The Medical Wheelhouse Of Surrogacy.

Procreation is the primary role of a woman or is it?

After overcoming the first hurdle which is marriage, the second hurdle and test of ‘womanity’ is having kids. 

In a society like ours, having a child isn’t going to cut it, four to five children or even more is the ideal goal. (Let’s be real, a lot of people still frown on a choice that isn’t theirs to make).

Womb watchers have a full-time job! The inability to procreate gets tongues wagging, then comes the name-calling, constant shaming, the trip to different churches and prayer houses to find a solution, e.t.c. When nothing works, however, the man is advised, most times pressured to take another wife or sow his seeds somewhere else so his lineage can continue. 

One can only imagine the mental agony women in these situations go through. Cue in the 21st century, or as I like to call it, “the unfettering times”.

Here, ignorance is not an excuse. Technology comes very much in handy. We have come to learn that the inability to birth a child is surrounded by a number of factors, most of which are not the fault of the woman.

However, technological advances such as IVF, softening of cultural attitudes, and the trend for having children later have fuelled a recent boom in surrogacy. Surrogacy is not a new phenomenon, the only problem is, we haven’t opened our minds yet to women contracting other women to birth their children. Hence, privacy, which is still very understood.

Surrogacy comes in two forms – gestational, where the surrogate mother is implanted with an egg and sperm; and traditional surrogacy, where the surrogate’s own egg is used.

Medical Perspective

For a lot of people who have no idea of the processes involved in surrogacy, Dr. Sekinat Raji-Olarinoye, a consultant gynecologist at Bridge Clinic Fertility Centre, explains in detail what it entails.

“Surrogacy refers to a situation whereby a third-party female elects or is commissioned to carry a pregnancy on behalf of another couple, delivers a baby, and hands the child over to the commissioning parents at birth. Two forms are discernible, depending on the existence or not, of the genetic link between the surrogate mother and the fetus.

“In traditional surrogacy, there is a genetic link between the surrogate mother and the baby. She is inseminated with the semen of the commissioning father or donor sperm and she is the biological mother of the child. When pregnancy is as a result of IVF using either the commissioning mother’s eggs or donor eggs, it is regarded as Gestational Surrogacy. In gestational surrogacy, the surrogate has no genetic link to the child. Traditional surrogacy is not practiced in Nigeria.

“There are various factors that can affect the length of the surrogacy process. Finding a suitable surrogate mother could take up to four to six months. Provided your surrogate becomes pregnant after the first embryo transfer, the whole process will generally take about a year and a half.

“Intending surrogates should be physically healthy young women between the ages of 21 to 35 years, with a healthy weight. They should have had at least one successful previous pregnancy and no major complications in their previous pregnancies. They should be free of infectious diseases that could be transmitted to the baby, have no tattoos or body piercings in the last year, and should have no history of a mental health disorder. 

“The commissioning parents should have a clear indication for seeking surrogacy. As earlier discussed, surrogacy isn’t for the faint-hearted. There’s so much at stake and things could potentially go awry. So the practice of people undertaking surrogacy for ‘convenience’ is unethical. Surrogacy becomes necessary in women who do not have a womb or whose wombs cannot support a pregnancy; or in women in whom pregnancy can be life-threatening eg. women with severe medical conditions. It is also indicated in women who have had repeated miscarriages or repeated IVF failures.

“Children born through surrogacy have been shown to have no physical or mental abnormalities compared to those children born through natural conception.”

Everything comes with its challenges and Dr. Sekinat did the honours of intimating us on the most challenging part of the whole process.

Dr. Sekinat

“For the surrogate mother, the major challenge would probably be how to separate emotionally from a child that she carried for 9 months. 

“Pregnancy for most people is often not a walk in the park. At the minimum, it comes with physical and psychosocial inconveniences. They experience physical changes, nausea, and vomiting, body aches, constipation and loss of work hours to meet hospital appointments etc. There’s also a risk of serious illness or death resulting from pregnancy complications and the surrogate mother must be willing to accept such risks. What happens if the biological parents die or the baby is born with a malformation? What if they decide not to take the baby from her? 

“The biological parents would probably be anxious throughout the pregnancy. They really do not have much control over the surrogate mother and her lifestyle. Is she eating healthy, smoking? What if she absconds with the baby? They just have to wait on the sidelines till the journey is over. The whole process can be emotionally draining for both surrogate and biological parents. This is why they must undergo psychological screening and counseling before they embark on the process, through pregnancy and beyond.

“As the doctor, managing the concerns and expectations of both surrogate and intending parents can be complex. There are also ethical and medicolegal aspects of surrogacy to contend with. Sometimes, the desires of intending parents may not be in tandem with best clinical practice. Though it is desirable to satisfactorily address clients’ needs, a doctor should not do anything to compromise the health, wellbeing or rights of either the surrogate or intending parents.”

In addition to the medical risks of surrogacy, there are sometimes emotional challenges. While pregnancy in itself can be a difficult process, some women find surrogacy to be more emotionally challenging because, in the end, they will not be going home with the child they have carried with for nine months. Want to know how the clinic steps in? Keep reading…

“It’s only natural that a surrogate feels a sense of loss following separation from the child. The extent to which this is experienced depends on the individual. At the clinic, we recognize this reality and we have put mechanisms in place to help them through this period. 

“We do this by carefully selecting surrogates with the help of our Ethics committee that consists of both internal staff and external professionals in the healthcare industry. We ensure that surrogates start the process in a state of optimum physical and mental health. They also have access to ongoing counseling and emotional support throughout treatment and during pregnancy. This way, we start preparing them for delivery and separation from the onset.”

Meanwhile, open communication and a healthy relationship between the surrogate and intending parents are encouraged.

“Most relationships between surrogates and intended parents are actually incredible and many of these relationships will end up creating life-long friendships. However, every surrogate-intended-parent relationship will be different, so it’s good to be prepared for any potential challenges, just in case.”

This is only the medical aspect, next I talk to Sarah Sani who explains the legalities of surrogacy in Nigeria.

More details coming up in part two.

This article was contributed by Ekpedeme Umoh

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