whether it is commercial, altruistic, partial, or full surrogacy. Also, all family types can access this fertility treatment: single men or women, same-sex or straight couples. Other countries such as Canada allow every family type to undergo surrogacy, but just the altruistic option.

In Russia, only heterosexual couples can undergo surrogacy, which means gay couples and single individuals do not have the chance to become parents through this method. Spain, France, and Germany are examples of countries in which this fertility treatment is forbidden or not contemplated in national law.

For example, surrogacy is not allowed in Spain because the Law on the Application of Human Assisted Reproduction Techniques explicitly says the legal mother is the woman who gives birth to the baby. Also, every agreement made for the purpose of waving the entitlement of maternity in favor of another woman is legally void.

FAQs from users

In which cases should you use a surrogate to have a baby?

By Mark P. Trolice MD, FACOG, FACS, FACE (reproductive endocrinologist).

In general, the two reasons for the use of surrogacy are the absence or abnormality of the uterus or a medical contraindication.

Cases of absent/abnormal uterus:

  • MRKH syndrome. Mayer-Rokitansky-Küster-Hauser syndrome is a disorder where the female is born with an underdeveloped or absent uterus and vagina.
  • History of hysterectomy – a surgery to remove the uterus
  • Multiple fibroid tumors of the uterus that cannot resolved by a surgery
  • Severe intrauterine scarring (Asherman’s syndrome) irreparable
  • A single male or gay male couple
  • Unexplained recurrent pregnancy loss or unsuccessful embryo implantations
  • Inability to develop the uterine lining (endometrium)

Cases of medical contraindications (relative and absolute):

  • A serious medical condition that worsens with pregnancy posing risk to mother and fetus
  • Pulmonary hypertension
  • Turner’s syndrome
  • Uterine cancer

What are the different types of surrogacy?

By Mark P. Trolice MD, FACOG, FACS, FACE (reproductive endocrinologist).

There are two types of surrogacy:

  • Traditional surrogacy involves the woman who will carry the pregnancy also to be the source of the egg. She usually will ovulate naturally and undergo intrauterine insemination (IUI). Countries vary in their laws overseeing this arrangement so it is imperative that you consult, in advance of your treatment cycle, with an attorney who is well versed in this area.
  • IVF surrogacy is the process of using an egg donor and a separate gestational carrier. Following hormonal stimulation of the egg donor and egg retrieval, the eggs are fertilized with the sperm of one or both partners in a reproductive laboratory through IVF. The embryo is then transferred into the gestational carrier’s uterus, previously prepared hormonally to synchronize optimal receptivity. The resulting baby is genetically unrelated to the carrier.

Can two males have a biological child with the DNA of both in a single pregnancy?

By Mark P. Trolice MD, FACOG, FACS, FACE (reproductive endocrinologist).

Currently, fertilization of an egg only occurs by one sperm cell that is produced from one man.

Authors and contributors

 Cristina Mestre Ferrer
BSc, MSc
Embryologist
Bachelor's Degree in Biological Sciences, Genetics & Human Reproduction from the University of Valencia (UV). Master's Degree in Biotechnology of Human Assisted Reproduction from the UV and the Valencian Infertility Institute (IVI). Embryologist at IVI Barcelona. More information
 Mark P. Trolice
MD, FACOG, FACS, FACE
Reproductive Endocrinologist
Mark P. Trolice is the Director of Fertility CARE – The IVF Center and Clinical Associate Professor in the Department of Obstetrics & Gynecology (OB/GYN) at the University of Central Florida College of Medicine. He is Board-certified in REI and OB/GYN, and maintains annual recertification. His colleagues select him as Top Doctor in America® annually, one among the top 5% of doctors in the U.S. More information
License: ME 78893

3 comments

    1. Julius Hevia

      If the surrogate receives money for the surrogacy the arrangement is considered commercial surrogacy, if she receives no compensation beyond reimbursement of medical and other reasonable expenses it is referred to as altruistic.

    2. zoey mulligan

      There are plenty of reasons why surrogacy has nothing to do with exploitation of women. First, when one talks about “exploitation”, we assume the woman is being forced to do something against her will. I don’t think gestational carriers are forced to carry a baby, but do it because they’ve a strong desire to help others. Second, a pregnancy is a 9 month period in which the surrogate, unfortunately, feels the same pains and discomforts every woman who gets pregnant naturally feels, so she deserved being compensated in some way. Our capitalist world has decided that this compensation is in the form of money… I’m not going to share my opinion, but if that’s how it should be, or the only way a woman who’s been a surrogate can feel rewarded, then I agree in all terms.

      • anonymous

        So… you say “plenty of” and then just mention 2? hahaha there’s no way surrogacy can be that perfect, it contravenes many social aspects we humans have been building for a long time… And suddenly we aim to break tradition? it’s not that easy bae