1. Getting Started
The first step of starting a surrogacy journey is to educate yourself about surrogacy and the long and sometimes complicated process. Going through surrogacy to start or expand your family can be complex and will require you to make hard decisions either as an individual or as a couple. Only once you understand the process will you be in a position to take those decisions confidently.
Why choose surrogacy: one couple’s story
After being married 6 years, we decided on surrogacy as an option to have a baby. I was 34 and my husband was 36. We had no kids and I wanted to pursue gestational surrogacy sooner than my husband – I felt hopeful that this would work. A friend had already explored surrogacy. After researching the different agencies, they pursued gestational surrogacy successfully and had a 3-year-old from that journey. My husband was apprehensive about surrogacy and I knew we both had to be comfortable with all aspects of gestational surrogacy. We spent 1 more year doing research and I used the time to learn about gestational surrogacy, agencies, fees, statistics, figuring that this information would educate my husband so he could feel comfortable with it too.
Although we had info on many agencies we scheduled a consultation with the agency that our friend used based on their recommendation. My husband felt more comfortable after meeting everyone at the agency, including a surrogate that had worked with that agency before. For us, it was good knowing that the agency would handle a lot of the medical, legal, and financial aspects involved. We signed a contract that covered every imaginable detail and a trust fund was set up in which we would receive a monthly ledger detailing the gestational surrogacy expenses.
We told a few close friends that we were exploring the option of surrogacy. They had so many questions like whose eggs and sperm it would be? How do they do this? Why do the women want to do this? And how much do they get? We also told the prospective grandparents and I think they were concerned at first but once we explained how everything worked they felt positive about it.
Over the course of the next 6 months (6-8 months was the quoted wait), we received 2 profiles of women we chose not to go with because of their medical history. They try to match couples and surrogates on all aspects: personality, beliefs, lifestyle, hobbies, etc. We expected the surrogates would typically all be married and have at least 2 kids and no miscarriages but that was not the case. Some were young unmarried mothers with only 1 child and some had miscarriages. Most important to us was a very good medical and pregnancy history.
When a suitable profile came in – the 3rd profile was the charm – she was everything we had hoped for in a gestational surrogate. We met her, her husband and their five kids and instantly clicked! We went through the IVF process very quickly, in under 4 months. Then we learned we were pregnant with twins after the first transfer! It was definitely “whirlwind” but as you know our elation was short lived because our surrogate miscarried at 7 weeks! We were discouraged of course, but we carried on. We did another transfer as soon our amazing surrogate was ready and once again we were pregnant – this time with one! Our lovely daughter was born through surrogacy and we are now a family.
Who is surrogacy for
Surrogacy is increasingly more common, as there are many situations in which parents might choose to reproduce using surrogacy. Some candidates for surrogacy may be:
- No uterus – A woman may be biologically unable to conceive a child due to not having the biological capacity
- Carrying a child presents a health risk – For example a woman who takes medications that would be dangerous during pregnancy
- Age – A woman’s advanced age makes reproduction impossible or difficult
- Unable to carry to term – A woman who has miscarried multiple times
- No female partner – A gay couple or single male may want to have a biological child.
In the USA, a medical reason is not required to undergo surrogacy. So, although a woman may be biologically able to carry a pregnancy to term, that does not mean they cannot use surrogacy as a way to create their family.
Types of surrogacy
There are two types of surrogacy that we generally refer to. The first is known as traditional surrogacy. In essence, the surrogate mother is also the biological mother, who then relinquishes parental responsibility over to the intended parents. In a typical example of this, the traditional surrogate becomes pregnant through artificial insemination of the intended father’s sperm either through basic at-home insemination or at a clinic using intrauterine insemination. However, donor sperm can also be used for traditional surrogacy (either from a sperm bank or a willing friend). This method is the most affordable as it requires the least amount of specialised medical treatment. The baby will share their DNA with the surrogate and the sperm source, who is normally one of the intended parents. Traditional surrogacy is less invasive, less time-consuming, and for IPs less-expensive.
For perspective intended parents, choosing the traditional method means feeling comfortable with the knowledge that their child is genetically related to the surrogate. You must also be comfortable knowing that traditional surrogacy arrangements are not legally binding. The surrogate can change her mind about the arrangement you made together and decide that she wants to keep the baby after all. This is legally possible because she is the biological parent.
The second type of surrogacy that is most common is known as gestational surrogacy. With gestational surrogacy, the embryo is created via IVF using eggs that were provided by the intended mother or by an egg donor. The sperm that fertilises the egg is provided by the intended father or a sperm donor. Using this method ensures that the surrogate is not biologically related to the child, and she will not legally be able to claim the child as her own.
The gestational carrier receives the embryo in what is known as an embryo transfer procedure carried out in an IVF clinic. The biggest challenge for gestational surrogacy are the invasive screening procedures, hormone injections and medications, and overall extended length of the entire process. What this means for the intended parents is many additional costs and fees payable to the IVF clinic that aren’t necessary for traditional surrogacy. Although this method is more expensive, it is the preferred method as it gives the most peace of mind knowing that the arrangements that were made are all legally binding. A gestational surrogate cannot change her mind and decide to keep the baby – the law observes the intention to become parents, not the biological factors.
