When the womb is overseas: the meaning-making of the gestational surrogacy in gay couples

Study question: How do gay couples deal with gestational surrogacy overseas? Summary answer: Feelings of impotence due to the distance, the importance of a close relationship with the gestational carrier, and gratitude for pregnancy emerged. What is known already: In the last two decades an increasing number of gay men has entered into surrogacy arrangements to become parents. Previous studies have addressed various aspects of this process, including changes associated with the transition to parenthood, the effect of upcoming fatherhood on how coping with the seemingly contradictory identities as gay and as parents, the motivations for seeking extraterritorial surrogacy, and the ethical issues regarding the potential exploitation of the women involved. However, there remains a dearth of studies that deals with the psychological implications of the physical distance between the gay fathers and the gestational carrier during the pregnancy. Study design, size, duration: Cross-sectional study. Data were collected between February and August 2015 on 20 gay-partnered fathers who pursued gestational surrogacy overseas in America or Canada because in Italy surrogacy is prohibited by law. Gay fathers were eligible for the study if they were Italian, had at least one child born in their current relationship, and did not receive a friend or relative’s oocyte donation. Participants/materials, setting, methods: Gay fathers were recruited via the Italian Rainbow Families. Joint, semi-structured interviews took place at fathers’ home and lasted 60–90 min. After the transcription, a draft was sent to each participant for amendment and approval, often with additional questions. An Interpretative Phenomenological Analysis was performed by two independent coders to identify recurrent themes. Critical feedback was discussed during all phases of analysis in team meeting. Main results and the role of chance: This study showed three recurrent themes in how Italian gay fathers deal with their gestational surrogacy arrangement overseas. All themes are related to consequences of the distance between fathers and the physical pregnancy. The loss of a sense of control with the subsequent feelings of frustration and anxiety is the main implication of the inability to experience the physical presence of the fetus. As consequence, fathers highlighted the importance of establishing a close relationship with the gestational carrier also to be always posted about ultrasounds and test results. Most couples reported that their emotional involvement is mirrored by the gestational carrier, who want to be called “special auntie” for including in the relationship also their husbands and children. Finally, fathers represented their gestational carrier with images of hospitality and force of nature, expressing a deep sense of gratitude for making them parents. Limitations, reasons for caution: Conjoint interviews process could have affected fathers’ personal points of view, hindering their ability to express themselves if they perceived their opinions as inconsistent with those of their partner. Moreover, retrospectively constructed stories do not allow for an extrapolation of the conclusions made. Wider implications of the findings: Our findings help in developing strategies to counsel Italian gay parents who experience distance with the gestational carrier and the fetus. The value of defining international guidelines for cross-border reproductive services is also supported at the aim of handling the uncertainty, unease and potential complications arising from the surrogacy process.