Surrogacy is a procedure in which a woman accepts to carry out a pregnancy to term for a couple or for another woman, either altruistically or for financial gains. She pledges to abandon the child at birth, which is to be adopted by the woman who will become the legal mother. Female carrier, surrogate mother, maternity substitute, pregnancy agreement, pregnancy for another, uterus location, delegation pregnancy, surrogate motherhood, and gestation for another are all expressions to denominate this practice.The main indications for surrogacy include: the absence of the uterus, or uterine abnormalities, either congenital or acquired (e.g., a hysterectomy for an oncological disorder), repeated in vitro fertilization (IVF) failures, medical conditions for which pregnancy is contraindicated (e.g., severe thrombophilia, antiphospholipid syndrome, end stage renal diseases, or vasculitis), single males, and same sex male couples (Machtinger et al., 2017). There are also other instances in which surrogacy could be recommended, including the situation in which the woman cannot carry the pregnancy due to objective reasons, such as a high risk of impaired fetal development, the impossibility of the mother to take life-saving medications during pregnancy (such as chemotherapy), when there is a high maternal risk generated by the pregnancy itself (i.e., catastrophic antiphospholipid syndrome, active systemic lupus erythematosus, previous cerebral vascular hemorrhage, and pulmonary emboli), or when the intended mothers have contraindications for regular gonadotropins doses for ovarian stimulation in order to avoid any significant increase of estradiol levels as well as the risk for ovarian hyperstimulation syndrome.In this situation, the child could have until six parents, three mothers and three fathers, if the surrogate is also married
Even if nowadays surrogacy is seen as a modern form of ART, it is actually an ancient practice. In Ancient Rome, abdomen rental—ventrem locare—was a common practice. Therefore, a man whose wife was fertile was able to give her temporary to another man, whose wife was sterile or was giving birth to dead children. The difference between these practices and the current concept of surrogacy is that in the above-mentioned cases fertilization was done naturally, its aim being the birth of a child for another party. In the current concept of surrogacy, a woman agrees to bear a child for another woman, a child that will be abandoned at birth, either altruistically or for a certain amount of money (it is worth mentioning that in the European Union altruistic surrogacy is usually the only accepted method), the conception being done through the doctor’s intervention. After we have described the ARTs, we will present the ethical issues and difficult situations raised by consequences of using ARTs.