Surrogacy – Edinburgh Fertility Centre

Intended Parent(s) Information

What is Surrogacy?

Surrogacy is when a woman carries and gives birth to a baby for another person or couple. Our regulator, the Human Fertilisation and Embryology Authority does not regulate most aspects of surrogacy. In the UK, you can only pay a surrogate for their expenses.

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How does surrogacy work?

There are two types of surrogacy:

Full surrogacy (also known as host or gestational surrogacy) is when the eggs of the intended mother or a donor are used and there is therefore no genetic connection between the baby and the surrogate.

Partial surrogacy (also known as straight or traditional surrogacy) involves the surrogate’s egg being fertilised with the sperm of the intended father. If you go down this route, we recommend you have treatment at a licensed UK fertility clinic.

How successful is surrogacy?

Success rates for surrogacy depend on many factors, including:

the surrogate’s ability to get pregnant
the age of the woman whose eggs are being used
the success of the treatment you’re having (ie, IUI, IVF or ICSI)
the quality of the father’s or donor’s sperm.

The age of the woman who provides the egg is the most important factor that affects chances of pregnancy.

Due to the low number of surrogacy treatments carried out by the centre each year, an accurate success rate for surrogacy treatments cannot be given. However, as surrogacy uses the same techniques as IVF (the main difference being that the surrogate carries the child instead of the intended parent) success rates for this treatment are expected to be similar.

Does the age of the surrogate matter?

If you’re using the surrogate’s eggs, your chances of having a baby will depend on the age of the surrogate.

Women over 35 can be at greater risk of health problems or complications during pregnancy, which is something else to consider.

How much does it cost to have a surrogate?

If you are eligible for NHS funded surrogacy treatment, the cost of the surrogacy treatment itself [e.g. investigations, medications, IVF or intrauterine insemination (IUI)] will be met by the NHS. This will be discussed with you in your clinic appointments.

You’re not allowed to pay a surrogate in the UK. However, you are responsible for reimbursing any reasonable expenses that the surrogate incurs such as maternity clothes, travel expenses and loss of earnings.

Expenses vary. According to a report by Surrogacy UK, surrogates typically receive £10,000-£15,000, although this will depend on your circumstances. For example, extra expenses may apply if your surrogate has twins.

If you’re planning on using the surrogate’s own eggs, whose fallopian tubes are healthy, you’ll probably have intrauterine insemination (IUI) treatment if the sperm is optimal quality.

If you’re using your own eggs and sperm, or donated eggs from someone who isn’t the surrogate, you’ll need to have in vitro fertilisation (IVF).

If you’re using sperm that isn’t of the highest quality you may need to have intracytoplasmic sperm injection (ICSI) treatment.

Who might have surrogacy?

Surrogacy may be appropriate for women with a medical condition that makes it impossible or dangerous for them to get pregnant and give birth. These include:

absence or malformation of the womb
women with severe medical conditions for whom a pregnancy is not safe , for example major heart or lung disease

It’s also a popular option for male same-sex couples who want to have a family and can be used by people who are single.

Working parents who use a surrogate are entitled to adoption leave and pay.

Terminology for surrogacy treatment:

Intended Parent(s): This refers to a couple or parent who requires a surrogate to carry a pregnancy and give birth to the baby. They are also known as the Commissioning Couple/Parent(s).
Surrogate: This is the woman who carries the pregnancy and gives birth to the baby. Once the baby is born, it is handed over to the commissioning couple who will become the child’s legal parents after a Parental Order is granted
Egg Provider: The eggs used in surrogacy may be from the commissioning mother or an egg donor (host surrogacy), or from the surrogate herself (straight surrogacy). The woman providing the eggs is known as the egg provider.
Sperm provider: This can be an Intended parent providing sperm or a sperm donor.

Surrogacy for Male Couples:

Edinburgh Fertility Centre offers an NHS surrogacy service to male couples
who wish to have a family. You may choose either straight surrogacy, where the surrogate is also the biological mother of your child, or you may prefer host surrogacy using donor eggs from another woman. With either option, either your sperm, or your partner’s (whichever of you is the intended biological father) will be used to fertilise the eggs. In straight surrogacy, if the sperm is good quality and the surrogate’s fallopian tubes are healthy, timed insemination of prepared sperm into the surrogate’s womb may be carried out. In host surrogacy using donor eggs, IVF will be needed to fertilise the eggs in the laboratory before transferring an embryo to the surrogate’s womb.

If the quality of the sperm is suboptimal, IVF with ICSI (sperm injection into the eggs) may be needed. (Please see separate IVF/ICSI patient information).

You will need to find your own surrogate, and the organisations are listed below.. NHS Lothian does not pay for surrogacy arrangements or expenses. The clinic staff will explain what is funded and not funded.
If you wish to use an egg donor, there are a number of ways of sourcing donors. We may be able to source an egg donor for you. However, there is a long waiting list for egg donation treatment because of the shortage of egg donors.
As with heterosexual surrogacy, the sperm provider will need to be treated as a ‘known sperm donor’ and comply with the requirements of the HFEA Code of Practice. This will mean the quarantine of your sperm for six months with detailed infection screening before and after this period to minimise the risk of transmission of infection to your surrogate.

