What Is a Surrogate?

A surrogate is a person who carries a baby for a person or couple unable to do so themselves. Surrogacy is used for people who have medical issues that make pregnancy unsafe or impossible, for same sex couples, or for single male parents.

The majority of the time, the surrogate does not share any genetic material with the baby they are carrying. Instead, the intended parents or donors provide sperm and eggs. Surrogacy involves assisted reproduction, such as in vitro fertilization (IVF). It’s estimated that about 2.5% of infants are born to a surrogate.

Why Someone May Choose Surrogacy

There are many reasons why a person or couple may choose surrogacy. Choosing to use a surrogate is a complex, carefully considered decision—one that usually comes after significant personal deliberation, and in consultation with medical and legal professionals.

Reasons that surrogacy may be a good option for you include:

• Situations when pregnancy is impossible, such as when you don’t have a uterus
• Repeated implantation failure
• History of repeated miscarriage
• History of cervical or uterine cancer
• Structural issues correlated with infertility, such as multiple fibroids, a T-shaped uterus, or a unicornute uterus (half a uterus)
• Medical conditions, such as heart or kidney issues, which would make pregnancy unsafe
• If you are a same sex or transgender couple where pregnancy is not an option
• If you are a single male who wishes to start a family on your own

The American College of Obstetricians and Gynecologists (AGOG) recommends that surrogacy only be used in cases where pregnancy would be biologically prohibited or unsafe medically for the prospective parent or parents. The American Society for Reproductive Medicine (ASRM) has a similar recommendation and suggests that the medical reasons which indicate surrogacy be documented by a physician before the surrogacy process begins.

Types of Surrogacy

In general, there are two main types of surrogacy: gestational and traditional.

Gestational

In gestational surrogacy, the surrogate doesn’t share any genetic link to the baby they are carrying. Genetic material comes from the intended parent’s sperm, the intended parent’s egg, or donor sperm or eggs. The sperm and eggs are implanted in the surrogate using artificial reproductive technologies. Gestational surrogacy is currently the most common type of surrogacy.

Traditional

In traditional surrogacy, the surrogate uses their own egg, and the egg is fertilized by the intended parent’s sperm, or donor sperm. These days, traditional surrogacy is rarely used, according to ACOG. In fact, ACOG doesn’t recommend traditional surrogacy because of the complicated legal and ethical considerations that can arise when the surrogate is the biological parent of the fetus they are carrying.

Choosing a Surrogate

There are usually two ways that someone finds a surrogate:

• You may use the services of a surrogacy agency that specializes in matching surrogates with intended parents, and ensuring that both parties interests are protected.
• You may choose someone you know personally or who was personally referred to you.

All surrogates undergo medical and psychological screening, to ensure that they are in good health to undergo the demands of surrogacy and that they understand the conceivable risks involved. Likewise, intended parents undergo counseling and psychological evaluations to ensure that they are ready to become parents via surrogacy, and that they are able to shoulder the emotional and financial burden of the process.

Regardless of how you find your surrogate, once your selection has been made, it will be important that you and your surrogate establish some rules and boundaries about your arrangement. This comes in the form of a legally binding agreement that both parties sign off on. Each party (surrogate and intended parents) should have their own, separate lawyers help to draw up this agreement.

Legal agreements between surrogates and intended parents usually involve:

• Establishment of who the legal parents are
• Decisions surrounding prenatal testing
• How pregnancy and childbirth decisions will be made
• Which expenses will be covered by the intended parents

Legal requirements are not set federally. Each state has its own requirements that might impact your surrogacy. That’s why it’s important to have a lawyer helping you from the outset, so you are aware of how your state’s surrogacy laws may impact your arrangements.

How to Become a Surrogate

According to the American Society for Reproductive Medicine (ASRM), a person must meet a few basic requirements in order to qualify as a surrogate:

• You must be at least 21 years old, and preferably younger than 45.
• When possible, a surrogate should have had at least one prior pregnancy that they were able to carry to term.
• It’s best if the surrogate hasn’t had more than five past deliveries, and no more than three C-section deliveries.
• Preferably, the surrogate would have a secure home life and enough help and support to get through the demands of pregnancy.

If you want to become a surrogate, you should contact a surrogate agency to be enrolled. It’s also possible that you will be asked to become a surrogate, if you have a personal or familial relationship with someone who is looking for a surrogate.

Usually surrogates will have to pass certain screening tests before they are chosen. This may involve:

• A basic health examination
• Blood work
• A mental health examination
• Consultations with physicians specializing in reproductive health and surrogacy
• An educational session to ensure that you understand what it means to be a surrogate and the possible risks involved
  

The Process of Surrogacy

Once you select your surrogate, and legal agreements are drawn, you can begin the process of surrogacy, which starts with the transfer of an embryo to the surrogate. How this embryo is formed varies from one scenario to another.

Eggs may come from you or a donor, and sperm may come from you or a donor. If you are using your own eggs, they will have to be harvested, and then fertilized with sperm from your partner or a donor. Either way, the sperm and egg will be fertilized in a laboratory, using IVF. Meanwhile, your surrogate will be given fertility medication to ready their body for implantation. When your surrogate is ready, the fertilized egg will be transferred to them, which is a minor medical procedure.

Once pregnancy is established, your surrogate will receive medical care in the manner that you and your surrogate agreed upon. You may or may not be involved in your surrogate’s prenatal care, such as accompanying your surrogate to appointments. Although many people are present at the birth of their baby born to a surrogate, this is not always the case. Again, these are personal  decisions made between the surrogate and the intended parent.

The Cost of Surrogacy

The cost of surrogacy varies from one situation to another, and from one geographical area to another. Whatever the case, it’s important to understand that surrogacy is costly. The intended parents are responsible for all costs associated with it, including fees paid to lawyers and agencies, medical expenses not covered by insurance, and compensation to the surrogate. Surrogacy costs can fall anywhere from $60,000 to upwards of $150,000.

A Quick Review

A surrogate is someone who gestates and births a baby for a couple or individual who can’t carry a pregnancy. Surrogacy is used for people who have medical reasons that prohibit pregnancy, or who are unable to achieve pregnancy on their own. Surrogacy can be a positive experience for both surrogates and intended parents, but it needs to be done thoughtfully, and under the counsel of medical professionals and lawyers.