How Does Surrogacy Work
Surrogacy is becoming an increasingly common family-building option that offers hope for people who are unable to carry a pregnancy on their own. But how does surrogacy work?
It’s a great question and one most people thinking about surrogacy want to know. Interestingly, the answer depends on the type of surrogacy used, so we’ll start things there.
Continue reading to learn more about the different types of surrogacies and how they work, including, how surrogate pregnancies are established, how payments for surrogacy work, surrogacy contracts, how to establish legal parentage, and more.
Types of Surrogacy
While surrogacy is often used as a catch-all phrase to describe the process of an individual carrying a child for another person or couple, there are two distinct types of surrogacy, traditional surrogacy and gestational surrogacy.
The difference between the two involves the genetic relationship between the person carrying the pregnancy and the resulting child. While they share some base similarities, other aspects are quite different.
Traditional Surrogacy
In traditional surrogacy, the surrogate is the biological mother of the child they carry.
In traditional surrogacy, the surrogate mother is usually artificially inseminated with sperm from the male partner or sperm donor, though IVF or other methods could be used. Regardless of the method by which sperm and egg meet, traditional surrogacy always means the surrogate’s own eggs are used.
Traditional surrogates are used much less often than gestational surrogates and surrogacy programs rarely offer them because of ethical and legal implications. Some states prohibit traditional surrogacy.
Gestational Surrogacy
Gestational surrogacy utilizes a gestational carrier—or person who carries someone else’s pregnancy from an egg that is not their own—and thus is not the biological mother to the resulting child.
For gestational surrogacy, in vitro fertilization (IVF) is used to retrieve eggs (either from the intended mother or donor) which are then fertilized with the intended father’s (or donor) sperm inside a lab.
The resulting embryo is grown inside a lab for around 5 days and then transferred to the gestational carrier.
Pros and Cons of the Types of Surrogacy
See the below table for a summary of the pros and cons of traditional and gestational surrogacy.
Traditional Surrogacy | Gestational Surrogacy | |
Pros | • Usually less expensive • The child could have a genetic relation to the intended mother if the surrogate is a relative | • less complicated legally and emotionally. • both intended parents may be the biological parents • can often set up pre-birth parentage orders which removes the need for post-birth legal measures. • Supported by many agencies |
Cons | • Highly complicated from a legal standpoint, often illegal • normally have to complete a post-birth adoption with the consent of the traditional surrogate to gain custody of the baby • The surrogate has parental rights as the biological mother of the baby. • The intended mother is unable to be the biological mother of the baby. • Emotional issues can come into play • Emotional issues can come into play • Not supported by surrogacy agencies • Challenging to find a surrogate | • Gestational surrogacy is more expensive due to needing an egg donor and IVF treatments. • Usually more expensive |
How Finding a Surrogate Works
Agency Surrogates
There are many surrogacy agencies or programs that help intended parents find and match with an ideal gestational carrier.
Going through an agency is more expensive than using a family member or friend or finding someone on a message board.
However, agencies offer valuable support and help navigate this complex process.
The process of finding a surrogate with an agency begins with a conversation in which the intended parents and agency will discuss everything the intended parents are looking for in a surrogate. The agency will then use these criteria to build out a desired profile, search their database for a match, or recruit others who fit their requirements and requests. In this process, the agency will perform a preliminary screening of the surrogates and provide the intended parents with candidate profiles to review.
They will also mediate initial conversations between the couple and the surrogate. If both parties agree to work together, then the match is made and the process continues. If either party is not comfortable with the match, the agency will continue the search until a new potential match and meeting can be arranged.
Independent Surrogates
The surrogate can also be a person that the couple knows or finds through an online group or message board.
Choosing a relative or friend to be a surrogate mother has some benefits. Intended parents already know the woman who will be carrying their baby and already have a rapport with her. They may live in the same city or close by so the intended parents can be more involved with the pregnancy and attend medical appointments. It is however important to be cautious when using a family or friend as surrogacy is a highly complex and emotional process.
Similarly, finding a surrogate in an online group or message board may have some benefits, primarily cost. However, be cautious as many would-be surrogates in online groups are working independently because they failed the screening process with a surrogate agency.
