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How Does Surrogacy Work?

People arrange a surrogacy for many reasons. The most common one is that a couple wants a child but pregnancy is not possible. In this article on Assisted Reproductive Technology (ART), we will discuss surrogacy from the perspective of intended parents and surrogates.

What Is Surrogacy? 

Surrogacy is a formal, legal arrangement between two parties: the intended parents and the surrogate. 

The surrogate agrees to become pregnant to give birth to a child for another person or couple.

If the surrogate knows the intended parents, she may become a surrogate as a favor to help the mother or the couple who desperately want a child but can’t have one for medical reasons. 

If she doesn’t know them, then she will receive monetary compensation, an arrangement called “commercial surrogacy.”

The legality of surrogacy varies from one country to another and from one jurisdiction in a country to another. Some countries ban surrogacy because its law-makers question the ethics surrounding it; some countries permit surrogacy if no money changes hands, and some countries place no legal constraint on surrogacy. 

In the U.S., individual states decide the legality of surrogacy and laws vary from one state to another. 

In developed countries where commercial surrogacy is legal, third-party agencies may offer comprehensive services. They often provide things like psychological screenings and a battery of medical tests to the surrogate to help ensure a healthy gestation and normal delivery. They will also coordinate all the legalities to protect both the parents and the surrogate.

However, we advise caution when working with a third-party agency. You must do a thorough background check to make sure they are legitimate. Because of the high fees involved in surrogacy, the FBI has discovered egg donation and surrogacy scammers who ruthlessly defraud everyone involved in a surrogacy — the intended parents, egg donors, surrogates, and even the attorneys.

Surrogacy means distinct things for different people and affects the intended parents and surrogates in dissimilar ways. Often both parties experience the highs and lows and find the journey exhausting. However, both parties also find it to be a life-changing journey. While it thrills parents to have a baby, the surrogate has a deep feeling of satisfaction at bringing a child into the world to loving parents.

Types of Surrogacy

There are only two types of surrogacy: traditional and gestational. 

In traditional surrogacy, an intended father or an anonymous donor artificially inseminate a surrogate mother. This makes her the biological mother of the child.

In gestational surrogacy, doctors use in vitro fertilization (IVF) to create an embryo for the surrogate. Either the intended parents or donors provide the egg and sperm for the embryo. Here, the surrogate mother is not biologically related to the child.

In both traditional and gestational surrogacy, the surrogate mother carries the baby to term.

Does a Surrogate Mother Share DNA with the Baby?

This depends on the surrogacy. In traditional surrogacy, the surrogate mother contributes to the DNA of the baby and in gestational surrogacy, she does not contribute DNA to the baby.

Traditional Surrogacy

In traditional surrogacy, the mother is artificially inseminated by the father or a donor and shares her DNA with the baby because doctors use her egg. Although she carries the child to term for another woman or couple, she is the child’s biological mother.

Gestational Surrogacy

In gestational surrogacy, the mother does not share DNA with the baby. Since doctors make the embryo from a donated egg before they transfer it to the surrogate, it is not her biological child.

How Does Surrogacy Work?

In vitro fertilization (IVF) allows the intended parents to make an embryo. The sperm of the intended father fertilize eggs gathered from the intended mother. Doctors then place the embryo into the uterus of the gestational surrogate, who will carry the baby until birth.

Another way of doing surrogacy is to use the intended father’s sperm to artificially inseminate the surrogate’s womb. Doctors use the egg of the surrogate mother to make her pregnant.

Will the Baby Look like the Surrogate Mother?

If a couple donates the egg and sperm before doctors insert the embryo into the womb of the surrogate, then the baby will not look like her because the DNA will come from the intended parents. 

However, if the surrogate mother agrees to artificial insemination, she will donate her own eggs. Since her eggs carry her DNA, the child may resemble her.

Who Uses Surrogates?

Couples who can’t have a child and don’t want to adopt one may use a surrogate. In some instances, a couple may not be able to have a child because of the father’s or mother’s medical issues. In other instances, a male same-sex couple may want to have a child. One of the men will contribute his sperm to fertilize the egg of the surrogate mother through artificial insemination.

Finding a Surrogate

There are two ways for a couple to find a surrogate: through an agency or on their own.

