Surrogacy comes at a price. And no, it is not paid only by the commissioning parents, who spend between €30,000 ($34,000) and €300,000 ($342,000), depending on their budget, the country, the agency and the specifications chosen for their child. It is also paid by the women, the children and a society that permits all of this.
The bill for the customers comes immediately. For everyone else, the true cost emerges only later. In the end, we all pay the price if we allow the birth of a child to become a global trade.
Planned High-Risk Pregnancies
Being impregnated with genetic material from strangers in order to carry a child for someone else is not merely an ethical dilemma. It is not merely a violation of the human rights of women and children, or a gateway for organized crime. It also poses a very real threat to the health of both the woman carrying the child and the child conceived in this way.
In Germany, as elsewhere, an entire country can work itself into a state of indignation over whether gay couples have a right to reproduce, or whether infertile couples and single people ought to be helped now that these brave new reproductive technologies exist. Yet scarcely anyone cares what this process does, physically and psychologically, to the women who make themselves available for the business.
Nor does anyone care what it means for the children whose mothers are pumped full of medication throughout pregnancy and must spend nine months carrying a child from whom they are required to remain emotionally detached, lest their hearts break when they have to surrender it immediately after birth – often without ever having held it in their arms.
Every surrogacy pregnancy – every single one – is an unnecessary high-risk pregnancy planned as such. The possibility that the woman will suffer lasting harm is simply accepted. After all, she is being paid, is she not?
The “100% baby guarantee” that agencies promise customers in their VIP packages is paid for with the health of rented mothers, the physical depletion of women’s bodies and the indiscriminate use – which is to say, the death – of embryos.
The false promises of the reproductive industry have fostered a delusion of limitless possibility that obscures both the dangers and their physical cost, as though having a child were merely a question of how much money someone has at their disposal.
Hormones Are Not Sweets
In the glossy brochures of the surrogacy industry, the process of acquiring a child is often described as a “surrogacy journey”, as though everyone involved were embarking on an exciting holiday at the end of which the child would be brought home as a souvenir.
The real horror trip imposed on women through coercive contracts looks rather different. They are loaded with leuprolide, estrogen, progesterone, antibiotics, the steroid Medrol and immunosuppressants such as tacrolimus to prevent their bodies from rejecting the embryo like a foreign organ.
All of this contributes to an extremely high rate of miscarriage. Then the entire ordeal begins again and again, until one attempt succeeds.
The treatment sharply increases the risk of high blood pressure, preeclampsia, seizures and even liver rupture, to name only some of the common complications. A significant number of women lose their uterus and are themselves left infertile.
Pregnancy always places an immense physical burden on the woman carrying the child. There is a reason why far too many women and children around the world still die from complications during pregnancy and childbirth.
The risks and side effects of this already highly complex physical process increase further when a donor egg is used. The additional interventions include hormonal stimulation, egg retrieval, artificial fertilization, embryo transfer, medication intended to prevent miscarriage, embryo “selection” in the womb – the euphemism used for aborting unwanted children – planned Caesarean sections and numerous additional examinations throughout the pregnancy.
A Scandinavian meta-analysis published as early as 2016 found that the risk of preeclampsia in pregnancies involving a donor egg was twice as high as in naturally conceived pregnancies.
In multiple pregnancies, which are also favored in surrogacy because they allow several children to be produced more cheaply at once, the risk of preeclampsia triples.
For the rented mother, this means the danger of chronically elevated blood sugar, which can lead to life-threatening seizures; an increased risk of high blood pressure and HELLP syndrome, which can cause cerebral hemorrhage and liver rupture; and a greater likelihood of premature birth and stillbirth.
Preeclampsia is not merely a problem during pregnancy. It can have lasting consequences, including vascular disease caused by endothelial dysfunction, and can damage the cardiovascular system later in life.
This is not “joyful anticipation”. It is a life marked by lasting harm.
The Long-Term Damage of Egg Donation
Surrogacy also requires egg donors. The retrieval process alone carries so many health risks that it is rightly prohibited in numerous countries and permitted only for women having their own eggs removed for later use in artificial fertilization – at their own risk.
