Let's be honest - surrogacy can feel very intimidating. As much as you may long to grow your family, the process is often quite overwhelming. For LGBTQ+ dads-to-be, there's so much to think about (like how to choose a surrogacy agency, egg donor, gestational carrier, fertility practice, and attorney), that it's sometimes hard to even know where to start.
In this article:
- What is surrogacy?
- What is the difference between a gestational carrier and a surrogate?
- Why would a person (or partners) choose surrogacy?
- What is the typical timeline for a surrogacy journey?
- Should I try to find a surrogate first? Or find the egg donor?
- Why should I use an agency rather than find a surrogate on my own?
- How are egg donors screened?
- How does someone become a surrogate?
- What happens if I want to pursue surrogacy but it is banned in my state?
- What are the legal considerations around surrogacy?
- How much does surrogacy cost?
- How do people afford surrogacy?
- Does insurance cover surrogacy?
As a fertility doctor who specializes in helping intended parents grow their families through surrogacy, one of the most common things I hear is “I don’t know what I don’t know.” In other words, even identifying which questions to ask is challenging for many people!
By the time a patient makes an appointment for a consultation with me at our partner clinic Illume Fertility, they have typically begun to research surrogacy on their own by reading articles online, attending surrogacy conferences, or talking to friends. But it can be difficult to find comprehensive answers to some questions. So let's talk about them!
General FAQs About Surrogacy
After two decades working in LGBTQ+ family building, I've collected some of the most common questions that intended parents ask. Let's tackle the basics first with a quick crash course (or refresher) about the surrogacy process:
What is surrogacy?
The short answer: Surrogacy is an arrangement in which a woman carries a pregnancy for another individual (or couple). It involves a legal agreement between the woman (the surrogate) and an individual or couple (the intended parents).
What is the difference between a gestational carrier and a surrogate?
A gestational carrier (also sometimes referred to as a gestational surrogate) is someone who carries a pregnancy for another person but has no biological link to the child. In contrast, a traditional surrogate donates her egg and carries the child, so she is biologically related to the pregnancy that she is carrying.
Traditional surrogacy is now rare in the United States due to its complex ethical and legal implications.
Why would someone choose surrogacy?
There are many different reasons people choose surrogacy to grow their families! While we often think of surrogacy as a family-building method primarily utilized by gay men, here are some other scenarios where someone might pursue surrogacy:
- Those born with a uterus who are unable to carry a healthy pregnancy themselves, or if becoming pregnant would be dangerous to their health or the health of the baby.
- Those who are either born without a uterus or have had their uterus surgically removed.
- Those have had serious pregnancy or delivery complications in the past, or may have ongoing medical issues that make pregnancy unsafe.
- Those with a history of many unsuccessful embryo transfers or pregnancy losses.
- Those who are cancer survivors and may have had treatments like chemotherapy, radiation, or hysterectomy.
- Single men or same-sex male couples who are looking to expand their families.
Now that we've covered the basics, let's dive in to the nitty gritty details.
Getting Started with Surrogacy
What is the typical timeline for a surrogacy journey?
Every surrogacy experience is unique, including the timeline. For single men or gay couples, the most important first steps are selecting an egg donor as well as a surrogate. Finding an egg donor typically takes 4-6 months, depending on the donor source (e.g. donor egg agency or known donor).
Finding a surrogate typically takes 6-12 months, and includes interviewing the potential surrogate, her spouse or partner, medical screening, psychological screening and agreeing on a contract. All in all, most surrogacy journeys (on average) take between 15 to 24 months.
Should I find a surrogate first? Or an egg donor?
Intended parents can simultaneously search for an egg donor and surrogate. Typically it takes less time to find an egg donor and create embryos. Embryos created prior to finding a surrogate can be cryopreserved through an advanced technology called vitrification.
The cryopreserved embryos are stored until a surrogate is chosen and screened. The best embryo will then be thawed for transfer into the gestational carrier.
If the surrogate is found first, the intended parents may need to pay to keep her on hold while a donor is chosen and embryos are created.
Why should I use an agency rather than find a surrogate on my own?
Many patients wonder if they can find a surrogate on their own to reduce costs. While we understand the desire to streamline the financial aspect of surrogacy, we highly recommend utilizing a professional surrogacy agency, since they specialize in finding suitable carriers and managing the rigorous screening, relationship and legal processes.
Agencies will carefully vet their gestational carrier candidates with thorough initial screenings that weed out all but a fraction (about 10 percent) of the women who apply.
Beyond this, surrogacy agencies have many years of experience finding a good personality match for intended parents and surrogates. Illume Fertility only recommends well-established, reputable surrogacy agencies we've successfully partnered with.
Working with an Egg Donor & Surrogate
How are egg donors screened?
Reputable fertility practices follow the guidelines from the American Society of Reproductive Medicine (ASRM) with oversight from the U.S. Food and Drug Administration (FDA).