Aspects of surrogacy
Anyone looking into surrogacy to start their family has to understand the massive emotional, legal, financial, and medical demands. It is important to try to anticipate the more difficult stages of this journey, rather than just thinking about the nice aspects of it. Surrogacy can be very emotional for both the intended parent and the surrogate who is carrying the child. It is important to think about what impact this journey will have on the surrogate and her family. As well as your own expectations, do keep the surrogates expectations in mind. Understandably, there are emotional risks to everything in life. So here are the three ‘must-haves’ for every surrogacy journey.
Unless you are going for a traditional surrogacy, you will always need a fertility specialist (Reproductive Endocrinologist). The doctor who will look after you and your surrogate for all surrogacy related medical screenings and will take care of the embryo transfer. They will be caring for you all the while until a pregnancy is achieved. After that, your surrogate will see her own doctor for the remainder of the pregnancy.
Every surrogacy arrangement will require funds to be managed by a third party, a specialist escrow management company or individual. It works like having an administrator who ensures all the bills are paid on time. Using an escrow makes the process simpler for you, and serves as a guarantee to the other parties involved (surrogate and agency), that you are solvent to complete a journey. The management company will keep track of all the invoices and payments and ensure that everything is paid as per the contract. Gestational surrogacy is more expensive than traditional surrogacy and the financial implications should be considered carefully before deciding to undergo this journey. For some, finding out what their surrogacy journey is likely to cost can be like having the wind knocked out! In the US, many estimates place the cost of a journey in the range of $80,000 to $140,000. For many, it is not affordable without careful budgeting.
Finally and equally important is to have proper, professional legal representation. This is essential for every journey as it provides legal protection to all parties involved. You will be responsible for providing an attorney for your surrogate as well as for yourself. The ‘contract’ between you and the surrogate should cover every eventuality so that in the unforeseen circumstances of things not going according to plan, you have already stipulated your wishes with regards to what needs to be done. The surrogacy contract will detail all the critical issues involved in the process, like confidentiality, abortion/selective reduction issues, medical/psychological screening, parental rights, contact, and compensation are all part of the contract. In the case of international surrogacy arrangements, it is necessary for the intended parent to take legal counsel in the country of residence as well as the country where the surrogacy will take place.
Importance of having a strong support network
Having a strong support network is important because of the demanding issues that arise during a surrogacy journey. There will be ups and downs, good times and bad, so it is important that you keep people close who can support you along the way. Family and friends are an excellent support to help you through times of crisis or difficulty. They will also be there to cheer you on. Support can mean different things to different people. Emotional support refers to the actions which make us feel cared for or loved. Practical support refers actions or things like someone just helping out with chores. Informational support is what you will find on our site and in our Surrogacy Community.
A strong support network can help you reduce stress and stay positive. Online social networks like our Facebook Group and other forums are also a fantastic way find mutual support. Their thoughts or advice may come in handy.
Surrogacy is controversial as it is often talked about in the media in negative terms. It is not uncommon for parents via surrogacy to experience some disapproval or anger for their participation in surrogacy. You can expect questions like; why didn’t you just adopt?
Remember that some people will not understand surrogacy, and will make you aware of their opinions. You can decide ahead of time what you will say to those friends, co-workers, and even family members who might not be as supportive as you hope. Be aware and prepare for mean, rude or impolite comments from people.
The better you understand how surrogacy works, then you are more prepared to answer these types of personal questions. You may also consider finding a support group or other people who have been through the same experience – for example, our Facebook Group, where you can share your experience and speak to others who are going through the same thing.
Budgeting for your journey is the best type of planning you can do. You should not expect to have to fork out all the money at once, but you won’t really be paying out in monthly installments either. Instead, most surrogacy journeys require you to pay for each section of the journey in stages. You might start by sorting out the egg donation cycle or fund an escrow account for the surrogate’s compensation. Be sure to request estimates from a few different agencies. Compare between agencies and look at their fees and success rates.
Start thinking about where you will find the money for this. Can you borrow from family? Do you have savings you can use? Will you be able to sell some of your assets? Or is taking out a loan a possibility?
2. Journey Planning
Start at the end
‘If you don’t know where you’re going, you probably won’t get there.’
A really good piece of advice to anyone in the stages of planning, and that means planning for anything from a DIY project to a long term life changing journey like surrogacy, is to start by thinking about how you want it to end. If we start by having the clarity that comes with knowing the end goal, everything else becomes easier. Often people can become stuck on small details along the journey, not knowing where to go next. Taking a step back and looking at the end goal can often make those details come into focus. Keep in mind that having the end goal in mind will guide you along the journey and help you make those big decisions.
So the first thing to start creating our ideal journey is to determine the vision for what you’d like your journey to be. How big do you want your family to grow? Will you be going through multiple surrogacy journeys? Do you prefer to try for twins or singletons? At the end, what will the surrogacy journey mean for you as an individual? For you as a couple? For your future child/children? For your future extended network of surrogates and donors?
Talking about your vision with your partner or those nearest to you will help you plan every other step of the journey. Remember, this is your ideal journey you are planning here, so allow yourself to dream big! Once you know exactly where you want to be, you can begin to lay the pieces of the puzzle together.
