Information for intended parents

"Family became aware of our situation and a family member offered to be a surrogate for us. Before we even got to the first point of undertaking any medical procedure we had to make sure we’d considered every aspect of issues that might have occurred during that surrogacy process". Leanne

General considerations

Reasons for surrogacy

There are a number of reasons why people may be considering surrogacy, such as:

A woman is unable to become pregnant or carry a baby for medical reasons -
- she may have had surgery to remove her uterus (hysterectomy)
- is missing part of her uterus or the lining of her uterus has been damaged
- pregnancy may be a risk to her health due to a medical condition - e.g. heart problems, cystic fibrosis -or to the child
- recurrent miscarriage
- repeated IVF attempts have failed.
A same-sex couple (male or female) or individual may want to have a child conceived using their own sperm or eggs and donor sperm or eggs.
A couple who are involved in an IVF treatment program may have embryos in storage and, if the woman dies, the male partner may wish to commission a surrogate to carry and give birth to a child.

Chances of having a baby through surrogacy

The chance of having a baby through surrogacy depends on a range of factors, including:

the age of the person providing the egg or sperm
the age of the surrogate
the lifestyle of the surrogate and egg or sperm providers
the quality of the embryo which is transferred to the surrogate.

The different surrogacy options

Gestational surrogacy

Gestational surrogacy means that the surrogate’s egg is not used in conception, so she has no genetic link to the baby. In other words, she is not the biological mother but simply carries the pregnancy (also referred to as 'gestational carrier') on behalf of the commissioning parents. The embryo implanted in the surrogate may be created using the sperm and egg of the commissioning parents, or donor embryos may be used.

Victorian ART clinics are only permitted to practise gestational surrogacy. Some overseas and interstate clinics may also only practice gestational surrogacy.

Traditional surrogacy

Traditional surrogacy is where the surrogate mother provides her own egg and she undergoes donor insemination with the commissioning father’s sperm or has embryos transferred which have been created using the surrogate’s eggs and the commissioning father’s sperm. Where a surrogate has also provided the egg and is therefore genetically related to the child, this raises additional issues about the child’s right to information about their identity and medical history. See also donor conception. It may also be more difficult emotionally for the surrogate to give the baby to the commissioning parents.

ART clinics in Victoria do not practise traditional surrogacy due to legal requirements. It is however possible to procure a traditional surrogacy through home insemination procedures. This is permitted under Victorian law. Overseas clinics in some countries may also practise traditional surrogacy. If you are contemplating a traditional surrogacy, VARTA recommends that you obtain legal advice, especially with respect to obtaining legal parentage of any child born.

Altruistic surrogacy

Altruistic surrogacy is where the surrogate mother is not paid a fee or reward beyond being reimbursed realistic out of pocket expenses for the pregnancy, e.g. medical costs, travel, etc. An altruistic surrogacy arrangement may be either gestational or traditional.

Each of the States and Territories (except the Northern Territory) has legislation requiring altruistic surrogacy.

Commercial surrogacy

Commercial surrogacy is where a surrogate is paid or gains a material benefit for carrying the child. Commercial surrogacy arrangements within Australia are illegal and can be punishable by imprisonment in some States. Unlike in Australia, commercial surrogacy is legal in some countries.

Possible health effects of surrogacy

There are certain medical risks involved in surrogacy, which are similar across all methods of ART (refer to Possible health effects of IVF brochure). These can include:

Effects on the child born as a result of the treatment. IVF treatment has a greater chance of producing multiple births, which increases the chance of the baby being born prematurely and therefore having below-normal birth weight. This chance is naturally reduced if only one embryo is transferred.
Effects on the egg provider. Reactions to fertility drugs prescribed, including hot flushes, feelings of depression or irritation, headaches and restlessness. There is also the small risk of ovarian hyper-stimulation syndrome (OHSS), which can cause stomach pains, nausea, vomiting, shortness of breath and faintness.
Effects on the surrogate. The usual risks associated with any pregnancy and birth. These risks increase with the age of the surrogate.