The easier way is to use an agency surrogacy program that arranges everything, including finding a surrogate. 

The more challenging way is for the couple to find a surrogate on their own and organize almost all the details themselves.

If a couple chooses the more challenging route, they must take the following steps after they find someone who agrees to be the surrogate mother:

  1. They must screen the surrogate mother for any potential psychological or physical problems. 
  2. They must find an attorney to do all the legal paperwork. 
  3. They must coordinate with a fertility clinic to help with artificial insemination or the embryo placement into the womb of the surrogate mother. 

Another optional step is for the intended parents to offer the surrogate mother the services of a counselor as she carries the baby to term.

Surrogacy Qualifications 

In the United States, a surrogacy clinic will use strict surrogacy requirements to qualify someone as a surrogate candidate.

What’s involved in being a surrogate? 

Qualifications:

  • Someone who wants to be a surrogate should be between 21 and 40 years of age and be a citizen of the United States. 
  • She should live in a state that permits surrogacy.
  • She should follow a healthy lifestyle that omits smoking, drinking, substance abuse, or recreational drugs. 
  • She should be willing not to use medications that might harm a pregnancy, like antidepressants or anti-anxiety medications. 
  • She should also have excellent health and carry a healthy body weight for her height, with a body mass index of 33 or less.
  •  She should have a history of healthy reproduction and have given birth to one or more children. 

Screening:

  • Someone who wants to be a surrogate mother will go through extensive psychological testing to rule out any possibility of neurotic or psychotic behavior that would prevent her from becoming a good surrogate. 
  • The fertility clinic will also interview and screen her life partner to ensure that they will emotionally support the process of surrogacy.

Surrogacy clinics have strict guidelines in place to protect both the potential surrogate and the newborn that they will bring into the world. 

How to Choose a Surrogate

If you don’t know anyone who wants to be a surrogate, then contact a fertility clinic to help you find the right person.

Some things to keep in mind when choosing a surrogate are their medical history, psychological health, and lifestyle choices. 

You will also have to get a clear idea of the cost and consider if there are any legal issues. The cost for the surrogacy process may be more than you can afford, and legal issues could arise if the surrogate lives in a surrogate unfriendly state. 

Finally, you must decide what type of relationship you want to have with the surrogate after the birth of the child. Some parents want the surrogate to remain part of their child’s life while others want to end the relationship after delivery. 

The Surrogacy Process

When considering the surrogacy process, intended parents often have two important questions in mind. The first question is about the confirmation of pregnancy surrogacy and the second question is how long the process will take. 

Confirmation of Pregnancy Surrogacy

About nine days after doctors have transferred an embryo into the surrogates’ womb, she will visit the fertility clinic for a human chorionic gonadotropin (hCG) level check — a medical test that measures pregnancy hormone levels and confirms if she is pregnant.

How Long Does Surrogacy Process Take?

On average, the entire process will take about a year and a half. This time period accounts for how long it will take to find a qualified surrogate, for her to be physically ready for embryo transplant, for her to become pregnant, and for her to carry a child to term.

Surrogacy Success Rates

Intended parents often ask, “Will surrogacy work?” According to the Society for Assisted Reproductive Technology (SART), the success rate will vary because there are many factors involved in the surrogacy process. 

According to the Center for Disease Control’s report in 2017 on surrogacy success rates in Fertility Clinics, “there were 284,385* ART cycles performed at 448 reporting clinics in the United States during 2017, resulting in 68,908 live births (deliveries of one or more living infants) and 78,052 live-born infants.”

When researching fertility clinics, it’s essential that intended parents ask about the clinic’s surrogacy successes. The more successful clinics will have plenty of surrogacy success stories to share.

The Cost of Hiring a Surrogate

There is no fixed price for surrogacy because many factors affect fees and pricing. On average, it will cost about $100,000. For instance, Circle Surrogacy fees range from $100,000 to $150,000 to cover everything — agency fees, attorney fees, screening costs, medical costs, and insurance costs. Cost may be lower if a couple donates their own eggs and sperm, dropping down $80,000 to $130,000.