Ideal gamete donor and surrogate profile
Building your family via surrogacy most often involves donor genetic material, either in the form of donor eggs or sperm and occasionally both. Genes carry information that determines how the baby will inherit the parent’s traits, and actually, genes carry information going back through the generations. Some inherited traits can be seen, like the color of the hair and eyes, while others can’t, such as blood type. Research shows that a person’s traits are a combination of the genes passed on by their biological parents and their surroundings and environment during their upbringing. For example, a person’s height is determined by both their genes but also by their nutrition growing up.
Make it something you discuss and think about… A good starting point is to think about the people in your life and what characteristics in them you admire. Are their physical characteristics like height, hair color, and health/medical history the first thing that pops into your mind? Or is it something less tangible that defines them in your mind?
Similarly, start to think about what the ideal surrogate looks like in your mind. Although the surrogate will not affect your baby in such a lifelong way as the gamete donor, it is more likely that you develop a relationship beyond the 9 months of gestation with the surrogate.
Desired relationship with gamete donor and surrogate
The relationships between surrogates and surrogacy families vary depending on each situation. Many times the relationship becomes life-long, and many surrogates go on to help couples have a sibling. These relationships require excellent communication from both sides. Trust is also an important factor, as things can become complicated and nerves can be tested. During a surrogate pregnancy, the surrogate has to insist on healthy boundaries and to maintain her own right to just carry on living her life and attending her family.
Other relationships can be purely transactional. They will also maintain a good relationship during the journey, but may both decide not continue with communication after the fact. Even during the pregnancy, they may want communications to be kept to a minimum.
Know the kind of relationship you want to have, and find someone who wants the same thing. You will be able to agree on a routine for updates throughout the pregnancy, which is a good way to maintain a positive and healthy communication open. It also helps to set some boundaries in the relationship.
Building your team
There will be a lot more people involved in the birth of a baby born through surrogacy than through traditional gestation. You will be required to choose to work with some people and not others, but how do you choose when you have so many options. The best advice is to do your research and make your selection based on what your instinct tells you. Your team is going to be there to advise and support you, so make sure they are people you feel that you can trust.
Agency or independent
Surrogacy agencies operate as project managers for your surrogacy journey. They can help intended parents with a lot of the logistical elements of a journey. They can help to choose a surrogate, a gamete donor, and an IVF clinic. It really depends on each agency, as they all offer similar services. It is good to keep in mind that surrogacy agencies are self-regulated, so reading other clients reviews is a good idea. Each agency is different; if you decide to go the agency route, you should do extensive research and compare costs versus services offered. Our surrogacy agency directory might be of help finding an agency that suits your needs.
The agency can usually look after things like facilitating matching, coordinate attorneys for contracts, pre-screening surrogates and help arrange clinic appointments. All of these things are there to help the IPs save time and make the journey easier for them.
In an independent journey, on the other hand, intended parents and surrogates must plan every step of the journey themselves. However, this does not mean that you do it all yourself either. You will always require the services of medical professionals and legal experts. You will have the additional work of coordinating meetings and contact between the various people involved, which is something that the agencies normally look after.
Going independent means matching with a surrogacy on your own terms. Some websites, such as Surrogate Mothers Online, have classified ads where both surrogates and IPs can outline the type of person they’re looking for and the type of journey they want to have. Both parties have complete freedom from start to finish in learning about each other and there is a greater sense of control over what happens through the process.
Which is better – indy or agency? The answer to this question is another question: which is better for you? Your choice is about personal preference and sometimes influenced by your financial situation. Many people who are doing this for the first time will feel more comfortable with agencies. Those with less money than time might prefer going indy.
So your financial circumstances could be the deciding factor here. If you are unable or unwilling to pay the agency fees, you may find a surrogate on your own. Many IP’s and surrogates have made successful surrogacy journeys without the aid of an agency. Sometimes the surrogate could even be a friend or relative.
Choosing an agency
If you decide to seek the help of an agency, make sure to do some thorough research so you can make an informed decision. As an IP, you need to get detailed information on any agency you are considering using. You should check if they are listed in our directory and what the reviews say about them. The location is important, however, agencies can be located in any state and generally work with surrogates located in any state that permits surrogacy. For example, if you know you want to find a surrogate in California, that doesn’t mean that your agency must be in that state also.
Consider how long the agency has been in business. Have they built a good reputation in that time? Most agencies will be happy to arrange a consultation with you and they will even refer you to previous clients so you can ask about how the agency worked for them. Find out how many clients they served and whether you will have a dedicated case manager or not. Ask how many cases each case manager handles. Ask them about the size of their team and the qualifications they hold, if any.
When deciding on your agency, you can always ask directly in our Facebook community if anyone else has experienced the agency. Personal feedback is important. It’s easy to be misled so be alert and look for red flags. If it seems too good to be true, it probably is. Ask all your questions and expect straightforward answers.
The surrogacy agency is going to be your sidekick, your project manager – there to organise and coordinate, making sure nothing gets missed. It is in their interest to ensure that precautions are taken to protect all parties involved. Many offer legal consultations included in their fees from a staff attorney. Most agencies make it a point to check that the surrogate has suitable insurance in place (although you will be responsible for paying for it). Many agencies offer to counsel and they always have to make sure that any surrogate you match with has passed a professional psychological screening. You can find out if surrogates are physically and psychologically screened before acceptance by the agency or if that comes after matching with IPs.
