What is surrogacy, exactly?
So, a surrogate is someone who becomes pregnant with someone else’s baby. But what you might not know is that there are two types of surrogacy: a traditional surrogate refers to a woman who’s carrying a pregnancy for someone else using her own egg; while a gestational surrogate is the more accurate term used for a woman who’s not related to the baby she’s carrying. But today, becoming pregnant with your own egg for someone else is generally frowned upon, says reproductive endocrinologist Mark Leondires, MD, FACOG. “Traditional surrogacy isn’t recommended by the American Society for Reproductive Medicine (ASRM), and most agencies won’t do it,” he explains. “With [that] genetic link, it can make transfer of the baby legally difficult, and it can change the emotional connection the surrogate has to the child.” Instead, it’s almost always the intended mom’s egg or a donor’s—and not the surrogate’s. So here, we’ll be talking about gestational surrogacy, which is what the term surrogacy has come to mean these days.
Why choose surrogacy?
People who decide to go the surrogacy route have a deep desire for a baby, but don’t have one key thing: a healthy uterus. This includes women who’ve had hysterectomies, repeated miscarriages, certain cancers or who are dealing with health conditions, such as heart problems, that would make carrying a baby too risky. Same-sex male couples sometimes choose surrogacy too.
There are cases where a woman chooses a surrogate because she simply doesn’t want to carry a pregnancy, but those are few and far between, says reproductive endocrinologist Maher Abdallah, MD, FACOG. Wanting a child who shares their DNA is probably the biggest reason to choose surrogacy over adoption, but there are others too. Some people find it difficult to find an adoptive child, since it’s often the birth mother’s choice who adopts. Plus, there’s always the chance she could change her mind and keep the baby, says Gayle East, RN, a surrogacy agency owner in Texas. That can be heartbreaking if you’ve been anticipating taking the child home. “Adoption takes about two years,” Leondires says. “Plus, there can be anxiety of how well the birth mother took care of the child while she was pregnant.”
Who’d want to carry someone else’s child?
For starters, women who love being pregnant and who are good at it! Often, surrogates are people who’ve been touched in some way by infertility; they may have a family member or close friends who’ve struggled to have a baby of their own. Or some of them love being a parent so much, they want to pay it forward so someone else can experience the same joy. “Obviously there are also people who try to do it for the money, but we try to filter them out in the beginning,” East says. Yes, surrogates are usually well compensated—it varies but it can be from about $15,000 to $30,000, according to Leondires—so money is many times a motivating factor too. The exception to that rule: women who choose to carry a baby for friends or family members out of sheer kindness.
Can anyone be my surrogate?
Qualifying to become a surrogate isn’t exactly easy. Good quality agencies have strict requirements: The woman must have delivered at least one child and have had a healthy pregnancy and uncomplicated delivery. She has to undergo both health and psychological screenings, and be financially stable. Her partner must be supportive of her decision and undergo psychological screening too. “In reality, probably less than five percent of women would fit all the screening requirements,” Leondires says. If you’re skipping an agency and choosing a friend or family member, then there are no restrictions on who might be your surrogate, and it can make the process extra meaningful as Rachelle Friedman discovered. You may recall Friedman, the bride who was paralyzed during her bachelorette party, went this route when her college friend Laurel Humes volunteered to carry a child for Friedman and her husband. Daughter Kaylee Rae was born in April and Friedman called her “the most beautiful gift we will ever receive,” as she thanked Humes via Instagram.
How would I start this process?
An important first step is finding out what the surrogacy laws are in your state. Some states are “surrogacy friendly,” but others have a number of restrictions. You don’t want to leave yourself open to a situation where the surrogate could become the child’s legal parent. Some states don’t allow paid surrogacy at all, so for some couples it makes sense to find a surrogate who lives and will deliver the baby in another state, East says. The usual next step is to find a reputable surrogacy agency—a good place to start is with a referral from your fertility center or from other women you trust who’ve gone through the surrogacy process. As you research agencies make sure they follow ASRM guidelines.
How does the agency decide who will be my surrogate?
Potential surrogates are matched with intended parents based on a variety of factors, including shared beliefs on issues like selective termination or what would happen in certain scenarios, like if the baby was found to have a birth defect. East says her agency goes so far as to have surrogates fill out questionnaires that include their personal taste in music and hobbies. In the end, it most likely comes down to whether or not she and the couple seem to click after several conversations.
How it actually works
“There’s a multidisciplinary team,” Leondires says. Doctors are in charge of helping create and deliver a healthy pregnancy. Lawyers from both sides—the surrogate and the intended parents—work together to make sure all the details and “what ifs” are agreed upon up front. A psychologist ensures everyone involved is in the right mind-set to carry it all out.
Once all of these team players give the go-ahead, it’s time to make a baby. Usually the surrogate undergoes IVF, with the intended parents’ egg and sperm. In some cases, a couple might also need an egg and/or sperm donor. After that, the couple and surrogate stay in touch throughout the process, sometimes connecting for doctor’s appointments.
Costs vary based on many things—what part of the country you’re in, the surrogate’s experience, whether there are pregnancy complications and more—but for the most part, it’s a pretty expensive process. “Everything, including compensating the carrier, IVF, the pregnancy itself and legal bills, can cost couples anywhere from $80,000 to $120,000,” Leondires says. “The higher end of that range is when they need donor eggs.” Most health insurance plans don't cover surrogacy, but some may include some coverage, so find out up front.
The surrogate-couple relationship
There are surrogate relationships that are more like business transactions than anything else, but there are quite a few that are much deeper than that, Abdallah says. “Usually at minimum, they speak one time per week, in my experience,” Leondires says. “Once the journey has started, regular email and texting or phone calls are common. Everyone is excited.”
For a vaginal delivery, very often the intended parents are in the delivery room. If it’s a c-section, just the surrogate and her partner would be allowed.
The horror stories we’ve all heard
Yes, there have been negative surrogacy stories. There are people who’ve been scammed by “agencies” that went out of business after checks were cashed. There are people who haven’t gotten along with their surrogates. Bad contracts, babies lost and messy custody battles — they’ve all happened. But, the experts say, positive experiences are the overwhelming majority. “People hear about the 1 percent of surrogacies that go poorly, but they don’t hear about the 99 percent that go really well,” Leondires says.
Having a positive experience
It’s important to be patient with the surrogacy process, to wait to find the surrogate who’s right for your family. Don’t settle on the first one to come along. Be sure your agency is reputable and that you trust the surrogate completely. Having a lawyer experienced in surrogacy law is also key for both the parents and the surrogate. They can help draw up a comprehensive contract and, if your state allows it, help you get a prebirth order that says the intended parents are the baby’s legal parents at birth. Once the legal Ts and Is are crossed and dotted (and you have some peace of mind), it can be an amazing process—and an even more amazing outcome. “It’s a journey of joy when two families come together to bring a child into the world,” Leondires says, whose sons, now one and three-and-a-half years old, were the result of two wonderful surrogacy journeys.
Experts: Mark Leondires, MD, FACOG, medical director and lead infertility doctor with Reproductive Medicine Associates of Connecticut (RMACT); Maher Abdallah, MD, FACOG, reproductive endocrinologist and OB-GYN at American Reproductive Centers in Southern California; Gayle East, RN, founder of Surrogate Solutions, a surrogacy agency in McKinney, Texas