Couples will need to decide who is going to be the biological father. If you are funded by NHS Lothian, treatment can only be carried out from sperm provided by one partner and provided all eligibility criteria are met.

How can I find a surrogate?

Some people ask a family member or friend to be a surrogate. This can be a good solution as there should already be a lot of trust between you.

If using a friend or family member isn’t an option, or you’d prefer to use someone you don’t know, you’ll need to do your research. Fertility clinics aren’t allowed to find a surrogate for you, however there may be other organisations who can help. A good place to start would be:

Either way, it’s really important that you’re clear about how things will work in the future.

How much contact will you have with the surrogate before, during and after pregnancy? At what point will you talk to your child about their origins?

You might find it helpful to draw up an agreement beforehand (although it won’t be legally binding) for clarity. If you go through an organisation, this is something they can help you with.

We recommend you draw up an agreement before starting treatment

Whether you choose a surrogate who you already know, or find someone who wishes to help you, it is important to ensure you have a good understanding between you about how your treatment will work in the future. We have highlighted just a few things to consider. The counsellors and staff in the Centre will be able to discuss these with you carefully:

How much contact will you have before the treatment?
Would you like to attend appointments during the treatment together?
Would you attend all pregnancy (antenatal) consultations together?
Which antenatal screening do you wish to consider, and what does your surrogate feel about this?
What would you do if the antenatal screening is abnormal?
What birth plan does your surrogate have in mind and do you agree with her birth plan?
What would you do if your baby born as a result of treatment requires urgent medical treatment after delivery? What does your surrogate feel about this?
Will you be keeping in touch with the surrogate after your child has been born?
What will you tell your child about his/her origin?

It is important that you are certain that your surrogate is able to have a safe, healthy pregnancy and birth. Your surrogate should be someone you can build a close, trusting relationship with. However, there are no guarantees and the decision to proceed is purely up to the surrogate.

Are there any risks I should be aware of?

If you’re having fertility treatment such as IVF or IUI then there are some risks you should be aware of. These will be discussed with you at your medical appointment.

Find out more about the risks of fertility treatment

There’s also a risk of transferring infectious diseases such as HIV and hepatitis to the surrogate, so the egg and sperm provider must be screened before treatment can begin. If you’re using sperm or eggs from a donor from our clinic or from a clinic based in the UK, the donors are automatically screened for infections.

Also, until a parental order has been granted to you, the surrogate can change their mind about the arrangement at any time.

What preparations are needed for surrogacy?

The fertility counsellors in our Centre play an important role in successful surrogacy arrangements. It is a requirement that both the intended parent(s) and potential surrogate (and their partner, if applicable) attend counselling prior to starting treatment. All parties will attend counselling separately and will meet together in a third session to ascertain that everyone is clear and happy with the planned treatment.

The intended parents and surrogate (and the surrogate’s partner) are required to undergo a number of screening tests. These include detailed infection screening for HIV, HTLV, Hepatitis and Syphilis, Chlamydia and Gonorrhoea. The surrogate will be requested to provide dates of rubella vaccination or proof of immunity. If she has not completed a full vaccination course, our recommendation is that your surrogate should be vaccinated and wait for a month post vaccination before trying to become pregnant.

A genetic test is also carried out on the egg and sperm providers which includes a blood test for chromosomes and for common genetic conditions such as cystic fibrosis. This means that some conditions that could be passed on to a child are identified before treatment starts and the implications will be discussed. The genetic tests do not rule out all genetic problems because rare genetic conditions can occur that have not been specifically tested for.

The sperm provider will be required to freeze sperm and the sperm is quarantined for 6 months before further screening of the sperm provider.

What are the clinical risks of surrogacy?

The risk of transferring infectious diseases such as HIV, HTLV, hepatitis and syphilis to the surrogate is minimal when treatment is managed by our Centre because of the screening and quarantine practices required by the HFEA. If a registered donor at a licensed clinic is used, the donor will automatically be screened under the same requirements of the Code of Practice.

Please refer to the Centre’s separate IUI, IVF and ICSI patient information leaflets for information about risks related to these treatments. Relevant copies of information sheets will be given to you.

Are there any legal issues to consider?

Yes. Surrogacy involves a lot of complicated legal issues which is why you should seek independent legal advice, especially if you are considering having treatment overseas.

The most important thing to know is that, in the UK, the surrogate is the legal mother of the child unless you get a parental order from the court.

Who the second legal parent is at birth will depend on your circumstances. See section below on legal parenthood.

The law previously only allowed two people to apply for a parental order. However, it has recently been changed and it is now possible for one person to apply for a parental order if you are a biological parent of the child (ie, your eggs or sperm were used to create the baby). See section below on Parental Orders.

This is a complicated area so you should talk to your clinic early on about nominating a second legal parent so they can support you through the process.