The agency will also make sure that any surrogates that you are matched with are complying with all necessary legal requirements – some agencies screen the surrogates before they become available to match. When choosing which agency you want to work with, think about the level of service they offer and whether it is enough for your personal needs. In general, the agency’s fees depend on how much involvement they will have in your surrogacy journey. Ask your potential agencies for their fee schedule as quickly as possible during the initial consultation. Some agencies publish it on their websites. Agencies often give general answers when discussing cost. Specific fees can really vary depending on individual situations.
Choosing an IVF clinic
One of the most important aspects of surrogacy is the medical side of your journey. Your IVF doctor, a reproductive endocrinologist, is going to play a key role in your team. You should find out about your doctor’s training and experience. A good starting point is our IVF clinic directory where you can find reviews about any IVF clinic. The location is important, however, in surrogacy arrangements, it is common for the surrogate to travel out of state, and even internationally, for IVF treatment. Therefore your IVF clinic can be located in any state that permits surrogacy. For example, if you know you want to find a surrogate in California, that doesn’t mean that your IVF clinic cannot be located somewhere else.
What really helps in deciding is to research and find out about the teams working at the particular clinics. Many IVF clinics offer the same or similar services for the most common procedures related to IVF; for example, ICSI or embryo cryopreservation. You could find out if they do that in-house or if they outsource it. If you require a particular procedure, such as sperm washing (for HIV-positive IPs), that will leave you with a shortlist of clinics that offer that procedure. It is also generally recommended to check your potential clinic’s SART statistics – that is the Society for Assisted Reproductive Technology. You can compare their program’s SART results with the results of other programs and with the SART national averages.
For most IPs, the statistics are not the most important part of the decision-making process. A clinic’s pregnancy rate over the past year for all embryo transfers performed, and pregnancy rate for cases with IPs situations similar to yours are probably more important. You must also be sure whether they are giving you initial pregnancy rates or live birth rates.
Make sure to probe about how much the treatment will cost. If they say that “IVF costs $9000”, make sure that you know exactly what this covers and what additional costs you will need to cover. For example, medications are not generally included in the price for an IVF cycle. Some of the common points to consider:
- Doctor’s fees
- All ultrasound and blood monitoring
- All facility fees
- All anesthesia-related fees
Always request a copy of their fee schedule for IVF services and probe until you get satisfactory answers to all of your questions.
The IVF clinic is a very important part of your journey, think about how they will fit into your team. Although you will initially be consulting with the doctor, it is his team that you will deal with once you decide to work with them. Find out if there will be a single point of contact throughout, or if you will be dealing with different nurses or coordinators throughout the journey.
Choosing your gamete (egg or sperm) donor
Choosing a gamete donor is probably one of the most important things about building your family via gestational surrogacy. With surrogacy, the most general form of gamete donation is whereby the IPs require an egg donor and supply the sperm from one or both of the IPs. The intended parent or couple have to accept that the egg donor is going to be a part of your child’s biology, their DNA. So much of what makes us who we are is based on our genes – but what makes us a family is not. The donor is aware that she is the genetic mother, but that doesn’t make her ‘a mother’. Heterosexual IPs, whereby the female partner cannot carry a child, usually will require an egg donor and surrogate. While male intended parent couples, the use of an egg donor is unavoidable.
Many intended parents choose their egg donor based on their own background, looking for someone who shares a cultural or religious bond. You may decide to choose an egg donor based on their physical characteristics, like hair and eye colour, height, etc. Some intended parents are looking for someone with musical or artistic abilities. Others prioritise education and intelligence. It is up to you to decide – after all this will play an important part of your child’s development.
Just as there are criteria that must be met to become an egg donor, surrogates must also pass certain requirements. Outside of those basic requirements, you must make up your mind about what constitutes the ideal surrogate for your personal journey. It is personal so, like these guys, do what feels right for you.
Your ideal donor will be different to anyone else’s idea of ideal. You should be able to find out whether your donor is an artist, athlete, musician, or science geek by reading profiles. Most agencies or databases provide such information. Think about it as if you were to read this information to your future child. Most matching services provide childhood pictures of the donor as well as info about their background and what their childhood was like. Hopefully, this information will help make your ultimate decision that much easier.
Even if you want the donor to remain anonymous, spare a thought for your future child who may want to know more about their biological ancestry. One small thing you can factor into your agreement with the donor is that both of you will register for the Donor Sibling Registry. This registry acts like an in-between for all communications between the donor and the recipient. Communications are anonymous, as you simply exchange screen names. If your kids want to connect with the donor at any point in the future, they can do so via the registry in a safe and private way.
Choosing your surrogate
There are lots of factors to consider when choosing your surrogate. One of the most important things is to look at the surrogates motivation for becoming a surrogate. The financial benefits to the surrogate and their family is an obvious one. However, money alone is not a good reason for a woman to enter into a surrogacy arrangement. If that is the only motivation, it should ring alarm bells. Carrying a pregnancy, a child within you, for the term and then handing the baby to its parents is not easy. If the surrogate has a sense of altruism, a desire to help others, then she is a good candidate. Altruism is essential for a good surrogacy journey. A surrogate who is mostly motivated by money is at risk of experiencing psychological and emotional pain.
