A Brief History of Surrogacy
Surrogacy is a complex topic, with a rich and diverse history that spans centuries and continents. From ancient civilizations to modern times, surrogacy has been a means of creating families and overcoming infertility.
When did Surrogacy Begin?
Surrogacy has a long history, dating back to early civilizations. In ancient Greece, surrogacy was practiced among royalty and the wealthy, with women acting as surrogates for women who were unable to carry a pregnancy to term.
In Hindu scriptures, there are references to surrogacy on the Indian subcontinent as a means of preserving a family line.
The ancient Egyptians believed that a woman's ability to carry a child was a gift from the gods, and surrogacy was seen as a way of ensuring that the gift was passed on to future generations.
Surrogacy can also be traced back to Ancient China, when a couple might ‘borrow a woman's belly to produce offspring’ (借腹生子).
In these ancient civilizations, surrogacy was often seen as a means of ensuring the continuation of a royal dynasty. And it was also a way for women who were unable to carry a pregnancy themselves to still have biological children.
Hagar, the First (Known) Surrogate
The first surrogate to be named in texts is Hagar, who is described in the Book of Genesis, an account of the creation of the world, and the first book of the Hebrew Bible and the Christian Old Testament.
Hagar was from Egypt, and a servant to Sarah and the biblical patriarch, Abraham. The couple were unable to have children, and Sarah suggested that Hagar would carry their child, in order that God's promise to Abraham (the "covenant of the pieces") would be fulfilled. “It may be that I may obtain children by her” (Genesis 16:2).
Upon becoming pregnant, tensions developed between Hagar and Sarah. Hagar fled to the desert, and the story goes that an angel appeared to Hagar, telling her that the child "shall be a wild ass of a man: his hand shall be against every man, and every man's hand against him; and he shall dwell in the face of all his brethren" (Genesis 16:12) and that the child should be named Ishmael.
She returned to Sarah and Abraham, and gave birth to a boy shortly after. The child was named Ishmael, and he would become a another important patriarch for the three major Abrahamic religions, Christianity, Judaism and Islam.
Surrogacy in the Common Era
The history of surrogacy in the Common Era (CE, or AD) prior to the twentieth century was limited by a lack of medical technology and a different cultural and legal understanding of the practice.
In medieval Europe, surrogacy was rare, but did happen. In these cases, the surrogate would often be a close relative of the intended parents and would carry the pregnancy on their behalf, and the surrogate was the biological mother of the child.
The first Artificial Insemination
Fast forward through time and the next milestone occurred in 1790, when Scottish surgeon John Hunter, FRS — one of the most distinguished scientists and surgeons of the time — carried out the first recorded artificial insemination on a London woman whose identity remains private, using her husband’s sperm. The husband, a linin merchant, suffered from hypospadias, a birth deformity of the penis which meant that his semen was lost during intercourse. The procedure resulted in a successful pregnancy.
Other, unrecorded instances of artificial insemination are believed to have taken place prior to that. For example. Henry IV (1425-1474), King of Castile, married Princess Juana, sister of Afonso V of Portugal in 1455. After six years of marriage living in the Royal Alcázar of Madrid, she gave birth to a daughter, Joanna. Many of the contemporary chroniclers and historians assumed Henry suffered from erectile dysfunction, and that the child was conceived with donor sperm.
Surrogacy in the Last Century
It wasn't until the late 20th century that surrogacy became more widespread, with advances in reproductive technology making it a viable option for many people.
Decades of research lead up to the moment in 1978 when the first successful live birth after conception via in vitro fertilization (IVF) was announced by Dr. Patrick Steptoe and Dr. Robert Edwards in the Royal Oldham Hospital in Greater Manchester, England.
Lesley Brown gave birth to a healthy daughter, Louise Joy Brown, the world's first "test tube baby", on July 25, 1978, marking one of the most important medical breakthroughs in history, and the development gained widespread attention. A few years later, on December 28, 1981, Elizabeth Carr was born in Norfolk, Virginia, becoming the first IVF baby born in the United States.
