A to Z of the international language of surrogacy : terminology for medical , legal and more….
AI – Artificial Insemination
- Is when sperm is introduced into the cervix or uterine cavity for the purpose of achieving a pregnancy through in “vivo fertilization” by means other than sexual intercourse. (See IUI)
- In certain jurisdictions surrogates cannot be paid compensation above their reasonable expenses. The term can also refer to surrogacy agreements not being enforceable and intermediaries not being able to profit from making introductions between surrogates and Intended Parents.
- A hormone produced in the antral follicles of the ovaries.
- Through a simple blood test, it is possible to measure and estimate a woman’s “ovarian reserve” – how many follicles and eggs she has left. Women are born with all the eggs they will ever have and this number declines with age. However, whilst the measurement of AMH supports many clinical decisions, it should always be considered in conjunction with other tests. AMH can also be used as a marker for ovarian dysfunction, such as PCOS.
- Is when the ovaries do not release an egg during the menstrual cycle.
ART – Assisted Reproductive Technology
- These are techniques used to address infertility. Treatments are generally considered any procedure in which both eggs and sperm or embryos are handled, for example creating embryos in a laboratory with eggs surgically removed from a woman’s ovaries, combining them with sperm in the laboratory, and returning them to a woman’s body.
A101 Consent Form
- This is the form that the surrogate and her civil partner or husband will need to sign post birth. This cannot be signed until six weeks following birth.. This provides the consent for the parental order to be grantedwhich will release the surrogate and her spouse (if she has one) from parental responsibility. This form must be signed giving free and informed consent for the parental order to be granted.
- Is the lowest body temperature after rest, e.g., upon waking but before getting out of bed. Women who are trying to conceive often track their BBT to determine when they are most fertile. This is because the body’s temperature decreases very slightly before releasing an egg, rising again 24 hours later, and staying up for several days.
- The term blastocyst describes an embryo that has reached day 5 or 6 of development. Embryologists typically wait until embryos have reached this stage, in which the embryo has 200-300 cells and is close to hatching, before using it for implantation.
- This stands for the Children and Family Court Advisory and Support Service. In surrogacy situations, the Family Court in England and Wales will appoint a Court Reporter from Cafcass to write a report to inform the court whether the Parental Order should be granted. The Cafcass officer will interview the intended parents with the child at home and also have a discussion with the surrogate.
- If there are any concerns they would look to address or recommend how to address issues.
- Or biochemical pregnancy is the term used for pregnancy loss before 5 weeks of gestation. This happens when an egg is fertilised but does not implant into the uterus. Chemical pregnancies are fairly common and may account for 50-75% of all miscarriages. However, because this happens so early in the pregnancy, many women do not yet realise they are pregnant and may mistake the loss for their menstrual cycle.
- Is the term used to define the contract signed between gestational carriers and Intended parents. This contract is the most important contract of any surrogacy arrangement and in Ukraine, must be signed before an embryo transfer can take place.
Surrogacy Court hearing
- The court will hear the Cafcass report recommending surrogacy. They will ensure that the surrogate has given consent and released all parental responsibilities and will check the only reasonable expenses have been incurred. If successful the court hearing will result in the court granting the sealed parental order. Sometimes however, a second hearing may be required if there is a gap with regards to the evidence of expenses or any additional complexity. Detailed records and statements may provide enough information for the court. If a second hearing is required it should not be of concern but it’s more just to give the court time to review matters carefully.
- is any facility where human organic tissue and material is stored at very low temperatures. This can be eggs, sperm, embryos, umbilical cord, stem cells.
- Or extrauterine pregnancy is when a fertilised egg or embryo implants outside of the uterine wall, usually in the fallopian tube but it can also occur in the ovaries and cervix.
- An ectopic pregnancy is life threatening and patients should seek medical assistance immediately.
- This is where the surrogate does not use her own egg but that of a donor. This is not permitted in some countries but essential in others. You should check the requirements of the jurisdiction.
- It is possible to fertilise an egg here in the UK and transport that over to the jurisdiction where your surrogate will receive the fertility treatment. This may require an egg donor and/or sperm donor, the embryo is frozen and transported to the clinic. This is extremely established as a process for UK intended parents.
- Is a condition where the tissue which lines the uterus, the endometrium, grows elsewhere in the body. Common places for endometriosis are the ovaries, bowel, and tissue of the pelvis.
- Endometriosis, although benign, can affect fertility and cause serious discomfort.
- A type of legal holding account, where a third party keeps items/funds until certain conditions are met.
- An umbrella term for the male (sperm cell) and female (ovum) reproductive cells that fuse to form a zygote.
- A surrogate who has no biological link the baby she carries.
- This is where an intended parent/s maintain a genetic link to their child, and the surrogate has no genetic connection to the child. Also called full surrogacy.
- Are hormones secreted by the pituitary gland. The two hormones FSH and LH are responsible for ovulation. During IVF treatment, synthetic versions of these hormones are replicated and used during the ovarian stimulation process.
HCG – Human Chorionic Gonadotropin
- Is a hormone present in females. During pregnancy, levels of this hormone rise because it is excreted from the trophectoderm (outer shell) of an embryo, which later becomes the placenta.
- Is a procedure used to inspect the uterus for signs of abnormal bleeding. A small thin telescope is passed through the vagina and cervix into the uterus
- It is a requirement in some jurisdictions that the intended parents can prove there is a medical reason why they need to have a surrogacy arrangement. This is the case in Georgia, for example, you need to have medical records to support your need for a surrogacy arrangement. However, in countries like Canada or the USA there is no requirement for such. (Again, check your jurisdiction requirements).
