University of Cambridge Centre for Family Research Publications on Surrogacy 2012-2019 Contents Page 1. 2012, Surrogacy families 10 years on: relationship with the surrogate, decisions over disclosure and children’s understanding of their surrogacy origins. 1 2. 2014, Children of surrogate mothers: psychological well-being, family relationships and experiences of surrogacy. 8 3. 2014, The long-term experiences of surrogates: relationships and contact with surrogacy families in genetic and gestational surrogacy arrangements. 15 4. 2015, Surrogate mothers 10 years on: a longitudinal study of psychological well-being and relationships with the parents and child 27 5. 2017, The role of age disclosure of biological origins in the psychological wellbeing of adolescents conceived by reproductive donation: a longitudinal study from age 1 to age 14. 34 6. 2016, Gay father surrogacy families: relationships with surrogates and egg donors and parental disclosure of children’s origins. 44 7. 2017, A longitudinal study of families formed through reproductive donation: parent-adolescent relationships and adolescent adjustment at age 14. 51 8. 2017, Gay fathers’ motivations for and feelings about surrogacy as a path to parenthood. 63 9. 2018, Parenting and the adjustment of children born to gay fathers through surrogacy. 71 10. 2018, The psychological well-being and prenatal bonding of gestational surrogates. 82 11. 2018, The perspectives of adolescents conceived using surrogacy, egg or sperm donation. 90 12. 2018, Cross-border and domestic surrogacy in the UK context: an exploration of practical and legal decision-making. 98 13. 2019, Parents' relationship with their surrogate in cross-border and domestic surrogacy arrangements: comparisons by sexual orientation and location. 110 Human Reproduction, Vol.27, No.10 pp. 3008–3014, 2012 Advanced Access publication on July 18, 2012 doi:10.1093/humrep/des273 ORIGINAL ARTICLE Psychology and counselling Surrogacy families 10 years on: relationship with the surrogate, Downloaded from https://academic.oup.com/humrep/article-abstract/27/10/3008/750058 by University of Cambridge user on 13 June 2019 decisions over disclosure and children’s understanding of their surrogacy origins V. Jadva*, L. Blake, P. Casey, and S. Golombok Centre for Family Research, University of Cambridge, Free School Lane, Cambridge CB2 3RF, UK *Correspondence address. Fax: +44-0-12-23-33-05-74; E-mail: [email protected] Submitted on December 1, 2011; resubmitted on June 13, 2012; accepted on June 20, 2012 background: This study aimed to prospectively examine families created using surrogacy over a 10-year period in the UK with respect to intending parents’ and children’s relationship with the surrogate mother, parents’ decisions over disclosure and children’s understanding of the nature of their conception. methods: Semi-structured interviews were administered by trained researchers to intending mothers, intending fathers and children on four occasions over a 10-year period. Forty-two families (19 with a genetic surrogate mother) participated when the child was 1-year old and by age 10 years, 33 families remained in the study. Data were collected on the frequency of contact with the surrogate mother, relationship with the surrogate, disclosure of surrogacy to the child and the child’s understanding of their surrogacy birth. results: Frequency of contact between surrogacy families and their surrogate mother decreased over time, particularly for families whose surrogate was a previously unknown genetic carrier (P , 0.001) (i.e. where they had met through a third party and the surrogate mother’s egg was used to conceive the child). Most families reported harmonious relationships with their surrogate mother. At age 10 years, 19 (90%) children who had been informed of the nature of their conception had a good understanding of this and 13 of the 14 children who were in contact with their surrogate reported that they liked her. conclusions: Surrogacy families maintained good relationships with the surrogate mother over time. Children felt positive about their surrogate mother and their surrogacy birth. The sample size of this study was small and further, larger investigations are needed before firm conclusions can be drawn. Key words: genetic surrogacy / gestational surrogacy / disclosure / surrogate Introduction some states in the USA allow commercial surrogacy (Tieu, 2009; Crockin and Jones, 2010) where the surrogate mother is paid by Recent years have seen a growth in the use of surrogacy to help the intending parents (IPs). The USA has commercial surrogacy couples start a family. Despite this increase, surprisingly few organizations to facilitate contact between couples and surrogates studies have attempted to examine the outcomes for families and legal contracts are drawn up between the parties involved created in this way. Surrogacy is permitted in the UK but illegal in (Braverman et al., 2012). In the UK, commercial surrogacy is prohib- many other European