Made to Order: The costs of surrogacy

“The human body is not lent out, is not rented out, is not sold.”

That was the 1991 conclusion of the high court of France when it ruled against the practice of hiring a woman to carry a child for someone else to parent, a practice known as surrogate motherhood.

Yet, in many countries today, including some parts of the United States, it is perfectly legal to “rent out” the human body as an incubator for a baby who is ordered up by someone who wants a child and has the cash to pay a woman to be impregnated and then hand over the child at birth.

Surrogacy thus reduces the baby to a commodity to be purchased and the mother to an object to be used. The practice also demeans the family and “fractures” the “triune relationship” between the parents and the Creator, said Marie Hilliard, director of Bioethics and Public Policy at the National Catholic Bioethics Center (see Page 12).

No national statistics on surrogacy are kept, but experts say thousands of surrogate pregnancies occur every year in this country, and untold thousands more in other countries, for surrogacy has become a multi-billion-dollar industry that is largely unregulated. Even “surrogacy tourism” has become popular in poor countries like India, where “surrogacy farms” house poor women eager to earn money and willing to accept less than the going rate in wealthier countries.

Manufacturing process

Surrogate pregnancies originally were accomplished by artificially inseminating a woman, and this is called “traditional surrogacy.” However, after science developed in vitro fertilization (IVF) to create an embryo outside the womb (1978), so-called “gestational pregnancy” has become a more popular way of getting a baby since the 1980s.

This method is popular for legal reasons, because it is more difficult for a surrogate mother to try to keep the child after birth since the baby is not biologically related to her. The surrogate mother is considered to be merely the “carrier,” “vessel” or “surrogate uterus,” according to terms in the industry.

In a gestational surrogacy, the intended parents may contribute their own eggs and/or sperm, or the eggs and/or sperm are obtained from an egg or sperm bank. So-called “designer babies” are offered by some IVF clinics, which allow prospective “parents” to choose the gender of the child as well as egg and sperm donors by profiles that detail the donors’ appearance, talents and ethnicity.

The price charged by a surrogacy broker in the United States ranges from $40,000 to $120,000, but the U.S. surrogate mother typically receives only $20,000 to $25,000, according to The Center for Bioethics and Culture Network. On the other hand, an “exceptional” egg donor with high I.Q. and grades from a prestigious college can receive more than the $10,000 maximum recommended by the American Society for Reproductive Medicine.

The specter of eugenics and exploitation of the poor certainly is raised by surrogacy, and disdain for human life is evident not only by discarding embryos that don’t measure up, but also by aborting children that are not the perfect little creatures the “parents” ordered.

This business of manufacturing children to order for anyone with the money to pay has become accepted in many cultures without a full analysis or understanding of the implications for humanity and society.

Exploited women

While surrogacy agencies provide feel-good accounts by surrogate mothers, a large body of anecdotal evidence reveals that surrogate mothers risk being exploited, bullied and abandoned, all the result of the commodification of human life.

In March, for example, CNN medical correspondent Elizabeth Cohen told the story of Crystal Kelley of Connecticut, who agreed to be a surrogate mother and was promised $22,000. When an ultrasound at five months revealed the baby had a cleft lip and palate, brain cyst and serious heart defects, the couple offered her $10,000 to abort the child.

When Kelley refused to abort, the couple told her they would assert their legal rights to the child and relinquish her to the state when she was born. Wanting better for the baby she carried, Kelley moved to Michigan, which does not enforce surrogacy contracts, and found a loving adoptive home able to care for the special needs of the little girl.

ABC News reported in 2011 about Carrie Mathews of Colorado, a mother of four who agreed to carry a child for an Austrian couple for $25,000. Pregnant with twins, Mathews experienced several medical problems during the pregnancy, including pre-eclampsia and need for a Caesarean section delivery. After the birth, the Austrian couple departed the country with the twins, still owing Mathews more than $14,000 and leaving her with more than $200,000 in medical bills.

