How to do surrogate

What Is a Surrogate Mother? Process, Types, Cost, More

What do Kim Kardashian, Sarah Jessica Parker, Neil Patrick Harris, and Jimmy Fallon have in common? They’re all famous — that’s true. But they’ve also all used gestational surrogates to grow their families.

As these celebrities know, there are many ways to have children these days. And as technology advances, so do the options. More and more people are turning to surrogacy.

While you may associate this practice with movie stars and the rich, here’s what you can expect — from the general process to the overall costs — if you think this route may be a good match for your family.

First comes love, then comes marriage, then comes baby in a baby carriage. The old song sure leaves a lot out, doesn’t it?

Well, surrogacy can help fill in some of those details for the 12 to 15 percent of couples experiencing infertility issues — as well as for others who want to have biological children and are in other situations.

There are many reasons people choose surrogacy:

• Health issues prevent a woman from getting pregnant or carrying a pregnancy to term.
• Infertility issues prevent couples from either getting or staying pregnant, like recurrent miscarriages.
• Same-sex couples wish to have children. This may be two men, but women also find this option attractive because the egg and resulting embryo from one partner can be transferred and carried by the other partner.
• Single people want to have biological children.

Related: Everything you need to know about infertility

The term “surrogacy” is generally used to describe a couple different scenarios.

• A gestational carrier carries a pregnancy for an individual or couple using an egg that is not the carrier’s. The egg may come from either the intended mother or a donor. Likewise, sperm may come from the intended father or a donor. Pregnancy is achieved through in vitro fertilization (IVF).
• A traditional surrogate both donates her own egg and carries a pregnancy for an individual or couple. The pregnancy is usually achieved through intrauterine insemination (IUI) with sperm from the intended father. Donor sperm may also be used.

According to the Southern Surrogacy agency, gestational carriers are now more common than traditional surrogates. Why is this? Since a traditional surrogate donates her own egg, she is technically also the biological mother of the child.

While this can definitely work out just fine, it can create complex legal and emotional issues. In fact, several states actually have laws against traditional surrogacy for these reasons.

Some people find a friend or family member who’s willing to serve as a surrogate. Others turn to surrogacy agencies — in the United States or abroad — to find a good match. Agencies first screen candidates to ensure they meet the criteria associated with the process. Then they cross-match your own wants/needs to find the best situation for your family.

Don’t know where to start? Nonprofit group Society for Ethics in Egg Donation and Surrogacy (SEEDS) was created to review and maintain ethical issues surrounding egg donation and surrogacy. The group maintains a member directory that may help you find agencies in your area.

The qualifications for being a gestational surrogate vary by agency, but they involve things like:

• Age. Candidates must be between the ages of 21 and 45 years old. Again, the specific range varies by location.
• Reproductive background. They also have to have carried at least one pregnancy — without complications — to term but have fewer than five vaginal deliveries and two cesarean sections.
• Lifestyle. Surrogates must live in a supportive home environment, as confirmed by a home study. Drug and alcohol abuse are other considerations.
• Tests. Additionally, potential surrogates must have a mental health screening, a complete physical — including screening for sexually transmitted infections (STIs).

Intended parents have certain requirements to meet as well. These involve:

• providing complete health histories
• having physical exams to ensure they can successfully go through in vitro fertilization retrieval cycles
• screening for infectious disease
• testing for certain genetic diseases that could be passed to a child

Mental health counseling is also recommended to cover things like expectations from surrogacy, addiction, abuse, and other psychological issues.

Related: The 30-day guide to IVF success

Once you’ve found a surrogate, achieving pregnancy differs depending on what type of surrogate you use.

With gestational carriers, the process looks something like this:

1. Choose a surrogate, usually through an agency.
2. Create a legal contract and have it reviewed.
3. Go through the egg retrieval process (if using intended mother’s eggs) or obtain donor eggs. Create embryos using intended father’s sperm or donor sperm.
4. Transfer embryos to the gestational carrier (surrogate) and then — if it sticks — follow the pregnancy. If it doesn’t work out, the intended parents and surrogate may pursue another IVF cycle.
5. The child is born, at which time the intended parents obtain full legal custody as outlined in the legal contract.

Traditional surrogates, on the other hand, are also donating their eggs, so IVF is usually not involved in the process.

