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The journey to parenthood can be challenging, especially for couples and individuals facing fertility challenges. According to the World Health Organization, approximately 1 in 6 couples worldwide will experience infertility. Surrogacy offers a path for individuals struggling with infertility to have children.

When considering surrogacy, you’ll have to decide between one of two primary types of surrogacy: traditional and gestational surrogacy.

While Joy of Life focuses on gestational surrogacy, we want to help both potential surrogates and future parents understand the medical, ethical, and legal differences between traditional surrogacy and gestational surrogacy.

What Is Traditional Surrogacy?

Traditional surrogacy is one of the oldest forms of assisted reproduction. In traditional surrogacy, the surrogate mother is both the carrier and biological mother of the child. The surrogate mother is inseminated with sperm from either the intended father or a donor, making the surrogate both the egg donor and the gestational carrier.

Traditional surrogacy most commonly employs intrauterine insemination (IUI) as the method for fertilization. During IUI, a concentrated sample of sperm is prepared and then directly placed into the uterus through a catheter. This procedure is quick and relatively painless, usually taking no more than a few minutes. The timing is carefully coordinated to coincide with the surrogate’s ovulation to increase the chances of conception.

Less commonly, in vitro fertilization (IVF) might be used in traditional surrogacy, especially if previous IUI attempts were unsuccessful.

What Is Gestational Surrogacy?

Gestational surrogacy is a more recent development in assisted reproductive technologies than traditional surrogacy, becoming prominent in the last few decades. In gestational surrogacy, the surrogate mother carries a child to whom she has no biological relation. The embryo is created through in vitro fertilization (IVF), involving eggs and sperm from the intended parents or donors. The embryo is then transferred into the surrogate’s uterus for gestation.

The IVF process in gestational surrogacy starts with the intended mother or egg donor undergoing ovarian stimulation to produce multiple eggs. In this phase, hormone injections are administered over the course of 10 to 14 days in order to stimulate the ovaries to mature multiple eggs rather than the single egg typically released during a natural menstrual cycle.

Following ovarian stimulation, a minor surgical procedure is performed to retrieve the matured eggs directly from the ovaries, usually using ultrasound guidance. The eggs are retrieved while the donor is under mild anesthesia and fertilized in a lab, where they are carefully monitored for a few days.

After confirming successful embryonic development, one or more embryos are selected and implanted into the surrogate’s uterus using a catheter in hopes of achieving a successful pregnancy.

What are the Key Differences Between Traditional and Gestational Surrogacy?

1. Genetic Connection Between Surrogate Mother and Child

In traditional surrogacy, the surrogate’s own eggs are used, making her the biological mother of the child. In gestational surrogacy, there’s no genetic link between the child and the surrogate. The egg and sperm come from the intended parents or donors.

2. Medical Procedures Involved

Traditional surrogacy commonly uses intrauterine insemination (IUI), a less invasive and less expensive technique where sperm is directly inserted into the uterus to facilitate fertilization. It’s a procedure that can often be performed in a clinic without the need for extensive hormonal treatments.

In gestational surrogacy, the use of in vitro fertilization (IVF) is mandatory, which is a more complicated and resource-intensive process. IVF involves extracting eggs, fertilizing them in a lab, and then implanting the embryo into the surrogate’s uterus, often necessitating hormone therapy for both the intended mother and the surrogate.

3. Medical Risks and Complications

In traditional surrogacy, the medical risks are generally equivalent to those of any naturally conceived pregnancy but can include additional risks if the surrogate is older or has underlying health conditions.

While IVF involved in gestational surrogacy is a well-established medical procedure, it comes with its own risks, such as ovarian hyperstimulation syndrome in the egg donor or intended mother. The chance of multiple pregnancy is higher, which raises the risks of premature birth, low birth weight and other complications for the babies.

4. Cost and Financial Considerations

For traditional surrogacy, the relative simplicity of medical procedures like IUI makes traditional surrogacy generally less costly. However, potential legal costs associated with establishing parental rights can add unexpected expenses.

With gestational surrogacy, the combination of advanced IVF techniques, potential medication for multiple parties, and often more straightforward legal proceedings can be significantly more expensive.

5. Legal Complexities and Parental Rights

In traditional surrogacy, the surrogate’s biological link to the child creates a more complicated legal situation. This often necessitates additional legal steps to establish the intended parents’ rights and may require the surrogate to relinquish parental rights formally.

