Australian intended parents’ decision-making and characteristics and outcomes of surrogacy arrangements completed in Australia and overseas

Abstract

Markets for international surrogacy often arise in jurisdictions with limited regulations regarding assisted reproductive technologies. In some countries, like Australia, regulated domestic surrogacy services are often sidestepped for international providers. This study describes how Australian intended parents decide where to pursue surrogacy and compares the characteristics and outcomes of arrangements completed within and outside of Australia. The findings show that, although intended parents preferred undergoing surrogacy in Australia, perceiving the process as too long and complicated was a common reason to pursue an international arrangement. Multiple embryo transfer, anonymous gamete donation, and a lack of counselling were common in international surrogacy arrangements. When compared to surrogacy arrangements completed in Australia, where single embryo transfer is mandatory for surrogacy cycles, the rates of multiple birth, preterm birth and neonatal intensive care in international surrogacy were higher. These findings raise concerns about the health and welfare of international surrogacy participants, particularly the surrogates and children. In lieu of any international instrument regulating surrogacy, improving access to surrogacy at a domestic level would reduce the number of people engaging with international arrangements and in turn, reduce the potential for harm.

Keywords:

• Surrogacy
• reproductive decision making
• gamete donation
• embryo transfer
• multiple pregnancy
• cross-border reproductive care

Acknowledgements

We thank the individuals and organizations who advertised the study and helped us recruit participants and those who completed the survey.

Author’s roles

All authors contributed to the conception and design of the study, interpreted the data, critically revised the article, gave final approval of the version to be published, and agreed to be accountable for all aspects of the work. EK analyzed the data and drafted the article.

Disclosure statement

SE is the Global Director of Growing Families, a non-profit organization educating and advising on third-party reproduction. He is also a board member of a charity supporting Australian surrogacy participants. The remaining authors report there are no competing interests to declare.

Data availability statement

The data underlying this article cannot be shared publicly due to the confidentiality of the participants. The data will be shared on reasonable request to the corresponding author.

Additional information

Funding

EK receives a Research Training Program Scholarship awarded by the Australian Government Department of Education.