Gestational surrogacy — With gestational surrogacy, a surrogate carries a pregnancy to term for the intended parent(s), using the intended mother’s eggs or eggs from a donor. This means that the surrogate has no genetic link to the baby.
Traditional surrogacy — In addition to carrying the pregnancy to term for the intended parent(s), a traditional surrogate provides her own eggs, which means she is genetically linked to the child she carries. This is now a relatively rare process, and comes with complicated legal and emotional implications.
Who Uses Gestational Surrogates?
There are many reasons people turn to surrogacy. Couples or individuals with fertility issues—whether caused by age-related diminished ovarian reserve, cancer treatment, or other circumstances—often turn to surrogacy to help grow their families. Women who have experienced miscarriages or have had particularly difficult pregnancies in the past may also explore surrogacy as an option to help build their families. And for single men and LGBTQ couples looking to have children, surrogacy can allow them this exciting opportunity.
Very few clinics have their own surrogacy programs. If your chosen clinic does have a program, however, the surrogate candidates are probably very promising, and have most likely already been medically cleared for surrogacy. But because most clinics do not have full-time staff dedicated to finding and screening candidates, you may need to wait longer for the right match.
Agency surrogacy programs focus on finding women who are interested in being surrogates. At these agencies, the screening processes typically begins with a phone interview between the surrogate candidate and an agency staff member. If the candidate is deemed a good potential surrogate, a personal interview may be conducted in the candidate’s home. From there, a psychological evaluation will take place. Because they are not medical facilities, agencies cannot medically screen surrogate candidates. Actual screening is only done once a surrogate is matched with an intended parent.
The surrogacy cycle is long and complex, so you’ll want to be sure you’re working with an agency that will be helpful and supportive throughout the entire process. Do your research, get recommendations, and ask lots of questions. Most agencies have waiting lists; this is because they have more hopeful parents looking for help growing their families than they do surrogates ready to be matched.
Don’t be discouraged if an agency tells you the waiting time for a surrogate is three to six months. There are surrogates out there waiting to be matched, if you know where and how to search for them. Donor Concierge has working relationships with more than 40 trusted surrogacy programs.
How do I choose a surrogate?
We have a saying in this industry: You choose your surrogate as much as she chooses you. While the financial compensation is often a factor, most women who choose to be surrogates do so out of a true desire to help someone have a baby. Your clinic will have its own surrogate requirements based on age, pregnancy and delivery history, and health history, but there are many other factors to consider. For example:
Your chosen surrogate will first be screened by your doctor to ensure that she is medically approved to carry your baby.
You’ll also need to be involved in negotiating legal contracts and establishing escrow. This is a critical time, as any issues regarding the pregnancy must be discussed during the contract period. All contracts must be signed, and an escrow or trust account must be funded before any medical procedures can begin. All funds for your surrogacy journey are held in escrow and paid out to the surrogate in predetermined amounts, as stipulated in the contract with your surrogate. The surrogate usually receives a monthly allowance while she is preparing for the embryo transfer. As the pregnancy progresses, she’ll receive a higher allowance each month, with a final payment at the time of birth.
All contracts will be reviewed by your attorney and your surrogate’s legal representative. Once your reproductive endocrinologist (RE) has approved your surrogate, and once both parties have signed their respective contracts, your surrogate will start to be prepped for the embryo transfer.
2. Surrogate evaluation and mock cycle
Next, the surrogate will have a more in-depth medical evaluation. In order for your surrogate to carry a child that is not genetically related to her, and to prevent her body from rejecting the pregnancy, your RE will prescribe injectable hormones, which the surrogate will administer herself.
Part of the evaluation may require that your surrogate go through a mock cycle. She will begin taking prenatal vitamins and estrogen to thicken the lining of her uterus just as she will during the actual cycle. A small piece of the uterine lining will be removed, in a process called an endometrial biopsy, and sent to a lab to determine if her uterine lining is thick enough for an embryo to adhere to.
3. Prepping for embryo transfer
Both the surrogate and you (or your egg donor) will be given Lupron injections in order to synchronize your cycles. Your surrogate will gradually reduce the amount of Lupron she is taking as she begins estrogen injections. In most cases, she will stop taking Lupron the day before the egg retrieval. On the day of egg retrieval, your surrogate will start progesterone injections to prepare the lining of the womb. This will continue until the twelfth week of the pregnancy.
4. The embryo transfer
The embryo transfer is a relatively simple and painless process. Your surrogate may be given a mild sedative to help her relax. Typically, someone close to the surrogate will accompany her to the transfer and drive her home afterward. If possible, we recommend that you and your partner be there for support as well. Plus, this is a monumental, exciting step in building your family! The case manager or agency owner will also usually be on hand for the embryo transfer.
With the aid of ultrasound, the embryos are drawn up into a thin catheter that is then placed inside the surrogate’s uterus. The embryos are gently released into your surrogate’s uterus, and she is instructed to lie down and relax with her hips slightly elevated for about 20 to 40 minutes. She can then return home to her normal activities, unless otherwise instructed by your reproductive endocrinologist.
5. The pregnancy test
The first pregnancy test will usually be conducted 10 to 12 days after the egg retrieval. At that time, the surrogate will undergo a blood test to determine her hormone levels. If she is pregnant, these levels should be elevated. But this is not the final test: She will not be considered pregnant until a heartbeat is detected, which usually occurs around week five or six.
Your surrogate will continue to see a fertility specialist until the end of the first trimester, when she can stop taking hormones. At this point, she can begin seeing her regular OB/GYN, closer to her home. The surrogate’s OB/GYN must be Board Certified and have privileges to practice at a hospital that has at least a Level 2 Neonatal Unit.
How much does surrogacy cost?
There is no simple answer to this question due to the varying complexity of surrogacy and the number of people who need to be involved in the surrogacy process. Typically, working with a surrogate costs between $95,000 to $195,000.You can learn more about the expected cost of surrogacy here.
How long does the surrogacy process take?
The entire surrogacy process can take anywhere from 14 to 18 months. If you work with Donor Concierge, we can find you a surrogate within 4 to 6 weeks. After matching, it can take up to three months to complete contracts, medical screenings, and legal requirements. Then you and your surrogate will undergo an IVF cycle, followed by the 40 weeks of pregnancy.
Can Donor Concierge find a surrogate without an agency?
No. We encourage our clients to work with one of our surrogate-agency partners.
Does insurance cover surrogacy?
Insurance is a complex issue. Some gestational carriers will have their own insurance packages that cover surrogacy, but many insurance companies have a surrogacy exclusion. You may need to purchase additional insurance to cover the surrogate’s pregnancy and to cover the baby upon birth. We can provide you with resources to find out more about surrogacy insurance.