Your surrogacy arrangements are based on trust. In the UK, your surrogate will be treated as the legal mother of your child. Until you have a Parental Order, she can change her mind about the arrangement at any time. If your surrogate decides not to hand over the child at birth, you will not be able to apply for a Parental Order. You can make other applications to the Court and the Court will decide what is in your child’s best interests. On the other hand, you as the intended parent(s) may also change your mind and choose not to apply for a parental order to keep the baby e.g. if the baby is born with a physical problem.

Find out more about the legal rights of parents and surrogates: Surrogacy: legal rights of parents and surrogates

Legal Parenthood

In the United Kingdom, the surrogate is the legal mother of the child until a Parental Order is granted from the court; even if the eggs and sperm are yours, or donated (i.e. the surrogate is not genetically related to the child). Her name will appear on the birth certificate and a new certificate will be issued once the Parental Order has been granted. Once you have a Parental Order for the baby, the surrogate will have no further rights or obligations to the child.

Legally, a child can have two parents, and in a surrogacy arrangement the first legal parent is the surrogate until the Parental Order is granted.

Who the second legal parent will be at birth, and whose name will appear on the birth certificate, will depend upon your circumstances:

If the surrogate is married or in a civil partnership her partner will automatically be the second legal parent (until a Parental Order is granted) unless it can be shown that her partner did not consent to her treatment.
If the surrogate is unmarried (single, widowed or divorced), then the man providing the sperm (if he wants to be the legal father) will automatically be the second legal parent at birth.

However, it is possible for the surrogate to nominate a second legal parent such as the intended mother or non-biological father (e.g. when donor sperm is used). If you wish for this, then both the intended second parent and the surrogate will need to give their consent before the sperm, egg or embryo are transferred using the following forms:

The surrogate must complete: SWP – Your consent (as a surrogate) nominating an intended parent to be the legal parent form.
The intended second parent must complete: SPP – Your consent to being the legal parent in surrogacy form.

Please discuss this with the Centre, so we can support and guide you through this process.

The Parental Order

If you, the intended parents wish to become the legal parents of the child, you must apply for a Parental Order after the child is born. The application must be made between six weeks and six months of age. The Parental Order allows transfer of the rights and obligations of parenthood to the intended parents, provided certain conditions are met:

Applications for a Parental Order must be made to the Court.
To obtain a Parental Order, at least one partner of the commissioning couple must be genetically related to the baby and be “domiciled” in the UK.
This means that embryo donation or embryos created with donated eggs AND sperm cannot be used in surrogacy treatments.
“Domiciled” does not just relate to where you are living, but where your “permanent home” is. Unless you are a British citizen and have always lived in the UK, you must seek legal advice.
Commissioning couples must be married, civil partners or two persons living together as partners.
The surrogate (and their husband / civil partner if they have one) will also need to give their consent.
The Court will consider any payments you have made to your surrogate and whether these constitute “reasonable expenses”.
When a Parental Order is granted, you will receive a new birth certificate with your partner’s name and your name as the legal parents of your baby.

For further information, please read the law on UK surrogacy arrangements: Surrogacy Arrangements Act 1985

What about if we want to go abroad?

More and more hopeful parents are having surrogacy treatment overseas. In UK law, surrogacy is treated as an altruistic act so paying a surrogate anything more than reasonable expenses is illegal. However, commercial surrogacy is permitted in some other countries. We advise you to seek legal advice if you are thinking of surrogacy treatment overseas. Please be aware that we are not permitted to export gametes of embryos for use in commercial surrogacy.

Many people who have treatment abroad are very happy with the quality of care they receive, but it’s important you do your research first. Legal arrangements differ from country to country and actually getting a passport and getting your child back to Britain can be a very difficult and time-consuming process. You should also know that even if you’re named on a foreign birth certificate as the legal parents of your child, you’ll still need to apply for a parental order when you return to the UK. This is because UK law recognises the surrogate as the legal parent(s) until you have a parental order.

We advise that you do not embark on treatment overseas until you have obtained legal advice covering legal parenthood, immigration status and passport arrangements, the adoption or parental orders process for that country, and recognition of those procedures under relevant UK law.

The Foreign and Commonwealth Office have produced guidance for people considering having surrogacy treatment abroad: Surrogacy overseas

Where can I go for further advice or support?

Whatever your situation, it is important you are getting enough support during what can be a long and emotionally draining process.

Treatment and pregnancy can have its ups and downs and there’s a real risk of your surrogate having a miscarriage or the treatment simply not working.

If you do have a baby, there will be lots of questions for you to think about, particularly as your child grows up.

If you have treatment at a licensed fertility clinic, you will be offered counselling as standard to talk through these issues. You may also wish to contact Fertility Network UK for further advice and support Fertility Network.

Find out more about getting emotional support by looking at this HFEA link: Getting emotional support

We offer a specialised counselling service that will provide care throughout your treatment and prepare you for the future. Counselling is free and appointments are made via our nursing or administrative or medical staff.

We require that all parties (the intended parents, surrogate and her partner) involved in a surrogacy arrangement undergo implications counselling to fully understand the implications of their actions and choices on all the people concerned, including any child born as a result of treatment and any existing children.