What is Surrogacy? Process, Types, Benefits, Risks & Eligibility in India

Do you know that India is one of the most popular destinations for surrogacy? Many couples and individuals start their journey to parenthood, and it’s not always a smooth ride. Some may conceive naturally, while others may experience fertility issues, recurrent pregnancy loss, or medical conditions that may make it difficult or impossible to carry a pregnancy. Luckily, the field of reproductive medicine has come a long way, and many assisted reproductive technologies (ART) have opened up the possibility of parenthood, such as the way surrogacy works.

Before considering treatment, it is important to understand who is eligible for surrogacy in India under the current Surrogacy (Regulation) Act and related guidelines. 

If you have ever wondered what is surrogacy, how it works, or if it is right for you, then this guide is for you. From the surrogacy journey step by step to the types of surrogacy, eligibility, benefits of surrogacy, risks, and legal aspects in India, this guide will help you understand the entire process.

Our fertility specialists offer personalised advice and ethical fertility treatments, empowering intended parents to make informed decisions along the way.

What is Surrogacy?

Surrogacy is an assisted reproductive technology in which a woman carries and gives birth to a baby for the benefit of another woman and/or man, called the intended mother and father. For most modern births, the birth is through In Vitro Fertilisation (IVF). During IVF, the egg and sperm are fertilised in a laboratory to create embryos. One healthy embryo is then inserted into the surrogate’s uterus and allowed to develop until it is time for birth.

In the case of a medical condition, the embryo can be made through one of the following;

• The intended mother’s eggs and intended father’s sperm.
• Donor eggs
• Donor sperm
• Donor egg and donor sperm (as permitted by law)

The goal of surrogacy is to enable an individual or couple to be a parent to a child when they would not otherwise be able to do so. Surrogacy is very different from adoption in that it enables intended parents to be involved in the pregnancy journey from the outset, and in many instances, the baby is genetically related to one or both intended parents.

Who Can Consider Surrogacy?

This is not the first fertility treatment that is suggested. It is generally only considered if pregnancy is of no medical use or is a medical risk.

If you have any of the following, your fertility specialist might suggest surrogacy:

Women Born Without a Uterus

Congenital uterus anomalies (such as Mayen-Rokitansky-Küster-Hauser syndrome) can make it impossible for some women to conceive. If you can’t have a baby without a uterus, you may want to pursue surrogacy as the best route to biological parenthood.

Removal of the Uterus (Hysterectomy)

Cancer, large fibroids, heavy bleeding, and other medical issues may be the reason for a hysterectomy, which means that women who have one cannot carry a pregnancy. If there are healthy eggs or those already frozen, however, there is the possibility of having a genetically related child with the option of surrogacy.

Recurrent Pregnancy Loss

Multiple miscarriages can be heart-wrenching. If it is established during investigations that the pregnancy is not likely to be healthy, surrogacy could offer a great opportunity to have a healthy baby.

Multiple IVF failures

A condition in which some women consistently fail to implant good-quality embryos. Surrogacy is an option to consider after careful evaluation if the uterus is being a hindrance to the IVF treatment.

Serious Medical Conditions

Some medical conditions may cause pregnancy to be risky for the mother, such as:

• Severe heart disease
• Advanced kidney disease
• Pulmonary hypertension
• Certain autoimmune disorders
• Diabetes, if there are complications, that is very severe.

Under such circumstances, it might be the best way to build a family through surrogacy.

Severe Uterine Problems

If they don’t have a good chance of becoming pregnant due to uterine problems, heavy scarring (Asherman’s Syndrome), or large amounts of adenomyosis, they might be offered the option of surrogacy.

Types of surrogacy – Choosing The Right One

Gestational surrogacy and traditional surrogacy are the most popular types of surrogacy in India. The difference is that the surrogate is not related to the baby. Families that are pursuing parenthood can use the knowledge of these types to guide their decisions about their fertility journey.

Gestational Surrogacy

Gestational surrogacy takes place when an IVF procedure is used to create an embryo, which is then placed into the womb of the intended mother. The baby is placed in the uterus of a surrogate who is not genetically related to the baby. This is the most popular and healthiest variety.

Traditional Surrogacy

Traditional surrogacy uses the surrogate’s own egg, and thus she is genetically linked to the child. Artificial insemination is normally used for conception rather than IVF. Due to the ethical, legal, and emotional issues that arise, it is no longer widely used.

Which Type is allowed in India?

The Surrogacy (Regulation) Act, 2021, permits only eligible intended parents to opt for gestational altruistic surrogacy in India. Commercial and traditional surrogacy are not allowed. The necessary legal and medical requirements must be met by intended parents before treatment.

