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Surrogacy: Removing the Stigma

Updated: Mar 22

Better technology has transformed the way we carry and give birth to babies. This no longer has to happen within a specific framework or family system. While services like surrogacy are increasingly common and available, women who utilize these tools to achieve their goals of motherhood may feel marginalized. When the stigma remains long after surrogacy has become a viable option for women, we’re left to wonder: has medicine outpaced culture?

Traditional surrogacy is when a surrogate’s eggs are combined with donated sperm. In gestational surrogacy, both the sperm and egg are donated. Surrogates can be referred to as gestational carriers. These are women who—either for free or for a substantial fee—carry a baby for someone else. The American Society for Reproductive Medicine (ASRM) outlines these indications for using a surrogate:

  • When a medical condition prevents pregnancy

  • If a woman cannot conceive after multiple rounds of IVF

Extensive screening for all patients (male and female) is required under their conditions for surrogacy.

It may feel like the ASRM’s standards don’t align with cultural practice. Increasingly, occasions of elective surrogacy for lifestyle reasons have a place in our society. Gay couples also benefit from surrogacy.

Legality and support play a role in whether women choose to have a baby through a surrogate. From complicated economics to challenged moral notions, it’s vital to cut through the clutter and provide women with an open path to motherhood, whatever that looks like. Let’s review the past and consider the future of surrogacy.

The History of Surrogacy

The concept of surrogacy has existed since ancient times, when women had other females get pregnant by their husbands in the interest of bearing large families. Gestational surrogacy is when a baby is conceived using a woman’s own egg and a sperm. In vitro fertilization (the first of which was in 1978) created new opportunities, as embryos could be created outside of a woman’s body. Depending on whose egg and sperm are being used, surrogates may or may not be biologically related to the baby they carry.

The first gestational surrogacy happened in the 1980s. Here is a review of some of the major historical milestones in surrogacy:

1976 marked the first legal surrogacy agreement in the United States

1980 recorded the first compensated surrogacy in the United States

1982 was the year the first baby was born from a donated egg

1984-1986 held a legal custody battle over a baby born from surrogacy

1985 was the year of the first, successful birth from gestational surrogacy

1990 the state of California court case upheld the rights of intended parents

Legal Barriers to Surrogacy

Surrogacy is legal in most, but not every, state. As of 2019, aggressive efforts to change legislation in the state of New York failed and surrogacy remains illegal there. It is, however, legal in 47 of the other states.

State-to-state, the legal matters of surrogacy vary. There are different regulations on surrogacy depending on whether a couple is married or heterosexual. Some states have numerous legal hurdles (like parentage proof and birth certificates) that can severely impede the straightforward process of surrogacy.

For example, in Arizona, gestational surrogacy is an unenforceable but legal contract. This creates legitimate uncertainty and challenges to women who want to have a child through surrogacy. Many states also legislate things like egg and sperm donation, second parents and same sex couples.

What does all of this mean? It means that, in addition to the medical decisions you are facing, pursuing surrogacy requires some legal legwork and understanding.

Two Types of Surrogacy: Two Ways to Pay For It

There are two types of surrogacy:

Gestational surrogacy: another woman’s egg and a sperm are carried by a surrogate.

Traditional surrogacy: a surrogate’s egg creates the embryo, which means the surrogate is biologically related to the baby she carries.

With either method of surrogacy, the surrogate can be paid or unpaid. These two methods are referred to by the terms altruistic and commercial.

Altruistic surrogacy: a woman carries a baby as a surrogate and charges no fee (note: this method is more legally acceptable in many states than commercial surrogacy).

Commercial surrogacy: a surrogate is paid for carrying a pregnancy.

Innovations in Surrogacy

The advent of modern surrogacy was arguably ushered in by procedures that can create human embryos outside of a woman’s body. These procedures—as well as the extensive regulatory processes that accompany them—make surrogacy without biology a possibility. In other words, a surrogate isn’t necessarily related to the baby she carries. This is also an important innovation for gay men who want to have a child for whom they choose both parents.

The Society for Assisted Reproductive Technology (SART) reports improving statistics for the successful implantation of eggs retrieved from freezing. The Centers for Disease Control (CDC) and Prevention monitors assisted reproductive technologies. Their numbers indicate a surrogacy success rate in IVF clinics of around 75%, with a healthy birth rate up to 95%.

For the most part, the procedure itself is enjoying success. Innovations in surrogacy center around the legal and cultural conversation. How do women or gay couples who choose surrogacy avoid being stigmatized? Full legalization is part of the battle. Here are some articles you can read to learn more about the legal fight and social issues transpiring in numerous states:

Surrogacy Is Complicated. Just Ask New York. NY Times

House to Consider Ban on Commercial Surrogacy Agents, U.S. News and World Report

‘It takes a lot of trust’: Surrogate delivers first baby of 2020 at UPMC Carlisle Penn Live

Paying gestational carriers should be legal in all states, Stat

What is Surrogacy Like? Today

Surrogate Pregnancy Battle Pits Progressives Against Feminists, NY Times

Support for Surrogacy

At Fertility4Me, we believe that the right choice is the one you make. Whether you are building a family or offering to be a surrogate for someone else, beloved babies enter the world in many ways. Innovations in technology should be supported by an update to our cultural language and norms. If you or someone you know needs support for surrogacy, feel free to review our resources and join our social community. We are here to support all women’s health issues by providing the right knowledge and understanding so you can make the right decisions for yourself.