- Intended Parents – the term for a person or couple participating in a surrogacy arrangement.
- Stands for Intracytoplasmic Sperm Injection and is a fertilisation technique used within IVF procedures. A single sperm is injected into a single egg cell. This method is often used when the sperm count is low or of bad quality.
- Stands for Intra-Uterine Insemination. This is a form of Artificial Insemination in which sperm is inserted into a woman’s cervix or uterus using a thin catheter to achieve pregnancy. This procedure reduces the distance the sperm must travel to reach the egg.
- Is a type of Assisted Reproductive Technique to help achieve pregnancy. During the procedure eggs and sperm are extracted and fertilised outside the body. The then fertilised egg, now called an embryo is put back into the uterus to grow and develop.
- The Luteinising hormone is produced by gonadotropin cells in the pituitary gland. It is one of the main hormones which control the reproductive cycle in females. Each month a surge of this hormone occurs to trigger ovulation and the development of the corpus luteum.
- Again, subject to where you are undertaking the surrogacy arrangement you may need a local lawyer in that jurisdiction. This could be a Canadian or Ukraine or USA lawyer or it may be a hybrid of two lawyers if the arrangement is taking place in two jurisdictions. They will help you with the paperwork and process to ensure that everything is compliant and run smoothly. Usually, it is recommended that your UK solicitor liaises with them immediately so that they understand the UK requirements and the synergy throughout the process and following this to obtain the parental order in the UK.
- This is a medical screening for the surrogate (before she is cleared) for how their body reacts to medication necessary to the surrogacy treatment.
- Stands Non-Invasive Prenatal Test. This is a simple blood test which can be performed during pregnancy to determine genetic conditions and chromosomal aneuploidies of the foetus.
- An unfertilized egg.
- This is a final order that gives one or both intended parents full legal parental rights and responsibilities for their child in the UK.
- Stands for Power of Attorney, where a solicitor can act on your behalf for a certain aspect of your affairs. This is a standard document in Ukraine surrogacy because parents are not usually in Kiev at the time of signing the Child Carrying Contract with their surrogate, so a POA gives someone else the authority to sign this on their behalf.
- Stands for Poly-Cystic Ovary Syndrome. This condition is a hormonal imbalance and affects the function of the ovaries. In some cases it can mean the woman is unable to get pregnant.
PGS, PGD – Preimplantation Genetic Screening/Diagnosis
- Are genetic screening tests at an embryonic level, before implantation of an embryo in an IVF procedure.
PISCI – Physiological Intracytoplasmic Sperm Injection
- Essentially ICSI with an extra step. Before being injected into an egg cell, sperm passes through a selection process which involves being bound with hyaluronic acid. Some studies have shown that sperm which have undergone this process have reduced levels of DNA damage and aneuploidy.
- This is where monies are paid by the intended parents to the surrogate to meet the expenses which are a result of the pregnancy. These can be things like hospital bills, childcare, prenatal massages or medical treatment, travel and other costs associated with the pregnancy. It is not to include any compensation or commercial payment.
Regulated vs Un-regulated destinations
- In some countries, surrogacy is illegal, or there are restrictions on who can be an intended parent. It is important to understand the laws for the jurisdiction you are applying in.
Social freezing or oocyte preservation
- Is the practice of freezing eggs or oocytes for use at a later date. The decision to postpone pregnancy could be due to economic, health or social factors and is generally recommended before a woman reaches 35 years of age.
- Like a hysteroscopy, this is another procedure used to examine the uterus. A fluid is injected through the cervix into a woman’s uterus and thanks to sound waves, ultrasounds create images of the uterine cavity.
- In a surrogacy arrangement this can be by one of the intended parents or both for same sex couples or in some countries it’s possible for this to be an anonymous donor for a couple or woman using her own gametes. Again, you need to ensure that you have checked the jurisdictional regulations but note that if you come back into the UK one of the intended parents must have a genetic link to the child.
Surrogate Mother – SM
- The term surrogate mother refers to a woman who carries a baby for a couple or individual when own pregnancy is not possible. This term is the correct term for traditional surrogacy pregnancies but is often used even when the surrogate is not biologically connected to the baby she carries, in which the correct terminology is Gestational Carrier. This may be because in the UK the person giving birth to the child is regarded as the Mother until the Parental Order is granted.
Travel arrangements, passport, and Visa
- When you return to the UK and apply for a parental order you will be able to apply for a UK birth certificate with both IP is named as parents. However, to leave your overseas jurisdiction to the UK you need to check the immigration requirements. Some jurisdictions will give you a birth certificate and local passport which then need to be replaced with UK documents upon return or you may need to apply for British passport whilst overseas, such as in the Ukraine, this will take potentially up to 10 weeks. Make sure you have arrangements to stay overseas until that time and you understand the requirements. It may be that you can get emergency papers or visas and you should consult the immigration team prior to making these arrangements
Traditional surrogacy (“straight” surrogacy)
- This is where the surrogate uses her own egg and is inseminated naturally by the intended father
- Subject to where the surrogacy arrangement has been carried out, you may already have a birth certificate with the intended parents named as the legal parents. Please note this is not recognised in the UK when you return. You need to apply for a parental order in order to then obtain a UK birth certificate.
- a zygote is formed when sperm fertilizes an egg. This is the first developmental stage in forming an embryo which will later grow and develop into a foetus. A zygote is the fusion of male and female chromosomes and contains all the genetic information and DNA to form a new individual.
ACLF with its international partners fashioned this Glossary for your use and seeks to include terminology from the UK, USA, Canada, Ukraine and Georgia ….we intend to add Greece and Argentina, Mexico and Columbia soon