Surrogate Motherhood: A Complex Choice Across Medicine, Law and Ethics
Physical Health and Medical Management
The health of the surrogate mother is directly related to the safety of the pregnancy and the development of the fetus, and medical protocols require strict health assessment and nutritional management:
Hormone and Reproductive System Testing: Follicle Stimulating Hormone (FSH), Luteinizing Hormone (LH), and endometrial status (≥8mm thickness) need to be monitored to ensure that the uterine environment is suitable for embryo implantation.
Weight and metabolic control: BMI should be maintained at 18.5-24.9, and weight gain during pregnancy is recommended to be 11-16 kilograms (singleton) to reduce the risk of gestational diabetes mellitus, hypertension and other complications.
Nutritional fortification program:
Protein and micronutrients: 120 grams of high-quality protein (fish, beans, low-fat dairy products) per day, along with folic acid (400-600 μg/day) and iron (30 mg/day), to prevent fetal neural tube malformations and maternal anemia.
Health Contraindications:
Avoid raw foods, high mercury fish and alcohol, caffeine intake needs to be controlled below 200mg/day.
Legal Risks and Contractual Disputes
Surrogacy is facing legal ambiguity in most parts of the world, and the validity of the contract is often invalidated due to violation of public order and morality, making it difficult to protect the rights of the surrogate mother:
Contract invalidity: Surrogacy agreements are usually not legally binding, and surrogate mothers may not be able to recover payment and may even be responsible for their own support.
Criminal risk: illegal egg collection and embryo transfer may violate the crime of illegal medical practice, and if it involves baby trading, it may constitute the crime of child abduction and trafficking, and the sentence can be up to 10 years.
Cross-border surrogacy: Some countries allow surrogacy, but problems such as identification of babies and falsification of birth certificates occur frequently, leading to legal disputes and risks of human trafficking.
Self-protection advice:
Choose a medically-qualified agency with clear terms of embryo ownership and staged payment;
Ethical Controversies and Social Implications
Surrogacy instrumentalizes women’s bodies, leading to deep ethical controversies:
Physical Exploitation and Health Damage: Ovarian Hyperstimulation Syndrome (OHSS) is caused by the misuse of ovulation stimulating drugs, and violent egg retrieval may lead to abdominal infections and even infertility.
Emotional severance of mother and baby: surrogate mothers need to be forcibly separated from their babies after delivery, and more than 35% suffer from traumatic loss symptoms (e.g., anxiety, depression, PTSD).
Class Exploitation and Commoditization of Population: The demand for surrogacy mostly comes from high-income groups, while surrogate mothers are often forced to participate due to economic hardship, exacerbating social inequality.
Industry disorganization:
Education, appearance, etc. are marked up, and women are reduced to “reproductive commodities”;
The live birth rate is only 55%-68%, and some intermediaries falsely advertise the success rate in order to recruit clients.
Technological Processes and Fertility Options
Surrogacy relies on assisted reproductive technology, and its success rate and risks need to be scientifically assessed:
Ovulation Promotion and Embryo Culture: Using antagonist regimen (Gonal-F 225 IU + Menopur 150 IU) to obtain 8-12 eggs/cycle, Blastocyst culture technique to increase live birth rate to 72%.
Embryo screening: PGT-A technology can exclude more than 200 genetic diseases with 99% accuracy, but misuse of the technology may exacerbate eugenic controversies.
Transfer operation: ultrasound-guided localization of the upper and middle uterine segments, transfer in 10 minutes, and a 40% reduction in preterm birth rate in twin pregnancies.
success rate data:
Approximately 68% live birth rate in self-egg cycles under 35 years of age, decreasing to 55% in donor egg cycles over 40 years of age.
Psychological support and long-term health
Surrogate mothers require systematic psychological interventions and social support:
Psychological support mechanisms: cognitive behavioral therapy (CBT) can alleviate separation anxiety, and screening for postpartum depression should cover 100% of cases.
Residential and health management: no smoking and alcohol consumption in centralized custodial environments, with a 24-hour medical team to respond to emergencies.
Social support initiatives:
Push for legislation to clarify criminal penalties for surrogacy, such as including the organization of surrogacy in the crime of illegal business operation;
Establish health records of surrogate mothers to track gynecological diseases and psychological status within 5 years after delivery.
Conclusion
Surrogate mothers are at the intersection of medicine, law and ethics, and their choices are often accompanied by physical risks, psychological trauma and social rejection. The world needs to strengthen technical regulation to combat the illegal surrogacy industry chain, and at the same time provide surrogate mothers with medical assistance and psychological support to prevent them from falling victim to commercialization. The choice of surrogacy should prioritize compliant medical institutions and fully assess technical transparency and long-term consequences.
