Gestational Surrogacy 101: Psychological Aspects
Gestational surrogacy arrangements are not new. According to the Old Testament, when she could not get pregnant, Sarah offered her maiden, Hagar, to her husband Abraham, so that Hagar could give them a child. However, although Hagar (the traditional surrogate) delivered a baby from this arrangement and gave the baby to Abraham and Sarah (the intended parents), this deal created a big strain in the relationships of all parties involved. Although, unlike the case of Sarah and Hagar, in current surrogacy arrangements the “egg donor” is different from the woman who is carrying the pregnancy (gestational carrier or gestational surrogate), there are still many psychological considerations that need to be explored before establishing such agreements between the gestational surrogate and the intended parents. Today, gestational surrogacy is a great option not only for women who can’t get pregnant, as in the case of Sarah, but also for the members of the LGBTQ+ community.
Before starting any treatment, intended parent(s), gestational surrogate and her partner, if applicable, are evaluated and counseled by a qualified mental health specialist.
The intended parents undergo a psychological evaluation in order to identify any significant psychological issues that may endanger a successful collaboration between them and the surrogate. This evaluation often includes the general expectations from the gestational carrier and understanding her rights during the pregnancy. For example, the gestational carrier has the right to accept or refuse treatments during pregnancy, even if her decision is at odds with that of the intended parents. These decisions may include but are not limited to termination of a pregnancy in case of an abnormal fetus, reduction of fetus(es) in case of a multiple pregnancy, acceptance of certain tests or treatments during pregnancy, etc. By the same token, both parties should ideally agree on the number of embryos to transfer to avoid any conflict that may arise during the treatment. Disclosure to family and friends and disclosure in the future to the offspring are also reviewed during this evaluation. Other topics that are considered are the relationship between the intended parents and the surrogate (and her family if applicable) during pregnancy, the surrogate’s behavior including eating and other habits, the potential need for the surrogate to interact with the baby when born, and how to deal with complications that may arise before or during pregnancy (i.e., unsuccessful embryo transfers, miscarriage, prematurity, etc.).
Similar to the intended parents, the gestational surrogate, and her partner if applicable, undergoes a psychological evaluation in the form of a clinical interview to rule out a psychological or a psychiatric disorder. The surrogates are often evaluated with one of the personality assessment tools, the Minnesota Multiphasic Personality Inventory (MMPI) or the Personality Assessment Inventory (PAI). The motivation of the surrogate to carry the pregnancy, her social environment, religious beliefs, maturity and judgment are assessed. Previous history of being a surrogate, if applicable, and that experience, desire for more children of her own, the effect of the arrangement on her social, work and family life are reviewed. The possibility of treatment failures, complications that may arise and coping mechanisms, relations with the intended parents during pregnancy and at decision making milestones are examined during this interview. The possibility of bonding and the ability to separate from the baby after birth are also discussed.
The creation of a family with the help of a gestational surrogate is a team effort, including the source of the gametes, the person carrying the pregnancy, and the intended parents. Ideally, the intended parent(s), the gestational surrogate and her partner, if any, are interviewed individually and also as a group, to ensure all parties are on the same page on their journey to create a family for the intended parent(s). At Reproductive Medicine Associates of New York (RMA of New York), we help you with an expert team of providers that include a world class reproductive psychologist, with the sole aim to serve you in achieving your dream to build a family in the healthiest and most successful manner, for all parties involved.