Surrogacy in Israel

The required medical documents for a prospective mother

1. An OB-GYN opinion or medical opinion (HE) specifying the reason for the prospective mother's inability to conceive and carry a pregnancy, or stating that a pregnancy may significantly endanger her health; paragraph 4(a)(2) of the Law.
   Such an opinion shall be prepared by a specialist gynecologist, or a specialist in the relevant field.
2. A record of medical history from a family physician as to the state of health of the prospective mother.

An individual prospective mother shall also be required to provide the following documents:

1. A document attesting to the source of the sperm to be used for fertilization.
2. The ovum to be used for the performance of the agreement is hers (no use of an ovum donation shall be permitted).
3. The following laboratory tests:
   • Blood type
   • HIV (AIDS) test
   • Antigen for hepatitis B and C (HbSAg test)
   • Syphilis (V.D.R.L.) screening test 

The required medical documents for a prospective father

1. An opinion by a family physician as to the state of health of the prospective father.
2. A document attesting to the source of the ovum to be used for fertilization.
3. The following laboratory tests:
   • Antigen for hepatitis B and C (HbSAg test)
   • A sperm test (spermogram) performed at a recognized institute
   • HIV (AIDS) test
   • Syphilis (V.D.R.L.) screening test 

The following must hold true for the Surrogate:

1. Residence: the Surrogate is an Israeli resident.
2. Age: at the time of approval of the agreement she is at least 22 years old and less than 39 years old.
3. Marital status: the Surrogate is not married, or is married but:
   • The Approval Committee has concluded that the designated parents have not been able, with reasonable efforts, to enter into an agreement for the carriage of fetuses with an unmarried surrogate.
   • The implications of the carriage of fetuses process and the risks involved in the performance thereof have been explained to the Surrogate's spouse, and he/she has been afforded the opportunity to voice his or her position before the Approval Committee.
4. The Surrogate has previously been pregnant and given birth other than as a surrogate, and her children have not been removed from her custody under any law.
5. The surrogate has not been a surrogate more than twice, and has not given birth as a surrogate more than once, i.e., in any one of the following three cases, the agreement with the surrogate shall not be approved:
   • Both processes ended in a birth.
   • One of the processes ended with a birth and the other ended in the completion of 6 embryo transfers.
   • Both processes were completed, and 6 transfers were performed in each.
6. The Surrogate is in a normal state of health, she had no more than 4 childbirths, without complications and full-term, the newborns had a normal birth weight for the age of the pregnancy and no significant medical complications occurred during the pregnancy and childbirth.
7. At the stage of the submission of the complete application, the time that has elapsed from the last birth was:
   •  In the case of a vaginal birth: at least one year (the commencement of the performance of tests/the collection of documents not before 11 months have elapsed from the birth).
   • In the case of a C-section: at least 18 months (the commencement of the performance of tests/the collection of documents not before 15 months have elapsed from the C-section).
8. The Surrogate is not a relative of any of the designated parents.
9. All the medical tests are normal, as required by the Committee.
10. The results of the required medical tests undergone by the Surrogate's spouse are normal.

The surrogate must submit the following documents:

• Summary of medical information from a family doctor – confirmation of good health and absence of conditions that could harm her or the fetus (including surgeries, hospitalizations, medical treatments, smoking, overweight, drugs, and alcohol).
• Specialist gynecologist opinion, including: (This opinion is in addition to the Form 8 – Declaration from a specialist obstetrician/gynecologist):
  • Summary of obstetric history, pregnancies, births, miscarriages, and risk factors in previous pregnancies and maintenance of pregnancy in prior deliveries: if any, please specify the reason and duration of pregnancy maintenance and attach relevant documentation, including National Insurance documents.
  • Clinical examination including pelvic ultrasound and endometrial thickness measurement (minimum 7 mm) to rule out uterine pathologies such as congenital anomalies, cervical insufficiency, or fibroids that may interfere with pregnancy.
• Birth records and discharge summaries (copy)
• Summary of pregnancy terminations, both voluntary and spontaneous (copy)
• Medical history, surgeries, and hospitalizations, if any (copy)
• Medical confirmation of weight, height, pulse, and blood pressure
• Breast exam by a surgeon and breast ultrasound
• Laboratory tests:
  • Blood type + RH
  • Complete blood count
  • Creatinine
  • Fasting glucose
  • Hepatitis B and C antigen tests
  • HIV test
  • VDRL (TPHA)
  • PT and PTT tests
  • Liver function tests
  • Toxoplasma and CMV IgG, IgM
  • TSH
  • Cervical screening test – Pap (PAP) + HPV
• Declaration from a specialist obstetrician/gynecologist (Form 8) – confirming that the surrogate received an explanation of the procedures, implications, and consequences of treatments, with emphasis on the hormonal treatments required during the embryo carrying process. The doctor will also address specific data of the intended parents listed in the form:
  • The mother’s age when using her own eggs.
  • Egg donation, PGD.
  • Method of procedure: IVF, IVM.
  • Egg retrieval method: hormonal stimulation or natural cycle.
  • Chances, complications, and risks in the process (e.g., preeclampsia, diabetes) and tests during the process (e.g., amniocentesis, embryo reduction), including possible risks and complications in twin pregnancies from embryo splitting.
• Medical confidentiality waiver form
• Your rights and direct contact with the committee – Form 13
• Comprehensive psychological assessment according to the guidelines for psychological reports – including psychiatric hospitalization summaries (medications and dosages), psychological/couples therapy summaries from the last 5 years (according to the attached format).

