Surrogacy & Gestational Carriers

Surrogacy & gestational carriers overview

  • In fertility medicine, a surrogate is a woman who carries a pregnancy for another individual or couple.
  • A traditional surrogate carries the pregnancy using her own egg that is fertilized with the sperm of the intended father.
  • A gestational carrier (GC) is a woman who carries a pregnancy using the egg and sperm of the intended parents, which are implanted into the GC after in vitro fertilization (IVF).
  • Gestational carriers are nearly always preferred in order to minimize genetic relation of the child to the surrogate; if the intended mother’s eggs are not viable, a donor’s eggs may be used.
  • A surrogate is typically compensated for her effort, time and expenses.

What is surrogacy?

There are two different types of surrogacy: Traditional surrogacy and gestational carrier surrogacy. A traditional surrogate is impregnated by the sperm of the intended father, either through intrauterine insemination (IUI) or IVF. The child born by a traditional surrogate has the surrogate mother’s genes and not the genes of the intended mother.

With a gestational carrier (GC), pregnancy is achieved by implanting the fertilized embryo created in IVF using the intended mother’s egg and the intended father’s sperm. With a GC, the intended parents are both genetically related to their child born by the surrogate.

Because of this genetic relation, most couples seeking surrogates choose a gestational carrier over a traditional surrogate. If the intended mother’s eggs cannot be used (for health or genetic reasons), the intended parents may choose to use a donor egg so that the gestational carrier is not genetically related to the child.

Surrogates are often compensated for their time, effort and living expenses incurred during pregnancy. Commercial surrogacy involves paying a surrogate a base rate in addition to paying for all medical expenses. This amount can range from $20,000-$40,000 depending on the experience of the surrogate, medical needs and the fertility center.

Altruistic surrogacy involves reimbursing the surrogate only for her expenses during the pregnancy. Expenses typically include medical bills, clothes, food and rent.

Who should use a surrogate?

Surrogacy is recommended for women who have functioning ovaries but may have a medical condition that makes carrying a pregnancy very difficult or impossible. Common medical conditions of women seeking surrogates are the absence of a uterus, recurring miscarriages, uterine abnormalities or a medical condition that could put both mother and baby at risk.

If donor eggs must be used and the intended mother cannot carry a pregnancy, then a couple may decide to use a gestational carrier so that the child is genetically related to the intended father.

Gay partners may also choose to use a surrogate in order to have a child that is genetically related to one of the partners.

How should you choose a surrogate?

Surrogates can be a person with a relationship to the intended parent(s), such as a close family member or friend. The surrogate may also be located through an agency or through the fertility clinic.

The criteria for choosing a surrogate include:

  • The woman is between the ages of 21 and 41
  • Has had at least one uncomplicated pregnancy and live birth
  • Has a positive outlook about being pregnant and is in an environment supportive of a surrogate pregnancy
  • Is of a reasonable weight and displays healthy personal habits (non-smoker, non-drug user, healthy diet and regular exercise).

What is involved in the surrogate process?

Once a surrogate is chosen, she undergoes thorough health screenings and tests to ensure that she is healthy. This workup includes:

  • Health questionnaire
  • Review of medical records
  • Physical examination
  • Blood work
  • Infectious disease testing
  • Transvaginal ultrasound to assess reproductive health
  • Psychological counseling.

After the surrogate, either traditional or gestational carrier, is chosen, all parties involved must consent to the arrangement. This typically involves legal contracts specifying terms of the surrogate arrangement, payment for the arrangement and rights and responsibilities of the intended parents and the surrogate.

It is important to detail expectations, such as amount of contact between parties throughout the pregnancy and what type of diet the surrogate should have. These details are often overlooked and tend to cause conflict between the surrogate and the intended parents.

Preparing for pregnancy

Once all contract agreements are reached, the steps for achieving pregnancy are similar to the steps of the egg donation process. The surrogate and intended mother will be placed on medications to coordinate their menstrual cycles. This process could take a few weeks to two months.

Once the two women’s cycles are in sync, the intended mother will be stimulated for egg retrieval. When the intended mother has mature eggs available, egg retrieval will be performed.

The eggs retrieved from the intended mother are fertilized with the intended father’s sperm in the laboratory. Fertilized embryos develop in the lab for three to five days prior to implantation in the surrogate.

Once the best embryo is chosen, it is placed directly into the surrogate’s uterus. A simple blood test about nine days after the procedure will either confirm or deny pregnancy.

Once pregnant, the surrogate will be monitored until about the eighth week of pregnancy. Then her care will be transferred to her Ob/Gyn. She will update the intended parents throughout the pregnancy, as detailed in their contract.

Once the surrogate gives birth, the baby will be taken home from the hospital by the intended parents.

What are the risks of surrogacy?

The process of IVF can result in multiple pregnancies (twins, triplets) if more than one embryo is transferred. The Loma Linda University Center for Fertility recommends strongly however, that patients going through IVF (including surrogates) do a single embryo transfer.

Both the intended parents and the surrogate must be on the same page regarding a multiples pregnancy. These are high-risk pregnancies and can have a negative effect on the surrogate’s day-to-day life and income.

Different states have different laws regarding legal and natural parentage in a surrogacy situation. Hiring legal counsel familiar with surrogacy contracts can help all parties navigate the legalities and ensure that all bases are covered.

Another risk of surrogacy is that the surrogate may become attached to the pregnancy as if it is her own and desire to keep the baby. This is rarely ever a problem however, especially if the surrogate is found through an agency, as the proper legal documents are an integral part of that process. If a carrier is a family member or friend, it is important to still follow proper legal protocol in regards to surrogacy contracts.

What are the benefits of surrogacy?

Surrogacy allows an individual or couple to have a biological child even if the female partner is unable to carry a pregnancy to term. Surrogacy also allows the intended parents to be involved in their child’s life from conception, as apposed to adoption.

The State of California is a “surrogacy friendly” state, meaning that California recognizes surrogacy contracts and establishes parentage to the individuals who intended to create the pregnancy (the intended parents). Unlike some states, California allows those participating in surrogacy arrangements to get a judgment naming the intended parents as the legal parents prior to the birth of the child, should there be any legal issues.