You would automatically assume maybe that surrogacy ceased to be a viable option during lockdown and that with the vaccination available this then all changed, but it is not anywhere near as clear cut. We had an amazing opportunity to talk directly to providers; agencies; lawyers from all over the world following the Growing Families conference. We have collated responses for your understanding.

How and has Covid 19 and lockdown effected how many surrogates are available?

In some jurisdictions, we are told, during the summer 2020 lockdown the number of surrogates offering to assist was sky high. Clinics believe this was due to many women being placed on furlough in the U.K. or equivalent overseas or working at home so had a greater opportunity to offer their time. It is also fair to hypothesise whilst you cannot pay a surrogate, compensation or even reasonable expenses would be an attractive proposition during this time.

However, this is in direct opposition to what other clinics are publishing for example “The number of women exploring gestational surrogacy has dramatically decreased,” says Tina Dettlaff, managing principal at the Surrogacy Experience, based in New Jersey. It’s “more than a 60% decrease from previous years.”

Clinics we spoke to from the USA likewise confirmed due to a vaccine now being mandatory for many clinics to accept them on the program and surrogates reluctance to have this, surrogate numbers are low. 

Does your surrogate have to be vaccinated against Covid-19 to receive fertility treatment ?

Rachel: Carbert Waite LLP (Canada) –  ‘Currently, there is no requirement for surrogates receiving transfers in Canada to be vaccinated.  We are aware that some clinics in the United States require vaccinations prior to transfer though so if you are using a USA clinic this may pose issues. In Canada, we are not aware of any clinic requiring vaccination prior to transfer, but it is encouarged’.

Louise: Nest and Co (Ukraine) – ‘Ukraine is showing signs of the government encouraging vaccination by bringing in restrictions for non-vaccinated people such as mandatory PCRs or antigens to travel between regions and access to public places such as shopping centres and restaurants. Clinics are also starting to refuse non vaccinated surrogate candidates. This has meant that in the last few weeks the number of people registering for the vaccine has risen significantly.

Some, if not the majority, of USA clinics though John Whitney (USA) explains ‘will not allow you on to their programme until the surrogate has been vaccinated’.

Georgia based clinic Reproart Natia confirms:  ‘it works according to the guidelines of the World Health Organization and recommends surrogate mothers and pregnant women get vaccinated’.

During ACLF initial meetings with the IPs, we explore everything they should be considering as they embark on this journey. So this is now something we have been discussing more. As U.K. clinics are certainly actively encouraging it and many do require this.

If surrogates are not having the vaccine, do we know why and what the consequences are ?

Rachel: Carbert Waite LLP (Canada) ‘Surrogates choose not to be vaccinated for many different reasons. Generally, their reasons can be summed up in three categories:

• – Surrogates who cannot have the vaccine due to medical concerns (prior allergic reactions, etc.).
• – Surrogates who are not yet vaccinated, because they want to wait until it is more widely used and tested.
• – Surrogates who choose not to be vaccinated for personal reasons unrelated to medical concerns. 

We are not seeing fewer surrogates due to vaccination queries but being unvaccinated does create some additional hurdles during the surrogacy journey , unlike the position facing the USA.

Karen Holden (UK) There was obviously going to be genuine concerns for surrogates and IPs about pregnancy during the height of the Covid 19 infection period. Covid 19 was and remains a danger to pregnant mums and their new-born baby. Data from the UK published on 29th July 2021 shows that around one in ten pregnant women admitted to hospital with symptoms of COVID-19 require intensive care and one in five gave birth prematurely. There has been a worrying rise in unvaccinated pregnant women being admitted to hospital with severe COVID-19 (99% of those admitted were unvaccinated), and evidence that the Delta variant poses a significantly greater risk than all previous strains.

However, the vaccine is still not recommended for pregnant women in some countries but considered safe and essential in others so it remains confusing

Have trends changed with the availability of the vaccine?

As an example, Leeds fertility on their website state it is important now to become vaccinated before pregnancy if possible. There is no evidence or known mechanism by which vaccines will impact male or female fertility. There is on-going research looking at what is known as reproductive toxicity, including animal studies, and no concerns whatsoever have arisen to date. The current advice in the UK is that it is safe to be vaccinated if you are planning a pregnancy. 

Uptake regardless of the availability remains very low in the USA though;  whilst the Ukraine are encouraging  it by making surrogacy arrangements more difficult for those not vaccinated. Most clinics and providers are appearing to actively ask surrogates to have the vaccination prior to pregnancy ; but in some countries there is a real reticence , by surrogates, to do so yet .  

