Surrogacy: 5 Things Doctors Want You to Know

March 29, 2019
By Nancy LeBrun

What Surrogacy Is Really Like

The ins and outs of using a surrogate to carry your child are complicated, but it can open the door for people who want a child and are unable to have one themselves. With many celebrities opting for surrogacy and raising awareness of the process, more couples may have questions about how surrogacy works. Here’s what doctors who are experienced in taking families through the surrogacy journey want you to know about this growing reproductive option.

1. “We now tend to call surrogates ‘gestational carriers.’”

In the past, “traditional surrogacy” used the surrogate’s own egg to create an embryo, but that is rarely the case today because the genetic relationship between carrier and baby can lead to custody issues. Instead, in most surrogacies, the egg and sperm are from the intended parents or a donor. “The kind of surrogacy [now] isn’t really surrogacy at all. It’s known as a gestational carrier,” says William Schoolcraft, MD, fertility specialist and founder of CCRM, the Colorado Center for Reproductive Medicine. “That’s where a woman volunteers to carry an embryo for a couple. She’s offering to provide the uterine environment for nine months.”

2. “You must have a valid reason to use a surrogate for a pregnancy.”

“[Someone] can’t say, ‘Hey, I don’t want to bother being pregnant because I’m busy at work.’ They have to have a bona fide medical reason why they need somebody to help them have a baby,” says Dr. Schoolcraft. “Most hospitals or fertility groups have a committee that will meet in controversial situations. It’s kind of case by case,’ says Elizabeth Ginsburg, MD, medical director, assisted reproductive technologies at Brigham and Women’s Hospital in Boston. “The only reason we offer it where I practice is where it’s medically contraindicated to carry the pregnancy,” adds Ginny Ryan, MD, director of reproductive endocrinology and infertility at University of Iowa Health Care.

3. “It’s essential to work out all the details of a surrogacy before moving forward.”

A gestational surrogacy usually involves several parties: an agency who finds a carrier, the parent or parents, a fertility clinic, and reproductive attorneys. “Having a clinic whose pregnancy rates are high is very important, and finding a good agency to connect with a carrier–those are really the keys,” says Dr. Schoolcraft. There are extensive screenings and tests for all concerned to ensure the medical and psychological health of everyone involved. Before proceeding, a reproductive attorney should draw up a contract covering every detail of the arrangement, so everyone is on the same page.

4. “Most gestational carriers tend to do really well with their pregnancies.”

Because the gestational carrier, egg and sperm have all undergone rigorous testing, the pregnancies usually go well. “The medical risks of the pregnancy are usually less in a gestational carrier [than other pregnancies],” says Dr. Ryan. Still, “We always make sure the intended parents are well counseled. If somebody thinks they’re guaranteed a perfect baby and a perfect pregnancy, that’s not the case,” says Dr. Ginsburg. “It’s as safe a pregnancy as anybody’s going to have, but it’s important not to be cavalier about it.”

5. “Cost can be the biggest barrier to gestational surrogacy.”

“The out-of-pocket costs for a gestational carrier are probably somewhere between $80,000 to $100,000, so that’s out of bounds of the vast majority of the U.S. population,” says Dr. Ginsburg. Most carriers are not in it for the money, however. “Growing other people’s families has been very gratifying for them, and those relationships have been very positive,” says Dr. Ryan. “They really feel good about it. They know what their [own] kids mean to them, and it makes them feel really good to help somebody else have a child who wouldn’t be able to otherwise,” adds Dr. Ginsburg.