What Should I Know Before I Get Serious About Surrogacy?

On the surface, surrogacy might seem like a rather simple arrangement: find a healthy woman, willing to carry a child for someone else. But there are many legal scenarios that can quickly complicate the relationship between the surrogate and the intended parents if the process isn’t navigated correctly. So, here’s a quick primer for those just beginning to understand this process, to help you decide if it’s right for you and your family.

Surrogacy 101: the basics

There are two types of surrogacy, traditional and gestational:

• Traditional surrogacy is when the same woman contributes the egg and carries the pregnancy, and is actually very rarely done these days for many reasons, including legal ones traced back to the Baby M case of the 1980s. In this case, a surrogate was inseminated with the intended father's sperm and then sued for custody of the baby after giving birth.
• Gestational surrogacy is more common by far, and is when the egg comes either from the intended mother or an anonymous donor. That way, the baby has no biological link to the woman who carries the pregnancy. This is the ideal arrangement for most families.  

One more point on vocab: while most of us are only familiar with the word "surrogate" when talking about the woman who physically carries the pregnancy, the more medically accurate term is "gestational carrier." So for the purposes of this piece, we're going to refer to the process as surrogacy and to the women who carry the pregnancy as gestational carriers.

Who might consider surrogacy?

Surrogacy can be a great option for a variety of people facing challenges on conceiving their own biological children. This includes:

• Same sex male couples
• Women who've had recurrent miscarriages, implantation failures or other medical issues that preclude them from getting pregnant
• Women who have had to have a hysterectomy as a result of other health issues
• Women with breast cancer or a form of cancer that may prevent them from carrying a baby safely

OK, I'm interested. What else do I need to know?

Find a reputable agency

Surrogacy requires a deft hand navigating medical and legal requirements but also jumping through complicated medical insurance hoops. In order to make sure every legal T is crossed and I is dotted, you'll want an established, experienced agency on your side.

Check your bank account

Most agencies list the total expenses to be anywhere between $60,000 and $125,000, including all legal fees as well as the medical care and payment for the gestational carrier. Some states also allow what’s called altruistic surrogacy (where the gestational carrier is not financially rewarded—say, if your cousin offered to carry the baby), but the vast majority of gestational carriers are paid.

Understand the process

The first step is to work with the agency to find the right gestational carrier, and a separate egg donor. Here is an average timeline, according to Dr. Sheeva Talebian, reproductive endocrinologist at Colorado Center for Reproductive Medicine (CCRM) in New York:

1. Recruiting and matching the gestational carrier: 3-4 months to over a year.  
2. Egg retrieval, insemination and embryo transfer: 1-2 months
3. Pregnancy: 40 weeks

Line up all your legal ducks

Surrogacy is a huge legal undertaking. Fun stuff, right? Because laws vary so widely from state to state, every stage of the surrogacy process might take place in different locations. For example, if the intended parents live in New York (where surrogacy is illegal), they may have to collect the sperm sample in New York, then send it to California, Oregon or another state deemed "surrogacy friendly" where they can find a gestational carrier and egg donor.

That said, surrogacy laws have been changing, and while it may not be legal in your state today, it may be as soon as next year. Fingers crossed!

Who are these "surrogates" you speak of, anyway?

Almost all agencies require the following of potential gestational carriers:

• She has been pregnant before and has delivered a healthy child of her own.
• She must be medically healthy, have no history of drug use and no history of infectious disease.
• She has to demonstrate that she has no mental health challenges. This may involve home visits, extensive psychological interviews and group meetings with the gestational carrier and the intended parents.

Exceptions are sometimes made for an altruistic carrier, but again, most surrogacy arrangements involve the carrier being paid for her 9+ months of "work."

Summing up surrogacy

If you're interested in surrogacy, talk to your reproductive endocrinologist about third party reproduction services offered through your clinic and what's possible in your state. If you can afford it, it could be an awesome way to make your parenthood dreams come true, and a good RE will hold your hand the whole way through.