Surrogacy is a reproductive process whereby a woman, called surrogate or gestational carrier, carries someone else's baby. Depending on the assisted reproduction technique used, we can distinguish between traditional surrogacy and gestational surrogacy, and the woman carrying the baby will be referred to as surrogate mother or gestational carrier accordingly.
Irrespective of the technique of choice, whether IUI for traditional surrogacy arrangements, or IVF in cases of gestational surrogacy, the surrogate can act altruistically or be financially rewarded (altruistic vs. commercial surrogacy). So, in short, there exist four types of surrogacy, which you will find explained in detail below.
The different sections of this article have been assembled into the following table of contents.
Understanding the differences
Often, heterosexual couples turn to surrogacy in cases of female infertility or sterility, especially when there is a condition preventing the intended woman from getting pregnant successfully.
Likewise, gay male couples and single males have no alternative but to use a surrogate or a gestational carrier to have offspring, given the absence of a female to bear the pregnancy.
Surrogacy can be classified into two different types depending on the technique used to achieve pregnancy, and based on whether the surrogate is genetically liked to the baby or not:
- Partial, traditional, or genetic surrogacy
- Pregnancy is achieved by intrauterine insemination (IUI), thereby using the eggs of the surrogate. She will be the biological mother of the child.
- Full, gestational, or host surrogacy
- The gestational carrier becomes pregnant by means of in vitro fertilization (IVF), and she has no genetic connection to the child. The intended parents contribute their own gametes, or use donated eggs and/or sperm.
Also, surrogacy arrangements can be classified into altruistic or commercial depending on whether the surrogate receives a financial reward or not for carrying someone else's pregnancy:
- Altruistic or uncompensated surrogacy
- No payment is given to the surrogate as a reward for carrying the pregnancy. However, it is possible to reimburse her all the expenses incurred during pregnancy or as a consequence of being pregnant, including maternity clothes, special care, emotional support, special diet, etc.
- Commercial, gainful, or paid surrogacy
- The gestational carrier is economically compensated for the inconveniences caused as a consequence of the surrogacy process, including physically and emotionally. Additionally, she received a reimbursement of expenses.
As we said earlier, there exist four types of surrogacy depending on the viewpoint: On the one hand, based on the fertility treatment used and the origin of the eggs; on the other hand, based on whether the surrogate is economically rewarded or not.
From a technical & genetic viewpoint
We can distinguish between two primary types of surrogacy: Partial or traditional, and full or gestational. The main differences between them, as we shall see, are related to the assisted reproduction technique used, and the origin of the eggs—from the surrogate, an egg donor, or the intended mother.
Traditional surrogacy (TS)
Also known as partial, straight or genetic surrogacy, it is the first kind of surrogacy known in history. In fact, this is the reason why it is known as traditional surrogacy. Today, it is falling into disuse.
It involves inseminating artificially, by means of intrauterine insemination (IUI), the surrogate, which turns her into the genetic mother of the child. This means that the surrogate and the baby share their DNA. In other words, she is at the same time the gestational mother and the biological mother of the child.
Technically, the process is simple: The surrogate undergoes mild ovarian stimulation to control her cycle and the moment of ovulation. When she is about to ovulate, the sperm of the intended father or a sperm donor is placed inside her womb so that fertilization occurs as it would naturally.
Although this was the technique of choice at first due to its low level of technical complexity, its use is becoming less frequent because it creates an emotional bond between the surrogate and the baby, which can lead to a greater number of ethical and legal issues, especially if the surrogate decides to keep the baby in the end.
Gestational surrogacy (GS)
Gestational, full, or host surrogacy is a more complex procedure from the technical point of view. However, given that the gestational carrier is not genetically linked to the child, it is the type of surrogacy used nowadays.
In this case, the surrogate does not uses her own eggs: Her role is just limited to carrying the pregnancy. For this reason, she is called gestational carrier, often abbreviated as GC.
The ovulation stimulation process and the subsequent collection of eggs is carried out in the intended mother, as long as she does not have any fertility problem, or an egg donor (a third party). By no means will the GC the same person as the egg donor.
The eggs are fertilized in the laboratory using the husband's or partner's sperm, or donor sperm if needed, by means of classical IVF or IVF with ICSI. Finally, the resulting embryos are transferred in the gestational carrier.
From the technical point of view, the process follows the same steps as in IVF without surrogacy. However, the difference lies in the moment of the embryo transfer: The embryo is not transferred back to the intended mother's uterus, but to the surrogate's. This makes it possible for the GC to have no genetic link to the child.
You may also enjoy some further information reading this: What Is IVF Surrogacy? – Process, Success Rates & Cost.
From a financial viewpoint
Irrespective of whether it is a traditional or a gestational surrogacy arrangement, we can classify it into altruistic or commercial, based on if the surrogate is given a financial compensation or not. In most cases, choosing one type or the other depends on the regulations governing surrogacy in each country.
In altruistic surrogacy arrangements, the gestational carrier or surrogate doesn't receive a financial compensation, although she will be reimbursed all the expenses derived from the pregnancy.
