Infertility & Surrogacy – What Are the Medical Reasons for Surrogacy?

Surrogacy, also known as surrogate motherhood, is a third-party assisted reproduction treatment that brings parenthood to those who are unable to conceive or carry a child until birth naturally.

Medical causes include absence of uterus, Müllerian duct anomalies, conditions considered contraindications to pregnancy, or lacking the necessary body parts to cause and bear a pregnancy, as in the case of gay and single men who want to become parents.

Infertility causes leading to surrogacy

It is estimated that nearly one out of six couples of childbearing age experience issues when they start trying to conceive. This is known as infertility or infertility problems. The causes are varied and can be associated with the man, the woman, or even both.

Most of the problems that can appear when a woman tries to get pregnant are caused by anomalies in the reproductive cells or gametes (eggs and sperm) which prevent egg fertilization. However, female infertility can also be attributed to certain uterine diseases that make it difficult for the embryo to attach to the womb.

On the other hand, a woman may be childless because she is unable to get pregnant or bear a pregnancy until birth. The good news is that there's a reproductive option for all of them called surrogacy or surrogate motherhood. With surrogacy, they can have another woman carry a child for them, thereby fulfilling their dream of having a baby.

Why surrogacy?

Making the decision of having a baby using a surrogate or gestational carrier is not something that one does hastily. However, depending on the cause that has led you to consider this fertility treatment, you may choose it as:

Your first choice

In women born without a uterus or those who have had it surgically removed, or when there is a condition considered a contraindication to pregnancy. Also, for gay couples and single men who want to expand their family and be genetically related to the child.

A last resort

When repeated implantation failure (RIF) is diagnosed after several failed IVF cycles. In this case, your doctor may recommend that you use a surrogate to have a child.

A man can't get pregnant because he lacks the necessary organs for causing and sustaining a pregnancy. For this reason, male couples and single men need a surrogate with an egg donor to have a child, should they wish to have a biological child.

Medical reasons for surrogacy

According to the guidelines for practices utilizing gestational carriers provided by the Practice Committee of the American Society for Reproductive Medicine (ASRM), surrogate motherhood might be medically indicated in the following cases:

Absence of uterus

Either congenital (MRKH Syndrome) or acquired (hysterectomy or complete removal of the uterus).

Significant uterine diseases

Uterine or Müllerian duct anomalies, including bicornuate uterus, fibroids, polyps, severe endometriosis (grade IV), unstuck Asherman's syndrome (endometrial sclerosis), etc.

Repeated IVF failure

Implantation failure, recurrent pregnancy loss...

Absolute medical contraindication to pregnancy

Due to certain conditions in the mother, the fetus, or both (e.g. pulmonary hypertension).

Biological inability to conceive or bear a child

As in the case of gay males and single men who wish to have offspring, as they lack the female reproductive organs necessary for causing a pregnancy.

Medical reasons for surrogacy

To get a much deeper insight about these medical causes, continue reading:

Hysterectomy

A woman may have no uterus due to acquired causes, including the complete removal of the uterus through a surgical procedure called hysterectomy. Without a uterus, embryo implantation can't take place, as there is no place for the embryo to attach. In other words, a pregnancy is not possible.

Fortunately, women who have had their uterus surgically removed have three options should they wish to have children:

Adoption

The child is not genetically related to the adoptive parents.

Surrogacy

The intended mother can still have a genetic link to the child as long as she has ovaries and produces viable eggs.

Uterus transplant

Although children have already been born using this method, it is a still an experimental procedure due to its technical complexity.

In cases of radical hysterectomy, the surgeon removes both ovaries as well. When this type of hysterectomy is required, the woman will not only miss her chance of becoming pregnant, but also of being genetically related to a child born via surrogacy. Gestational surrogacy with egg donation would be the treatment option of choice in such cases.

Types of hysterectomy

And the same treatment options are available when the uterus is absent from birth (congenital). We are talking about the Mayer-Rokitansky-Küster-Hauser Syndrome or MRKH Syndrome. Since egg production exists in women with MRKH Syndrome, they are still able to have biological children in spite of using a surrogate.

Uterine diseases or anomalies

The womb or uterus is the female reproductive organ where the fetus develops until birth. The presence of severe anomalies or diseases in this organ might prevent a woman from carrying a child until birth.

Müllerian duct or uterine anomalies (malformations), large fibroids o polyps, or endometrial sclerosis (unstuck Asherman's syndrome) are the most common causes of embryo implantation failure and inability to bear a pregnancy. For this reason, surrogacy might be a reproductive solution for these patients.

Müllerian duct anomalies and uterine diseases

It should be noted that, contrary to what happens in women without a uterus, uterine anomalies do not always translate into being unable to bear a pregnancy. In short, surrogacy is indicated only in the most severe cases.

Repeated IVF failure

Having gone through multiple failed IVF cycles is another reason leading infertile women to consider surrogacy as the solution for creating a family.