For the egg donor, the process starts when a young woman connects with a clinic or agency that provides egg donation services. During the initial screening, the donor completes a thorough questionnaire categorizing her family history, personal medical history, and some of her personal achievements and lifestyle choices. She will also likely answer why she would like to be an egg donor.
Once this is complete and the clinic is comfortable with the answers in regards to her medical, family, and social history, the potential egg donor is invited to the clinic for screening. She is then screened for infectious diseases, genetic conditions, and gynecologic health.
In addition, she completes psychological screening by a mental health professional to assess whether this is a good choice for the young woman and to rule out any mental health issues.
Assuming the medical, genetic, and mental health screenings are in order, the donor is considered part of the donor egg recipient pool. The donor is then available for matching with intended parents, who may choose an egg donor in part by characteristics such as ethnicity, education and physical attributes.
How does someone become a surrogate?
Women who are interested in becoming gestational carriers (commonly referred to as surrogates) can apply to work with a surrogacy agency that matches them with intended parents. There is typically an extensive intake process in which the agency gathers information about the woman’s prior medical and pregnancy history.
They will also request medical records from her prior pregnancies and run a background check. She will undergo a medical screening process that includes blood tests, a uterine evaluation, and a full psychological assessment to make sure she understands the process and the implications of her decision. She will also meet with a physician to review her history, discuss the process, and get any follow-up questions answered.
Once she is approved to move forward and is matched with intended parents, she will work with an attorney on the surrogacy contract. Background checks and home studies may also be a requirement or recommendation once you are close to signing with your gestational carrier.
For the embryo transfer process, the gestational carrier will take hormonal medication to prepare the lining of her uterus for transfer, and will have a simple procedure (no anesthesia required) to place the embryo in her uterus.
She will continue taking hormonal medications for most of the first trimester of pregnancy.
The Legal Aspect of Surrogacy
What if surrogacy is banned in my state?
Surrogacy laws vary from state to state, but a person can become a parent through surrogacy no matter where they live.
The most important laws for a surrogacy agreement are the state laws where the surrogate lives (and will deliver the baby). If an intended parent lives in a state where surrogacy is not legal, they can work with a surrogate who lives in a surrogacy-friendly state.
Having a great legal team who understands the intricacies of surrogacy is essential for success.
What are the legal considerations for surrogacy?
There are many important legal issues associated with working with a gestational carrier, and the laws governing these relationships can differ from state to state. As a result, it is very important to work with a knowledgeable attorney when choosing this option.
Your attorney will draft contracts, provide legal counsel and coordinate the termination of parental rights for the surrogate or the gestational carrier and egg donor. Egg donors should also make sure that they understand and address any legal issues associated with their services.
Gay Parents To Be (through our partner clinic, Illume Fertility) is able to refer intended parents to experienced attorneys and legal practices that specialize in third party reproduction.
The Cost of Surrogacy
How much does surrogacy cost?
There are many different costs associated with surrogacy, so let's break them down.
Intended parents will need to do an IVF cycle to create embryos, which may or may not be covered by insurance. The surrogate is compensated for carrying the pregnancy, and the intended parents are also responsible for covering her medical costs.
There are also legal fees, agency fees, costs associated with screening the surrogate and doing the embryo transfer cycle, and travel costs to consider. The cost of working with a surrogate varies greatly.
Typically, you can expect to pay $48,000-$140,000+ for surrogacy with IVF in the United States. (if you are paying out of pocket for all services and associated fees).
How do people afford surrogacy?
It can be stressful trying to figure out how to afford surrogacy. Thankfully, you have resources and support to help you! At Illume Fertility, we assign a financial advisor to each family to help them figure out their potential surrogacy costs depending on their unique situation.
Does insurance cover surrogacy?
Unfortunately, surrogacy is not usually covered by insurance, though it depends on the individual situation. Advocacy groups are continuously working to increase access to family-building care like surrogacy. Want to get involved? Check out RESOLVE!
Surrogacy is Complex, But Worth It
As a physician and a father who has been through the surrogacy process twice in order to grow my own family, I want you to know that all your hard work will pay off. At times, surrogacy can seem to have too many obstacles, be too complicated, or require too much of you.
But every hurdle is surmountable, and with perseverance and right team of surrogacy professionals, you can get through it! When an intended parent finally gets to meet their baby and transition into parenthood, there is no greater joy.
Dr. Mark P. Leondires is the Founder and Medical Director of Illume Fertility, an inclusive, award-winning fertility clinic with five locations in Connecticut and New York. Dr. Leondires is board-certified in both Obstetrics and Gynecology and Reproductive Endocrinology and Infertility. Dr. Leondires is also the Founder of Gay Parents To Be, a leading family-building resource for the LGBTQ+ community - a passion project created after undergoing his own journey to parenthood as a gay dad.