One of the hardest topics to take under consideration when choosing to become a surrogate is deciding how you feel about allowing the parents to make the medical decisions including choosing to terminate or reduce a pregnancy in the case of serious defects, disabilities or higher level multiple embryo splits (e.g. triplets). Living in the U.S. after the overturning of Roe v. Wade has made this topic more sensitive.
To help potential surrogates and intended parents (IPs) understand this better, we wanted to take a moment to cover the basics, key considerations, and answer frequently asked questions about termination and reduction during a surrogacy journey.
When understanding all that surrogacy entails, it's imperative to for everyone involved to be familiar with the terms "termination" and "reduction".
Termination refers to the medical procedure of ending a pregnancy, often due to health risks to the surrogate or fetus, or due to unforeseen complications. On the other hand, reduction involves the selective reduction of multiple fetuses in a high-order pregnancy, typically to improve the chances of a healthy outcome for the remaining fetuses and the surrogate.
While both procedures are deeply personal and complex, their implications in surrogate pregnancies add layers of legal and emotional considerations that distinguish them from similar procedures in non-surrogate pregnancies. Understanding these distinctions is essential for intended parents, surrogates, and medical professionals navigating the intricate journey of surrogacy.
In surrogate pregnancies, termination and reduction are considered under specific and often critical circumstances.
The importance of thorough genetic testing and screenings conducted by the surrogacy agency cannot be overstated, as these measures help identify potential complications early on, allowing for informed decisions that prioritize the health and safety of both the surrogate and the unborn child.
Medical reasons, such as serious health risks to the surrogate or severe fetal abnormalities, may necessitate these procedures to safeguard the well-being of those involved.
High-order multiple pregnancies, where carrying several fetuses to term could pose significant health risks, might also lead to the consideration of selective reduction to improve the chances of a successful and healthy pregnancy.
Open discussions about termination and reduction are essential before matching surrogates with intended parents. These conversations help ensure that all parties share similar views on these sensitive topics, fostering a foundation of trust and understanding. Aligning the perspectives of IPs and surrogates on potential scenarios that might necessitate termination or reduction is crucial for preventing conflicts and emotional distress later in the pregnancy journey.
The role of the surrogacy agency is pivotal in facilitating these discussions, providing a neutral and supportive environment where both parties can express their concerns and preferences openly. At Hatch, we aim to match surrogates and IPs with aligned views, ensuring that everyone involved is comfortable and prepared for any decisions that may arise. This proactive approach promotes a smoother, more harmonious surrogacy experience, safeguarding the emotional well-being of both the surrogate and the intended parents.
Understanding the rights of both surrogates and intended parents is fundamental to a successful surrogacy arrangement. Legally, intended parents typically hold the right to make medical decisions for their unborn baby or babies, and the surrogate’s willingness to allow the parents to make these medical decisions, including decisions regarding termination or reduction, is stipulated in the surrogacy agreement.
However, surrogates also have specific legal rights throughout the process, including the right to receive comprehensive medical care and to be fully informed about all medical procedures and decisions.
Balancing the rights of both parties is achieved through a carefully crafted surrogacy contract, which outlines the responsibilities, expectations, and decision-making processes. This contract, facilitated by legal professionals, ensures that both the surrogate and the IPs are protected and that their rights are respected, fostering a cooperative and respectful relationship throughout the surrogacy journey. At Hatch, we work with some of the best attorneys in reproductive and family law that we can refer you to.
Navigating the legal considerations of termination and reduction in surrogacy involves understanding the complex legal frameworks governing these decisions. These laws can differ significantly by state, with varying regulations and restrictions impacting the options available to intended parents IPs and surrogates. The impact of landmark cases, such as Roe v. Wade, continues to influence these legal landscapes, affecting the permissibility and processes of termination and reduction.
Within the surrogacy contract, specific clauses related to these procedures must be carefully reviewed and understood. These clauses typically outline the conditions under which termination or reduction may occur, the decision-making authority of the IPs, and the rights of the surrogate. Additionally, the contract should detail the financial responsibilities, clarifying who is responsible for the costs associated with these procedures. Ensuring that these legal aspects are comprehensively addressed in the surrogacy agreement helps protect the interests and rights of all parties involved, providing a clear framework for navigating these sensitive and potentially complex decisions.
