Who may consider gestational surrogacy
Gestational surrogacy is a way for a couple or individual parent to grow their family if they are unable to carry the pregnancy themselves.
It is, for example, one way LGBTQIA+ couples can become parents. It’s also a way for single men to become parents, or it can be used by people dealing with infertility.
For example, people who have had difficulties getting pregnant during IVF themselves may consider a gestational surrogate, as may parents who have had repeated unexplained miscarriages or stillbirths.
Parents who have certain medical conditions that make pregnancy life threatening or unsustainable might also consider gestational surrogacy. Such medical conditions could include:
- heart disease
- kidney disease
- cystic fibrosis
- past reproductive cancers
- severe diabetes
- history of preeclampsia
- Asherman’s syndrome
- untreatable uterine adhesions
- uterine malformations
People may also consider gestational surrogacy if they don’t have a uterus, either due to a congenital cause (such as Müllerian agenesis) or hysterectomy.
Finding a gestational surrogate
When looking for a gestational surrogate, you can either go through an agency or ask someone you know.
The matching process with your gestational surrogate is very important. You will likely want to choose someone who has similar:
- religious beliefs
- ideas about what a healthy pregnancy looks like
This will help make the legal negotiations with your gestational surrogate easier and help give you peace of mind while they carry your child.
Several states, such as New York, give rights to your gestational surrogate, which allow them to make decisions about the pregnancy and birth, so making sure you share similar values can make the process easier.
Using an agency
Agencies can help match you with a gestational surrogate — and support you and your surrogate through the process.
If you decide to use an agency, a good place to start your search is by asking your doctor at your fertility clinic for recommendations of agencies they have heard good things about. You can also join a local RESOLVE support group.
Even if you get a recommendation, though, make sure to ask for references from the agency and meet with them to inquire about their services and their matching process with a surrogate. If something feels off, look for a different agency. There are scams or agencies that might not have your best interests at heart.
Some states, like New York, require agencies to have licenses. If you live in a state that requires licensing, make sure that your agency is properly licensed.
With many agencies, you may pay fees to compensateTrusted Source your gestational surrogate, as well as pay fees to the agency, though that varies by state and country.
Using someone you know as a surrogate
You can also use someone you know as your gestational surrogate, such as a friend or family member.
There are some advantages to doing it this way. For one, it might cost you a little less and you might find it easier to trust your gestational surrogate. After all, if they are a friend or family member, your values might more naturally align.
Still, remember that gestational surrogacy is complicated. There are a lot of ethical, legal, and psychosocial dynamics involved, so make sure you consider how that might impact your relationship and your comfort level.
For example, Megan Lentz, whose second baby was born with the help of her sister acting as her gestational surrogate, says there were some awkward moments.
“I felt weird telling my sister things she could and couldn’t do in the pregnancy,” she says. “In hindsight, I probably should have added more things to the contract just to help me avoid needing to state my wishes about things during the pregnancy.”
You might need to check local laws, too. Some states and countries require an agency to be involved.
“If you decide to use a known carrier, I’d recommend still considering using the services of an agency for the administrative stuff,” says Lentz. “There are a lot of moving parts, many of which have to be done by certain dates, and it was really hard keeping track of everything.”
Whether you go through an agency or choose a gestational surrogate you know, there will still be some screenings involved before the process can continue.
“The surrogate must have previously had a child and her prior medical records will be reviewed,” explains Dr. Lauren Sundheimer, a double board certified reproductive endocrinologist and infertility specialist and OB-GYN at CCRM Fertility Orange County. “She will then undergo a medical screening, as well as psychological screening.”
The medical screening might involve:
- a Pap smear
- a physical exam
- an infectious disease screening
- blood work
- an ultrasound
Generally, gestational surrogates are between the ages of 21 and 42, though many doctors prefer them to be under age 35 with a history of healthy pregnancies and full-term delivery.
Some agencies or fertility centers may have additional requirements for surrogates as well. For example, some require gestational surrogates to have certain BMIs or to have not had too many cesarean deliveries.
There will also be egg and sperm donor testing to minimize the risk of infection to the gestational surrogate.
Then, the gestational surrogate will begin taking hormones to help prepare their uterus for embryo transfer. The egg and sperm will either be donated by the intended parents or a donor, and fertilization of the eggs will be done via IVF to produce embryos. When the embryos are ready, they will be implanted in the surrogate, usually about 3 to 5 days after fertilization.
From there, the process varies by state and country after pregnancy has occurred.
“In the state of California, once the surrogate is pregnant, we can ask a court for a judgment recognizing the intended parents as the legal parents and excluding the surrogate as a legal parent,” says Hasenbush. “In other places, sometimes this has to wait until after the birth and might have to be treated more like an adoption.”
Donor eggs vs. intended mother’s eggs
Depending on your reasons for opting for gestational surrogacy, you have the option of either using your eggs or a donor’s eggs.
“If you use the intended mother’s eggs, then the intended mother has the added benefit of being genetically related to her child, even if she couldn’t carry the pregnancy,” says Hasenbush.
However, this is not possible for all intended parents.
“Embryo quality is essential to a successful surrogacy journey and there may be instances where a donor’s eggs, which are carefully evaluated, contribute to higher embryo quality,” explains Nazca Fontes, founder, and CEO of ConceiveAbilities Surrogacy and Egg Donation Agency.
For example, age or genetic concerns could mean it is a better choice to use a donor egg.
Some parents may also not be able to produce their own eggs.
Donor eggs and semen are generally available through fertility clinics or donor databases.
How much does gestational surrogacy cost?
While the costs of gestational surrogacy can vary widely, especially depending on whether you are paying fees to your surrogate or an agency, it’s still generally a pretty expensive process.
Fees to surrogates in the United States are estimated to be between $20,000 and $55,000.
Intended parents also have to pay for:
- the surrogate’s medical care
- the surrogate’s attorney
- travel expenses
- health insurance
Agency fees, even if you use a known surrogate, can be pretty high too.
As a result, Hasenbush says “gestational surrogacy in the United States generally costs over $100,000.” And that’s before the cost of procuring donor eggs, which can cost another $15,000.
IVF doesn’t always work on the first try, so you could pay more if you need to restart the process of finding a new surrogate or performing IVF.
“If you are out of the state or country where the surrogate lives, there could be increased travel expenses and legal fees to make sure everything translates across borders,” says Hasenbush.
Fees as an employee benefit
Some employers have started offering fees associated with surrogacy as an employee benefit.
If you are consideri