Intended parents will cover all the medical and legal expenses incurred during the surrogacy process, including those directly derived from the pregnancy and the wellbeing of the GC, such as maternity clothes, special foods, vitamins, etc.
Unfortunately, it is not easy to find someone who is willing to carry a pregnancy without being compensated for her effort. A pregnancy translates into many alterations in the woman's body, which can be uncomfortable or lead more serious problems if not supervised by a professional.
In contrast, if the potential GC is a family member or a close friend, it is more likely that she is willing to carry a baby for them.
In this case, the gestational carrier receives an economic reward for the tremendous physical and emotional effort she makes. Being pregnant is a major change in a woman's life, as she has to control the foods that she eats, and modify her professional career in some way until childbirth.
For this reason, we cannot talk about a payment or salary for carrying someone else's baby, but for the time, inconveniences and discomforts that may occur throughout this period, and the potential risks involved. The compensation given to GCs is typically limited by law in those countries where surrogacy is legal.
The pre-determined sum of money that will be given to the GC is limited by law in order to prevent the commodification of the woman's body and surrogacy from becoming a business. This sum should not become an incentive for women living in poverty to become surrogates: It should be a symbolic amount that rewards her solidarity and desire to help others, not a form of surrogacy for profit.
FAQs from users
Why is traditional surrogacy unadvisable?
Traditional surrogacy is when the surrogate also provides her egg to create the embryo, so the surrogate is biologically related to the child and may argue to claim the parental rights of the child. Traditional surrogacy is highly not recommended due to the lack of legal protection.
What are the risks of gestational surrogacy?
First of all, it should be clear that a surrogacy pregnancy works like any other pregnancy, and as such it involves the same medical risks. In addition to the most common pregnancy symptoms, some serious side effects include gestational diabetes, hypertension, etc. Also, there is also the risk of miscarriage or preterm labor, aspects that should be properly envisaged in the surrogacy contract.
In gestational surrogacy, the are also some medical risks and side effects associated with IVF. Whether it is the intended mother or an egg donor who contributes the eggs, injecting herself with fertility medications can lead to some adverse reactions, such as allergy or slight needle bruising.
The gestational carrier can experience cramping or bleeding from the embryo transfer procedure as well. Although rarely, there is also some risk of developing an infection. In such case, treatment with antibiotics would be necessary.
Finally, if multiple embryos are transferred, it is likely that the GC gets pregnant with twins or even triplets, which at the same time increases the likelihood of preterm labor, C-section, placental abruption... To reduce the risks associated, GCs should follow their doctor's recommendations strictly.
Why is commercial surrogacy bad?
First, it should be clear that there are different opinions on this. While some consider it "bad" because it leads to the exploitation of women living in a situation of poverty and therefore the commodification of their bodies, proponents see it as a reward for their effort, a sign of gratitude for their solidarity.
What are the pros and cons of traditional surrogacy?
Although the surrogate may understand at first the details of the surrogacy contract she signs with the intended parents, the fact that she's the biological mother of the child may make it difficult for her to relinquish the child after giving birth.
This is considered the major con of traditional surrogacy, contrary to what happens with gestational surrogacy, where she is not genetically linked to the child. This may make it easier for her to relinquish the baby in favor of the commissioning parents. For this reason, straight surrogacy arrangements have fallen into disuse nowadays.
On the other hand, from a technical standpoint, traditional surrogacy involves a simpler medical process than host surrogacy. Since the surrogate is inseminated artificially through IUI, it is not required that she undergoes medical treatments prior to the procedure.
Can a traditional surrogate get pregnant by means of natural insemination?
No, natural insemination means having intercourse with the intended father, and that cannot be considered a type of surrogacy. In fact, it is explicitly mentioned in some sets of regulations, such as the Texas law.
Is traditional surrogacy legal in any US state?
Florida permits both traditional and gestational surrogacy arrangements, though in practice only gestational surrogacy arrangements are carried out nowadays.
In New Jersey, for instance, the law forbids traditional surrogacy arrangements, and is favorable toward gestational surrogacy. The statute of Arizona forbids both traditional and gestational surrogacy arrangements.
So, in conclusion, we can say that traditional surrogacy is not allowed in the United States.
Can you use donor sperm in traditional surrogacy arrangements?
Yes, you can. Since the surrogate is inseminated, the semen sample can be collected from either the intended father or a sperm donor.
Suggested for you
Throughout this article, we have defined the different types of surrogacy and the possible combinations depending on the origin of the gametes used, but what do you actually know about this treatment? Check this out: What Is Surrogacy?
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FAQs from users: 'Why is traditional surrogacy unadvisable?', 'What are the risks of gestational surrogacy?', 'Why is commercial surrogacy bad?', 'What are the pros and cons of traditional surrogacy?', 'Can a traditional surrogate get pregnant by means of natural insemination?', 'Is traditional surrogacy legal in any US state?' and 'Can you use donor sperm in traditional surrogacy arrangements?'.