Surrogacy laws are often more favorable toward gestational surrogacy, especially in states with established surrogacy laws. The absence of a genetic link between the surrogate and the child in gestational surrogacy generally makes it easier to establish the intended parents’ legal rights.

6. Ethical and Emotional Considerations

In traditional surrogacy, the surrogate’s genetic tie to the child can create emotional and ethical challenges, such as around emotional detachment, both for her and for the intended parents.

Many people find gestational surrogacy emotionally simpler than traditional surrogacy. Since the child is not biologically related to the surrogate, there are generally fewer emotional entanglements and ethical conflicts.

7. Availability and Prevalence

While not as commonly practiced today, traditional surrogacy is still available and may be the preferred or only option in some legal jurisdictions or for surrogates and intended parents with certain medical or financial constraints.

Gestational surrogacy is the more common route today, largely because it sidesteps many of the legal and ethical complications associated with traditional surrogacy. Gestational surrogacy is also more widely available in fertility clinics that specialize in advanced reproductive technologies.

Related FAQs Surrogate Mothers or Intended Parents May Have

Do both types of surrogacy require legal contracts?

Yes, both traditional and gestational surrogacy generally require a comprehensive legal contract to protect the rights and responsibilities of all parties involved. However, the contracts for gestational surrogacy tend to be less complex due to the absence of a genetic link between the surrogate and the child.

How long does the process take for each type of surrogacy?

The timeline for both traditional and gestational surrogacy can differ based on various factors, such as the legal process, medical procedures and whether a suitable surrogate is readily available. Generally, traditional surrogacy, which often involves simpler medical procedures, may be somewhat quicker, potentially taking around 12 to 16 months from start to finish. On the other hand, gestational surrogacy typically involves more complex IVF procedures and generally takes closer to 14 to 18 months.

What role do surrogacy agencies play?

Surrogacy agencies like Joy of Life act as intermediaries between the intended parents and the surrogate, providing services like screening, matching and facilitating the legal and medical processes. While not strictly necessary, many people find their expertise invaluable in navigating this complex journey.

What happens if the surrogate changes her mind?

Laws vary by jurisdiction, but generally, legal agreements are put in place to protect both surrogates and intended parents. However, the emotional and ethical complexities of surrogacy mean that these situations can still be legally challenging, particularly in traditional surrogacy, where the surrogate is biologically related to the child.

What should international couples take into consideration?

International couples interested in surrogacy should be particularly cautious about the legal aspects of traditional and gestational surrogacy. Different countries have varying laws concerning surrogacy, which may favor one method over the other. It’s crucial to consult with legal experts familiar with both your home country’s surrogacy laws and the laws of the country where the surrogacy journey will take place.

Still Have Questions About Surrogacy? Joy of Life Can Help

The path to parenthood is an intensely personal journey filled with choices that can feel overwhelming. Understanding the medical complexities of traditional vs. gestational surrogacy can help you decide the most suitable path for you and your family.

If your heart is pulling you toward becoming a gestational surrogate, or if you’re considering using a gestational surrogate to grow your family, you don’t have to navigate this journey alone.

At Joy of Life, a California-based surrogacy agency, we’re committed to supporting you every step of the way with care, expertise and compassion. Visit our surrogate application or reach out to our team of surrogacy experts to learn more about the gestational surrogacy process.

*The information on this page was written or reviewed for accuracy by qualified members of the Joy of Life team. Our surrogacy agency team encompasses former surrogate mothers, parents who have welcomed children via surrogacy, and experienced clinical coordinators. Meet our team and learn more about us.

Joy Millan

Author Joy Millan

I’m Joy, the founder and CEO of Joy of Life. With a professional background as a fertility clinician, I’ve spent thousands of hours working with surrogates and intended parents alike. As a mother of two, I often wished for more support and a deeper commitment to care for those embarking on non-traditional family-building journeys. This is why I established Joy of Life: to create a more robust, compassionate experience in parenthood for both parties involved with surrogacy. In 2021, I stepped back from daily operations at Joy of Life to fight cancer. Fortunately, the combined 20 years of experience from our incredible team has allowed me to focus on my health & recovery. I continue to provide company guidance and serve as the head liaison for our network of doctors, clinicians and caregivers.

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