Surrogacy for Couples with Genetic Disorders

A word rooted in Latin (Subrogare) meaning to substitute, surrogate refers to that “which acts in the place of.” This implies that the surrogate mother is a woman who becomes pregnant and gives birth to a child to give away this child to another person or couple (the intended or commissioning). Surrogacy can be an incredibly fulfilling experience, both for intended parents and gestational carriers. However, it requires significant commitment from both parties such it is vital to consider all aspects of the process before embarking on it. It has revolutionized the standing options within the assisted reproduction field.

Why do people become surrogates?

Gestational carriers choose surrogacy for a variety of reasons, and each may reap different benefits from the experience. Some of these may include:

• Surrogates are fairly compensated (usually financially).
• Surrogates enjoy a sense of community.
• Surrogacy is a rewarding gift.
• Surrogacy allows you to experience pregnancy. 
• Surrogates are legally protected. 

Factors to Consider Before Embarking on Surrogacy

For the intended parent(s):

• In-depth counselling and consideration of alternative treatments if possible.
• The cost and difficulty of treatment.
• The psychological risks of surrogacy to parent and child.
• Possibility of the child being born with abnormalities.
• Possibility of multiple pregnancies.

For the surrogate:

• The possibility of multiple pregnancies and associated risks.
• Medical risks associated with pregnancy.
• The full ramifications of IVF and surrogacy treatment. 
• Social implication associated with surrogacy practice.
• Psychological risks associated with surrogacy.

Types of Surrogacy

Two common types of surrogacy exist:

Traditional surrogacy (genetic/partial/straight): In this case, the father’s or donor’s sperm is used, either naturally or artificially, to inseminate the surrogate’s oocyte. This method results in an embryo that is genetically linked to the surrogate. 

Gestational (host) Surrogacy: The implanted embryo and the surrogate mother have no genetic connection. A heterologous IVF is employed to implant the parent’s sperm and egg which has been fertilized into the surrogate.

Surrogacy may be commercial or altruistic, depending on the presence of a financial reward for the surrogate. If the surrogate receives money for the surrogacy arrangement, it is considered commercial. If she receives no compensation outside the cost of her medical and other pregnancy-related expenses then it is altruistic. 

Surrogacy is one of the sought-after programs in fertility tourism. This is mainly due to its social and legal implications. Places like India, Israel, Mexico, Barbados, etc., have liberal surrogacy views (commercial surrogacy is legal), and such are top destinations for European and American couples to seek surrogates. This is because surrogacy is not allowed in Germany, Sweden, Norway, and Italy while altruistic surrogacy is adopted in England, in many states of the United States and Australia. 

Pros of Surrogacy

Although the process of surrogacy looks difficult, successful families have all admitted that it is worth it. The common pros of surrogacy include the following:

• Surrogacy fosters new relationships between the intended and the surrogate.
• Surrogacy helps add children to families.
• Surrogacy has a high success rate.
• Surrogacy allows for genetic connections between parents and the child.
• Surrogacy involves few surprises, both legally and otherwise.
• Surrogacy ensures you are involved in the process.

Cons for surrogacy

Despite the pros, several downsides exist to surrogacy. These are:

• Surrogacy can be expensive and time-consuming. 
• Surrogacy necessitates the surrender of some control. 
• Surrogacy can have some complicated legal implications.
• Surrogacy is physically and emotionally demanding.

Indications for Surrogacy

The major indication for surrogacy is usually patients without a functional uterus. The common indications are:

• Müllerian anomaly or uterine and/or vaginal absence at birth.
• Medical conditions leading to infertility.
• Mayer-Rokitansky-Küster-Hauser Syndrome is characterized by a female genotype and phenotype leading to a congenital aplasia of the uterus and the vagina.
• The uterus and ovaries are absent in Complete Androgen Insensitivity Syndrome (CAIS). 
• Women who have undergone a hysterectomy.
• Turner’s Syndrome is suspected in these patients due to known cardiac and medical complications. 
• Women suffering from recurrent miscarriages or unidentified infertility treatment failure. 
• Heart or renal disease during pregnancy.
• Rhesus isoimmunization during pregnancy.
• Maternal medications that could potentially predispose the embryo to teratogenesis
• Career-driven mothers who would be hindered by pregnancy and its complications.
• A small unicornuate uterus, a T-shaped uterus, or multiple fibroids are examples of structural abnormalities. 

Surrogacy and Genetic Disorders in Couples

There are so many hereditary diseases that are dangerous to the health of a child. These hereditary diseases are passed on from one generation to another with some of them having severe implications on both mother and infant. Due to modern assisted reproductive technologies like egg donation and surrogate motherhood, the problems of genetic diseases can be circumvented and make having children possible.

The process involves the analysis of both the sperm and egg donor DNA to identify possible genetic disorders that may exist in the DNA. The IVF procedure is carried out, the embryos obtained are monitored, and the healthiest one is taken for implantation into the surrogate. This process helps to reduce the chances of genetic defects in the resulting offspring. It is also necessary to conduct a preimplantation diagnosis of the embryo.

Some of the common genetic defects that can be passed on to the offspring are haemophilia, Duchenne muscular dystrophy, sickle cell anaemia, Fabry disease, Marfan’s syndrome, Hypertrichosis of the ears, etc.

Another concern of couples is the possibility of genetic transfer between the surrogate mother and offspring. This is a common misconception about surrogacy is false since the genotype of the child is formed during fertilization, and the surrogate only supplies nutrients to the offspring.

Conclusion

Although there are so many hurdles in the surrogacy process, the pros usually outweigh the cons in most instances. However, this is not a suitable pathway for every intended parent. This is because the physical and emotional effects may affect parenting abilities. It is important to also perform a proper screening of the potential surrogate. This would help reduce the chances of pregnancy complications. The surrogate should also be educated on practices that would lead to both a safe pregnancy and a healthy child.