Assisted Reproduction: From Wet Nurses to Surrogacy and IVF

Assisted reproduction has a rich history spanning over 4,000 years, evolving from ancient practices like wet nursing to modern technologies such as surrogacy and in-vitro fertilization (IVF). This article explores the historical and contemporary methods couples have used to build families, addressing challenges like infertility and societal needs for heirs. Whether you’re exploring surrogacy, IVF, or adoption, understanding this evolution provides valuable context for modern family-building options.

Historical Practices in Family Creation

Since the earliest days of civilized man, couples have engaged the services of 3rd parties to assist them in nurturing and creating families. Royalty and wealthy couples have employed wet nurses for thousands of years. This was usually due to difficulties experienced by the new mother in producing or lactating sufficient breast milk for their newborn. Still, sometimes it was to help the royal mother from encountering the “deflationary effect” and the inconvenience of nursing.

Wet Nursing in Ancient Civilizations

Wet nursing, documented as early as 2000 BCE in ancient Egypt, was a common practice among royalty and elites. For example, in the 18th Dynasty, Pharaohs hired wet nurses to ensure infant survival when mothers faced lactation issues. This practice also allowed royal mothers to maintain social status and avoid the physical demands of nursing. In medieval Europe, wet nurses were often lower-class women, sometimes coerced into service, highlighting the complex social dynamics of the time.

Key Reasons for Wet Nursing:

• Insufficient breast milk production.
• Preserving the mother’s health or social role.
• Ensuring infant survival in high-mortality eras.

Mistresses and Stand-Ins for Heirs

More to the point, though, is the use of mistresses or other stand-ins when either the royal/wealthy mother or the father could not reproduce. These were essential steps to providing the political and financial stability of an heir for a kingdom or a commercially powerful family. While not true surrogates in the current nomenclature, these fertile women and men helped keep many a monarchy or fiefdom stable when the lack of an heir might produce civil war or destructive legal battles.

For instance, in the 16th-century Tudor dynasty, mistresses like Elizabeth Blount bore children for King Henry VIII, ensuring political continuity. These arrangements, while not equivalent to modern surrogacy, addressed infertility or the need for male heirs, preventing crises like the Wars of the Roses (1455–1487), which erupted partly due to disputed succession.

• Historical Examples:
  • Tudor England: Mistresses provided heirs when queens faced infertility.
  • Ottoman Empire: Concubines bore children for sultans, securing dynastic stability.

Modern Surrogacy: A Solution for Infertility

For the last 30 years, infertile couples have employed surrogates to help them create children for their families. Usually, as a result of problems with the wife’s uterus, fallopian tubes, or other parts of their reproductive system, the couple enters into a contract with a fertile woman (proven by her demonstrated ability to bear healthy children with relative ease), who the couple’s OB/GYN inseminates with the sperm of the husband. The couple pays all the expenses for the pre- and post-insemination medical and psychological needs of the surrogate. It provides her with a reasonable monetary stipend for her time, discomfort, and risk.

Types of Surrogacy

Since the 1980s, surrogacy has become a formalized process, with two main types:

• Traditional Surrogacy: The surrogate is artificially inseminated with the intended father’s sperm, making her the biological mother. This is less common today due to legal complexities.
• Gestational Surrogacy: The surrogate carries an embryo created via IVF, using the intended mother’s egg or a donor egg, with no genetic relation to the surrogate. This is the dominant form, accounting for over 90% of surrogacy cases in the U.S.

The Surrogacy Process

The surrogacy journey involves several steps, ensuring legal, medical, and psychological alignment:

• Selecting a Surrogate: An Agency that matches couples with surrogates who have proven fertility and pass rigorous screening.
• Signing a Legal Contract: Contracts, often drafted by family law attorneys, outline responsibilities, compensation, and parental rights. In California, a surrogacy-friendly state, these contracts are legally enforceable.
• Medical Procedures: An OB/GYN or reproductive endocrinologist performs insemination or embryo transfer, with costs ranging from $100,000 to $150,000, covering medical, legal, and surrogate fees.
• Ongoing Support: Couples cover the surrogate’s medical and psychological needs, ensuring her well-being throughout the pregnancy.

Legal and Ethical Considerations

Surrogacy laws vary globally. In the U.S., states like California and Illinois support surrogacy, while others, like Michigan, restrict it. Internationally, countries like India and Thailand have banned commercial surrogacy, citing ethical concerns such as exploitation. Ethical debates also include:

• Surrogate Autonomy: Ensuring surrogates are not coerced by financial need.
• Child Welfare: Protecting the rights of children born via surrogacy.
• Intended Parent Rights: Clarifying legal parentage to avoid custody disputes.

For expert guidance on surrogacy contracts, explore our family law services at Reape Rickett.

In-Vitro Fertilization (IVF) and Alternative Reproductive Technologies

In the last 2 decades, the efficacy and availability of in-vitro fertilization, using the sperm of a donor male, a viable donated egg, or the donated egg and sperm of unrelated 3rd parties, either in the expected mother or in a woman hired just to carry the fertilized embryo, has expanded the incidence of couples, heterosexual, gay, and lesbian, employing alternative reproductive technology and procedures to assist them in forming their families. This is not to minimize the importance of adoption in this history and our current affairs, about which another whole story can be told!