1. Choose a surrogate.
2. Create a legal contract and have it reviewed.
3. Go through the IUI process using the intended father’s sperm or donor sperm.
4. Follow the pregnancy or — if the first cycle doesn’t work out — try again.
5. The child is born. The surrogate may need to legally terminate parental rights to the child, and the intended parents may need to complete a stepparent adoption in addition to any legal contract set up in earlier stages of the process.

Of course, this process may be slightly different depending on the state in which you live.

The costs associated with surrogacy depending on the type and where you live. In general, the costs for a gestational carrier may fall somewhere between $90,000 and $130,000 when you take into account the compensation, health care costs, legal fees and other situations that may arise.

The West Coast Surrogacy Agency, based throughout California, lists its costs in detail on its website and explains that these fees can change without notice.

Overall compensation

Base pay is $50,000 for new surrogates and $60,000 for experienced surrogates. There may be additional fees as well. For example:

• $5,000 if the pregnancy results in twins
• $10,000 for triplets
• $3,000 for a cesarean delivery

You may also incur costs (that vary) for things like:

• monthly allowances
• lost wages
• health insurance

Costs may also include special circumstances, such as canceled IVF cycles, dilation and curettage, ectopic pregnancy, fetal reduction, and other unexpected situations.

Screenings

Expectant parents will also pay around $1,000 for mental health screenings for themselves, the surrogate, and the surrogate’s partner. Criminal background checks for both parties cost between $100 and $400. Medical screenings will depend on recommendations by the IVF clinic.

Legal costs

There are actually quite a few legal fees involved, from drafting and reviewing a surrogacy contract ($2,500 and $1,000, respectively) to establishing parentage ($4,000 to $7,000) to trust account management ($1,250). The general total here is somewhere between $8,750 to $11,750.

Other costs

This varies by clinic and agency. As an example, West Coast Surrogacy recommends psychological counseling to its intended parents and surrogates at 90 minutes a month and after different milestones, like embryo transfers. In total, these sessions may cost $2,500 — however, this support may or may not be recommended by other agencies.

Other possible costs include the surrogate’s health insurance ($25,000), life insurance ($500), and hotel stays/travel fees associated with IVF cycles ($1,500). Parents may also arrange for private health insurance verification ($275).

Again, there are other miscellaneous situations, like IVF medications and monitoring or lost wages due to pregnancy complications, that may vary in cost.

What about traditional surrogates?

Your costs may be lower with traditional surrogacy because there’s no IVF involved. The cost of IUI is less and tends to have fewer associated medical procedures.

Does health insurance cover any costs?

Likely not, but it’s complicated. According to the ConceiveAbilities agency, around 30 percent of health insurance plans include verbiage that specifically states it will not cover costs for a woman for surrogacy. Around 5 percent do provide coverage, but the other 65 percent are a bit shady on the matter.

In short: There are many appointments, procedures, and then the birth itself to think about. You don’t want an unexpected and costly health insurance bill.

Most agencies will help you review the surrogate’s health insurance plan to determine coverage. They may also recommend that you purchase outside insurance for the surrogate using comprehensive surrogacy insurance programs through agencies like New Life or ART Risk Solutions.

There aren’t any federal laws surrounding surrogacy. Instead, the laws that apply depend on the state in which you live. Legal issues may arise when one parent is biologically related to a child and the other isn’t — even if the surrogate is not biologically related.

Traditional surrogacy — when the surrogate is also the biological mother — can be particularly complicated. Among other issues, you may need to secure what’s called a pre-birth order to be listed as a parent on the birth certificate when the baby is born. Some states may not allow this, even if they don’t have laws against traditional surrogacy. This means the non-biological parent(s) may need to go through adoption proceedings.

No matter the scenario, the American College of Obstetricians and Gynecologists recommends that the surrogate and the intended parents arrange for independent legal representation with lawyers who have experience with surrogacy.

Related: Lawsuit filed by surrogate mother raises new legal, moral issues

When planning surrogacy, everything may seem quite straightforward. However, it’s important to note that as with most things in life, there are opportunities for issues to arise and make things tricky.