The two doctors along with nurse and embryologist Jean Purdy who worked on the procedure are credited with developing IVF.
The First Fetal Babysitter: the Emergence of Gestational Surrogacy
1985 was when the first case of surrogacy where the baby has not genetically related to the surrogate took place. Until then, every instance of surrogacy was what we now call traditional surrogacy.
Shannon Boff, from Detroit, acted as surrogate to intended parents, East Coast residents Sandy and Elliot, and baby Shira was born at St. Joseph Mercy Hospital in Ann Arbor, Michigan.
Sandy had lost her womb after a miscarriage a few years earlier.
In contrast to all instances of surrogacy up until then, where the surrogate has also been the egg donor, in this case it was Sandy's egg which was fertilized with Elliot's sperm via IVF and implanted in Shannon's uterus.
Shannon Boff described herself to news outlets as “the world’s first fetal baby-sitter.”
Shannon's husband Gerald was reported as saying ″I was very happy this is the best pregnancy she’s had… ...This was exactly the experience we had hoped for. We were very fortunate to find the couple we did.″
The pioneering doctor in this case was South African Dr Wulf Utian, Director of Obstetrics and Gynecology and co-director of an in vitro fertilization and embryo transfer team at the Mount Sinai Medical Center in Cleveland, Ohio, and a reproductive endocrinologist and clinical researcher. As well as facilitating the first ever gestational surrogacy, Dr. Utian is also known for first recognizing menopause as a potential health-related issue.
Shannon Boff was paid $10,000 by Shira’s parents Sandy and Elliot. “I wasn’t going to turn the money down,” said Boff, who had a 4-year-old son of her own with her husband. But she said that the financial aspect was not the driving factor in her decision to act as a surrogate for another family. “I love my own son so much, I feel sorry for people who can’t have kids” she said at the time.
Baby Shira's father, Elliot, also spoke about the compensation. “As a physician, when I save a life the patient is charged for my time, skills and education, not for the value of his life… …We were paying Shannon for her time, her effort and her energy."
Validation of Surrogacy Agreements: the Johnson v. Calvert ruling
For a long time Mark and Crispina Calvert, of Orange County, California, had wanted a baby, but were unable to have children of their own. Crispina’s had been forced to undergo a hysterectomy years earlier, however she still produced eggs.
The Calverts entered into an agreement with their friend Anna Johnson, who acted as gestational surrogate for the couple. The embryo was conceived using one of Crispina's eggs, and Mark's sperm.
The Calverts were to pay Anna $10,000 for her troubles during the pregnancy, and take out a life insurance policy for her, with her agreeing to relinquish parental rights upon the birth of the child. The relationship turned sour after Anna found that the Calverts had not done everything they could to obtain the agreed insurance policy, and the Calverts discovered that Anna had previously experienced stillbirths and miscarriages.
After she gave birth, Anna refused to release the child to the Calverts. And so the couple sued.
The Supreme Court of California ruled in 1993 that Crispina and Mark Calvert were the child’s genetic, biological, and natural parents, and that Anna Johnson had no parental rights.
This was a landmark ruling, validating a gestational surrogacy agreement as a legally binding contract that would be supported in the courts, ensuring the legal parentage of the intended parents.
The situation for Gestational Surrogates today
Creating families through surrogacy has come a long way. But it's important to remember that the law varies by state, and that a small number of states outright forbid surrogacy.
It's important to check the law in your state when considering helping a family by acting as a surrogate.
The history of surrogacy is rich and varied, reflecting changing attitudes and advances in reproductive technology. As more and more people choose surrogacy as a means of starting a family, and as the number of those becoming a surrogate continues to grow, it's interesting to reflect on the history of surrogacy and the challenges and discussion that still exist today.
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