How Establishing a Gestational Surrogacy Pregnancy Works
In many cases, the intended parents create and freeze an embryo before or while finding a surrogate via IVF.
In IVF, the intended mother or egg donor (if not using the intended mother’s eggs) undergoes ovarian stimulation to produce multiple eggs. The eggs are then surgically retrieved from the intended mother or egg donor and are fertilized in the laboratory with the intended father’s sperm or donor sperm. The resulting embryos are then cultured and monitored for around 5 days and frozen in liquid nitrogen.
After matching with a surrogate, the surrogate will undergo extensive medical and psychological screenings to ensure she is physically and emotionally prepared for the surrogacy journey.
Some of the requirements include excellent physical and mental health, a history of uncomplicated pregnancies, and a stable home life.
Once the surrogate passes all their screening they will prepare for an embryo transfer using an embryo that has already been created via IVF from the intended parent’s or donor sperm and eggs.
To optimally prepare the uterus to receive the embryo, the surrogate will usually begin taking medications approximately two weeks before the embryo transfer and be seen regularly by the fertility clinic to monitor the uterine lining development.
Once the uterine lining is properly developed, the embryo will be thawed and transferred into the uterus of the surrogate.
In nearly all cases, a single embryo transfer is done to avoid the risks of multiples which can significantly increase the risk of pregnancy complications.
If the embryo transfer is successful and an embryo implants in the surrogate’s uterus, she becomes pregnant with the intended parents’ child.
Throughout the pregnancy, the surrogate receives regular prenatal check-ups and necessary medical care to ensure the health of the baby and herself.
How Establishing a Traditional Surrogacy Pregnancy Works
Traditional surrogacy is another surrogacy path for intended parents looking to have a child. While it is a much less common one than gestational surrogacy, it still is an option for some people.
In many ways, the traditional surrogacy process is not much different than the gestational surrogacy process, at least when it comes to the steps involved.
However, because the surrogate is the biological mother to the baby she carries, there are some differences in establishing the pregnancy and there will be additional legal and emotional complications to consider.
First, the intended parents will need to find a surrogate who is interested in traditional surrogacy.
After finding a surrogate intended parents and the surrogate will need to complete a legal surrogacy contract with experienced lawyers and undergo additional medical screening.
Usually, the surrogate will undergo an artificial insemination with the intended father’s (or donor’s) sperm to establish the pregnancy.
How Paying for Surrogacy Works
Generally, gestational surrogacy costs anywhere between $70,000 and $200,000, most of which is held in and managed by an escrow account.
To begin working with an agency, intended parents typically pay part of the agency fee. That will allow the agency to start working on finding a surrogate.
Once a match is made the intended parents are usually required to pay for and fund an escrow account with the remainder of the agency fee plus approximately $10,000 in additional funds to pay for surrogate screening and attorney fees.
Setting up an escrow to manage payments:
- Provides Security and Peace of Mind: Both the intended parents and the surrogate can be assured that the financial resources for the entire surrogacy process are securely set aside.
- Managed Disbursements: Funds from the escrow account are disbursed as needed, ensuring timely payments for medical procedures, surrogate compensation, and other expenses.
Setting up an escrow account helps streamline the financial aspects of surrogacy, providing clarity and security for all parties involved.
How the Surrogacy Contract Works
A surrogacy agreement, known as the gestational carrier agreement in gestational surrogacy, sets out the rights and obligations of the gestational carrier and the intended parents.
The purpose of the surrogacy agreement is to allow the intended parents and their surrogate to outline their responsibilities to one another.
The surrogacy agreement will also define the rights and responsibilities of both parties.
Every surrogacy agreement will look different based on state surrogacy laws, as well as each party’s individual needs and circumstances.
In general, every surrogacy contract should cover the following elements:
- Finances, including the surrogate’s base compensation, and additional compensation the surrogate may receive for invasive procedures, carrying multiples, going on bed rest, etc.
- The risks and liability associated with the pregnancy
- The surrogate’s health and her responsibilities to take care of herself and the baby throughout her pregnancy
- An agreement on issues such as selective reduction and termination if that becomes necessary
- Who will be present at prenatal appointments and birth
When the surrogacy contract is negotiated correctly, it can help limit disputes and miscommunication while protecting everyone involved in the surrogacy process.