Whether the precise cause is recurrent implantation failure (RIF) or recurrent pregnancy loss (RPL), it is only logical to feel devastated after seeing how your efforts to make IVF succeed are in vain. For this reason, after several failed IVF cycles, infertile couples may decide to have another woman carry a child until birth for them as a last resort.

Implantation failure and recurrent miscarriage

Frustration and distress are common emotional effects in these cases, often leading hopeful intended parents to considering giving up on their dream of becoming parents. However, this is precisely one of the multiple positive of surrogacy—it gives them hope when they feel like there's none.

Contraindications to pregnancy

There exist certain serious diseases and health problems that are considered contraindications to pregnancy in spite of not being directly linked to the process of conception.

When a woman has any of these conditions, getting pregnant may worsen their symptoms and the risks associated, leading in certain cases to the death of the mother and the fetus. When pregnancy becomes a life-threatening factor, your doctor may "forbid" pregnancy to prevent further complications.

These are some examples of conditions considered contraindications to pregnancy: autoimmune diseases (systemic lupus erythematosus), blood clotting disorders (thrombophilia), cardiovascular diseases (Marfan syndrome), neurological disorders (epilepsy), etc.

Another option for becoming parents

We already have commented on surrogacy as a means to become parents when there is no possiblity to carry a pregnancy to term be it for biological reasons be it for health reasons.

There is, however, a second option for those who don't consider surrogacy as a reproductive option for themselves:

Adoption

There are more conservative persons who are reluctant to resort to surrogacy or it also could be the case that they just have not the financial resources to opt for this costly reproductive treatment.

This is why there is only one possible solution left in order to become parents: the adoption of a minor. These are the following adoption types:

Domestic adoption

The adopted child is U.S citizen or resides in the U.S when being adopted.

International adoption

The child to be adopted has foreign nationality coming from a country who is party of the Hague Convention on Protection of Children and Co-operation such as Haiti or China or coming from a different country who is not party of the Convention.

If you like to know more about as to how adoption works in the U.S, we recommend you read the following article: Adopting a child in the United States.

FAQs from users

Can a man give birth to a baby?

No, there's no possible way for a man to be able to get pregnant and give birth to a baby. Men lack the reproductive organs that allow pregnancy in women: ovaries, cervix, uterus, etc. Without a uterus, pregnancy can't take place. A couple of two men or single men willing to have a child should consider other options like surrogacy or adoption.

Is surrogacy an option for HIV positive parents?

Yes, it is as long as it is medically indicated. However, there exist other techniques such as sperm washing that can allow HIV-infected male patients to have a child via IVF without needing a surrogate.

Can a woman have a baby without a womb?

No, pregnancy can't take place if there's no uterus. The uterus is home for the developing baby during the 9 months of pregnancy. Without a uterus, a fetus would be "homeless".

How can a transgender man have a baby?

It depends on a case by case basis. Since transgender men were born with the anatomy needed for natural embryonic and fetal development, some trans men who retain functioning ovaries and a uterus can become pregnant successfully in spite of having physically transitioned to male.

Can a man have a baby without a woman?

Yes, surrogacy is a fertility option that allows single men to have a baby without a woman. Since men are born biologically incapable of getting pregnant and bearing a pregnancy, the only option for them to be genetically related to a baby in spite of not having a female partner is surrogate motherhood.

Can a man become a woman and give birth?

Yes, this is the case of transgender men (commonly referred to as FTM, an acronym for female to male). As long as they have decided to retain their ovarian function and a uterus, they can become pregnant and give birth. It is the case of Matt Rice and Thomas Beatie, two transgender men who have borne children successfully.

Is surrogacy for non-medical reasons possible?

Yes, it is permitted in various countries, including the United States. This option is known as gainful or commercial surrogacy and is a common choice among celebrities who want to avoid the physical changes associated with pregnancy. In other countries like Ukraine, Greece or Georgia, surrogate motherhood is allowed only for medical reasons.

Related: International Surrogacy – Laws & Options for Surrogacy Abroad.

Where is it necessary to prove the impossibility of pregnancy in order to have access to surrogacy?

Russia, United States, Canada, Greece, Georgia and Ukraine are the most common and safest countries to obtain a surrogacy. Among them, Georgia, Russia, Ukraine and Greece require that expectant parents, known as intentional parents, demonstrate difficulty in becoming pregnant.

If you want to know the conditions of surrogacy in each of these countries, you can read this link: Surrogacy Laws by Country – Where Is It Legal?.

Suggested for you

All in all, surrogacy is a fertility treatment that involves a third-party. This is the case of donor conception as well. To learn all the details about this treatment option, read: What Is Surrogacy & How Does It Work? – Everything You Should Know.

Or, if you want to get a much deeper insight about the medical process of surrogacy step by step, including the costs and chances of success, I recommend that you take a look at the following guide: What Is IVF Surrogacy? – Process, Success Rates & Cost.