Some considerations:

• IVF or IUI isn’t a guarantee of pregnancy. Sometimes these procedures don’t work on the first or even subsequent tries. You may need several cycles to achieve pregnancy.
• We don’t mean to be a Debbie Downer here. But another consideration is that even if pregnancy occurs, miscarriages are possible.
• Just as with the traditional pregnancy-to-parenthood path, there is always a chance for health issues with the baby or complications with the surrogate or actual birth.
• Pregnancy with IVF and IUI may result in multiples — twins or triplets.
• While home studies and psychological evaluations are part of the screening process, they can’t guarantee that surrogates won’t engage in behaviors you may consider risky. (On the other hand, most surrogates carry babies out of a desire to bring the joy of parenthood to people who might not experience it otherwise.)

There are various ways that being a surrogate may make sense in your lifestyle. You may find the money appealing or feel fulfilled giving a couple something they may not be able to achieve without your help.

Still, it’s a big decision. The Family Inceptions Agency outlines a few things to consider before applying to be a surrogate.

• You’ll need to meet all the minimum requirements — including those regarding age, health status, reproductive history, and psychological status — that may vary by agency.
• You’ll need to be OK with giving up control during the pregnancy. While it’s your body, what happens during the pregnancy isn’t entirely up to you. This involves things like testing that you may not choose for yourself but that the intended parents may wish to undergo.
• You’ll also need to think about the process itself. Getting pregnant via IVF takes a number procedures and medications. Consider how you’ll feel about taking injectable and oral drugs and hormones.
• You’ll want to consider if your own family is complete. Do you want more children? Understand that with each pregnancy and with advancing age, more risks for complications can arise that might impact your fertility.
• You’ll need to get input from the rest of your family as well. How does your partner feel about surrogacy? What about your children?

There aren’t necessarily right or wrong answers to questions you need to ask yourself — these are just things to consider. Surrogacy can be a wonderful process and gift.

Related: Infertility after donating eggs

While surrogacy may not always be simple or straightforward, more and more people are choosing this route.

In 1999 there were just 727 gestational carrier cycles reported in the United States. In 2013, this number jumped to 3,432, and it continues to climb each year.

It’s an involved process but certainly one worth investigating. If surrogacy seems like it might be a fit for your family, consider contacting an agency near you to go over the timeline, costs, and any other considerations that may be specific to your journey. There are many ways to become a parent — and this is one of them.

What It Is and How Does Surrogacy Work

Written by Rebecca Buffum Taylor

Medically Reviewed by Jennifer Robinson, MD on November 04, 2021

In this Article

• What Is a Surrogate Mother?
• Who Uses Surrogates?
• Finding a Surrogate
• How to Choose a Surrogate
• Using a Surrogate
• Legal Issues With Surrogates

There's still some controversy about using a surrogate mother to have a baby. The legal process is also tricky because it varies from state to state. Even so, whether it's because of fertility problems or other reasons, surrogacy is an option for you and your partner. Find out how it works and see if it's right for you.

What Is a Surrogate Mother?

There are two kinds:

Traditional surrogate. It's a woman who gets artificially inseminated with the father's sperm. They then carry the baby and deliver it for you and your partner to raise.

A traditional surrogate is the baby's biological mother. That's because it was their egg that was fertilized by the father's sperm. Donor sperm can also be used.

Gestational surrogates. A technique called "in vitro fertilization" (IVF) now makes it possible to gather eggs from the mother (or an egg donor), fertilize them with sperm from the father (or a sperm donor), and place the embryo into the uterus of a gestational surrogate.

The surrogate then carries the baby until birth. They don't have any genetic ties to the child because it wasn't their egg that was used.

A gestational surrogate is called the "birth mother." The biological mother, though, is still the woman whose egg was fertilized.

In the U.S., gestational surrogacy is less complex legally. That's because both intended parents have genetic ties to the baby. As a result, gestational surrogacy has become more common than a traditional surrogate. About 750 babies are born each year using gestational surrogacy.

Who Uses Surrogates?

If you're a woman, you may consider a surrogate for several reasons:

• Medical problems with your uterus
• You had a hysterectomy that removed your uterus
• Conditions that make pregnancy impossible or risky for you, such as severe heart disease

You may want to think about surrogacy if you tried but couldn't get pregnant with a variety of assisted-reproduction techniques, such as IVF.

Surrogates have also made parenthood an option for people who might not be able to adopt a child, perhaps because of their age or marital status.

