For some patients, gestational surrogacy is an option, if repeat implantation failure is a problem. This is particularly true if PGD normal embryos have been transferred, and the rest of the evaluation is negative. I started working with surrogates in 1992. Until recently, virtually all the agencies I worked with held to standard that surrogacy should only be considered when the intended mother really cannot safely carry a pregnancy to term.
A recent tragic death of a surrogate mother from a rare but well-know pregnancy complication known as abruption of the placenta, underscores the ethical problem with asking women to serve as surrogates for non-medical reasons. To the family of this unfortunate woman, the reason she was surrogate does not matter right now. However, for those of us who defend the practice of compensated surrogacy in the United States, it is an important reminder that the practice should only be allowed for legitimate medical purposes. Dying from a pregnancy-related complication is so rare in the U.S., that many people take it for granted and feel it is acceptable to transfer the risks of pregnancy to another woman. Somehow, a tragedy like this seems less egregious, if the surrogate mother was doing it for a woman who otherwise could not have a child.
Why the change in social attitude and acceptance of the looser standards? One possible reason is the recent rise in the popularity of doing surrogacy in less developed countries like India, Nepal, and Mexico. Most of these programs have a “no questions asked” policy, and financial reward for the surrogates is an important incentive. Also, we have seen an increase in wealthy women from certain countries that can easily carry a baby, but see gestational surrogacy as a way to obtain a U.S. passport for their child. Finally, there are some misconceptions about medical facts. For instance, many women in their late reproductive years forties erroneously think that surrogates have a better chance for success than they do. Ironically, many of these women are only in their late thirties or early forties, and we still work with healthy surrogate mothers in this age range!
Critics of compensated surrogacy will point to the financial benefits as an inducement for women to take this risk. In my experience, this may be true in poor countries. However, in the U.S., the agencies I work with do not accept indigent women, and the compensation to these wonderful women, when amortized over the whole pregnancy amounts to less than minimum wage.
In conclusion, while the serious risks of pregnancy in the U.S. are small, they do exist. The recent tragedy is a reminder of this and should make us all reflect on the importance of maintaining a high ethical standard in deciding which patients should benefit from surrogacy. Along with the more common and less serious complications, combined with the major imposition of a surrogate mother and her family, appropriate compensation still seems reasonable. However, the financial compensation should not induce women to take these risks. Intended parents and health care professionals alike should keep these risks in mind when they consider moving forward with gestational surrogacy.