So, will surrogates vaccinate?

Do IPs insist on this and will clinics offer treatment to the unvaccinated given the serious Covid 19 risks?

Karen Holden (UK) remarks : We understand contracts are being amended ; questionnaires adapted to address IP’s and surrogates thoughts on vaccinations so a candid and open dialogue takes place immediately.

• The majority , we are told, of USA clinics, won’t provide fertility treatment or even start surrogate screening until after vaccination & refuse those not vaccinated to join the programme.
• Ukraine and Georgia encourage vaccination, but it is not mandatory as of yet, but it becoming more difficult without.
• Canada makes no such mandatory requirements

Those refusing to accept surrogates not vaccinated because of this are telling us they are seeing dwindling numbers of surrogates being available in some countries. This has a knock effect for surrogate matching now ; treatments scheduled for 4-5 months in advance and it continues to look like there will be a 1yr blip as a direct result in the USA. IP’s and surrogates alike , we are told , do not want the vaccine.

What are IPs looking for in your opinion/experience vaccinated or unvaccinated?

Rachel: Carbert Waite LLP (Canada) – ‘In our experience, most Intended Parents would prefer to work with a Surrogate who is vaccinated. There are two reasons for this:

• – Most Intended Parents are familiar with research and news reports that indicate that pregnant women are at greater risk of severe Covid outcomes.
• – Intended Parents are concerned about the health of their surrogate and their baby.

The Canadian Government (Federal) has announced that, commencing in November, only vaccinated travellers will be allowed to travel by air or rail. This means that many unvaccinated Surrogates who live far from their clinic may have to drive for transfer appointments. Canada is a vast land mass, and this could require significant time and cost. For example, a drive from British Columbia to Toronto would take approximately 45 hours of continuous driving.

Canada have started charging UK IP’s medical expenses where post natal care is required which must now be factored into the IP’s costs and budget.

Whilst we have read that in the USA:

It has been reported that surrogacy agencies in the USA have been so overwhelmed by requests for unvaccinated surrogates that the vaccination status of surrogates and IPs preference has been added to the matching criterion that the agencies use. So, whilst treatment is being refused to some unvaccinated surrogates this isn’t the desire of the parties. This seems incredible given the medical health risk posed by Covid 19. Yet surrogates and IPs are saying they have more anxiety around the potential harm the vaccine can do to a baby than Covid?

Yet, whether the risk is the virus or vaccine, this has seen overseas surrogacy contracts being amended to ensure that intended parents can make medical decisions for the surrogate in the event of illness and incapacity in the USA. This is not possible in the U.K as surrogates remain fully responsible for the medical decisions for themselves & the baby ; raising serious concerns for providers about the morality of placing both surrogates and babies at risk and overwhelming the medical services. 

Louise: Nest and Co (Ukraine) : explains that once the baby is born the IPs will become liable for any medical costs and there is currently no insurance available, like in the USA, to cover this scenario. Given you may need to stay in the Ukraine 2-4 months before you obtain a British passport IPs need to carefully consider the risks of medical costs and vaccination benefits at this time.

An open and upfront conversation needs to be had, but what responsibilities do the agencies and clinics have? In some cases,  arguments over vaccinations have led to the breakdown of surrogacy teams which can be costly.

As one quote we have read says:

‘for those surrogates who are ready, often the vaccine is the dealbreaker. “For our agency, approximately 90% of our intended parents are requiring that a gestational carrier get the COVID-19 vaccine prior to starting a surrogacy journey, while only 10% of the carriers we are working with are willing to get the vaccine,” says Dettlaff. “The political viewpoints are causing a huge expectation gap.”’

 There is real controversy and mixed opinions.

Georgia based clinic Reproart, Natia tells us: Before starting the programs, surrogates and intended parents fill the questionnaire regarding Covid-19 vaccine, and we try to match together the Surrogate and Intended Parents who have the same opinions. According to our surveys and experience, the reason for refusing to vaccinate against Covid-19 is often cited as the fact that the vaccine is still new and causes mistrust in some people. However, more than 80% of patients follow the recommendations of the doctors.

If during pregnancy the surrogate or baby catches Covid-19 most of treatment is covered by social insurance, but if the baby is already born and doesn’t have Georgian citizenship, all the treatment should be covered by the Ips so this must be factored into the budget and plans.

If you find the terminology confusing please do use our international surrogacy glossary here