Often when we think of assisted reproductive technology (ART) in the emerging field of oncofertility, we assume that this technology is available to all women of reproductive age following cancer treatment - that with some manipulation of eggs or embryos transferred back into a woman’s body, they have the potential to become pregnant. Unfortunately for some women, their cancer treatment leaves them unable to gestate for a number of reasons including: the effects of radiation on the uterus, the removal of the uterus (hysterectomy) or the potential negative effect of chemotherapy on hormone regulation. In these situations, if a woman has banked her eggs or embryos she then has the option, the only option at this time, of using a surrogate to have a biological child.
Choosing surrogacy as a means of having a biological child necessitates a significant amount of research in order to fully understand the complicated legal, ethical and economic implications of an already emotional and personal decision. Decisions need to be made about which type of surrogacy you will pursue – altruistic or commercial – will you be compensating someone or not? Does your state even allow you to compensate a surrogate and if not, what are your options in other states? In surrogacy, a lot of what you decide to do depends on your geographical location and the laws and practices of that particular region.
Commercial surrogacy can be costly omitting a large number of people from opting in which makes international surrogacy a more accessible option to individuals with financial limitations. When choosing international surrogacy you will have to establish how to navigate another country’s legal and/or governmental system. Some countries have very limited governmental regulations while others are highly restrictive so working with an experienced and knowledgeable surrogacy broker may help you to avoid potential legal complications. A broker is there to protect your rights as the biological parents and to make sure that the surrogate chosen is prepared emotionally and physically to follow-through as contracted with the surrogacy agreement.
Regardless of the logistics of surrogacy, as we see an increase in cancer survivors through improved treatment plans, we will also see an increase in surrogacy arrangements. When discussing fertility preservation options with patients, it is the responsibility of the provider to also let the patient know about surrogacy in the event the cancer treatment leaves them unable to gestate. In order to make an informed decision about their fertility options, patients need to have all their possibilities laid out in front of them. You can read more about this topic in “Domestic and International Surrogacy Laws: Implications for Cancer Survivors,” by Kiran Sreenivas, PhD and Lisa Campo-Engelstein, PhD, in Oncofertility: Ethical, Legal, Social, and Medical Perspectives.