A complicated story, but surrogacy families are not so different from natural conception families.

Many reports of surrogacy document negative stories of failed arrangements, but in reality very few surrogacy arrangements end in tears. Many couples successfully have a child through surrogacy. Vasanti Jadva and colleagues from the University of Cambridge Centre for Family Research have been following these families to find out what happens to all concerned.

Surrogacy is perhaps the most emotionally complicated method of assisted reproduction because a third person is involved throughout the pregnancy. And, unlike anonymous egg or sperm donors, the surrogate mother is known to the couple from the outset.

Surrogate mothers can either be genetic or gestational carriers. Genetic surrogacy uses the surrogate mother’s own egg and conception occurs using the intending father’s sperm (or donor sperm). In gestational surrogacy, the egg and sperm cells (gametes) of the commissioning couple (or donor gametes) are used to create a pregnancy through IVF. Recent years have seen an increase in the number of couples considering surrogacy as a means of starting a family. Despite this growing interest, research into the long-term consequences of surrogacy is still very limited.

At the Centre for Family Research, we have been carrying out the first and only study following up couples once they have successfully had a child through surrogacy. The study, led by Professor Susan Golombok, aims to address the concerns that have been raised about the potentially negative consequences of surrogacy for all of those involved.  

Infertility treatment can be a stressful process and surrogacy even more so. The pressure to maintain a good relationship with the surrogate mother during the pregnancy, coupled with uncertainty over whether or not the surrogate mother will hand over the baby, may put a strain on the couple, or on their relationship with each other. In addition, while some couples have an established relationship with their surrogate mother (where she is a family member or a friend), others do not know the surrogate mother beforehand, which may lead to additional anxiety. We also know very little about the impact of ongoing contact with the surrogate mother on children or how children feel about being born in this way.

Many of the concerns about surrogacy have focused on the surrogate mother - whether she may form a bond with the baby during pregnancy making it difficult for her to hand over the child. Others have suggested that she may distance herself from the pregnancy to an extent where she may put her own or her unborn child’s health at risk. Whether or not the surrogate mother is the genetic mother of the child, and whether or not the commissioning couple was known to her prior to the surrogacy arrangement, are also factors that may influence the surrogate mother’s experience of surrogacy and her psychological well-being. A further concern is that surrogacy may exploit women from disadvantaged backgrounds who embark on surrogacy because of financial hardship.

Our UK study has provided much-needed information about the experiences and impact of surrogacy. The study, which began in 2000, has collected information from 42 surrogacy families at four different time points, when the children were aged one, two, three and seven, and we are currently visiting these families again as the children turn nine.

Findings so far have revealed that couples who opted for surrogacy had been trying for a child for an average of 7.5 years and most had chosen surrogacy after experiencing repeated IVF failures or because the female partner had no uterus. During the pregnancy, couples generally experienced low levels of anxiety and maintained good relationships with the surrogate mother. We also found that surrogacy parents of one-year-olds reported lower levels of stress related to parenting and lower levels of depression when compared to natural conception parents.

On the other hand, surrogacy parents tended to be over-protective of their baby, which can sometimes have a negative effect on children’s development. However, this had diminished by age two. By the time the children were three years old, surrogacy families were very similar to natural conception families and some had begun to tell their children about the circumstances of their birth. Preliminary findings at age seven continue to show that surrogacy families do not differ from natural conception families in terms of the quality of relationships between the parents and their children and that the children are doing well

In a related study, we interviewed 34 surrogate mothers one year after they had given birth to find out more about why they had chosen to become surrogate mothers and their experiences of doing so. The findings allayed many of the fears and concerns about the impact of surrogacy on surrogate mothers. Some women did report feeling depressed in the weeks following the birth, but for most these problems had dissipated by the end of the first year. Relinquishing the child was generally not problematic, with one woman stating that she never viewed it as handing over the child, instead she was handing back the child, implying that the baby was never hers to keep. The large majority wanted to be surrogate mothers for altruistic reasons, stating that they had wished to help a childless couple. Only one said that she was motivated primarily by financial factors. 

It is important to bear in mind that, whilst our study presents a positive view of surrogacy during the early years of a child’s life, we still know very little about the long-term consequences for those involved. Furthermore, we are only now beginning to find out how children born using surrogacy feel about the unique nature of their birth. It is not until these children grow older and fully understand what it means to have been born in this way that we shall fully understand the psychological consequences for the most important person in a surrogacy arrangement – the child.

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