Surrogacy Process: A Step by Step Guide 

Several medical, legal, and counselling processes are carefully planned to ensure the health and wellbeing of the intended parents, the surrogate, and the baby. While each trip will vary, the following are typical steps.

Medical Evaluation

The first step is a thorough consultation with a fertility doctor. Your doctor will examine your health history, past pregnancies or fertility treatments, and ensure you are healthy enough for the procedure. This evaluation assists in deciding if surrogacy is the best choice and can pinpoint factors that could impact the chances of successful treatment.

Fertility Assessment

The intended parents have fertility investigations to determine their state of fertility. This can involve hormone testing, ultrasound, ovarian reserve testing, a semen analysis, and the screening of infectious diseases. The results assist in deciding whether the intended parents egg and sperm will work or not and if they need donor gametes.

IVF & Embryo Creation

The egg donor or intended mother has her ovaries stimulated to get mature eggs, which are later retrieved and fertilised with sperm in the laboratory with IVF or ICSI. The embryos produced are observed for several days, and the embryo that is the healthiest is chosen for transfer into the surrogate’s uterus.

Embryo Transfer

The surrogate is given the hormones before embryo transfer to condition the uterine lining for transfer. Embryo transfer is a simple procedure performed in the office, and the embryo selected is gently placed in the uterus. A pregnancy test is done about two weeks later to determine if the egg is implanted.

Pregnancy Monitoring

After confirmation of pregnancy, the surrogate is treated for her with regular antenatal care during the gestation period. This consists of standard ultrasounds, blood tests, fetal growth checks, nutrition advice and monitoring for pregnancy complications. Follow-up visits ensure the health of the surrogate and baby.

Delivery & Legal Formalities

When the pregnancy is full term, the delivery is scheduled at the proper hospital with an experienced obstetrics team. Upon completion of all legal documents and birth registration procedures per the Indian surrogacy laws, the baby is handed over to the intended parents.

Surrogacy Eligibility Requirements for Intended Parents in India 

The many queries revolving around surrogacy in India seem to include who is eligible for surrogacy.

Surrogacy is only allowed under certain conditions and has very specific legal requirements under the Surrogacy (Regulation) Act, 2021 and the ART (Assisted Reproductive Technologies) regulations. The main objective of the law is to stop exploitation and to ensure that surrogacy is only performed for medical indications.

Generally, who is eligible for surrogacy in India? Intended parents can be considered eligible if they:

• Be unable to become pregnant or pregnancy is unsafe.
• Comply with the requirements of Indian legislation.
• Have the necessary medical and legal documents.
• Be assessed by competent fertility experts.

Eligibility is assessed on an individual basis, and the exact requirements may vary depending on the latest government regulations. It is critical to seek advice from a knowledgeable fertility expert and legal professional before taking any action.

Benefits of Surrogacy: Why Surrogacy Is a Life-Changing Option 

When other fertility options have failed, surrogacy is a viable option for many people and couples who are suffering from infertility. Although each trip is different, intended parents may be able to determine if they would be better suited to surrogacy by knowing the advantages.

1. Makes Parenthood Possible

The biggest advantage of surrogacy is that those who are unable to carry a child can become parents. There are also women with uterine abnormalities, women who have had a hysterectomy or those with serious medical conditions that can still have a child via surrogacy.

Surrogacy can be a lifeline for many families who couldn’t possibly conceive a baby on their own.

2. Opportunity for a Biological Child

For gestational surrogacy, embryos are frequently made using the intended mother’s eggs and the intended father’s sperm via IVF. This will be true if the baby is related to either or both intended parents, depending upon the treatment plan.

For many families, this natural relationship is one of the most significant factors to take into account.

3. Safe Alternative for High-Risk Pregnancies

For some women, pregnancy is a threat to them and their unborn child. These can be heart disease, kidney disease, untreated diabetes, pulmonary hypertension, or some autoimmune diseases.

For intended parents, surrogacy is a way to circumvent the risk of potentially dangerous pregnancy issues for the mother when trying to conceive a child.

4. Great Improvement in Pregnancy Chances in Suitable Cases

If multiple IVF attempts have been unsuccessful and there are uterine issues, then transferring embryos to a healthy surrogate may increase the likelihood of implantation and pregnancy.

While not every surrogacy is successful, in certain specific cases, surrogacy can lead to much improved results.

5. Allows Participation Throughout the Pregnancy

Intended parents tend to be able to stay more involved in the pregnancy journey than with adoption. They can attend medical visits, watch the baby’s growth, get ready for birth, and form emotional ties before birth.

6. Planned and Medically Supervised Process

Fertility specialists, embryologists, obstetricians, and lawyers carefully plan and monitor all of the entire surrogacy process. Medical examinations, prenatal monitoring, and comprehensive medical care maximize the safety of the surrogate and the baby.