You willl need to think about what this ideal person should be like. Considering the following points will help you to get started:
- What kind of person do you want to go on this journey with?
- What kind of lifestyle does she live?
- What is her family situation and background?
- Is she married or living as a single parent?
Know where you stand (you as a single IP or as a couple) on issues like abortion, selective reduction, fees and expenses, and the amount of contact the surrogate will have with your child, and look for someone with a similar outlook. Matching with someone who naturally shares your vision for the journey is key.
Choose a surrogate who inspires a sense of trust. Someone you can build an open and consistent relationship with strong communication. Experienced surrogates are more expensive than first-time surrogates, but the fact that they have been through it before can serve as an indication that they are trustworthy.
There are guidelines by the American Society for Reproductive Medicine (ASRM), which is the leader for information, education, advocacy and standards in the field of reproductive medicine, about who can become a surrogate. IVF and surrogacy professionals consider their recommendations as best practice and will not work with surrogates who do not meet the criteria set forth. These guidelines are followed by IVF and fertility clinics, but clinics and agencies may have additional requirements not outlined here.
- Between the ages of 21 and 42 years old
- In good physical and emotional health
- Non-smoker and non-drug user
- Healthy weight and BMI
- Previously given birth to at least one living child
- A parent to your their own children
- Previous pregnancies have been healthy and without complications
The location is also important, as each state has their own law regarding each aspect of surrogacy. Most surrogacy agencies will only work with surrogates who live in states that are considered ‘surrogacy friendly’, so you won’t have to think too much about that unless you are planning your journey independently.
Give enough thought to the issue of control during the pregnancy, as this can later cause conflict to your relationship. As the IPs, you are responsible for the decisions that affect your future baby’s life, but you will have to accept that the surrogate naturally has control over the pregnancy. Since the baby is growing in her body, she is directly responsible for doing everything required to ensure a healthy baby at the end of the pregnancy. However, even if she does everything according to the best advice of doctors, there is no guarantee of a ‘perfect baby’ in the end. Trying to take control over the pregnancy could cause the surrogate mother unnecessary stress.
Choosing a surrogate for your child might not be the single most important decision you will ever make but it will affect your whole surrogacy journey. Think about your ideal scenario, set your standards, and be patient and wait for your perfect match.
3. On with your journey
Contracts are indispensable to any surrogacy arrangement, regardless if you are using an agency or planning the journey independently, the contracts will provide you with the legal framework for you to properly claim your future baby as your own.
You will be signing a lot of contracts during your surrogacy journey. You will need to complete a contract between you and the agency (if you use one). That is handled by the agency and is usually a straightforward agreement that doesn’t always require an attorney. Your IVF clinic will also ask you to sign a contract with them, again this is another contract that you do not always require legal assistance to complete. There are two contracts you may need, depending on your individual situation, an attorney to draft; the first between you and your egg donor and the second between you and your surrogate. Laws vary by each state, so you must have representation in the state where your surrogacy is taking place.
Select an attorney who is familiar with surrogacy and family law in all the states involved, if your situation crosses into multiple states. For example, if your IVF clinic and your surrogate are located in different states.
Even if your surrogate is a friend who is willing to be a surrogate, you should always have a professionally drafted contract signed by all parties involved. You are responsible for all legal costs associated with the journey, for you and your surrogate. The agency will usually provide contacts to suitable attorneys for you and the surrogate. Once you are in contact with your attorney, they will get in touch with the surrogates’ attorney to begin negotiation of the precise terms and conditions expressed in the contract.
Sometimes intended parents may think that to reduce costs, they could do the legal aspects of the surrogacy process themselves. In general, it’s better to have legal representation throughout your surrogacy process, both for your own protection and peace of mind. When someone attempts to draft their own contract or use a contract they found on the internet, they could end up with an incomplete contract that leaves out important elements. Such a contract could be very harmful to everyone involved if any issues arise. Surrogacy contracts that do not meet the required safeguards and protections before a court can be deemed unenforceable.
The courts often want to see certain language used in the contract to grant parental rights to the intended parents. The courts turn to the surrogacy contract to determine what should be the right thing to do if a case does become contested. So it is very important that you take proper legal counsel to protect ourselves during the surrogacy process.
Legal advice at home and abroad
The United States is widely considered as the best country for surrogacy due to the favorable laws, the excellent medical care available, and how well accepted surrogacy is in society. As stated before, the legal aspect is essential for you in the location where the birth will happen. It is also strongly recommended that you take legal advice back home. You will need to know exactly what the process is to bring your future baby home with you. Leaving the US with your baby won’t be an issue, as children born in the US are automatically US citizens and will be granted a US passport soon after birth, usually within 2-3 weeks.
You should seek out legal advice on your own surrogacy journey, to ensure that traveling home with your family, getting entry clearance and sorting out citizenship before they become issues. In general, you should be keeping an up to date file about your journey throughout the process that can be used later on if you needed to go to court to prove anything regarding your parentage journey. The local legal team is there to make sure your family gets through the process with the absolute legal rights you deserve.
For example, in the UK surrogacy is legal but the law does not recognize surrogacy contracts as a binding. So there is no pre-birth order as there is in the US. The American birth certificate can be used to apply for a British parental order after the birth. The parental order then legally declares you as the parent. It gives you full and permanent rights over the child and recognizes that the surrogate mother relinquishes all rights.