If gay men decide to use a traditional surrogate, one of them uses their sperm to fertilize the surrogate's egg through artificial insemination. The surrogate then carries the baby and gives birth.

A gay couple might also choose an egg donor, fertilize that donated egg, and then have the embryo implanted in a gestational surrogate to carry until birth.

Finding a Surrogate

There are several ways you can find a surrogate mother:

Friends or family. Sometimes you can ask a friend or relative to be a surrogate for you. It's somewhat controversial. But because of the high cost of surrogacy and the complex legal issues it raises about parental rights, a tried-and-tested family relationship can be simpler to manage.

The American Society for Reproductive Medicine accepts certain family ties as acceptable for surrogates. It generally discourages surrogacy, though, if the child would carry the same genes as a child born of incest between close relatives.

A surrogacy agency. Most people use one to arrange a gestational surrogate. There are about 100 agencies now operating in the U.S. They act as go-betweens.

An agency helps you find a surrogate and make arrangements. It also collects any fees that get passed between you and the surrogate, such as paying for their medical expenses.

How to Choose a Surrogate

Right now there aren't any regulations about who can be a surrogate mother. But experts agree on a few points about how to select one.

You should choose surrogates who:

• Are at least 21 years old
• Have already given birth to at least one healthy baby so they understand firsthand the medical risks of pregnancy and childbirth and the emotional issues of bonding with a newborn
• Have passed a psychological screening by a mental health professional to uncover any issues with giving up the baby after birth
• Sign a contract about their role and responsibilities in the pregnancy, such as prenatal care and agreeing to give you the baby after birth

Using a Surrogate

The American Society for Reproductive Medicine says surrogates should get a medical exam to check that they are likely to have a healthy, full-term pregnancy. The organization suggests they get tests that check for infectious diseases such as syphilis, gonorrhea, chlamydia, HIV, cytomegalovirus, and hepatitis B and C.

Surrogates should get tests to make sure they have immunity to measles, rubella (German measles), and chickenpox. Also, you may want to ask that they get a medical procedure to visually "map" the uterus, which can help the doctor check their potential to carry a pregnancy. Surrogate mothers should have their own doctor during pregnancy rather than use yours.

The cost of surrogacy can range from $80,000 to $120,000. A lot of different things go into the price, such as whether the surrogates have their own medical insurance or whether you need to buy a surrogacy-pregnancy policy for them.

Legal Issues With Surrogates

Parental rights aren't guaranteed after a surrogate pregnancy. The law continues to change as reproductive technology and the very definition of a "parent" changes.

There isn't a federal law on surrogacy and state laws vary. After a surrogate pregnancy in some states, you may still have to pass adoption proceedings to gain legal custody of the child. In other states, a "declaration of parentage" before birth lets you avoid having to "adopt" the baby.

To protect your rights as parents-to-be -- and the rights of the child you're hoping to have -- hire an attorney who specializes in reproductive law in your state. They can write a surrogacy contract that clearly spells out what everyone needs to do.

A contract like that may help if legal issues come up after birth. It can also outline agreements about a variety of possible scenarios with the pregnancy, such as what happens if there are twins or triplets.

Infertility & Reproduction Guide

1. Overview
2. Symptoms
3. Diagnosis & Tests
4. Treatment & Care
5. Support & Resources

Surrogacy program

The surrogacy program is offered to those women who, due to health reasons, cannot carry a pregnancy on their own.

The legislation of Russia allows such type of ART as surrogate motherhood, but with some restrictions. It is impossible to resort to the services of a surrogate mother only because of the desire to avoid pregnancy and childbirth. The list of indications for the program is determined by the order of the Russian Federation dated August 30, 2012 No. 107n "On the procedure for using assisted reproductive technologies, contraindications and restrictions on their use." The main indications are:

Some patients with these indications may have genetically related children (that is, it is possible to obtain their own oocytes for embryo cultivation with the help of hormonal stimulation), others additionally use the oocyte donor program. But in all cases, the surrogate mother is not an egg donor.

Medical surrogacy

The main difference between surrogate motherhood and egg donation is that the surrogate mother is transferred an embryo that does not genetically belong to her. By law, a surrogate mother cannot be an egg donor at the same time. nine0003

A surrogate mother always bears a child that is genetically alien to her. The embryo can be cultured from the egg of a future mother or an anonymous donor.

