In the United Kingdom (UK) and the United States (US) surrogacy is an accepted treatment option for certain specific causes of childlessness, but most countries do not allow it (Jones & Cohen, 2001). Until IVF produced an alternative, ‘natural surrogacy’ was the only treatment option available to women with congenital absence of a uterus or women who had lost their uterus to surgery. In vitro fertilization surrogacy is required by relatively few couples and accounts for approximately 1% of IVF treatment cycles at Bourn Hall (Brinsden et al., 2000) and only 0.1% of assisted reproductive treatment cycles in the UK (Human Fertilisation and Embryology Authority, 2000).

Definition of terms

Considerable confusion exists over the terms used in connection with surrogacy. ‘Natural surrogacy’, sometimes known as ‘partial surrogacy’, refers to an arrangement in which a female surrogate, sometimes known as the ‘surrogate mother’, agrees to be inseminated with the sperm of the male partner of the couple wanting a child, sometimes known as the ‘commissioning couple’, and this is often done without medical supervision. The resulting child is genetically the child of the female surrogate and of the male partner of the couple wanting the child, but genetically unrelated to the female partner of the couple wanting the child. ‘IVF-surrogacy’, sometimes known as ‘gestational surrogacy’ or ‘full surrogacy’, refers to an arrangement where the couple wanting a child provide both sets of gametes and, following fertilization in vitro, their embryos are transferred to the female surrogate. The resulting child is genetically the child of the couple wanting the child and genetically unrelated to the female surrogate. In this chapter the terms ‘IVF-surrogacy’ and ‘natural surrogacy’ will be used.