Surrogacy is one of the assisted reproductive technologies (ART) in which embryos created via in vitro fertilization (IVF) are transferred to the uterus of a woman who is not genetically related to the embryos. This method enables couples who cannot carry a pregnancy themselves to realize their dream of parenthood.

In the traditional surrogacy protocol, eggs from an infertile woman are fertilized with sperm from her partner (or a donor), and the resulting embryos are transferred into the uterus of a surrogate mother. It is one of the most complex IVF procedures, requiring careful coordination of medical, legal, and ethical aspects. Due to advances in reproductive medicine, surrogacy has become an option for women previously considered absolutely infertile.

When is surrogacy required?
Primary indications include:

• Absence of the uterus (congenital, such as Mayer–Rokitansky–Küster–Hauser syndrome, or acquired, e.g., after hysterectomy).
• Malformations of the uterus or cervix that make pregnancy impossible.
• Intrauterine adhesions unresponsive to treatment.
• Serious medical conditions that contraindicate pregnancy (e.g., significant heart disease).
• Repeated unsuccessful IVF cycles despite transferring high-quality embryos.

Medical procedures involved

• Synchronization of menstrual cycles between the genetic mother and surrogate (if needed).
• Hormonal preparation of the surrogate’s endometrium with estrogen and progesterone.
• Ovarian stimulation in the genetic mother (or egg donor).
• Egg retrieval and fertilization with sperm from the husband or donor.
• Embryo culture for 3–5 days.
• Transfer of one or more embryos into the surrogate’s uterus.

The number of embryos transferred depends on the age and reproductive history of the woman providing the eggs.

Success rates
The success of surrogacy programs primarily depends on egg quality and age, as well as the health of the surrogate’s endometrium. When donor eggs and a clinically healthy surrogate are involved, the pregnancy rate per transfer can reach 70–75%, among the highest in modern reproductive medicine.

Who can be a surrogate?
A surrogate may be a relative or a close friend of the genetic parents or a woman entering into surrogacy for compensation. In Armenia and many other countries, candidates must meet legal criteria:

Requirements:

• Aged 18 to 35 years,
• Have at least one healthy child,
• Physically and mentally healthy, as confirmed by medical evaluation.

Legal aspects

Before the start of the program, a notarized contract is signed between the genetic parents and the surrogate, detailing:

• the rights and obligations of each party,
• compensation terms,
• procedures for registering the child after birth.

In most jurisdictions, including Armenia, the genetic parents are legally recognized as the child’s parents, provided the contract complies with applicable laws.