More information for those wishing to become a surrogate mother

Despite the fact that during the entire period of pregnancy the embryo (then the fetus) develops in the body of a surrogate mother, it does not inherit any of its external features. If future parents can choose the most suitable donor (hair color, eye color, height, as well as nationality) when donating eggs, then these factors do not matter when choosing a surrogate mother. nine0003

Legal aspect in Russia

In Russia, surrogacy is legal and regulated by law. At the same time, the situation remains when certain medical aspects are not yet clearly spelled out in the law. All conditions in the contract that future parents and the surrogate mother sign with the clinic must be in accordance with the legislation of the Russian Federation.

In particular, the law says that the mother of a child is automatically recognized as the woman who gave birth to him. nine0003

When a child is born by a surrogate mother (despite the fact that he is not genetically related to her and there are documents from the reproduction clinic that confirm the fact of embryo transfer), only with the consent of the surrogate mother, the data of biological parents can be indicated in the birth certificate.

In practice, this is implemented as follows: in the near future after the birth of the child, the surrogate mother signs permission to have the data of biological parents entered into the birth certificate. Together with this document and the agreement with the clinic, parents apply to the registry office, where they issue a birth certificate. After that, according to the law, the biological parents of the child are endowed with full rights and obligations, and the surrogate mother is released from them. nine0003

Due to the fact that surrogate motherhood programs have been used in Russia for a long time, this procedure has already become routine in the registry offices. A single person can also be a biological parent, in which case only the mother or only the father is indicated on the birth certificate.

What disputes are possible?

In order to avoid any disputes, an agreement is drawn up, which describes in detail the rights and obligations of the parties and all possible situations.

Number of embryos transferred. Now, thanks to the success of IVF programs (especially in cryoprotocols), one embryo is most often transferred, but in some cases, at the request of the parents and with the consent of the surrogate mother, two.

A variant of the development of multiple pregnancy. In about 1% of cases, after the transfer of one embryo, its division may occur in the first days, and as a result, twins will be born. The contract should indicate whether the size of the surrogate mother's fee will increase in this case and by how much. nine0003

Surrogate mother's lifestyle: the contract will stipulate the obligation to follow the doctor's recommendations, visit the clinic chosen by the parents to monitor the pregnancy.

The possibility of having a child with congenital defects. Despite the fact that pre-implantation screening is carried out, and then several screenings during pregnancy, there are diseases that can neither be prevented nor diagnosed in early pregnancy. They are far from always associated with the lifestyle of a pregnant woman or her health (or the health of biological parents) and often occur spontaneously. nine0003

One of the key ways to avoid conflict situations is detailed counseling of all program participants before it starts and explanation of all possible consequences.

If it is not possible to resolve the conflict peacefully, one has to go to court: today the courts in the Russian Federation have a practice of resolving such disputes.

More information for those wishing to become a surrogate mother

Requirements for a surrogate mother

Before starting the program, a surrogate mother undergoes an examination:

01

Blood test for HIV, RW (syphilis), viral hepatitis B and C, TORCH infection.

02

Screening for STIs (sexually transmitted infections).

03

Fluorography.

04

Ultrasound of the pelvic organs.

05

Oncocytology of scraping from the cervix, smear for the degree of purity of the vagina.

06

Determination of blood group and Rh factor.

07

General and biochemical blood tests, coagulogram. nine0003

08

Urinalysis.

09

ECG.

10

Examination by a general practitioner and conclusion that there are no chronic diseases and contraindications to pregnancy.

11

Examination and conclusion of a psychiatrist.

How embryo transfer works

Embryo transfer

Embryo transfer is a fairly quick (about 30 minutes) procedure, it does not require anesthesia or a long stay in the clinic. By agreement of all participants in the program, two embryos can be transferred, but no more, since multiple pregnancy carries a high risk to the health of children. nine0003

After the transfer, hormonal support is prescribed, as in any IVF protocol. It is possible to diagnose the onset of pregnancy approximately on the 12th - 14th day after the transfer: you need to donate blood for hCG. An ultrasound is scheduled approximately on the 21st day after the transfer - an earlier ultrasound is not informative.