There is also the rare risk of transfer of HIV and/or hepatitis. To eliminate this risk, mandatory screening of everyone involved in surrogacy is required.

To enhance safety, embryos may be ‘quarantined’ for six months (although this time period may vary from clinic to clinic), at the end of which, the people who provided the gametes have repeat blood tests.

For more detail about the medical risks involved in surrogacy, please consult your doctor or fertility specialist .

Beyond the financial costs and the legal side of surrogacy, there are a number of emotional and practical things to consider, including:

Are you emotionally ready?

Your child is much wanted and planned for. It is important that you are positive and proud of the journey you took to bring them in to the world, so that they can be too.

Many intended parents experience doubts. Many fear that the surrogate will want to keep the baby or will want to intrude or interfere with your family. These concerns are not borne out by reality. Few surrogates do not relinquish the child. There are more cases of the commissioning parents not wanting to take responsibility for the child. Remember, a surrogate carries a pregnancy to help you become a parent. All surrogates and commissioning parents in Victoria have counselling to ensure that they are fully aware and are as emotionally prepared as possible for what is involved.

Intended mothers, ask yourselves: Have you have given yourself time and space to reconcile not being able to be pregnant and give birth, before you start looking for a surrogate? Most people need time to grieve for such a loss. If you want your child to be comfortable that they were carried by a surrogate, you need to be too.

Intended fathers, ask yourselves: Is surrogacy the most comfortable option for you? Have you explored other avenues to become a parent? It is important if you will not be genetically connected to the child that you feel comfortable with this and that you have given yourself the time and space to let go of not being able to pass on your genes.

The surrogacy experience: Leanne & Antoinette's story

Surrogacy perspectives: Pippy, Fiona, & Laura's stories

Finding a surrogate

Finding a surrogate within Australia can seem impossible. You may ask yourself - 'Where do I begin? Who could I possibly ask?' You may also feel apprehensive about needing someone's help for such a personal purpose.

The Finding a surrogate brochure aims to help guide you through this process. You may also wish to contact a fertility clinic counsellor for advice and support.

Your relationship with the surrogate

As with any relationship, good communication, respect and trust are crucial for a successful relationship between commissioning parent(s) and a surrogate. It can be difficult to take the time needed to build a strong foundation of trust and commitment when the desire to have a child is so strong. However, the issues are complex and both you and your surrogate need time and space to think them through and to decide whether or not to proceed.

It is important to have a shared understanding of expectations for the pregnancy, the birth plan, information exchange beyond the birth and what kind of continuing relationship you will have after a child is born. Little issues can become big issues if they are not dealt with. If there are any potential ‘red flag’ issues that you don’t agree on, it is important to pay particular attention to these and to talk these issues through, even though these are likely to be challenging conversations. It is essential that you continue to like and respect your surrogate and are able to stay in touch for your potential child’s sake.

A surrogacy agreement enables you to write down what is agreed, even if the surrogate is a close friend/family member. This process will help both parties clarify their wishes, expectations and responsibilities.

Ask yourself: ‘Will I be comfortable about our arrangement at my child’s twenty-first birthday and beyond? Will my child? Will the surrogate? Will her partner, children and extended family?’

The following are factors that can contribute to a positive outcome from a surrogacy arrangement.

Minimal risk factors - stable mental and physical health, positive life situation, supportive partner.
Clear and open communication.
Clear boundaries and realistic expectations.
Knowledge of the medical process, including being realistic about the timeline – it could be up to 12 months before embryo transfer occurs.
Realistic expectations about the emotional reactions that may occur during the process. Emotions should be managed with care and sensitivity - anxiety, grief, guilt and disappointment are all common feelings.
Discussions between all parties regarding what are fair and reasonable expenses for the surrogate. Commissioning parent(s) should also plan a budget.
Agreement on a pregnancy and birth plan that all parties are comfortable with. However, keep in mind that like any pregnant woman, the birth mother has the right to manage her own pregnancy - regardless of what may have been agreed in the surrogacy arrangement.

