Types of surrogacy

There are two types of surrogacy, ‘straight’ and ‘host’.

Straight (or traditional) surrogacy

Straight surrogacy is the simplest and least expensive form of surrogacy and is also known as artificial insemination.  The surrogate mother uses an insemination kit to become pregnant using the intended father’s semen.  The baby will therefore be conceived using the surrogate’s egg.

Some people prefer to use a clinic for inseminations, but it can also happen at home and can therefore seem a more natural and less ‘medical’ way of becoming pregnant than host surrogacy.  It can, however, can be harder emotionally for both the surrogate and the intended parents.

Host (or gestational) surrogacy

Host surrogacy is when IVF is used, either with the eggs of the intended mother, or with donor eggs.  The surrogate mother therefore does not use her own eggs, and is genetically unrelated to the baby.  It is physically more complicated and considerably more expensive than straight surrogacy, (although many IPs can have some costs covered by the NHS) and always takes place in a fertility clinic.

Some Surrogates prefer this method as they may not be comfortable with using their own eggs in surrogacy.

In essence, there are three stages to ‘host’ surrogacy:

  • Egg donation: the female IP, or the egg donor, undergo special procedures to extract a number of eggs
  • Fertilisation: the egg is fertilised with semen in the laborator
  • Transfer: the fertilised egg is transferred into the womb of the surrogate mother

The fertilised egg can be transferred to the surrogate either ‘fresh’ or after having been de-frosted from egg storage.  For a fresh egg transfer the monthly cycles of the surrogate and the egg donor must be synchronised, and this is done using hormone medications.  In cases where embryos have been frozen already and the de-frosted embryos are being transferred some IVF clinics will insist on the surrogate mother taking hormone medications to ‘ready’ her womb lining.

All clinics vary in practice but below is an example of a cycle where the intended mother is the egg donor, and there is a fresh egg transfer.

An example cycle timeline

WhenWhat happens
Day two or day twenty-one of the surrogate mother’s menstrual cycleThe Surrogate Mother’s natural hormones are “down regulated” with hormone medication
Twelve days later
Down regulation of the surrogate mother is confirmed by a vaginal ultrasound scan
After this• The egg donor starts daily injections to boost egg production
• The Surrogate Mother starts daily oestrogen tablets to build up the lining of her womb
When both the surrogate mother and the egg donor are ready - usually twelve to fourteen days after the step aboveAll suitable eggs are collected and fertilised with the quarantined sperm.
Two to five days laterUp to two embryos are placed into the uterus of the Surrogate Mother. Any remaining embryos that are of suitable quality will be frozen for use, if needed, in future attempts.
Ten to fourteen days laterPregnancy may be confirmed
Six weeks after a positive test resultViability scan takes place: if you are lucky, you may even see a tiny heartbeat. The clinic will inform your GP and the pregnancy will then be treated as any other pregnancy with care being given by the surrogate mother’s local NHS team.
If the treatment has been unsuccessful
The Surrogate will be advised to stop all medication and a heavier than normal period will start a few days later. You should also be offered a follow-up consultation where further options will be discussed. If all parties involved decide to try another transfer, you will need to wait for at least another month before treatment can continue, and most clinics suggest two periods occur after IVF before trying again.

The fertility clinic may require the surrogate mother to undergo a ‘mock transfer’ to ensure she is physically capable of being a surrogate.  This is no more painful or uncomfortable than the usual cervical smear.

Some clinics will insist that their ethics committee approves your case before allowing treatment to commence.  If you have not received surrogacy implications counselling the fertility clinic may require you to see one of the clinic’s independent counsellors.

Screening and preparing for surrogacy treatment

The clinic will require all parties involved in the surrogacy arrangement to undergo a number of checks or procedures.  These will vary, and your clinic will advise you which ones are required.

Because of the long incubation period for HIV, your fertility clinic will usually require that the semen used has been frozen for six months prior to use.

Host surrogacy with donor eggs

Some IPs are not in a position to create embryos themselves, either for medical reasons, or because they are a male same-sex couples.  There are several options available:

  • Known donor eggs. This is where a friend or relative of the IPs donates eggs in an IVF clinic.  In some cases it is possible to meet a potential egg donor through SUK, and there is an egg donor list within the organisation.  Please email membership.secretary@surrogacyuk.org for further information.
  • Anonymous donor eggs. Most IVF clinics have their own egg donors available, often with a waiting list.  You would need to make your own enquiries about this with the clinic of your choice.  In this case you will not meet the egg donor and would receive limited information about her, unless she had specifically chosen to remove her right to anonymity.  In all cases, children born through egg donation have the legal right to receive information about the egg donor when they turn 18.
  • In the above cases it is illegal to make any payments to the egg donor apart from reasonable expenses.  Commercial egg donation is available abroad, but it is illegal to bring commercially-obtained donor eggs or embryos into the UK.  This means that a surrogate mother would need to travel to the country of egg donation in order to receive her IVF treatment.

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