7. When Multiple Fertility Treatment Failures occur

After many years of failed fertility treatments, many intended parents opt for surrogacy. If couples have had multiple IVF attempts without success or if they have suffered recurrent miscarriages, surrogacy can offer them a second chance at parenthood.

Knowing the benefits of surrogacy enables individuals and couples to better understand whether it is the right fertility option for their unique circumstances. 

Disadvantages of Surrogacy for Intended Parents 

Although surrogacy brings a glimmer of hope to many families, it’s important to be aware of the risks that may be involved before embarking on the journey. Knowing these drawbacks will enable intended parents to make informed decisions and plan accordingly.

1. Complex Legal Requirements

In India, surrogacy is governed by a law known as the Surrogacy (Regulation) Act, 2021. This process is more complicated and time-consuming than in the case of the intended parents, and some requirements must be fulfilled, medical certificates must be acquired, and legal papers have to be completed before the treatment can commence.

2. Emotional Challenges

It’s a very emotional experience to be a surrogate and intended parent. Being ready for a waiting period, prepared for counselling and patient and emotionally supported during that period by strong emotional support.

3. Multiple Medical Procedures

The medical processes associated with surrogacy consist of fertility testing, ovarian stimulation, egg retrieval, in vitro fertilisation (IVF) and/or intra-cytoplasmic sperm injection (ICSI), embryo culture, embryo transfer and the regular checkup of the pregnancy. Careful planning and close supervision by experienced fertility specialists are necessary for each step.

4. Time-Consuming Process

Surrogacy is a well-planned and timed process. The medical examinations, legal process, IVF treatment, embryo transfer, prenatal monitoring, and delivery process take time, which can be several months or even more.

5. No Guaranteed Success

Although the field of fertility treatment has improved, surrogacy does not guarantee pregnancy and live birth. Many factors contribute to success, such as embryo quality, maternal age and reproductive condition, and sometimes a series of embryo transfer cycles may be necessary.

6. Financial Commitment

While commercial surrogacy is not legal in India, the intended parents are expected to cover medical investigations, IVF treatment, surrogate insurance coverage, hospital charges, and post-pregnancy care, which are all part of the treatment cost.

7. Emotional Uncertainty

Surrogacy, like any other fertility treatment, is filled with a combination of hope, worry, and uncertainty. It’s a roller coaster of emotions from the wait for a positive pregnancy test to watching the baby grow, and preparing for delivery, and it’s important to have professional counseling and family support along the way.

Once you have learned the pros and cons of surrogacy, you will know what to do and how to do it, and will stay motivated.

Surrogacy Risks: What to Expect 

Knowing the potential dangers of surrogacy enables intended parents to make well-informed decisions and prepares them for any potential difficulties.

1. IVF might fail

The embryo may not implant into the uterus after transfer, or it may implant but not lead to a successful pregnancy. Embryo quality, age of the mother, and any fertility problems all play a role in success.

2. Pregnancy Complications

While the surrogate is carefully vetted, complications during pregnancy may arise, such as:

• Gestational diabetes
• High blood pressure
• Preeclampsia
• Placenta-related complications
• Premature labour

These can be recognised and treated early with regular antenatal care.

3. Multiple Pregnancy

Where clinically appropriate, a higher risk of twins or higher-order multiples occurs should the embryo be transferred more than once, as these are associated with further risks to the mother and baby(s).

4. Miscarriage

If an embryo is successfully implanted, there is still a risk of a miscarriage, and this risk can occur at any point in the early stages of a pregnancy.

5. Premature Birth

Some babies conceived via surrogacy may be born prematurely and may need neonatal intensive care.

6. Emotional Stress

Both intended parents and the surrogacy itself experience emotional ups and downs in the surrogacy journey. High-quality counselling and supportive services during treatment can help reduce stress.

7. Legal and Administrative Delays

Sometimes, incomplete documentation or delays in approvals may delay treatment. A good fertility centre will help minimise these problems.

Success Rates of Surrogacy: What Factors Influence the Outcome? 

When a surrogate is a healthy, well-screened woman and a high-quality embryo is transferred to her uterus, pregnancy rates are similar to or even better than natural IVF.

Women under 35 years old may get the best results from their own eggs, while those with reduced ovarian reserve or older women could benefit from donor eggs.

After considering your medical history and fertility tests, your fertility specialist will give you an individual prediction of success.

The success rate of gestational surrogacy is around 60-75% per embryo transfer globally and  success rate varies from country to country and is dependent on the quality of the embryos, age of the mother and the standards of the IVF lab. Generally, success rates in India vary from 40%-80% in the first cyle and gradually it increases after 2 or 3 cycles at around 75% to 85%, depending upon the medical condition, the quality of the embryos and health of the surrogate.

