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Consider the Surrogate

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Let’s consider the surrogate. This is a woman you expect to provide an optimal environment – internally and externally – for the nine months your baby is in utero. She is someone who is unselfishly giving her body over to you and your baby for three-quarters of a year. (Yes, she is being compensated.) Your surrogate is someone who will be part of your child’s story forever.

The Ethics Committee of the American Society of Reproductive Medicine (ASRM) recently issued a committee opinion entitled Consideration of the Gestational Carrier. The document, “considers the protective safeguards that need to be in place to ensure the ethical treatment of gestational carriers.” According to the document, gestational carriers:

  • Have a right to be fully informed of the risks of the surrogacy process and of pregnancy
  • Should receive psychological evaluation and counseling
  • Should have independent legal counsel.
  • Should be at least 21 and at least one birth
  • Have the right to appropriate medical care
  • Should be counseled on risks of multiple pregnancy if more than one embryo is transferred
  • Need to understand types of infectious disease screening, (And, intended parents need to understand limits of screening)


  • Reasonable economic compensation to the gestational carrier is ethical
  • The intended parents are considered to be the parents of any children born by a gestational carrier
  • The obstetrician should be agreed upon by the surrogate and intended parents
  • There should be discussion with carrier about the broader social context – such as the effects on the carrier’s child(ren) or partner

Most of the points raised in the committee opinion are standard operating protocol for surrogacy agencies and fertility clinics that have surrogacy programs – or should be. They should advise clients to have separate legal counsel and provide psychological screening, for example. But they are worth repeating here, for the benefit of carriers and intended parents alike.

According to Dr. Paula Amato, a reproductive endocrinologist with OHSU Fertility in Portland, OR, and Chair of the ASRM Ethics Committee, “Pregnancy in and of itself is a risk,” and the surrogate needs to understand those risks. What goes on during and after the embryo transfer should be explained in detail beforehand.

One point of contention amongst the committee, Amato says, was whether the surrogate had to have had a delivery prior to becoming a surrogate. Amato considers that the most conservative of the recommendations. But from an emotional perspective, and without having a pregnancy and delivery, a surrogate risks being truly informed, she explains.

She also points out that the committee deemed that compensation is ethical, and adds, “People can debate what is appropriate.”

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