Healthcare insurance in the US is different than in other parts of the world. With the exceptions of Medicare and Medicaid, health insurance is provided by private companies. It can get pretty confusing for anyone who isn’t familiar with it. Health insurance is often provided by a person’s employer, and many times they cover the cost of maternity even in cases of surrogacy. It is important for you or your agency to read your surrogate’s health insurance policy to verify that there are no exclusions for gestational surrogacy. You may even choose to request written confirmation from the insurance provider that maternity expenses related to a surrogacy are covered. So it is important to consult with the knowledgeable attorney or a qualified insurance broker specializing in insurance for reproductive medicine to review the surrogate’s plan.
As intended parents, you will usually be expected to cover the cost of the surrogate’s insurance from the time you match, until the birth of your child, and an additional 3 months after the birth. These are additional costs you should budget for. In addition to that, you must also provide cover for the newborn baby. As an international IP, you may find that travel insurance with the family cover may be able to cover your baby’s expenses.
As someone who has never gone through a pregnancy, you may ask yourself if this insurance is necessary. A surrogacy arrangement via an agency always includes insurance, this is done to protect both the surrogate and the intended parents.
Retrieval and transfer
Using IVF means the gametes will be fertilized in vitro (that means in a petri dish by the will of your doctor or embryologist). There are many variables that come into play and one of the most common questions is around fresh versus frozen. Put simply, eggs don’t really like being frozen and defrosted. On the other hand, sperm does just fine in the cryopreservation process. However, when it comes to embryos there are strong views on both sides of the argument.
In recent times, there have been massive improvements in frozen embryo pregnancy rates, and today many IVF clinics actually recommend frozen over fresh transfers. Clinics utilize a method called ultra-rapid embryo cryopreservation (or vitrification), which freezes the embryo really quickly – thousands of times faster than with the previous method. The old freezing method resulted in low embryo survival rates after ‘defrosting’. And the process hurt the chances that the embryo would implant. In contrast, the newer vitrification method resulted in greater embryo survival. With this method, the embryos are basically unaffected by the freezing-thawing process. Not only that, there is actually an opinion that those embryos that do not survive the defrosting process would probably not have implanted.
In the past, it was more common to freeze embryos after 2-3 days, and today, most clinics will grow the embryos to the blastocysts stage at 5-6 days instead. If the embryo makes it to day 5-6, it already has a greater chance of implantation. And finally, using preimplantation genetic screening (PGS) methods and next generation gene sequencing (NGS) means the clinic can identify the best embryos that have the best possibility of implantation and pregnancy. Ultimately, discuss this with your doctor and your partner, and keep an open mind and ask all the question you may have until you are satisfied that you are making the best decision.
Once all the contracts have been signed, and you have funded your escrow, the doctor can set a transfer date. This is the date when the embryo will be placed in the surrogate’s uterus and you will cross your fingers and hope that it will result in a pregnancy. Medications and science can only go so far, and nature and perhaps luck also have to play their part. When it is a frozen embryo transfer (FET), it is much easier for everyone to plan around it. The surrogate will have medications and hormones to prepare her body for that date set by the doctor. With a fresh transfer, both the egg donor and surrogate have to prepare their bodies with medications at the same time and synchronize their cycles.
To complicate it further, you could opt for a natural cycle embryo transfer, which requires no medications for the surrogate, but everyone must work around her cycle to get the transfer in at just the right time. Coordinating everything around these dates can be done by your agency case manager working with the clinics’ case manager.
4. During the pregnancy
The first trimester
Once the transfer is done your surrogate will have to continue her hormone supplements and will soon have a pregnancy test. The first trimester can be an exciting time as well as an anxious one. During the first trimester, the chance of a miscarriage is at the highest level which is over 20%. The news of your pregnancy are sure to delight you, but bear in mind that anything can still happen!
The first pregnancy test will come just two weeks after transfer, followed by at least one more blood test 48 hours later. An ultrasound can be scheduled to be really sure. Also, seeing the results of an ultrasound scan that shows everything is fine is very reassuring for everyone involved. Typically, the surrogate will take hormones three times a day for the first 12 weeks after transfer. This time can be an emotional roller coaster. The surrogate’s support network is especially important at this time of the journey, as she will be experiencing some drastic mood swings.
Even though you have confirmed a pregnancy, you may not want to start sharing the news just yet. The doctor will be monitoring the surrogate closely during this time. They are looking for increases in the level of certain hormones, like oestrogen and progesterone. All going well without complications, your fertility doctor will release your surrogate to her obstetrician for continued care.
The second trimester is from weeks 14 to 26. Everyone is going to feel more relaxed once you make it to the second trimester as the rate of miscarriage drops dramatically. During these weeks, your surrogates belly will start to show and you will be able to hear the baby’s heartbeat. From about 20 weeks onwards, your surrogate will start feeling the baby move.
During the third trimester, you can start planning all the important things to prepare for your baby’s arrival. If you are an international intended parent, you can start making your travel arrangements. Some intended parent like to take a tour of the hospital with their surrogate to clearly plan how the day will go.