If the intended mother is married or has a permanent partner, she must also submit:

• Psychological evaluation for the partner, according to the guidelines for psychological reports
• HIV test
• Hepatitis B and C antigen tests
• Partner’s confirmation and signature acknowledging receipt of explanation regarding the medical process, its significance, and consequences, and signing Form 8
• VDRL (TPHA) test

1. Never given birth, or has had five or more deliveries.
2. Has had two or more cesarean deliveries.
3. Most recent birth was preterm (before 35 weeks), or the newborn had low birth weight for gestational age (IUGR).
4. Had a perineal tear of grade 2B or higher (after a grade A3 tear, cases are reviewed individually).
5. Had an ectopic pregnancy, either before or during the surrogacy process, once cleared to proceed.
6. Had surgery that could affect her health or a future pregnancy; each case will be evaluated individually.
7. Had bariatric surgery; if she has given birth at least once afterward, each case will be evaluated individually.
8. Had a miscarriage with risk for cervical insufficiency.
9. Experienced a stillbirth (each case will be reviewed individually).
10. Has a chronic illness that could endanger her or the fetus, such as type 1 diabetes.
11. Had gestational diabetes or abnormal HbA1c results.
12. Has or has had hypertension, or experienced hypertension in a previous pregnancy.
13. Had preeclampsia in a previous pregnancy.
14. Has obesity (BMI over 30).
15. Has a low BMI (below 18.5); cases are reviewed individually.
16. History of conization.
17. Carrier of a BRCA mutation.
18. RH-negative blood type with a positive Coombs test.
19. Uses or has a history of using tobacco, drugs, or alcohol.
20. Has a personality disorder or mental illness, and/or has been hospitalized in a psychiatric facility, or is currently in psychiatric treatment.
21. History of depression or postpartum depression.
22. Unable to provide informed consent.

An application for examination of entitlement (HE) to approval of a carriage of fetuses agreement shall be submitted to the Approval Committee together with the documents listed in the document "Applying to the Committee for an Examination of the Designated Parents' Satisfaction of the Threshold Conditions".

Explanations on the documents that must be submitted to meet threshold conditions

1. A personal application letter by the designated parents, stating the reason for their applying to the Committee, their marital status (e.g., married or living under a cohabitation agreement, an individual declaring that he/she does not have a spouse or partner), age, status in Israel, religion and contact details, including: their address, telephone number, email address.
2. For a designated mother – a medical opinion (HE) on her inability to conceive or carry a pregnancy, or stating that a pregnancy is liable to significantly endanger her health.
   Such an opinion shall be prepared by a fertility and OB-GYN specialist. In case of any underlying conditions, an opinion by the attending physician who is a specialist in the relevant field must be attached (Form 6) (HE).
3. A summary of medical information by a family physician, as to the state of health of each of the designated parents.
4. A statement as to the source of the sperm to be used for fertilization (the designated father/s, a sperm donor).
5. For a designated parent by whose sperm the fertilization is requested to be performed – the results of a recent sperm test.
6. A statement as to the source of the ovum to be fertilized (a designated mother, an ovum donor).
7. A psychological diagnosis of the designated parents, such opinion must be made in accordance with the guidelines for writing a psychological opinion (HE).
8. A waiver of medical confidentiality letter by each of the designated parents, signed before an attorney: waiver of confidentiality letter – designated mother (HE), waiver of confidentiality letter – designated father (HE).
9. A photocopy of the identity cards of the designated parents – both sides of the card and an up-to-date addendum.
10. A Population Registry extract for the designated parents.
11. A Details on a Traveler Certificate for the past 5 years.
12. Consent by the designated parents to the obtaining of a crime register report and police record from the Israel Police, for each of the designated parents.

