From the archive: Should one surrogate be told about the others?

Nov 16, 2021

Parents are building their families using multiple surrogates at the same time. What do the surrogates deserve to know?

This was first published here in HeyReprotech in September 2018, but it’s still relevant today. For various reasons — saving money, reducing the amount of time off work, avoiding the health risks of twins and triplets — some people are actively working with more than one surrogate at the same time.

Beyond the question of whether simultaneous surrogacy is a good idea, there is the question of what these parents owe the surrogates. Do surrogates deserve to be in the loop — to know they are not the only one?

5 minute read

When Jenny Lee posted that she was willing to be a surrogate for an Ontario couple, hundreds of people got in touch. Lee (not her real name) had been a surrogate before, but she was now approaching 40, and she was pretty sure this would be her last time. She wanted to make a real difference for someone. "I figured this was my last hurrah," says Lee.

She settled on a heterosexual couple who had no other children. They lived near enough that they could have some in-person contact throughout the pregnancy and beyond, something they both said they wanted.

Lee got pregnant, but at eight weeks, she had a miscarriage. Their contract committed them to trying four times, but the fertility doctor advised her to take a short break before the next round. So she left the country for a month, with the understanding that they'd give it another go as soon as she got back.

While away, though, the couple texted her that they were looking for another surrogate. "I was really confused by it," says Lee. "My response was: 'Is this to replace me?'" They assured her they were just getting the ball rolling in case things didn't work out. They reminded her that it could take time to find someone else, and in any case, they knew they wanted a second child.

Still, it hurt, says Lee. "We had just gone through a loss. We're all trying to recover from it, and suddenly I feel like if I don't perform, I'm replaced."

Luckily, on the next try, right after she got back, Lee got pregnant again. The baby was born nine months later. The parents posted an announcement of the birth, with a photo of the infant, on Instagram.

About a month later, however, they posted another announcement — this time about the birth of their twins. It turned out the couple had hired another surrogate after all, and had simultaneously managed two separate surrogacies. They now had three children.

Lee recalls staring at the post in disbelief. "I felt really betrayed," she says. "You just watched me birth your child out of my vagina, but you can't tell me this other important information?"

Simultaneous surrogacies are becoming increasingly common, according to Leia Swanberg, CEO of Canadian Fertility Consulting. This is partly due to an effort to reduce twin and triplet pregnancies. Families who want closely-spaced children will often embark on a second surrogacy before the first is complete, she says. Others may have a baby window in their careers or a concern that they'll soon be too old. Swanberg has 40 clients currently pursuing multiple surrogacies.

But do intended parents have an obligation to let a surrogate know that they have another surrogate? Does anyone have that obligation — the lawyer drawing up the surrogacy agreement, say, or the doctor treating both surrogates for the same intended parents? The answer is not entirely clear, says Vardit Ravitsky, a bioethicist at the University of Montreal. Because surrogacy is a young practice, she says, we haven't yet developed an intuitive understanding of who has a legitimate interest in knowing such information.

If the intended parents consider the surrogate to be a service provider — an incubator whose job is to nurture the embryo and deliver the baby — then they may decide she has no claim on this information, says Ravitsky. But if they see her as a person — an individual helping them out — they may decide she does.

Lee concedes that there is disagreement on this point even among surrogates. "Some are like, 'Who cares? It's a job. What does it matter to you? How does it affect you?'" she says. "And then there were some saying, 'I wouldn't like that either.'"

Ravitsky's own view is that a surrogate does have a legitimate interest in knowing. But she stops short of saying there is an obligation to disclose.

"I would absolutely let the surrogate know," says Tom Hannam, a fertility doctor in Toronto. Disclosure issues are a challenge in all reproduction, he says, because it always involves other people, but in third party reproduction it is especially so. Adding a second surrogate makes things even more tricky.

Hannam says he tries to have a "no secrets" policy in his practice. He lets patients know up front that he believes relevant information should be relayed to all the other parties in the reproductive project. The surrogate's past abortion, for instance, might be relevant, or the husband's past chlamydia infection. "It's the only way I know how to do it," he says.

Michelle Flowerday, a fertility lawyer based in Toronto, says she always advises clients to disclose, either in the opening section of the surrogacy agreement or in a conversation. A surrogate is making a decision about whether to carry a child based on certain facts, she says, and those facts need to be accurate and clear to her.

Lee, for instance, says if she had known the intended parents were going to have more than one surrogate, she might have chosen someone else — someone who truly had no other option.

Not only is disclosure the right thing to do for the surrogates, says Swanberg, but it is also better for intended parents, for practical reasons. With double the doctors' appointments, and two births to plan for, she says, the logistics can become complicated. "It's a big job. How will you split your time?" Swanberg says CFC doesn't match two surrogates to an intended parent unless both surrogates know.

Flowerday urges people to remember that surrogacy involves real people and emotions. Surrogates are often motivated by the fact that they are giving someone an incredible gift. "They are looking forward to playing a really special role in the life of somebody," says Flowerday. With simultaneous surrogacy, that gift-giving is now shared. That special role is no longer hers alone. "It needs to be handled delicately."

"Having a baby for somebody is super-intimate," says Lee. "It's the most intimate you could get with people." She believes she should have been told. "That's just respectful."

Cari Shane. "To Save on Surrogacy Costs, More Parents Are Aiming for 'Twiblings'."Parents.com. 21 May 2021.

"Two Surrogates, Three Babies, and One Very Full House." GaysWithKids.com. 10 Jan 2019.

Alex Horton. “Japanese millionaire dubbed the 'baby factory' dad just won custody of 13 surrogate children.” Washington Post. 20 Feb 2018.

Poonam Taneja. "The couple having four babies by two surrogates." BBC. 28 Oct 2013.

Melanie Thernstrom. "Meet the Twiblings." New York Times Magazine. 29 Dec 2010.

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