Delivery and birth plan
Your birth experience will be unique and special for you. One Redditor described it like this:
Labor lasted for 54 hours. After a little extra drugs, some body positioning and a really awesome midwife, and out my son came. It was awesome, and bonding and wonderful and exhausting. And then 30 seconds afterwards, the afterbirth, which landed with a squishy meaty schloping PLOP into the stainless steel bucket that was set right below her specifically to catch this alien-esque blob of meat, blood and nightmare fuel.
And user ‘Allcaps’ described it like this:
She was pushing for (what seemed like) the longest 2 hours, and it was completely nerve-racking. I absolutely hated seeing her screaming in pain, but I remember thinking to myself, “There’s literally nothing I can do for her right now, other than be positive.” As soon as my son was out, I cut his umbilical cord. I really can’t describe how beautiful of a moment it is when you see your child for the first time. It was the proudest moment of my life, hands down.
If you are going to be present or not, still do take some time to speak to your surrogate and note the important aspects you both want to happen during the delivery. Having a written ‘birth plan’ is a great way of reducing stress during labour. We all want a smooth and complication-free birth, so having some of the decisions already planned can help with that. A comprehensive birth plan includes lots of information, you can make it as detailed as you like. Life is unpredictable and labour can be an intense experience that requires decisions on the spot. Start making your plans well before the due date, you can ask the agency or hospital for more guidance on this.
The birth plan is especially crucial in surrogacy because your hospital (or birthing centre) might not have previous experience with a situation like yours. You want your birth to be special and free from trivial complications. Some of the things to include in your plan are:
- Where the birth will take place
- Who can be allowed into the room
- Will labour be induced or natural
- Will meds be allowed
- Who will cut the umbilical cord
- Who will hold the baby first
- Will the surrogate pump breast milk
- Are pictures and video allowed
- Clarity on who the parents are
- How the parent’s names will appear on the birth certificate
- Who to ask in regards to decisions regarding the baby’s health
The birth plan requires that you discuss and agree all these points with your surrogate. Your agency should be there to provide support and advice with this. It is normal for a birth plan to indicate who is the responsible decision maker; the surrogate for all medical decisions regarding her own health during labour and delivery, and the IPs for medical decisions about the baby during and after labour.
While some intended parents want to be involved during the birth, it is an individual choice and there is no ‘best way’. It all depends on you and your situation. Certainly, something that should be discussed with your partner and surrogate to achieve the best result for all of you!
Communicating with your surrogate
Your surrogate will be one of the most important people in your life during the journey. Keeping a positive and healthy relationship with her should be one of your priorities. In this section, we’re going to be focusing specifically on the communication between you and your surrogate. Communication is the key to all healthy relationships, and it can get awkward in surrogacy situations. For example, you may find that talking about the amount and frequency of your communications doesn’t seem to come naturally – however, this is one aspect that you could discuss directly and agree with your surrogate.
Whatever you agree at the contract stage, you may find that once you arrive at the pregnancy your feelings have changed. You may consider adding something in your contracts regarding this aspect; for example, to say that you will receive a weekly update is reasonable, but you could state that frequency of updates will be agreed by all parties at certain intervals. Find the balance for your relationship, fulfilling your wishes to be informed and also respecting your surrogate’s privacy. You may choose to add each other on messaging apps or you may prefer to communicate via video calls only. Alternatively, you may wish to place a limit on a number of messages you can send each other.
It will be a challenge to establish such a close and personal relationship in a very short period of time. You will need to show courage and empathy toward your surrogate. Courage to take that personal risk and show the willingness to engage on a broad range of topics. You will have to step outside of your comfort zone and consider things from her perspective or viewpoint. The first time going through a surrogacy journey will present you with situations that will be unfamiliar and even uncomfortable, situations where you feel that you are not in your control, or that make you feel vulnerable.
If you think about how you communicate and really connect in a positive way it will help to build trust with your surrogate. Taking the other person’s perspective helps you to communicate better. The relationship with your surrogate is about contributing to their well-being, which not only benefits her but your baby too. Sharing your personal beliefs and personal stories also take courage, but it can really pay off in developing a strong relationship with your surrogate.
Good communication can solve a lot of the problems in surrogacy relationships, but empathy is needed from both parties. As IPs, you might be anxious about the pregnancy, and that feeling comes from a place of concern for the future baby. The surrogate who empathizes with that and does her part to keep you updated on the pregnancy will contribute to a stronger relationship. Patience is needed from both sides.
As intended parents, you also have to acknowledge the right of the surrogate to have a life beyond your pregnancy. That includes her right to privacy. By agreeing to the frequency of your updates and communications from the beginning, you will be setting the boundaries for that respect. The best for you is to be aware of the benefits from proper planning in the very beginning of your relationship so you can mitigate the potential problems that could arise due to poor communication.
Your communication plan can be simple, it doesn’t require many guidelines. In fact, showing flexibility will help to cultivate a robust relationship. This process is full of potential unexpected twists and turns, and each journey is unique.
5. Baby’s arrival – the home stretch
Birth certificates and passport
During a typical pregnancy, the law recognizes the woman who gives birth as the mother legally and biologically. If you have entered into a surrogacy agreement, you must know the steps to take to have the birth certificate issued to reflect your parental status.