Hormonal drugs stimulate a woman’s body so aggressively that it produces far more eggs in a single cycle than it would naturally. The “egg harvest” – yes, that is genuinely what it is called – is intended to yield as many eggs as possible from each procedure.
The greatest danger is ovarian hyperstimulation syndrome, or OHSS, which occurs in around 5% of cases and can cause serious health problems as the donor’s ovaries become enlarged.
This can lead to blood clots, fluid accumulating in the lungs and abdomen, kidney failure or strokes. An overstimulated ovary can rupture, requiring emergency surgery.
The donor may be left infertile and can even lose both ovaries. The danger is particularly acute when ultrasound-guided egg retrieval is used. The procedure can cause infections, bleeding and internal injuries. In some cases, surgery is required because internal organs have been damaged or internal bleeding has occurred.
Health Risks as a Birthday Present
What effect does this pharmaceutical bomb have on the unborn child? No one even investigates what damage the children themselves may suffer when the women carrying them are pumped full of this arsenal of drugs.
Pregnant women are otherwise advised to avoid medication altogether wherever possible.
Artificial fertilization does not merely increase the potential for mistakes, fraud and mix-ups involving doctors, laboratories and profiteers. Compared with children conceived naturally, a child produced through this procedure also faces heightened health risks and greater susceptibility to certain conditions throughout its life.
“Egg children”, “womb children” and “sperm-donor children” are not merely linguistic descriptions of clinical procedures. They are real children who are deliberately exposed to the risk of separation trauma, difficulties in forming an identity and other psychological burdens so that adults can satisfy their longing for a child.
They are also exposed to the very tangible risk of cardiovascular disease and other vascular disorders with which they are routinely born.
This is not speculation. The increased risk is well established and applies to all children conceived through assisted reproduction. Children born through surrogacy must also bear the additional burden of the pharmaceutical cocktail administered to the women who carry them.
Nor does this market concern itself with the rights of children who are ordered, optimized and produced like commodities, only to be subjected to the trauma of separation from their own mother immediately after birth.
Anyone who has ever witnessed a birth will have seen the miracle of a newborn calming within seconds when placed skin to skin with its mother and hearing her voice.
With its mother, there is peace, security, protection and nourishment. All of this is taken from these children.
“But you wouldn’t give me away, would you?”
The market also ignores the social costs we will eventually have to bear if we allow tens of thousands of children around the world to watch their siblings being sold.
“But you wouldn’t give me away, would you?”
It is perhaps the most terrible sentence ever to have seared itself into my memory. It appeared in the diary of a surrogate mother published in a British newspaper and was spoken by her own young daughter, who had watched twins grow inside her mother’s womb.
But these babies were not going to stay at home. She had been told that the children were for her aunt and uncle.
She tried to understand what was happening and began to wonder, in her own childlike way, how secure she could still feel in her mother’s love when that same mother was prepared to give these two siblings to someone else.
All women who work as surrogates already have children of their own. Every one of them. They are accepted only after the incubator has proved that it can produce a healthy child.
“But you wouldn’t give me away, would you?”
How many children ask that question aloud? How many remain silent because they are frightened of the answer? Might they too be in danger of being pushed from the nest?
It touches one of a child’s most fundamental fears: that it cannot be certain of its mother and father. It shatters a child’s basic trust and calls into question what ought to be taken for granted.
Surrogacy affects not only the pregnant woman and the child growing inside her, but an entire social fabric of siblings, husbands, grandparents and friends who witness it, reflect on it, absorb it and draw very different conclusions from what they have seen.
What questions will haunt the child who was sold once it becomes old enough to understand how it was conceived and learns that its own mother has other children who live with her?
Children who were allowed to stay. Children she kept rather than sold. Children she loved.
The inevitable childish questions follow. Why were the others kept, but not me? Was I not good enough? Not lovable enough, not perfect enough, not worth keeping?
They may remain unspoken – no more than a quiet, gnawing doubt that reaches deep into a child’s soul.
Surrogacy is not an achievement of reproductive medicine. It is the darkest experiment on living human beings that mankind has yet devised.