In some states, like California, where there is a high demand for surrogates and a wide range of fees, the price will be on the higher end of the scale. Remember, the surrogacy process involves more than just paying surrogacy compensation. Surrogacy costs may include egg donation compensation, medical costs, travel and hospitality costs, psychological screening, medical screening, agency fees, legal fees, health insurance, and life insurance. 

Intended parents who can’t afford surrogacy can find a number of financing options available that can be divided into three broad groups: surrogacy loans, traditional loans, and surrogacy grants.

Surrogacy Loans

Many financial organizations offer loans for surrogacy, and many fertility clinics offer a financing option.

Traditional Loans

It’s possible to get a non-specific traditional loan. Intended parents can get money from home equity loans, borrow from their 401(K) plans, or from their credit cards. Sometimes, friends or family members may give them a loan.

Surrogacy Grants

It’s also possible for intended parents to get funds they don’t have to pay back if they apply for annual grants. The prospective parents must fill out an application form and meet the grant’s qualifications. These qualifications vary from one organization to another based on factors like religious affiliations, a medical diagnosis of infertility, or the state of residency.

Here are three examples of grant foundations:

Does Insurance Cover Surrogacy?

The law says that intended parents must provide their surrogate with health insurance because most health insurance plans refuse to cover the costs of surrogacy. The cost for special health insurance policies for surrogacy runs high, about $400 a month, because of unexpected complications. For instance, a premature delivery will incur NICU costs of about $5,000 a day.

Possible Risks of Surrogacy

The risks of surrogacy are the same as the risk of a traditional pregnancy because the only difference between the two is how the mother becomes pregnant. Unexpected risks of pregnancy include hypertension and damage to the reproductive organs and more common risks include lower back pain, muscular inflammation, excessive weight gain, morning sickness, and heartburn.

Legal Implications of Using a Surrogate

A legal surrogacy contract, drawn up by a lawyer, between intended parents and the surrogate mother is an essential surrogacy document. This contract has to be in place before a fertilization clinic can begin any medical procedures.

A legal surrogacy agreement tries to account for all contingencies, including who will get custody of the child should the intended parents die or experience a debilitating illness or accident before the birth of the child. 

Surrogacy documents not only protect all parties against any disputes that might arise but also prevent disputes from occurring in the first place because all the legal implications are spelled out and agreed to by all parties involved. 

The Pros and Cons of Surrogacy

The surrogacy process has its fair share of difficulties, many of which you can’t anticipate ahead of time because they’re based on emotions or unexpected events. 

However, here are some pros and cons reported by intended parents and surrogates:

The Pros of Surrogacy

  1. Intended parents often feel elated at now having a more complete family life.
  2. Surrogate mothers may often feel pride in giving the intended parents and child a happy family life. 
  3. Many surrogates who enjoyed being pregnant with their own children can now relive the happy feelings of pregnancy. 
  4. Surrogate mothers may be able to start a whole new life if they have been generously compensated — for instance, they will be able to go back to school to get a degree in a high-earning career, start a business of their own or relieve their own financial pressures.

The Cons of Surrogacy

  1. The cost of the surrogacy process may cause a family financial hardship for years to come.
  2. Both parties need to do their research before signing up with an agency or fertility clinic because the FBI has cracked down on many unethical companies whose business model is to steal from intended parents, surrogates, and surrogacy service providers.
  3. Pregnancy can be both physically and emotionally taxing for the mother.
  4. Surrogacy can involve a huge time commitment, stretching about a year and a half. This can disrupt any other significant life plans the surrogate may have regarding travel, schooling, career-building, or raising a family of her own.

Is Surrogacy Right for Me?

If you intend to become a surrogate mother and meet all the qualifications, you must take the time to decide if surrogacy is right for you. Research surrogacy facts and statistics and speak to counselors and other surrogates before you make a final decision. 

For potential parents, research is vital to you as well. Make sure any clinic or agency you use is legitimate and has a good reputation. There are also financial and psychological issues to consider as parents as well.

Conclusion

Assisted Reproductive Technology (ART) makes it possible for fertility clinics to increase the percentage of success stories and the number of healthy deliveries. Intended parents must decide between surrogacy or adoption, while surrogate mothers must decide if they believe the experience of carrying a child to term will be a rewarding one.