A couple of days ago, I bought a book. I thought it was just some easy-going romance novel and didn’t pay proper attention to the short description on the back. Once I finally had the time to read it, I was surprised to find that the book was actually an investigation into surrogacy in post-Soviet countries, starting with Ukraine.

It made me curious, as most of the literature we see regarding surrogacy cases only depicts the worst-case scenarios rather than the good ones. When I see such articles or books written about such a sensitive topic, I always want to ask the authors several questions from a friendly, expert perspective. Why is it always deemed necessary to bring the bad cases to the front instead of the good ones? Why do we not speak up about the many families whose dream of parenthood became possible only thanks to surrogacy? Why do we not speak about the surrogates whose lives are changed for the better due to their informed decision to become a surrogate? They make it happen for these families, becoming part of something very big and life-changing.

I have many questions… and I know that a lot of intended parents have millions of questions or doubts about what is going on “behind the scenes.” Is it the right choice for them? Are they ready for this? Is their surrogate kind? Will the surrogate take care of their unborn child? Will the agency or clinic take good care of the process? Yes, there are so many questions and so many challenges, but I can say only one thing: if you have trust in your agency, even during difficult times, it will work. No matter what others say, it will work—you just need to keep going and believe that this is what you dream of.

My articles are supposed to be about the unanswered questions in surrogacy—questions that people often refrain from answering or give unclear and confusing answers to. I will try to summarize some of them here: 

The Timeline of the Surrogacy Journey

One of the most frequently asked questions is how long the process will take. The answer is usually 14 to 16 months in an ideal case, but… every journey is different. Some cases take three or even four years, and there are cases that take only 14 months. It depends on several factors; some are predictable, and some are fully unpredictable. What you need to know is to be kind to your surrogacy team. Understand that you are one team. Do not start communication with your agency or clinic as if they are enemies. You are in this together, and whatever comes up needs discussion to find the best possible solution for you, for your surrogate, and for your journey. 

The Question of Exploitation

Another question is: are these women, the surrogates, being exploited? Of course, the answer will always be no; they are not. All surrogates have extensive discussions with team members. Based on certain country regulations, they are even required to have lawyers who further explain all of their responsibilities and the terms of the agreements. Only after evaluating all aspects do they either proceed or not.

Here, it is important to mention that when someone asks if surrogates are exploited, I want to answer that no, they are not (well, at least in our agency’s case). However, we do have cases where the opposite happens, and a surrogate behaves in a way that makes us feel exploited. Yes, I know that sounds bad, but it is true. There are cases where a surrogate might blackmail parents “through us”, try to get more benefits than were agreed upon, or try to change their terms after the agreements are already signed. Yes, there are cases where we immediately disqualify candidates because of alarming behavior that may not have been obvious during initial screenings. These topics are not usually discussed like this, but we are ready to discuss them and give you full insight into such aspects. We want you to know that this is a whole chain of processes that may cause ups and downs, but you should always remember that the only intention here is to make parenthood happen for you, while simultaneously ensuring the surrogate’s rights are protected equally, and her bodily autonomy is well respected.

Care of Surrogate and Unpredictability along the way

One more interesting question is how we take care of the surrogate while she is pregnant. The answer is simple: a surrogate receives way, way more attention than a typical pregnant woman. And when I say way more, I mean it. There are daily check-ins on how they feel, if they need anything, if they have any symptoms, or if they need some medication/supplements prescribed by a doctor. We provide appointments, psychological support, and so on.

I remember one case when, out of the blue, during a second-trimester regular infection screening, a surrogate tested positive for Syphilis (VDRL). This was literally shocking for all of us, as obviously her previous tests had been negative. I would say it was one of the most difficult cases in our agency’s history. All measures were taken immediately, including consultations across three continents with leading infectious disease specialists specializing in venereology and antenatal care. In the end, we welcomed a healthy baby.  However, … I still remember how the intended parents reacted. Until the very end, they believed it was because of the agency that she got Syphilis. That was heartbreaking. You all have to understand that no agency, no lawyer, and no legal contract can restrict a surrogate from having a private life. Yes, she is supposed to take precautionary measures, and with this action, she put the health of the unborn child at risk. But the agency cannot and will not violate a surrogate’s bodily autonomy or restrict her from her personal life. Surrogates are grown women who take full responsibility for their actions.

Changes in the legal landscape of surrogacy.

The question of whether to expect ups and downs in legal matters in the destination country is a “million-dollar question.” There is no single answer. One of the hardest things to navigate is a legal change happening in a destination country; this is a nightmare for everyone involved. Just like in the cases mentioned above, becoming frustrated and engaging in upsetting discussions with your team is completely unhelpful.  Legal changes follow the surrogacy field everywhere. It is fully unpredictable, and when you engage in international surrogacy, you must be aware that this could happen. There are constant ups and downs: changes in how birth certificates are issued, including or excluding the surrogate’s name on the document, removing a surrogate’s name after the fact, or shifts in court processing. These things happen.

Any delay with paperwork is the ultimate nightmare for any agency. Putting extra pressure on your team when they are already doing everything humanly possible is unfair, even though you may feel completely overwhelmed. You must remember that the legal landscape is outside of the agency’s direct control, and navigating it requires patience and a unified front.  What is important is to evaluate how your team works and solves the topics that emerge. Being frustrated at first is normal, but do not put that anger on your team—that is not helping. When difficulties come, we have to unite as a team and improve whatever can be improved and solve whatever can be solved.

It seems my article has become quite long, so I should pause here and give you a break. We will continue writing interesting articles for you, helping you along the way to make your surrogacy journey as smooth as possible.

 

Stay tuned!

Tamari Kachlishvili, MD. MPH

CEO of GS Consulting