Multiple repercussions

Surrogacy mother message boards and Internet postings also reveal many difficulties suffered by surrogate mothers, including the agony of giving up the child she carried for nine months, the problem of explaining to her children why she gave away their baby sibling, being abandoned during the pregnancy after the intended parents decided to divorce, and failure to honor agreements that would allow the surrogate to be part of the child’s life.

Jennifer Lahl, a nurse and president of The Center for Bioethics and Culture Network, told Our Sunday Visitor that surrogacy businesses try to present the facade that surrogacy is a win-win situation for everyone involved. In her research for her upcoming documentary film on surrogacy, Lahl said she interviewed a variety of surrogates who had “disastrous experiences,” all the outcome of the unnatural practice of “buying and selling babies.”

In her previous documentaries, “Eggsploitation,” dealing with donation of eggs for in vitro fertilization, and “Anonymous Father’s Day,” dealing with sperm donation, Lahl had investigated the negative health and psychological repercussions of those practices suffered by the donors as well the children created from those “donations.”

Internet message boards like The Other Side of Surrogacy and The Unanimous Us Project also detail many difficult personal experiences of surrogates and the offspring of these pregnancies.

Health risks

Acting as a surrogate mother or donating eggs for a pregnancy are not the carefree, simple, safe experiences they are often made out to be. Dr. Anthony Caruso of Chicago discussed with Our Sunday Visitor the medical risks involved for the surrogate mother, the egg donor and child.

Caruso had become a reproductive endocrinologist because he wanted to help infertile couples have a baby. However, after 15 years of helping couples achieve pregnancy through in vitro fertilization, he became uneasy about the process when he began to encounter multiple combinations of people who wanted to create a child. He also started to witness embryos being treated with little respect and easily discarded.

As his uneasiness was growing, “Dignitas Personae: On Certain Bioethical Questions” was issued by the Congregation for the Doctrine of the Faith in 2008, summarizing Church teaching on all the emerging reproductive technologies. Caruso studied that document and came to understand better the Church teaching that IVF was a commodification of human life that he could no longer practice.

Because of his religious and ethical positions, Caruso resigned from the Chicago Association of Reproductive Endocrinologists in 2010 and became an obstetrics hospitalist for a Catholic hospital. He also joined the Catholic Medical Association and the Catholic Physician’s Guild.

He currently is in the process of opening a medical practice in Downers Grove, Ill., to provide moral care for patients wanting to achieve pregnancy.

Caruso explained that a woman preparing to have embryos transferred into her uterus must take daily estrogen doses, and just before the embryo transfer, she takes high doses of progesterone. The estrogen increases the risk of blood clots, and though each woman is different, the hormone administration also potentially creates emotional problems.

He also noted that the bonding between mothers and their children that develops during pregnancy could have a psychological impact on the surrogate mother who is contracted to give up the child. Also, since between one and four embryos usually are implanted, twin and higher order pregnancies are possible and present additional risks to the mother.

Effects on donors, babies

Jennifer Lahl, a nurse and president of the Center for Bioethics and Culture Network

Risks for the donor of the egg also are present, for medications she must take can cause headaches, mood swings, bloating and nausea. There is always a risk that the ovaries will be overstimulated, Caruso said, leading to dehydration, possible blood clots and kidney problems. Also, retrieval of the eggs presents the risk of infection and injury to the surrounding blood vessels as well as risk of adhesion formation, which could theoretically increase the egg donor’s future risk of infertility.

Caruso said the majority of babies born from IVF are normal, but a number of studies show that IVF children have increased risks of lower birth rates, cardiac abnormalities, asthma and problems in the formation of the gastrointestinal tract.

“Studies have also suggested that IVF babies are twice as likely as naturally conceived children to be diagnosed with a major birth defect by 1 year old,” he said. “Pediatricians have described that a higher percentage of IVF children suffer from Beckwith-Wiedemann syndrome, a condition which can be associated with accelerated growth and cancerous tumors.”

As for the whole concept of surrogacy, Caruso said that of all the advanced reproductive procedures, none is more objectifying than the use of a gestational surrogate:

“It is the final step in the complete dissolution of the physical marital bond. Now any sperm, egg and uterus can be ‘combined’ to ‘make’ a baby.” 

Ann Carey writes from Indiana.