countries including France, Germany, Italy ited and only reasonable expenses may be paid to the surrogate and Spain. Some countries allow surrogacy but have particular regu- mother by the commissioning couple (Surrogacy Arrangements Act lations on its use. For example, in Israel each case has to be author- UK, 1985; Brazier et al., 1998). It is also illegal for individuals to ized and supervised by a public committee, only married infertile advertise that they are in need of, or are willing to act as, a surrogate couples are able to use surrogacy and the surrogate mother must mother and surrogacy contracts are not legally binding (Human be single or divorced (Benshushan and Schenker, 1997). India and Fertilization and Embryology Authority HFEA Act, 1990). Thus, UK & The Author 2012. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: [email protected] 1 Longitudinal study of surrogacy families 3009 legislation on surrogacy can be viewed as being on a middle path Statistics (ONS), which covers England and Wales. In the UK, details of internationally (Gamble, 2009). all families created through a surrogacy arrangement are recorded when There are two types of surrogacy: genetic and gestational. Genetic the IPs become the legal parents of the child. Legal parentage is granted surrogacy, also known as traditional, partial or straight surrogacy, is to the IPs by a court of law and this usually occurs within the child’s where the surrogate mother is also the genetic mother of the child. Con- first year of life. During the initial phase of the study, all parents of children aged 1 year who obtained legal parenthood between March 2000 and ception usually occurs by artificial insemination using the intending March 2002 were asked to participate in the study. A total of 58 families father’s (IF) sperm and can be carried out without attending a clinic. were contacted. Thirty families agreed to take part, representing 60% of With gestational surrogacy, also known as full or host surrogacy, con- those who responded to the request by ONS, with 20 (40%) declining Downloaded from https://academic.oup.com/humrep/article-abstract/27/10/3008/750058 by University of Cambridge user on 13 June 2019 ception takes place at a clinic using IVF. The transferred embryo may to take part. A further eight families did not respond. As IPs who had be created using either the intending couple’s gametes or the IF’s not yet become their child’s legal parents would not have been identified sperm and a donor egg. Surrogate mothers may have either been previ- by the ONS, all parents on the register of the surrogacy agency Childless- ously known or unknown to the IPs. Previously known surrogate ness Overcome Through Surrogacy (COTS) with a child in the same age mothers may be family members or friends, and previously unknown range were also asked to participate. Of the 34 families contacted, 26 surrogate mothers include those who met the IPs through a third agreed to take part, representing a response rate of 76%. As 14 families party (either a surrogacy organization or a mutual friend). This manu- responded to invitations from both the ONS and COTS, the final script will refer to the parents of children born using surrogacy as IPs. sample size was 42. The sample consisted of families who had used genetic surrogacy, The relationship between the surrogate mother and the resultant where the surrogate mother had used her own egg, and gestational surro- child has been an issue of great interest, particularly in cases where gacy, where the IPs embryo was implanted in the surrogate mother. the surrogate mother is also the genetic mother of the child, and Sample sizes at each phase were as follows: Age 1 year, N ¼ 42 (26 where the surrogate mother was previously known to the commis- genetic, 16 gestational); Age 3 years, N ¼ 34 (21 genetic, 13 gestational); sioning couple (Braverman et al., 2012). British surrogacy arrange- Age 7 years, N ¼ 33 (21 genetic, 12 gestational); Age 10 years, N ¼ 33 ments enable a strong relationship to develop between the (21 genetic, 12 gestational). Semi-structured interviews were carried out surrogate mother and the IPs during the surrogacy pregnancy (van with IMs during each visit, with IFs when the child was aged 1, 7 and 10 den Akker, 2007). This is partly because of the absence of commercial years, and with the children themselves at ages 7 and 10 years. A surrogacy agencies, which means that IPs and their surrogate are in section of the interview collected information on (i) the frequency of direct contact (van den Akker, 2007). The relationship is typically contact between IPs (and child) and the surrogate mother in the past maintained between the intending mother (IM) and surrogate year (measured on a four-point scale ranging from ‘not at all’, rated 0, to ‘more than once a week’, rated 4); (ii) the quality of the relationship mother rather than the IF (Ragone´, 1994; MacCallum et al, 2003; between IPs and the surrogate mother (coded on a three-point scale Teman, 2010).