Surrogacy is when another woman carries and gives birth to a baby for the couple who want to have a child. There are two types of surrogates - traditional and gestational. A traditional surrogate is a woman who carries a child for someone else and contributes her own eggs. A gestational surrogate, also known as a gestational carrier, is a woman who lends her body to the process of pregnancy but who has no genetic link to the child she is carrying.
Gestational surrogates are most common by far and recommended because it reduces the difficulty for a woman to separate emotionally from the baby. If you and your partner want to be the sole parents of the child, working with a gestational carrier presents fewer legal and psychological conflicts.
Why Surrogacy? When Do I Need a Gestational Carrier?
There are many reasons why you may need to use a surrogate. If you are a gay couple or a single man, the reasons are obvious (modern technology hasn’t got us that far yet!). For women, a fertility doctor will help you decide if it is medically advisable not to carry a pregnancy, and therefore to work with a gestational carrier.
Very few clinics have internal surrogacy programs. If the clinic you work with does have a program, they are probably strong candidates, and have most likely been medically cleared for surrogacy. But it is also likely that you will need to wait to be matched with a surrogate because good surrogates are not plentiful and most clinics don’t have full-time staff dedicated to searching for and screening surrogate candidates.
Agency surrogacy programs focus on finding women who are interested in being surrogates. Their screening process should include an initial phone interview with the surrogate candidate, followed by a personal interview in the candidate’s home, then a psychological evaluation. Agencies cannot medically screen surrogate candidates because they are not medical facilities. This is only done once the surrogate is matched with an intended parent.
The surrogacy cycle is long and complex. You need an agency that is supportive from the first call to the birth of your child and after. Do your homework and get recommendations. Not all surrogacy agencies are created equal. Most agencies have waiting lists because they have more couples looking than they have surrogates who are ready to be matched. Don’t be discouraged when one agency tells you the waiting time for a surrogate is 3–6 months.
There are surrogates waiting to be matched if you know where to look. Donor Concierge has working relationships with at least 40 surrogacy programs that have proven to be very accommodating.
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 desire to help someone have a baby. Your clinic will have its own requirements based on age, pregnancy and delivery history and health history. But there are many other factors to consider:
Your surrogate will have an initial medical screening by your doctor to make sure that she is medically approved in principal to carry your baby.
An important step in the surrogacy process is negotiating legal contracts and establishing escrow. This is a critical time. Any issues about the pregnancy must be discussed during the contract period. All contracts must be signed and an escrow or trust account funded before any medical procedures can begin. All funds for your surrogacy journey are held in escrow and paid out to the surrogate in pre-determined amounts that have been stipulated in the contract with your surrogate. She usually receives a monthly allowance while she is preparing for the embryo transfer, then a higher amount each month of the pregnancy with a balloon payment at the time of the birth to make up the balance of her base fee compensation.
Contracts will be reviewed by your attorney and your surrogate’s legal representative. Once your reproductive endocrinologist has approved your surrogate and has been given the legal go-ahead and she will then 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, your RE will prescribe injectable hormones, which the surrogate will administer to herself to prevent her body from rejecting the pregnancy. Part of the evaluation may require that your surrogate go through a mock cycle. She will start taking prenatal vitamins and estrogen to thicken the lining of her uterus just as she will during the actual cycle. In the mock cycle, a small piece of the uterine lining is removed, called an endometrial biopsy, and sent to the lab to determine if her uterine lining is thick enough for an embryo to adhere.
3. Prepping for embryo transfer
Both the surrogate and you (or your egg donor) will be given Lupron injections in order to synchronize cycles. Your surrogate will gradually lower the amount of Lupron she is taking as she starts to take estrogen injections. In most cases she will stop taking Lupron the day before the egg retrieval. On the day of the egg retrieval your surrogate will start taking Progesterone injections to prepare the lining of the womb, which she will continue to take until the 12th 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 to relax during the process. At the time of the transfer the surrogate and her husband or someone she feels close to will usually accompany her to the transfer to hold her hand and to drive her home after the transfer. You and your partner/husband will want to be there if at all possible to support your surrogate but also because this is a monumental step in building your family. The case manager or agency owner will also usually be on hand for this 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 and relax with her hips slightly elevated for about 20-40 minutes. She can then return home and to her normal activities unless otherwise instructed by your reproductive endocrinologist.
5. The pregnancy test
The first pregnancy test will usually be 10-12 days after the egg retrieval from your chosen egg donor. At that time, the surrogate will have a blood check to determine her hormone levels. If she is pregnant these levels should be elevated. This is not the final test - she will not be considered to be truly pregnant until a heartbeat is detected, which usually occurs around week five or six.
She will continue to see the fertility specialist until the end of the first trimester when she can stop taking the 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.
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 one month. After matching, it can take three months to complete contracts, medical screenings, and legal requirements. After that you and your surrogate will undergo an IVF cycle, and then 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 pregnancy, and to cover the baby upon birth. We can provide you with resources to find out more about surrogacy insurance.