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If you’re wondering “how does surrogacy work?” you’re not alone.  The number of people in the U.S. who are using a surrogate to carry their baby has been steadily rising, according to the Center for Disease Control. Let’s explore how surrogacy works.

What is a surrogate?

  • Gestational surrogacy – A surrogate mother carries the intended parents’ baby for them. This is the most commonly performed type of surrogacy because the surrogate is not genetically related to the baby she carries, which makes it preferable both legally and emotionally.
  • Traditional surrogacy – A surrogate mother carries a baby made from her DNA and that of the intended father. This is infrequently performed because the surrogate is related to the baby she carries.

There are many legal, emotional and medical advantages for gestational surrogacy, which is why it is the most frequently chosen by surrogates, intended parents and fertility doctors. A surrogacy pregnancy is achieved using a popular and complex fertility treatment method called In Vitro Fertilization (IVF). Using this fertility treatment, a Reproductive Endocrinologist, or infertility doctor, removes some of the intended mother’s eggs and fertilizes them with the intended father’s sperm. As a result of this fertilization, embryos are created which carry the genetics of the intended mother and father. These embryos are then cared for and allowed to grow in the fertility clinic’s laboratory for typically around three to five days. At that point, one or more of the embryos may be directly implanted into a gestational surrogate’s (also known as a gestational carrier) uterus in a medical procedure known as an embryo transfer. The surrogate will then carry the pregnancy (to whom she is not genetically-related) until she ultimately delivers the intended parent’s child.

Surrogacy pros and cons

There are many benefits and some drawbacks for becoming a surrogate mother. One drawback is that typically women gain weight when they are pregnant, which can be difficult to lose after the delivery. There is also a possibility that the surrogate may develop an unforeseen medical complication from the surrogacy pregnancy. There is also a lot of time and effort a Surrogate must spend in order to ensure that the pregnancy goes smoothly, such as attending doctor’s appointments, eating healthily, and getting adequate rest.

The biggest reason to be a surrogate is that it is one of the most impactful ways to help another person or people – by helping them to become a parent or add to their family. Most intended parents seek the assistance of a surrogate mom because there is a medical reason that prevents them from carrying a baby to term successfully. Therefore, the surrogate is helping people to become parents who would otherwise not have the chance to do so. Many choose to follow guidelines for surrogacy recommended by the American College of Obstetrics and Gynecologists.

How do I become a surrogate mother?

Overall, the surrogacy process works very differently for the surrogate than it does for the intended parent or parents. When a woman is considering becoming a gestational surrogate mother, or gestational carrier, her first decision should be whether she wants to work independently or with the help of an agency. One of the biggest reasons a surrogate chooses to work independently, and without help from surrogacy agencies, is because she doesn’t want the intended parents to have to pay the surrogacy agency fees. Wanting to relieve some of the intended parent’s financial burden is commendable and demonstrates that the surrogate is doing her best to help the intended parents. However, something the surrogate should bear in mind is that the surrogacy is a very complicated process about which most intended parents know very little. By choosing not to employ a surrogacy agency to manage their surrogacy journey, the intended parents may not only shoulder the burden of managing it themselves, but they may often pay even more money through missteps or mistakes they would likely have avoided should they have utilized the experience and knowledge a top surrogacy agency provides. Ultimately, many women choose to become a surrogate with the help of the best surrogacy agency they can find.

Once a woman makes the decision to be a gestational surrogate, she will search for and meet with potential intended parents with whom to work. She may have a preference in what she is looking for in an ideal intended parent. For example, some surrogates may want to work with gay couples. Others may only want to work with a husband and wife couple or a single parent. Other surrogates may want the intended parent to share their particular religious views, or be financially well-off, or want the same type of intended parent-surrogate relationship as she does. Ultimately, when the surrogate and intended parents agree to work together, they will proceed with the surrogacy process.

The intended parents usually require that she undergo testing to verify that she is well-suited to being their surrogate. Typically, this testing includes medical testing to verify that her surrogacy pregnancy will have little chance for complications and that her body is capable of carrying a surrogacy pregnancy to term. She may undergo psychological testing to verify that she completely understands how the surrogacy pregnancy will proceed, and whether she will be emotionally capable of caring for a pregnancy that belongs to someone else.

Many states in the U.S. have passed laws on surrogacy but they are not all the same. Every intended parent and surrogate should be aware of their state’s stance on whether their surrogacy contract is enforceable by law. A skilled attorney will help with this.

A gestational surrogate will likely sign a surrogacy contract, probably with guidance from a surrogacy attorney. The surrogacy contract can vary but usually includes what fees are to be paid to the surrogate, what steps will be taken in the event of pregnancy complications, details the expected delivery and post-delivery process and remove the surrogate’s legal right to the baby she is carrying for the intended parents. A background check and drug test may be performed on the surrogate, so as to give the intended parents peace of mind during the surrogacy.

Once the preliminary steps have been taken, the surrogate will begin the fertility treatment process. The fertility doctor will likely have her take birth control pills in order to regulate the timing of her menstrual cycle so as to sync with that of the intended mother’s menstrual cycle. For usually around three to six weeks the doctor will make the surrogate take fertility medications, the type of which vary from person to person, and may include self-injectable medications. When she is ready for the embryo transfer procedure, she’ll go into the fertility clinic and the embryo will be implanted into her uterus. There is usually no sedation required and no incision is needed to perform the embryo transfer. If the surrogate becomes pregnant, she will have the pregnancy monitored initially by the fertility doctor, before her care is graduated to usually a high-risk Ob/Gyn, with whom she will deliver. After she delivers, the baby is given to the intended parents and the surrogate may or may not continue to interact with them and the baby as they had previously agreed upon in the surrogacy contract.

Surrogate compensation

The surrogate’s medical expenses, travel expenses, health insurance and unpaid time off of work will usually be paid for by the intended parents. Unless it is an altruistic surrogacy, there will also likely be additional compensation the intended parents agreed to pay directly to the surrogate, for her time and effort. Generally, these payments are made on a monthly basis throughout the surrogacy pregnancy and can add up to $30,000 or more, depending on the agreement in the surrogacy contract.