The Rise of IVF

Developed in the 1970s, IVF has helped over 8 million babies be born globally since the first successful case in 1978 (Louise Brown, UK). The process involves:

• Ovarian Stimulation: Medications stimulate egg production.
• Egg Retrieval: Eggs are collected from the ovaries.
• Fertilization: Eggs are combined with sperm in a lab to create embryos.
• Embryo Transfer: A healthy embryo is transferred to the uterus.

IVF success rates vary by age:

• Under 35: 40% per cycle.
• 35–40: 30%.
• Over 40: 15%.

Advances in Assisted Reproductive Technology (ART)

Beyond IVF, ART includes:

• Cryopreservation: Freezing eggs, sperm, or embryos for future use, with over 1 million frozen embryos stored in the U.S. annually.
• Preimplantation Genetic Diagnosis (PGD): Screening embryos for genetic disorders, used in 5% of IVF cycles.
• Intracytoplasmic Sperm Injection (ICSI): Injecting a single sperm into an egg, improving success for male infertility cases.

These technologies have made family-building accessible for diverse groups, including same-sex couples and single parents, particularly in countries like the U.S. and Canada.

Challenges and Risks of IVF

IVF is not without challenges:

• Cost: A single cycle costs $12,000–$20,000, often requiring multiple cycles.
• Health Risks: Ovarian hyperstimulation syndrome (OHSS) affects 1–5% of patients.
• Emotional Toll: High stress and uncertainty impact 30% of couples.

Learn more about navigating family-building challenges with our co-parenting resources.

Adoption: A Vital Alternative

While the original content briefly mentions adoption, it’s a critical family-building option. Over 115,000 children are adopted annually in the U.S., with processes including:

• Domestic Adoption: Adopting through foster care or private agencies.
• International Adoption: Adopting from countries like China or Ethiopia, though stricter regulations have reduced numbers since 2004.
• Open Adoption: Maintaining contact with birth parents, chosen in 40% of private adoptions.

Adoption involves legal steps, such as home studies and court finalization, often guided by family law attorneys. Explore our adoption legal services for support.

Cultural and Societal Perspectives

Assisted reproduction varies culturally:

• Western Countries: High acceptance of surrogacy and IVF, with the U.S. leading in fertility clinics (over 450).
• Conservative Societies: Resistance in some Middle Eastern countries due to religious or ethical concerns.
• Global Trends: Growing demand in Asia, with China’s fertility market projected to reach $7 billion by 2027.

Public awareness, driven by celebrities like Kim Kardashian (surrogacy) and Chrissy Teigen (IVF), has normalized these practices, though stigma persists in some regions.

Why Choose Assisted Reproduction?

Couples pursue assisted reproduction for various reasons:

• Infertility: Affects 1 in 8 couples, per the CDC.
• Medical Conditions: Uterine issues, low sperm count, or genetic disorders.
• Diverse Family Structures: Same-sex couples or single parents seeking biological children.
• Career or Timing: Delaying parenthood, with 1 in 6 women over 35 using ART.

If you’re considering these options, consult our fertility law experts at Reape Rickett.

Building a family through surrogacy, IVF, or adoption is a deeply personal journey. At Reape Rickett, our experienced family law attorneys guide you through legal complexities, from surrogacy contracts to adoption finalization. Contact us today to schedule a consultation and start your family-building journey with confidence. Visit Reape Rickett for expert support.

Frequently Asked Questions (FAQs)

What is the difference between gestational and traditional surrogacy?

Gestational surrogacy involves a surrogate carrying an embryo created via IVF, with no genetic link to the surrogate. Traditional surrogacy uses the surrogate’s egg, making her the biological mother. Gestational surrogacy is more common, comprising 90% of U.S. cases due to clearer legal boundaries.

How much does surrogacy cost?

Surrogacy costs range from $100,000 to $150,000, covering medical procedures, legal fees, agency costs, and surrogate compensation (typically $30,000–$50,000). Costs vary by state and agency.

What are the risks of IVF?

IVF risks include ovarian hyperstimulation syndrome (1–5% of cases), multiple pregnancies (20% of IVF births), and emotional stress. Success rates decline with age, from 40% under 35 to 15% over 40.

Who can become a surrogate?

Surrogates must be 21–40 years old, have delivered at least one healthy child, pass medical and psychological screenings, and commit to legal contracts.

How do surrogacy laws vary by state?

In the U.S., California and Illinois are surrogacy-friendly, with enforceable contracts. States like Michigan and New York have restrictions or bans on commercial surrogacy. Always consult a family law attorney for state-specific guidance.

What is the adoption process like?

Adoption involves a home study, background checks, matching with a child, and court finalization. Domestic adoptions take 6–18 months; international adoptions may take 1–3 years. Costs range from $0 (foster care) to $50,000 (private adoption).

How successful is IVF?

IVF success rates are 40% per cycle for women under 35, 30% for ages 35–40, and 15% for over 40, per the CDC. Multiple cycles may be needed, increasing costs and emotional investment.

Can same-sex couples use surrogacy or IVF?

Yes, same-sex couples access surrogacy and IVF in countries like the U.S. and Canada. Gestational surrogacy and donor eggs or sperm enable biological connections for gay or lesbian couples.

Conclusion

From ancient wet nurses to modern surrogacy and IVF, assisted reproduction has transformed family-building. By understanding historical practices, modern technologies, and legal considerations, you can make informed decisions. At Reape Rickett, we’re committed to supporting your journey with expert legal guidance. Contact us to explore your options today.