To help potential surrogates understand this better we wanted to take a moment to cover some key frequently asked questions
A: We have the utmost respect for your beliefs, and it is important that you and your Intended Parents are in step for critical decisions like this. Unfortunately, we do not have any Intended Parents on our wait list who would be comfortable waiving their ability to make such an important medical decision regarding a child they will be raising.
A: Terminations and reductions are extremely rare with more parents choosing to do single embryo transfers, and more parents using genetically-tested embryos both of which help to reduce risks (but do not eliminate them entirely). The reasons we have seen included:
A: They are very rare due to increased embryo testing prior to transfer, many parents utilizing young, healthy egg donors, and because transferring more than one embryo at a time is less common. A surrogate can absolutely choose whether she is willing to transfer more than one embryo at a time or not, and the IVF doctor she is working with will also decide if a surrogate who is open to doing a double embryo transfer is a suitable candidate for carrying twins before approving this.
A: Most issues take time to diagnosis with first non-invasive prenatal testing, and then more invasive prenatal testing like an amniocentesis or CVS, as well as consultations with a maternal/fetal medicine specialist or possibly a geneticist depending on the issues before a decision can be made. Most commonly issues are identified in the early to mid 2nd trimester. Intended Parents want to have all the information before making these difficult decisions.
A: At Hatch we have been making families possible since 1991. In the history of our agency we have never had a client opt to terminate or reduce for a non-medical reason such as a split in their marriage, the baby’s sex not being what they hoped for, or for no reason at all. Our Intended Parents have often struggled for many years before turning to surrogacy to build their families, they want a healthy baby more than anything. These difficult decisions are not made lightly.
A: No, in a situation where a surrogate opted to not comply with her agreement with the Intended Parents and follow through with allowing their decision to terminate or reduce a pregnancy, she would still not have a claim to custody of the child and would also be in breach of the contract with the parents. It is very important to feel confident knowing you can uphold what you have agreed to before signing your surrogacy contract with the Intended Parents.
A: We absolutely respect your stance on this personal subject and would happily refer you to another reputable program that has Intended Parents who are firm in their own stance to not terminate or reduce, or to only do so in limited situations. It is important that you and your Intended Parents are on the same page.
A: Surrogates are not responsible for any medical expenses for their surrogate pregnancy, or their travel costs for any procedures for their surrogacy. Our surrogates also have the option of receiving counseling by a licensed mental health professional if needed, plus the emotional support from their Case Manager, our private online support group, and monthly support zooms.
A: Typically, this will not impact your ability to be a surrogate again, but any D&C or D&E procedure carries a small risk of impacting your ability to build an adequate uterine lining. If the reason for the termination was due to severe intrauterine growth restriction or complications related to the surrogate, rather than baby’s genetics or a fluke, this would preclude you from being cleared for another surrogacy because of the risk of recurrence.
A: These occurrences are exceedingly rare. The health and safety of a surrogate is always the top priority because a surrogate is already a mother to her own children. When a pregnancy cannot be continued safely for a surrogate then the contracts absolutely permit a termination of pregnancy or induction to delivery early (for example in the case of Eclampsia). Typically, someone cannot proceed with future surrogate pregnancies if they have needed a termination or induction to preserve their health. However, selective reduction of multiples does not usually disqualify a candidate from future surrogacies.
At Hatch, we pride ourselves on guiding our families through the complex journey of surrogacy with expertise and compassion. Understanding the intricacies of termination and reduction in surrogate pregnancies is just one of the many areas where we offer support. From defining these procedures and when they might be considered, to facilitating open discussions before matching, and ensuring a clear understanding of legal rights and considerations, we are dedicated to supporting all parties involved.
Our team is made up of previous surrogates, intended parents, and donors, and your case is near and dear to our hearts. Though refining our meticulous approach over the past 30 years, we work with all parties to ensure that the rights and responsibilities of both surrogates and intended parents are balanced and protected. We are here to help you navigate this journey with confidence and peace of mind.
.png?width=150&height=150&name=Open-Door-Badge_Beyond-Inclusion-LGBTQ-101%20(1).png "Open-Door-Badge_Beyond-Inclusion-LGBTQ-101"){kind=icon}
