Indications for surrogacy

A conference on surrogacy was organized on June 3, 2016 by the Tambre Clinic, a fertility center located in Madrid, in which several doctors spoke, among other things, about this technique from a legal, anthropological, social or medical perspective.

During this conference, Dr. Javier Nadal of the Quirón Clinic in Barcelona gave a presentation on the medical indications that can lead to surrogacy in order to realize the wish to have a child.

Reasons that prevent or complicate pregnancy

The doctor divided the main indications into two groups: absolute and relative. In the next section we detail them.

With the advance in science and the application of new technologies, new treatments and options have emerged in order to solve pathologies and to carry a pregnancy to term without risk. However, some situations continue to prevent gestation and are therefore still indicated for surrogacy.

Absolute medical indications

The main reasons for resorting to surrogacy are:

Uterine alterations

Even though there are few cases, the congenital absence of the uterus, known as Rokitansky syndrome, is one of the indications why a woman cannot gestate her baby, since she has no uterus to host the pregnancy. The same occurs in women who have had their uterus removed for different medical reasons.

The presence of significant uterine abnormalities can also lead to the inability to gestate. Some examples of these alterations are:

• Severe or irreparable Asherman's syndrome
• T-shaped uterus due to exposure to diethylstilbestrol, tuberculosis, multiple uterine interventions, etc.
• Abnormalities associated with recurrent miscarriage or repeated miscarriage.
• Polymyomatosis
• Severe adenomyosis

Medical contraindications

It can be absolute as in the case of breast, endometrial or ovarian cancer and also in the case of certain autoimmune diseases such as ulcerative colitis, scleroderma, severe renal failure or certain severe heart diseases.

Contraindication for pregnancy

It can also be a very serious medical condition. In this situation, if pregnancy occurs, the disease could aggravate or risk the fetus.

Social reasons

These are mainly cases where there is a biological incapacity that prevents pregnancy, that is, male homosexual couples and single men. Surrogacy is one of the options which allow these new family models.

It is also possible for a woman to resort to surrogacy due to panic during pregnancy and childbirth.

Use of certain medication

The use of certain medication or specific treatments for certain diseases may prevent pregnancy, such as chemotherapy or some drugs for autoimmune diseases.

Chronic diseases such as AIDS or hepatitis B with cirrhosis can also lead to gestational disability.

Relative indications

These are the other causes that can incapacitate in some cases a full-term pregnancy and for which therefore surrogacy could be the reproductive solution:

• Indeterminate endometrial factor: repeated miscarriage, implantation failure, multiple failures of IVF or multiple transfers of good quality embryos that do not result in pregnancy.
• Severe endometriosis and severe adenomyosis. They are benign alterations but behave as malignant.
• Advanced maternal age..

In the last case, the doctor throws a question to those attending his talk and, in short, to society in general about the age of mothers who need surrogacy.

In doing so, the doctor wanted to make people reflect about whether it was ethical or licit not to limit the age a woman is allowed to resort to surrogacy in order to be a mother.

In the case of other assisted reproduction techniques, many countries such as Spain or Denmark limit the age of the patients. The same applies to adoption. However, in surrogacy the age of the mother of intention is not limited in many cases and we must keep in mind that, although she is not going to "suffer" the pregnancy, raising a baby still varies from age to age.

FAQs from users

In which cases are gestational surrogacy needed?

Single males, same-sex male couples, as well as single females and heterosexual couples who are not able to carry a pregnancy due to various reasons.