How does surrogacy work in South Africa

What do stars like Sarah Jessica Parker, Nicole Kidman, Giuliana Rancic, Elton John and Ricky Martin have in common? They have all used surrogates to build their families!

Surrogacy is becoming more mainstream as increasing numbers of couples around the world face infertility challenges, and yet it is one of the least talked-about options to build a family. Fortunately, at Medfem Fertility Clinic in Johannesburg, South Africa, we have decades of experience assisting couples to successfully grow their families through surrogacy.

In this article, we explain what surrogacy is, how it works in South Africa – including what the legal, medical and ethical issues are – and how you can proceed to build your family with surrogacy.

What is surrogacy?

Surrogacy can be defined as an arrangement in which a woman (surrogate) carries and delivers a child for another (commissioning) couple – the intended parents. It can be a complex undertaking for both the intended parents and the surrogate, given the legal, medical and ethical issues involved.

There are also two different types of surrogacy – traditional surrogacy and gestational carrier surrogacy. Let’s look at the differences.

The first type of surrogacy is traditional surrogacy. In this type off surrogacy, a woman (called the surrogate or surrogate mother) carries and delivers a pregnancy for the intended parents, with whom she has a contract. The pregnancy may be achieved via insemination of sperm from the intended father, using intrauterine insemination (IUI) or artificial insemination (AI). Because the surrogate’s eggs are used to conceive the child, the intended mother is not genetically related to the baby.

Traditional surrogacy can achieve pregnancy with little coordination and through basic fertility treatments, making it a simple and relatively inexpensive treatment option. If more conservative treatments such as mid-cycle intrauterine insemination (IUI) fail, a traditional surrogate may be treated with more advanced techniques such as ovulation induction, using oral or injectable medications, along with IUI or In Vitro Fertilisation (IVF). The surrogate carries and delivers the child, giving the child to the intended parents after the birth.

This type of surrogacy is an option for women who do not have functioning ovaries or a functioning uterus. This could be due to a hysterectomy that included the removal of the ovaries; or radiation or other treatment that has damaged the uterus and ovaries. Traditional surrogacy can also be used by same sex couples.

Another type of surrogacy is gestational carrier surrogacy. In this case, a woman (called the gestational surrogate or gestational carrier) becomes pregnant after an embryo created from another woman’s eggs is transferred into her uterus. The embryos are typically conceived with IVF, using the intended parents’ eggs and sperm. In this case, the surrogate gestational carrier is not genetically related to the child. After birth, the child is given to the biological mother and/or father. Gestational surrogacy can also be used by same sex couples, using donated eggs and sperm.

This type of surrogacy is used when the intended mother is unable to carry a pregnancy for various reasons. These include uterine factor – when a uterine problem is diagnosed to be severe and beyond repair, such as an absent uterus following a hysterectomy; untreatable uterine abnormalities such as severe scarring; or previous radiation or other treatment that has damaged the uterus. There may also be recurrent pregnancy loss; or medical reasons that make pregnancy unsafe such as heart disease, cystic fibrosis or a history of hormone responsive cancer.

Because this process involves coordination between the intended parents, the egg donor, and the gestational surrogate, this treatment option tends to be more involved than traditional surrogacy. It is also more costly than traditional surrogacy, however, success rates of gestational surrogacy combined with egg donation are high.

Regardless of whether traditional or gestational surrogacy is used, however, the gift of surrogacy always changes the lives of childless heterosexual and same-sex intended parents.

What does the surrogacy process entail?

In South Africa, altruistic surrogacy is legal and it is governed by a complex set of legal, medical and ethical guidelines.

The first step would be to find a suitable surrogate. It may be easy to find a surrogate, for example, the commissioning couple (intended parents) may know the surrogate who could be a relative or a friend who volunteers to carry the pregnancy.

The surrogate may also at first be unknown to the commissioning couple. Because finding a surrogate can be time consuming and difficult, she is usually introduced to the commissioning couple through a third party, such as an agency or consultant, who may NOT – by law – charge for these services. The intended parents will meet the surrogate and it will be important to build a relationship.

Intended parents can visit the non-profit Surrogacy Advisory Group at for further information, assistance, support and guidance in the surrogacy process.

Once you have found a suitable surrogate, there are medical, legal and counselling issues to address before the process can commence.

Legal issues

In terms of the Children’s Act, altruistic surrogacy is legal in South Africa.

Intended parents will need a legal contract between themselves and the potential surrogate. This legal contract is arranged privately with confirmation and authorisation being arranged by the High Court. At Medfem Fertility Clinic, we will always recommend that commissioning couples seek the appropriate legal advice prior to treatment to prevent any future difficulties arising regarding parenthood and your rights.

This contract should also include details regarding any monetary arrangements. For example, the commissioning parents will usually cover the cost of a medical aid or hospital plan for the duration of the pregnancy and birth, including a few months after the birth.

Importantly, surrogacy can only be done for altruistic (selfless) reasons and not for commercial gain or payment. Under South African law, a surrogate mother may be reimbursed for expenses such as prenatal vitamins, costs of travelling to the doctor, and loss of income. However, she cannot receive any sort of wage for carrying the child. Similarly, agencies or consultants may not charge any fees for matching intended parents and surrogates.

Medical issues

At Medfem Fertility Clinic, we pride ourselves in providing a thorough screening process and an absolute commitment to safety. Our team of specialists and our psychologist will administer extensive screening of prospective egg donors and surrogates on behalf of our patients, before determining eligibility, to ensure a safe and healthy outcome.

Prospective surrogates undergo a comprehensive history and physical evaluation at our clinic to ensure safety for the pregnancy and surrogate. Surrogates in South Africa must be in good physical health and be non-smokers; have a BMI below 35; be between the ages of 21 and 42; have had at least one healthy term pregnancy with a living child of her own; and not have had more than two caesarean sections. Women who have not yet had a child are not eligible to be a surrogate.

Ethical issues

As mentioned, according to South African law, surrogacy can only be done for altruistic reasons. It is illegal to pay for surrogacy services or to advertise to pay for surrogacy services in South Africa. Companies and consultants that assist in making connections between surrogates and intended parents, are also prohibited from charging for these services.

Intended parents may be single, married or in a partnership. Gay, heterosexual, transgender or agender persons may qualify. However, at least one intended parent must be domiciled in the Republic of South Africa and the commissioning couple must be financially stable to adequately provide for the needs of a child.

Where egg donation is required for gestational surrogacy, Medfem Fertility Clinic works only with reputable egg donation agencies.

The intended parents and the surrogate must also attend a compulsory counselling session prior to starting treatment. Counselling is attended as a routine part of any surrogacy arrangement with ongoing support available.

How to build your family through surrogacy

Surrogacy arrangements can be complex undertakings and it is important to understand the process involved.

At Medfem Fertility Clinic, it is our joy to help couples who require surrogacy to have children. Our specialists have years of shared experience to help clients become parents through traditional and gestational surrogacy. We’ve been helping couples have children through surrogacy for over a decade and perform surrogacy regularly for couples each year.

If you would like to know more about surrogacy, simply click here to book an initial consultation or contact us telephonically on +27 (11) 463 2244.

We look forward to meeting you!


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