Factors Affecting Surrogacy Success Rates

Success of surrogacy is based on several medical factors, not just surrogacy. These include:

• Age of the female who is providing the eggs
• Egg quality
• Sperm quality
• Embryo quality
• IVF laboratory standards
• The health of the surrogate’s uterus
• The overall health of the surrogate
• The fertility team has experience in working with a wide variety of individuals

When to consult the Specialist? 

Seeking early consultation can ensure proper treatment and prevent delays in treatment. You should see a fertility expert if you:

• Have been diagnosed with infertility.
• Have suffered from several IVF failures.
• Have recurrent miscarriages.
• Do not have a uterus or have had a hysterectomy.
• Have serious uterine deformities.
• Have a medical condition that is not safe for pregnancy.
• Seeking advice about fertility before cancer treatment.
• Interested in learning about the legal and medical appropriateness

A fertility specialist will make a detailed assessment and discuss any options available to you, including IVF, donor programmes and surrogacy (where appropriate).

Conclusion

Many families have been able to make the dream of parenthood a reality with this procedure, particularly those that have not been able to conceive or carry the child themselves. Surrogacy advantages and disadvantages, awareness of surrogacy, how it works, types of surrogacy, who can be a surrogate and the pros and cons of surrogacy are all available to intended parents to allow them to make informed decisions.

Surrogacy in India is a legal procedure with a number of medical, legal, and emotional prerequisites. A seasoned fertility clinic guarantees that every aspect of the IVF process, along with embryo transfer, tracking and delivery, is done with compassion, expertise, and ethical care.

No two fertility journeys are alike and the best treatment option will be different for each person based on their health issues. Getting professional advice as early as possible can enable you to investigate all possibilities and take a step closer to fulfilling your dream of parenthood.

Expert Surrogacy Care at Femcare Fertility 

We realize that each journey to parenthood is unique at Femcare Fertility. Our skilled fertility doctors offer tailored consultations, cutting-edge IVF procedures, thorough fertility evaluations, and empathetic counsel for couples considering surrogacy and other surrogacy services.

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FAQs

1. Is surrogacy legal in India?

Yes. Gestational altruistic surrogacy is legal in India, while the Surrogacy (Regulation) Act, 2021 only allows for altruistic surrogacy with no consideration of any remuneration being made to the surrogate mother. Commercial surrogacy is not allowed.

2. Who can be a surrogate in India?

The eligibility criterion is based on the existing provisions of the Surrogacy (Regulation) Act and guidelines. Intended parents are required to satisfy certain medical and legal requirements, and obtain necessary approvals before proceeding.

3. How long does the surrogacy process take?

As for the duration of the process, from consultation to legalities to IVF treatment and delivery, it can take around 12 to 18 months, depending on the case.

4. Does surrogacy equal IVF?

No. IVF is one form of fertility treatment in which embryos are formed by a process of fertilization between eggs and sperm outside of the body. Surrogacy is when a surrogate is used to carry a pregnancy for others after the “intended parents” create an embryo using IVF.

5. Are there any potential dangers involved in surrogacy?

IVF failure, multiple pregnancy, miscarriage, pregnancy complications like gestational diabetes or preeclampsia, premature birth and emotional and/or legal problems are all risks of surrogacy. These risks can be minimised with proper medical screening and regular monitoring.

6. What is the difference between traditional and gestational surrogacy?

In traditional surrogacy, the woman’s egg is used, so the surrogate is the baby’s biological mother. Gestational surrogacy involves the production of an embryo in IVF using the intended parents’ or donors’ gametes, and the surrogate will not have a genetic connection with the child.

7. Can surrogacy be considered after multiple failed IVF cycles?

Yes. Surrogacy is a possibility after a comprehensive evaluation by your fertility specialist if repeated IVF failures are due to uterine problems and not embryo quality.

8. Is the baby genetically related to the intended parents?

When the egg and sperm of the intended parents are utilized, the baby may be genetically related to either one or both of the intended parents in gestational surrogacy. When using donor gametes, the genetic relationship will vary according to the treatment plan.

9. Which medical tests are necessary pre-surrogacy?

Usually, tests are conducted such as hormone testing, ovarian reserve testing, semen analysis, ultrasound tests, screening for infectious diseases, uterine testing, and a thorough health evaluation of intended parents and the surrogate parent.

10. How successful is surrogacy?

The success rate for surrogacy can differ from one IVF clinic to another, due to the quality of the IVF laboratory, as well as the health of the surrogate and the quality of the embryos. Your fertility specialist can offer you an individual estimate once they have done your medical history and fertility investigations.