There are states where the IPs status is recognized before the birth and states where it is done after. Either will require a legal document to be issued by court assigning parentage to the child. The law depends on the state in which your surrogate delivers the baby.
In states where the pre-birth order is issued, your parentage will be protected before the child is born. With the court order made available to the hospital, they will already be aware that the intended parents are the child’s legal parents and they will be required to list the intended parents on the child’s birth certificate. There will be no confusion as to who the baby should be discharged to from the hospital.
In states where a post-birth order is the only option, the intended parents may be required attend court after the birth. These hearings are a formality and as all your contracts are in place to demonstrate that the surrogate is helping you to create your family. The benefit of a pre-birth order is that once the baby arrives, you can just focus on family.
During the court hearing in either pre or post birth states, you will basically convince the court that you are the biological or intended parent of the baby through a surrogate. The courts have particular rules about the language so as previously mentioned always employ the services of a qualified fertility lawyer. You can go to court on your own if you feel confident with the process, however, a lawyer with experience will make the process far simpler. For births in California, you should allow about 6-8 weeks after the birth before requesting your child’s birth certificate, but it can be expedited.
For international IPs having a baby through surrogacy in the US, you must also consider immigration implications and be sure of a way to take the baby home. Most IPs use the child’s birth certificate and apply for a US passport for your child, which is issued very quickly. Always consult with an immigration lawyer in your home country to understand the legal position if you travel back with your child’s US documentation.
As an example, if you live in the UK, traveling back with the child’s US passport is generally fine. The intended parents must apply for a Parental Order within six months of the child’s birth and as long as one of the IPs is genetically related to the child. The birth mother must give written consent, the IPs must make a court appearance to be given full rights over the child. A birth certificate with the IPs names named as the legal parents will then be issued. You are no longer intended parents, just parents.
Second parent adoption
In surrogacy arrangements, especially for same-sex couples, it’s common that only one of the IPs will be biologically related to the child, having used an egg (or sperm), donor. Parental rights, or being recognized as the legal parent, are automatically present for the parent who has a biological connection. The partner of the biological parent, either through marriage or civil partnership, has their parentage rights by virtue of their relationship to the first parent. Where same-sex marriage is not recognized, the second parent may find themselves at a disadvantage, as they are not legally a ‘parent’ to their own child. The second-parent adoption process is there to legally grant a ‘second parent’ alongside the first, or biological parent, parental rights for the child. So, through this process, your child will have two legal parents.
The genetically unrelated intended parent will have to complete this second-parent adoption process. It is not a complicated process and the requirements are different to a full adoption.
State laws vary so always consult with your family attorney.
Although most pregnancies go smoothly, sometimes there are complications. Surrogacy pregnancies and births are no different to any ‘traditional’ pregnancy. The number of IPs who choose single embryo transfer, thus reducing the probability of a multiples pregnancy, is increasing. Some complications are more frequent during a pregnancy with two or more embryos. Less serious and more common complications are always a risk. Any pregnancy and birth can have complications. For one Redditor named ‘boolean’, the complications during the birth of his baby became life threatening:
When people ask about how the birth of my son went, I have to offer them a warning. It was a rather strenuous birth for her and they both nearly died in the process. Truth be told, a great deal of it is hard to remember. Labour lasted for nearly 32 hours before the OB made the call for an emergency c-section. The baby had gotten stuck, and complications had caused a great deal of internal bleeding. They had me put on a surgical gown and mask so I could be in there with them. I never really saw what went on behind the surgical curtain. I was scared to death for both their safety. A team of surgeons worked diligently to repair the damage and get my kid out safely. It was almost too much to process at the time, I’m not entirely sure how I managed to keep it together. In the end, everything turned out OK. I knew I was going to be able to go home with my baby.
These are some of the most common complications:
Bleeding is a common complication during pregnancy. It may be caused by a hematoma. That is when there is an accumulation of blood within the folds of the outer fetal membrane, or between the uterus and the placenta itself. This affects about a 1 in 4 women who become pregnant via IVF. The surrogates’ doctor will perform an ultrasound to check on the baby/babies and the size of the pocket of blood (the hematoma).
An ideal birth happens when the baby is born head-first. The baby should usually get into that position on its own weeks before the delivery date. Sometimes the baby doesn’t get into the right position, and they remain the wrong way around, with feet and bottom first. This is called a ‘breech presentation’.
Weeks before the due date, it is necessary to find out the baby’s position. This is usually done by feeling the baby bump. If there is any suspicion that it might be the case, they will perform an ultrasound for confirmation. The doctor will try to turn the baby around into the correct position.
Keeping in touch
The surrogacy journey has been described as an emotional rollercoaster. During that time, you may have come to develop a bond with your surrogate. There are many stories online about people who become parents via surrogacy and how they created ‘extended families’ along the way. Your relationship with your surrogate will be unique and yours alone. Like we mentioned earlier in this post, you should start by thinking about the relationship you envisage going forward. Those ideas may change along the way, but it is all down to you. Whether you decide to send each other yearly updates, pictures or letters, or you include each other on social media. Technology is a great tool for communication, so use it. Some people even take holidays together with their surrogate family.
So what is surrogacy for you? Is it stress and anxiety or large amounts of money? Is it the desire to have a family? Your surrogacy journey is your own, make it amazing!