Surrogacy

Surrogate motherhood is one of many currently available forms of Assisted Reproductive Technologies (ARTs) that have developed in response to the increasing number of individuals/couples who find themselves unable to conceive a child on their own. Surrogate motherhood involves the services of a woman who agrees to carry/gestate a child for the express purpose of surrendering that child to the intending/commissioning couple upon the birth of the child. The demand for surrogate motherhood is created by a diagnosis of female infertility, although a woman need not be infertile in order to employ the services of a surrogate. Factors that have contributed to the popularization of surrogate motherhood and other reproductive technologies are both medical and social in nature. In the United States there are reportedly two to three million infertile couples (Office of Technology Assessment 1988). A diagnosis of infertility is defined as the inability of a heterosexual couple to produce a pregnancy after one year of regular intercourse, that is, unprotected intercourse (Stangel 1979). The social factors that have contributed to the rise in the rates of infertility and that have resulted in an increase in the demand for reproductive technologies are the trend toward later marriages and the tendency for growing numbers of women to delay having children until later in their reproductive years. With advances in reproductive medicine, couples who would not have been able to reproduce in the past are now able to have children who are completely or partially genetically related to them.

Approximately 35 percent of couples who choose surrogacy have either attempted or considered adoption (Ragoné 1994). The majority of those who eventually choose surrogacy view the adoption process as one that is riddled with problems and that has been, in most cases, unable to provide them with a suitable child (Ragoné 2000). For example, in 1983, 50,000 adoptions were completed in the United States, but an estimated two million couples were still seeking to adopt (Office of Technology Assessment 1988).

Historically, there have been three profound shifts in the Western conceptualization of the categories of conception, reproduction, and parenthood. The first occurred in response to the separation of intercourse from reproduction through birth control methods. A second shift occurred in response to the emergence of assisted reproductive technologies and to the subsequent fragmentation of the unity of reproduction, when it became possible for pregnancy to occur without necessarily having been "preceded by sexual intercourse" (Snowden, Snowden, and Snowden 1983). The third shift occurred in response to further advances in reproductive medicine that called into question the "organic unity of fetus and mother" (Martin 1987). It was not, however, until the emergence of reproductive medicine that the fragmentation of motherhood become a reality; with that historical change, what was once the "single figure of the mother is dispersed among, several potential figures, as the functions of maternal procreation—aspects of her physical parenthood—become dispersed" (Strathern 1991). It is now possible for five separate individuals to claim parenthood in a given situation: the woman who contributes an ovum (genetic mother), the woman who gestates the child (gestational mother), the intending mother (the social mother/the woman who will raise the child and may also gestate the child), the sperm donor (genetic father) and the intending father (the social father/the man who will raise the child).

During the early 1980s, all surrogate motherhood arrangements (traditional surrogacy, in which the child was genetically related to the husband only) involved the union of the husband's sperm and the surrogate's ovum. Since 1994, however, over 50 percent of all surrogates are gestational, in other words, the surrogate gestates the couples' embryos (providing them with a child that may be genetically related to both wife and husband). However, one should not assume that it is the intending father's sperm or the intending mother's ovum that creates the embryo; the ovum may have been procured through ovum donation then mixed with the husband's sperm. Should a couple use the intending father's sperm, donor ova, and a gestational surrogate, the couple will have the same genetic relationship to the child as that provided by traditional surrogacy (i.e., a genetic tie for the father only). However, one of the reasons cited for choosing gestational surrogacy is consumer choice; specifically, couples who choose the route of donor ova plus gestational surrogacy rather than traditional surrogacy have a significantly greater number of ovum donors from which to choose.