Written by: Dr. Sara Barton, a board certified reproductive endocrinologist at CCRM Fertility of Colorado
If you’re looking to become a surrogate or you want to begin the process of finding a surrogate to have a baby, you might be feeling overwhelmed with all the information you need to know. Surrogacy is a big decision, one to not take lightly, and you want to make sure you’re in the care of experienced professionals who will guide you through the process.
Here we’ll walk through an overview of surrogacy, what the process is like, and the factors you need to consider.
What is surrogacy?
Surrogacy is when an individual carries and gives birth to a baby on behalf of another person or couple. There are two types of surrogates: gestational carriers and traditional surrogates. These terms are often used interchangeably.
Gestational carrier surrogacy involves a woman, known as the surrogate or gestational carrier, and the person or couple who provides the sperm and egg, known as the intended parents. The sperm and egg could come from the intended parents, or the sperm or egg could come from a donor.
Traditional surrogacy involves the surrogate using her own egg, meaning she will be biologically related to the child. This type of surrogacy is rarely used because of the legal and emotional challenges involved.
Reasons to use a surrogate
There are various instances in which someone might use a surrogate to have a child, including:
- A medical condition where pregnancy isn’t recommended or possible, such as infertility with failed treatments, if the uterus has been surgically removed, was damaged from past surgeries, or there were multiple unexplained miscarriages.
- Being advised by a doctor that carrying a pregnancy isn’t safe due to a medical condition.
- Being a single male.
- A same-sex male couple.
- Transgender individuals or couples.
Steps of the Surrogacy Process
Step 1: Creating Embryos
The first step in the surrogacy process is the creation of embryos. This is done by going through a process called in vitro fertilization (IVF). The IVF process can be done before a surrogate is found, or it can be done in tandem. However, because it can take time to find a surrogate, many people decide to create and freeze their embryos first and then begin the search for a surrogate.
The person providing the egg will first take hormones to produce several mature eggs in a single treatment cycle, which will then be surgically removed in a process called an egg retrieval. The eggs are combined with their partner’s or donor sperm in a lab for fertilization.
The embryos can then be frozen and chromosomally tested in a process known as preimplantation genetic testing for aneuploidy (PGT-A). PGT-A is often recommended if the egg source used is over age 35, because of increased chance of chromosomal abnormalities, which can result in failed implantation or miscarriage. PGT-A is often used with surrogacy to reduce the risk of miscarriage or facing difficult decisions in pregnancy is a chromosomal abnormality is diagnosed in the pregnancy.
At this point, the embryos can either be used to transfer to the uterus, or frozen and stored for future transfer.
Step 2: Finding a Surrogate
For Intended Parents:
The process of finding a surrogate can be daunting to some. Estimated time for matching with a surrogate is six months to over a year to find a surrogate that is best for the intended couple.
Surrogates can be a friend or family member you know. In these cases, the surrogate has to have a history of at least one uncomplicated pregnancy and delivery and pass other screening to make sure there is a low risk of pregnancy complication. Most of the time, intended parents use an agency that will help them find a surrogate. The agency is responsible for screening potential surrogates and matching surrogates to intended parents.
At CCRM Fertility, we understand the nuances of a surrogacy pregnancy. We have helped many people grow their families this way and can help find a gestational surrogate right for you.
Surrogates go through a series of screenings, such as physical exams, blood work, and interviews with healthcare providers and counselors, to make sure they’re healthy and up to the task of carrying a baby for someone else.
CCRM Fertility offers an in-house surrogacy program at our Colorado clinic that is streamlined and supported. Surrogates must meet certain requirements such as:
- Be between the ages of 21 and 40
- Be a U.S. citizen
- Be a non-smoker
- Having given birth and parented at least one child, but no more than 5 deliveries total
- Have a history of an uncomplicated pregnancy and delivery
- Be in excellent health
Step 3: Matching With Your Surrogate
When being matched with a surrogate, intended parents need to take into account several factors.
They need to have a good understanding of their potential surrogate’s overall health, as well as how their prior pregnancies went.
The location of the surrogate is important. If intended parents desire to attend the surrogate’s doctor appointments, they may decide to choose a local surrogate.
Intended parents, as well as surrogates, will need to decide whether or not they want to keep in touch after the baby is born. Some choose to continue with a relationship that may include photos or even get-togethers, and some may decide not to continue contact.
Surrogates don’t necessarily need a partner in order to be supported, but it is important for the intended parents that the surrogate has a strong support system to be there for them through the pregnancy.
Overall, intended parents need to feel comfortable with their choice and have a good connection with their surrogate. After all, the surrogate will be the one carrying their child.
Step 4 – Getting Pregnant & Embryo Transfer
The embryo transfer works the same regardless if it’s a surrogacy pregnancy or not. In this case, the surrogate will take steps to prepare her uterus for the transfer. Many surrogates are on birth control pills or a medication called Lupron that suppresses the natural ovulation cycle in order to better control when an embryo transfer occurs.
They will take estrogen to build up and thicken the uterine lining. Once the uterus is ready, they will take progesterone in order to support a pregnancy.
At the clinic where the transfer is performed, the thawed embryo is placed in the uterus using a thin flexible tube called a catheter. There may be some minimal discomfort during the process, but it shouldn’t be painful, and no anesthesia is needed.
The doctor will use an ultrasound machine to make sure the embryo is in the right spot. After the procedure, the surrogate will remain on estrogen and progesterone for about 8 weeks, if the pregnancy test is positive.
Step 5 – Becoming a Parent
Getting a positive pregnancy test is highly desired, something that may have taken years for intended parents to receive. The surrogate is monitored by the fertility clinic, but she doesn’t necessarily have to be physically there. If the surrogate is not local, she can have blood work and ultrasounds at another clinic ordered by the fertility doctor. At 8 to 10 weeks or so, care is transitioned over to the surrogate’s local obstetrician.
Step 6 – Legal Considerations
Surrogate pregnancies can bring about a lot of legal considerations, and intended parents and surrogates both need to work with experienced reproductive attorney specializing in assisted reproduction. They are experts in all the legal considerations that come with a surrogate pregnancy including contracts, varying state laws, and parental rights.
At CCRM Fertility, we’re here for you whether you’re looking to become a gestational carrier or you want to use surrogacy to build your family. Call us today to make an appointment with one of our CCRM Fertility specialists and we can help walk you through the process.