Ingredients for a successful relationship with a surrogate

When surrogate mothers were asked their views about a successful relationship, their answer was unanimous: open and honest communication, and trust and respect for each other are as vital as a healthy pregnancy.

What a surrogate wants from intended parents

Trust is an integral issue if the surrogacy arrangement is to be a happy one. Trust your surrogate to do the right thing by herself, her body and your baby. Be genuine, respectful, open, reliable and have some degree of flexibility to work well together.
Have common long-term goals about the rights and interests of the child and agreed openness about their conception and genetics.
Be open to ongoing contact and communication in regards to the child. Children need/like to know their origins and the more open that process is, the better for them.
Remember, by agreeing to carry your child, your surrogate is potentially putting a lot of strain on her personal relationships. The people who are most affected are her children and partner. Please consider them too as they are the silent parties in a surrogacy arrangement.

What happens if you are friends or family?

Your relationship will be taken to new dimensions but don’t push it. Don’t take for granted that your surrogate will do everything to please you just because you’re related or long-time friends. Pregnancy can be tough; it is important that you listen to her is she needs to complain about any unpleasant symptoms or fears.

During the treatment and pregnancy

Keep your promises. Only promise something if you are confident you can fulfill that promise.
Show a commitment to your surrogate and the pregnancy. Attend appointments; show an interest in the pregnancy, in your surrogate’s health and, of course, in her as a person. She will appreciate thoughtful texts and phone calls right throughout the pregnancy.
Be flexible. Your surrogate probably leads a busy life as a mother, partner and worker. Be prepared to plan with her; not forher.
Be honest about how you are feeling. There may be grief involved in watching someone else carry your baby. Difficult emotions are likely to come up for everyone involved at some point - do not hide from these emotions. Your surrogate is likely to pick up on those feelings and have concerns. While she gets to experience the first few tentative months with your unborn child, you will have a lifetime to experience all the firstsand the highs and lows. She is excited about this - she hopes you are too!
Expect feelings to change.Circumstances that a surrogate and commissioning parents may have considered acceptable before a pregnancy may change once it is a reality. Do not shut each other out. Just as commissioning parents are emotionally invested, a surrogate is also committed to her role of delivering a healthy baby for you.
Offer practical support. If your surrogate is struggling with the demands of the pregnancy, it might be appreciated if you cook the family some meals, organise a cleaner for her home, or take her children out for the day so she can get some much needed rest.
Offer emotional support. Listen to any complaint she may have about unpleasant pregnancy symptoms or fears.
Be financially responsible. Part of the relationship between a surrogate and intended parents is financial. When your surrogate needs funds to be reimbursed, either pay ahead or as quickly as possible after the event. Financial matters can be difficult to discuss. It is critical that both parties establish a system that gives the surrogate confidence to talk about the costs she has had to pay to ensure no undue stress or conflict between you.

Many thanks to Rachel Kunde and the members of the Australian Surrogate Support group she consulted, who contributed information and advice to this text.

Talking to your child about surrogacy

Talking to your child about how you became a family through surrogacy is no different from the experience for families created through donor conception or other forms of assisted reproduction. In fact, it is similar to how any child is taught about their conception. It is all about openness, honesty, how, when and why tell.

Whether a child is born with the help of a surrogate in Australia or a surrogate internationally, research and anecdotal evidence shows that children of surrogacy and donor conception benefit from being told how they came to be in the world. Children are also often curious to know more about their surrogate and/or donor.

Surrogacy perspectives: Fiona, Pippy & Laura's stories

Mother & son talk surrogacy: Karen & Matt's story

VARTA offers a range of resources on the subject of talking to children about donor-conception and surrogacy for you to explore.

Tip

In Victoria, ART clinics are only permitted to practise gestational surrogacy. This means that the surrogate is implanted with an embryo created using an egg from another woman (either the commissioning mother, or donated from another woman). Without the involvement of an ART clinic, traditional surrogacy is permitted. If you are contemplating a traditional surrogacy, VARTA recommends that you obtain legal advice, especially with respect to obtaining legal parentage of any child born.

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