Submission of the application

The documents should be sent, scanned as a PDF file to e-mail: [email protected]

If it is not possible to send the documents by e-mail, they should be sent by mail to:
National Coordinator for the Embryo Carrying Agreements Law, Ministry of Health 39 Yirmiyahu St., P.O. Box 1176, Jerusalem 9101002

Before the collection and delivery of the documents, please note: 

• The application shall only be handled after the delivery of all the required documents to the Committee.
• The process is the same whether submitted privately or by an agency.
• The application and the attached documents must be submitted in accordance with the order of their appearance on the list of documents (please do not use a stapler to attach the application and the original documents).
• The application must be sent by mail, together with 3 additional copies of the original document (4 hardcopies in total), to the following address:
  The National Supervisor for the Agreements for the Carriage of Fetuses Law, the Ministry of Health, 39 Yirmiyahu St., POB 1176, Jerusalem 9101002.
  Alternatively, the application can be delivered by hand delivery, by making an appointment with the National Supervisor for the Agreements for the Carriage of Fetuses Law.

Submission of an application for approval of a full surrogacy file

List of the required documents (Hebrew)

Explanations on the document collection stages

1. The Surrogate shall begin to undergo the medical examinations in accordance with the medical requirements for a surrogacy candidate (HE), and must obtain an examination certificate by a gynecology specialist. At the end of the examination, the physician must provide to the carrying mother explanations on the process, and fill out Form 8 (HE). 
    
2. After the physician certifies that the surrogacy candidate is medically suitable to the process, she must obtain a psychological opinion by a psychologist, for her and her spouse/partner, in accordance with the guidelines for writing a psychological opinion (HE).The purpose of the psychological diagnosis is to examine the
   strengths and capabilities available to the surrogacy candidate for the carriage of fetuses process.
    
3. Afterwards, an attorney who is knowledgeable and experienced in the field of surrogacy (the designated parents' advocate) must be contacted, for the purpose of the preparation of a draft agreement for the carriage of fetuses, expressing the relationship between the parties and the payment arrangements (guidelines on the legal aspects of an agreement for the carriage of fetuses, HE), and also for the purpose of signing affidavits: affidavit for the designated mother, affidavit for the designated father (Forms 2 and 3).
   The designated parents and the Surrogate shall be represented by different attorneys, knowledgeable in the field of surrogacy in Israel.
   The attorney who serves as the Surrogate's advocate must be knowledgeable and experienced in the field of surrogacy in Israel. The Surrogate shall choose her advocate, and his fees and expenses shall be paid by the designated parents.
   Such attorney shall explain the process to the Surrogate and her spouse/partner, and fill out for her the Affidavit by the Carrying Mother (HE) and the Declaration by the Carrying Mother's Attorney (Forms 4 and 9) (HE).
   It is recommended to read the documents about surrogate rights and how to contact the Committee directly: for surrogate see form 13 (Hebrew), for parents, see form 14 (Hebrew).
4. Next, an insurance quotation must be obtained from an insurance agent (Certificate of Provision of Explanations to the Carrying Mother on Life Insurance Form 10, HE). The surrogacy candidate must be informed that she must provide full and correct information, in order for the insurance policy to be valid.
    
5. Form No. 1  (HE) Application for Approval of an Agreement for the Carriage of Fetuses – must be filled out, and a meeting must be held for a discussion on the parties' expectations from the process. List of Recommended Topics for a Discussion on the Parties' Expectations (Form 11).
    
6. The designated parents can begin undergoing the tests and examinations in accordance with the medical requirements for designated parents, while the carrying mother undergoes the tests and examinations required of her.
    
7. At this stage, a trustee must be chosen for depositing the consideration money for the process in a trust account, but the money must not be deposited yet.
    
8. The Surrogate's spouse/partner must undergo the tests and examinations required under the Medical Requirements for a Surrogacy Candidate (HE).
   The carrying mother's spouse/partner shall receive explanations on the medical process and its consequences, the agreement and its implications and the insurance policy, together with the surrogacy candidate, and he/she shall sign Form 8 (Declaration by an OB-GYN Specialist), Form 9 (Declaration by an Attorney who is the Surrogate's Advocate) and Form 10 (Certificate of Provision of Explanations on Life Insurance to a Carrying Mother), in the presence of the physician, the attorney and the insurance agent.