Podcast Review: Making Babies — Surrogacy — what, why, how, who, where?

In late 2020, Andrea Byrne started a podcast series inspired by her seven-year fertility journey. When she thought she couldn't carry a pregnancy herself, she and her husband seriously considered surrogacy. This potential avenue for parenthood is discussed in the fifth episode of the series, entitled 'Surrogacy: What, Why, How, Who, Where?'.

In the hour-long episode, Byrne is joined by Natalie Gamble, a leading fertility lawyer in the UK, who discusses the legalities of the arrangements, Stephen Ashe who started his family through surrogacy, and Teresa Coots, a surrogate. This episode provides a detailed overview of surrogacy in the UK, bringing together various stakeholders' perspectives. It should be noted that the episode reflects the approach taken by Brilliant Beginnings, as all three guests were affiliated with the agency in some way.

At the beginning, Byrne introduces Coots as a 'surrogate mum'. It surprised me that none of the guests commented on Byrne's use of this term. The glossary at the start of the Law Commission's Consultation Paper indicates that they refrain from the use of the term 'surrogate mother' because surrogates do not like to be referred to as the mother of the baby. Coots discusses how the baby is not hers, but rather the intended parents, and Ashe mentions how surrogates are adamant about having the intended parents holding the newborn first because it's their child.

An experienced host, Byrne ensures that the conversation is balanced between Gamble, Ashe and Coots, while allowing each to draw on their expertise. Gamble provides an overview of the legalities involved with domestic and international surrogacy arrangements, before moving onto the misconceptions surrounding surrogacy in the UK. She analyses the false boundary between 'altruistic' and commercial surrogacy, noting average payments of £12,000-15,000 with the courts acknowledging that it is legally acceptable for this amount to encompass more than just 'reasonable expenses.' Even in the USA, where surrogates are criticised for their commercial motives, surrogates are driven by a desire to help, with the money seen as a recognition of their contribution.

Ashe and Coots discuss the awkwardness of entering into a surrogacy arrangement. As a client manager and surrogate manager with Brilliant Beginnings, respectively, they use their experiences to help match intended parents and surrogates appropriately, avoiding breakdowns where possible. The process takes time, with intended parents waiting up to 18 months for matches. Coots emphasises that it was very important for her to find a supportive organisation when she decided to enter into surrogacy. She mistakenly holds that the law requires surrogates to have their own children, although this isn't true: this is in consideration by the Law Commission, who are unpersuaded that prior experience of giving birth would be necessary for a potential surrogate.

Gamble notes that in addition to working with licensed fertility clinics, Brilliant Beginnings also uses external professionals, including a psychologist who provides an in-depth assessment of potential surrogates. The approach undertaken by Brilliant Beginnings is similar to the screening conducted in the USA, in line with ASRM Guidelines. The goal is to ensure that surrogates are healthy and stay healthy in the long-term, and it's good to see this step taken, without any Human Fertilisation and Embryology Authority (HFEA) or legal requirements in place.

Ashe outlines the costs associated with surrogacy, and it is expensive – even when staying in the UK. The total is around £50,000-60,000 inclusive of everything from fertility clinics, legal costs, counselling, and expenses. Of course, there are ways to reduce costs, such as undertaking a traditional surrogacy with home insemination, and skipping on counselling, but as all the guests highlight, psychological support is crucial in ensuring the mental health of all the parties. Going abroad is an appealing option for many, who view the current framework in the UK as not fit for purpose as the law does not respect the surrogate's decision to carry a child she does not intend to parent, and this halts some potential surrogates from coming forward. As it stands, the law prohibits the negotiation of surrogacy agreements on a commercial basis, with firms unable to provide a 'surrogacy service'. As such, legal advice in the initiation of surrogacy arrangements is prohibited. However, legal advice for the parental order process is very much encouraged, given its complexity.

Coots notes that the law's clumsiness deters many surrogates and intended parents, each of whom is worried about the other reneging on their agreement, as there is no legal force to their agreement. When discussing her own experiences, it is abundantly clear that like many surrogates, her bond was with the intended parents, with the journey being about their experience into parenthood. Her view is supported by Ashe, who mentions a highlight of his journey was building a lasting relationship.

Overall, the episode provides a succinct overview of surrogacy in the UK for anyone who is new to the topic or wants a refresher. By covering a range of topics, including the current law, reform, the actual matching process, and mental health, Byrne allowed her guests to outline how Brilliant Beginnings aims to reduce any risk, and safeguard the health of all those involved in the arrangement. I look forward to listening to the rest of this series and hope to see an episode dedicated to health and assisted reproduction.