Karina has been married for 20 years. At 20, she was diagnosed with severe endometriosis for which she has undergone two surgeries to remove the cysts in her ovaries. Her infertility has been a source of frustration until at age 42, she learned of surrogacy. She flew to the United States with her husband to find a surrogate mom. By artificial insemination, her husband’s sperm was inseminated to the surrogate woman, resulting in a live baby girl they eventually brought back to the Philippines.

Surrogacy is an arrangement whereby a woman, called the surrogate, agrees to carry the child of another woman, with the agreement that the surrogate will surrender the child upon birth to the mom who commissioned the child, and the surrogate relinquishes all her parental rights over the child,.

There are two general types of surrogacy:

Traditional surrogacy – the intended father impregnates the surrogate mom using her own ova or eggs  and the pregnancy is carried in her womb.

Gestational surrogacy – the sperm of the intended father and the eggs of the intended mother are  fertilized outside the womb and the resulting fertilized zygote or blastocyst is placed into the womb of the surrogate who carries the pregnancy.

REASONS FOR SURROGACY – the woman may be infertile or unable to carry a pregnancy to term for various reasons:

1. INABILITY TO OVULATE:
   1. Some women may have Polycystic Ovary Syndrome that prevents them from releasing eggs and ovulating.
   2. Others may have Premature Ovarian Failure, a condition the ovary stops functioning even before the age of 40 years old. This can happen after exposure to toxic agents like radiation, chemotherapy or heavy metals.
   3. Ovarian cysts like endometriosis can damage the normal ovarian tissue especially if they occur on both ovaries. This condition also causes inflammatory condition and distortion of the anatomy along with adhesions, thus, preventing the sperm from meeting the egg or preventing implantation.
2. IMMUNOLOGIC PROBLEMS – some women have Immunologic Disease of Pregnancy, a condition that predisposes patients to clotting or thrombosis, thereby cutting off the supply to the fetus during pregnancy, causing recurrent miscarriages, intrauterine fetal death, premature labor and hypertension.
3. UTERINE ABNORMALITIES /PROBLEMS
   1. 1 in 4500 women can develop a congenital malformation resulting in a missing uterus and variable degrees of underdevelopment of the vagina. This is called the Mullerian Agenesis or Mayer-Rokitansky-Kuster-Hauser Syndrome.
   2. Bicornuate uterus-
   3. Some women may also have multiple myomata which may cause major distortion of the cavity of the uterus preventing implantation or causing recurrent miscarriages.
   4. Adenomyosis is also another condition that can prevent pregnancy since the lining of the uterus implants on the muscle of the uterus, causing a thickening and hardening of the muscle of the uterus.
   5. Surgical absence of the uterus- Some women may have had to undergo a hysterectomy for uterine or cervical or ovarian cancer, or for intractable abnormal uterine bleeding due to tumors.
4. MEDICAL CONDITIONS – the woman may have a valvular heart disease, kidney disease or severe hypertension or diabetes that can worsen with pregnancy, jeopardize the fetus and cause prematurity or demise. A history of cancer or leukemia that requires the patient to be on maintenance meds contraindicating pregnancy can also be a deterrent to pregnancy.
5. AGE – some women decide too late in life that they want babies because the demands of career were prioritized. Or, by the time they found the right partner or another partner they wanted to have children with, it was beyond 42-45 years of age. Most IVF clinics cut off at 42-45 years beyond which they will not accept patients for fertility treatments.
6. GAY COUPLES – same sex partners will obviously need help to conceive. Male-male partners will require an egg donor and a surrogate mother to carry the pregnancy. Female-female partners will simply require a donor because usually one or the other will be willing to carry the pregnancy.

SURROGACY IN THE PHILIPPINES

Currently, there is no law prohibiting or openly allowing surrogacy. A bill prohibiting surrogacy was filed by Sen. Manny Villar on June 7, 2006. However, it did not gain support and was, therefore, never passed. No one has proposed any similar bill since.

The Philippines Society of Reproductive Medicine in 2006 and the Philippine Obstetrical and Gynecological Society in 2011 made a stand that it is unethical for a third party be involved in a couple trying to conceive. This means that donor eggs, donor sperm and surrogacy are not practiced by licensed fertility experts and is deemed unethical.

HOW TO CHOOSE A SURROGATE?

Commercial surrogacy, where the mother is paid a fee, is allowed in some states in the US, India, Russia and Ukraine. In Denmark, U.K, Belgium, Ireland, and, Hong Kong, surrogacy is allowed as long as the mother is not paid. France, Germany, Italy, Spain, Portugal, Bulgaria, Thailand and Cambodia prohibit all forms of surrogacy.

In choosing a surrogate mother, the following criteria are recommended:

-She must be at least 21 years old.

-She must at least have given birth previously to a child as proof of fertility and to insure that she understand what is involved with childbearing.

-Must be mentally sound and evaluated and counselled by a professional on mental health to insure she will not have issues on giving up the child.

-Must be willing to sign a contract that she is going to perform her role in insuring a healthy pregnancy, follow a diet, supplementation and go for regular pre-natal check-ups. Above all, she must sign that she is willing to give up the baby and all parental rights after the baby is born.

ADVANTAGES OF SURROGACY

• It allows a couple to create a family. There is a growing number of LGBT couples who are desirous of having children to complete their family. Women who lost their uterus to cancer or have medical illnesses or have passed the age of fertility can hope to have children.
• The expectations are defined. In cases where there is a legally binding contract, the rights of the surrogate mother are defined and the intended parents are also protected by law.
• There is a high chance of success. Because the surrogate has a history of a previous healthy birth, the chances are higher for the surrogate to carry a pregnancy than through fertility treatments.

DISADVANTAGES OF SURROGACY:

• It is not simple. One has to deal with complex medical procedures as well as legal paperwork
• It can be emotionally taxing to the surrogate mom. Many of them are detached from their families for the duration of their pregnancy to insure they will be properly nourished and cared for and giving psychological support. It still results in depression for many to know they cannot be a mother to the baby they are carrying. There are cases when the mother opts to keep the child and that can cause emotional and legal battles with the intending parents.
• It can be costly. The intending parents have to pay for the surrogate mom, her food, living expenses, supplements and medical fees for the procedures as well as the agency, if one is involved.

HOW MUCH DOES IT COST?

The cost varies from country to country. This is an approximate cost for the various countries according to Families Through Surrogacy:

• US – $100,000 (£60,000)
• India – $47,350
• Thailand – $52,000
• Ukraine – $49,950
• Georgia – $49,950
• Mexico – $45,000

There is hope for childless parents who have not been blessed with children naturally to still have their own child through surrogacy. The advancement of science has made possible the technology. The challenge is how to keep the practice from being abused by laying down the legal, moral and eithical ground rules to make it more acceptable to more countries to allow.