Multiple pregnancy: what to do?

Two embryo transfers are currently only allowed if the parents are ready to have two children. This is due to the fact that cryopreservation can significantly increase the chances of successful implantation of all transferred embryos. The surrogate mother must agree to the transfer of two embryos, having received all the information about the risks of a multiple pregnancy. nine0003

What if only one embryo was transferred but a multiple pregnancy develops? This case should be discussed in advance and spelled out in the contract.

• Either the pregnancy is kept as multiple, the parents are preparing for the birth of two children, the surrogate mother receives an additional payment.

• Or, by decision of the parents, a reduction procedure (removal of one of the embryos) is carried out at an early stage of pregnancy, which carries certain risks for the remaining embryo. nine0003

Pregnancy management

Future parents choose a pregnancy clinic where a surrogate mother should be observed. The number of appointments, a set of tests and examinations is standard, as in the management of a naturally occurring pregnancy. At the request of the parents, additional studies can be prescribed, for example, NIPT is a non-invasive prenatal test, in which at the 9-11th week of pregnancy, fetal DNA can be isolated from the blood of a pregnant woman and with an accuracy of 99.99% determine the sex of the child and the presence of a number of diseases.

Monthly payment

In addition to the basic payment (after the birth of the child), the surrogate mother receives a monthly payment - this condition is prescribed in the contract.

Delivery by a surrogate mother

Future parents choose a clinic or a maternity hospital for childbirth. In most cases, when there is no indication for a caesarean section, childbirth takes place naturally. The child is transferred to future parents immediately after birth. The consent of the surrogate mother to the transfer of the child to the biological parents is also issued. nine0003

If you have any questions related to participation in the surrogacy program, please contact the clinic.

Becoming a surrogate mother

Surrogacy process | Extraordinary Conceptions

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The surrogacy process involves many steps and they are all worth it!
Learn about the surrogacy process and the resources we offer to women who choose this wonderful path. nine0003

Apply to become a surrogate »

An overview of the surrogacy process

Learn how to become a surrogate

If you are considering becoming a surrogate, Extraordinary Conceptions will help you on your journey. Whether you're doing this for the first time or you've already been a surrogate mother, we suggest you have a few questions before diving into them, and we're here to answer them.

The surrogate procedure is useful, but it is also quite complex. This is clear; this is a big deal and every step is taken to protect you, the child, and their intended parents. That's why we're here - to help guide you through every step of this enriching and wonderful journey.

What is the surrogacy process?

Everything you need to know

The process of a surrogate mother is lengthy but simple. Here at Extraordinary Conceptions, the process starts at home - potential surrogates can check their eligibility and start their online application. Once your application has been accepted, your profile will be added to our Intended Parents database. Eventually, you will be selected and you can begin the steps towards becoming a surrogate mother. nine0003

Every agency works a little differently, but in Extraordinary Conceptions we've broken down our process into a ten-step system. This makes it easy for both potential surrogates and intended parents to digest, understand, and prepare for the process ahead.

The Surrogacy Process Step by Step

The Breakdown of the Surrogacy Process

In Extraordinary Conceptions, we have broken down the surrogacy process step by step:

1. Check eligibility

We recommend that surrogate mothers check their eligibility before applying. There are several big city legal, becoming a surrogate is to protect the surrogate, the intended parents and the unborn child. If you are considering surrogacy, take a look at our checklist. If you meet all the requirements, you can proceed to the second step.

All surrogates must:

• Be between the ages of 21 and 45 (the EU has a unique program for carriers between the ages of 39 and 45) 36)

• Have no more than 5 cesareans (EC has a unique program for GCs with 3 or more cesareans)

• Have no more than 8 deliveries (EC has a unique program for carriers with more than 6 deliveries ) nine0003

• Previously and currently living with their child

• Do not smoke or use illicit drugs and do not have a history of addiction to illicit drugs or alcohol.

• Be financially stable and not on Section 8/HUD

• Be a US citizen or permanent resident

• Have a driver's license and/or reliable transportation

• No previous criminal offenses (same goes for spouse/partner and any other adults living in the family) major depressive disorder.

• Not currently taking any medications that are unsafe for pregnancy, including medications for mental health problems (including anxiety or depression) and/or the possibility of safely weaning the medication. nine0003