The Process of Surrogacy in South Africa


Surrogacy is a life-changing process that has helped many couples across the world become parents. While surrogacy is one of the options considered by couples undergoing infertility treatments, it has been the family-building solution for same-sex couples and single parents for decades. It is also becoming more mainstream, with famous personalities like Sarah Jessica Parker, Nicole Kidman, Giuliana Rancic, Elton John and Ricky Martin choosing surrogacy to build their families.

Here at Medfem Fertility Clinic in Bryanston, South Africa, we have assisted many couples over the last decade to have children through surrogacy.

It is important to understand that surrogacy arrangements can be complex. Surrogacy is a long and emotional journey, and a huge commitment for both the commissioning parents and the surrogate. A full overview of the process involved is helpful to have when deciding whether this option is for you.

In this article, we explain when surrogacy is considered and provide a step-by-step breakdown of the process to build your family with surrogacy.

When is surrogacy considered as an option?

Surrogacy may be an appropriate option for women with a medical condition that makes it impossible or dangerous for them to get pregnant and give birth. Examples of conditions that prevent pregnancy can include absence of the uterus due previous surgeries or hysterectomy or a malformation of the womb. There are also certain medical conditions that may lead to a high-risk pregnancy such as obesity, diabetes, heart or blood disorders, maternal age, and certain sexually transmitted diseases. After the age of 35, the risk of pregnancy complications also increase and surrogacy may be an option for women of advanced maternal age.

It is often also one of the last options for couples who have exhausted other fertility treatments, for example, couples who have not had success with Assisted Reproductive Technology (ART) and/or experienced repeated in vitro fertilisation (IVF) implantation failures. Unexplained infertility and recurrent pregnancy loss may also lead to couples considering surrogacy as an option.

It’s also the option for male same-sex couples who want to have a family and for people who are single and want to have a child.

Altruistic surrogacy is legal in South Africa, in terms of the Children’s Act. However, it is governed by a complex set of legal, medical and ethical guidelines and these will also affect a couple’s decision to choose surrogacy to build their family.

The surrogacy process – step-by-step

1. Obtaining legal advice

At Medfem Fertility Clinic, we will always recommend that commissioning couples seek the appropriate legal advice upfront.
As we’ve noted, a surrogacy arrangement can be complex. It is a long and emotional journey, and a massive commitment for both the commissioning (intended) parents and the surrogate. To prevent any future difficulties arising regarding parenthood and your rights, you need professional legal advice.

An attorney specialising in surrogacy will explain what the surrogacy process entails, your legal rights and obligations, the possible risks you could be exposed to and the compensation you may legally offer, and will also answer your questions.

2. Finding a willing surrogate

Not many women are willing and suitable to carry a pregnancy for another (commissioning) couple. Surrogates are a few special women, and they must also meet certain legal requirements.

It is possible, however, that the commissioning couple (intended parents) know a willing surrogate, who could be a relative or a friend who volunteers to carry the pregnancy.

In many cases, though, the surrogate may 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.

Intended parents can visit the non-profit Surrogacy Advisory Group at for further information, assistance, support and guidance in finding a suitable surrogate.

3. Confirming the suitability of the surrogate

Once you have found a potential surrogate, there are medical, counselling and legal issues to address in order to confirm her suitability.

The potential surrogate mother will need to be screened by your fertility specialist, to determine if she is medically suitable to be a surrogate.

By law, surrogates in South Africa must meet certain requirements including:

* good physical health;
* non-smoking;
* BMI below 35;
* between the ages of 21 and 42;
* have had at least one healthy term pregnancy with a living child of her own;
* have not had more than two caesarean sections;

At Medfem Fertility Clinic, we pride ourselves in providing a thorough screening process and an absolute commitment to safety. Prospective surrogates undergo a comprehensive history and physical evaluation at our clinic to ensure safety for the pregnancy and surrogate.

Our team of specialists will administer this extensive screening of a prospective surrogate on your behalf, before determining eligibility, and will issue a report to confirm it.

4. Counselling

Prospective surrogates also undergo a psychological evaluation to ensure the surrogate’s suitability, as well as assessments by a social worker.

Prior to starting any ART treatment, each intended parent and the surrogate must also attend a compulsory counselling session.

At Medfem Fertility Clinic, counselling is included as a routine part of any surrogacy arrangement with ongoing support available through our resident psychologist, Mandy Rodrigues.

5. Finalise the legal requirements

Intended parents will need to draw up a legal contract between themselves and the surrogate. This legal contract is called a Surrogate Mother Agreement and is arranged privately with the assistance of a medical law attorney specialising in surrogacy.

If you go ahead with the surrogacy without this contract in place and approved by the High Court, the baby will legally belong to the birth mother (the surrogate), and not to the intended parents.

In addition, the contract should include details regarding any monetary arrangements, such as the commissioning parents responsibility for the medical aid or hospital plan for the duration of the pregnancy and birth, and the reimbursement of expenses. It should also details the terms and conditions, for example, how many IVF attempts you have agree to, and the expectations of the surrogate with regards to her health and lifestyle during the pregnancy.

6. High Court Approval

The surrogacy process may not proceed unless the High Court approves the agreement.

The attorney will collate all the paperwork and information required to lodge the application in the High Court, including the psychological and physical evaluations of the surrogate and the intended parents, as well as the supporting documents from you and your partner and from the surrogate mother and her partner, who must agree to the surrogacy.

Once the High Court authorisation has been confirmed, the medical procedures required to achieve the surrogate pregnancy can commence.

7. Fertility treatment

The most common form of surrogacy today is gestational surrogacy, whereby the eggs and sperm are provided by the commissioning parents (or an anonymous or known donor if the commissioning parent is unable to produce eggs/sperm).

The surrogate will undergo fertility treatments before the embryo transfer and during the pregnancy at an agreed upon fertility clinic. The extent of these procedures depend on what has been agreed in the surrogacy agreement.

Most commonly, IVF is the assisted reproductive technology (ART) used during surrogacy process. Eggs from either the intended mother or an egg donor will be developed with the assistance of specialised medication and collected during an egg retrieval procedure. The eggs are then fertilized in the laboratory with sperm, either from the intended father or from a sperm donor. One or two of the fertilised eggs – or embryos – is then transferred directly into the surrogate’s uterus where it will hopefully implant and become a pregnancy.

It may take several treatments before successful conception and birthing.

Where to start your surrogacy process

At Medfem Fertility Clinic in Johannesburg, South Africa, it is our joy to help couples who require surrogacy to have children.

Our specialists have decades of experience in assisting couples to successfully grow their families through surrogacy. 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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