Surrogacy: A Guide to Gestational Carriers for Intended Parents By The Egg Donor & Surrogacy Program on October 14, 2020

With IVF, gestational carriers can carry and deliver the intended parent’s child for them. Learn everything you need to know about this fertility service.

Infertility, although common, can be heartbreaking and distressful for intended parents and their support networks. Impacting an average 10% of the population, infertility can simply refer to the inability to get pregnant, but also encompasses cases of repeated failed pregnancies. 

If you have a history of experiencing infertility, it’s important to know you’re not alone. With modern medicine, assisted reproductive technology (ART) offers solutions to ensure those struggling with infertility can strive to conceive and grow their families. 

Additionally, there is an amazing network of people within the fertility industry who want to help you in your fertility journey. From fellow intended parents to donors and gestational carriers, many men and women dedicate their lives and provide services to make having a baby possible.

What is a gestational carrier?

A gestational carrier (or surrogate) is a woman with a history of at least one healthy pregnancy, who helps another couple’s or individual’s fertility journey by carrying and delivering their baby for them. Gestational Surrogacy is possible thanks to an assisted reproductive treatment called “in vitro fertilization” (IVF)

IVF treatment entails retrieving eggs and a sperm sample from the intended biological parents or donors, combining them to form embryos, and then placing the embryos into the uterus of the surrogate who will be giving birth to the baby if fertilization is successful. The surrogate then carries and delivers the baby for the individual(s) seeking to be parents.

Both intended parents or donors are the only biological parents of the child. The surrogate, although the birth mother, has no biological link to the baby as none of her own eggs are used during the IVF fertilization process. 

IVF and surrogacy are very successful, contributing to the births of thousands of babies across the world every year.

Best candidates for pursuing surrogacy 

IVF-led gestational surrogacy is an ideal fertility solution for same-sex male couples, women who cannot carry a pregnancy to term, or for whom pregnancy would be dangerous, and other scenarios when clinics need a woman with fertile eggs for the fertilization, pregnancy and delivery of a baby. 

By using surrogacy in conjunction with IVF, clinics can ensure that the intended parent’s or donor’s egg will always be used as opposed to practicing traditional surrogacy, where the surrogate is the biological mother. 

This means that egg donors, surrogacy clinics, and patients seeking surrogacy services can enforce a controlled and ethical practice while protecting all party rights and preventing legal or emotional complications. For these reasons, IVF has proven to be highly successful in facilitating positive and healthy surrogacy experiences.

The history of successful gestational surrogacy

Due to the increased protections provided during gestational surrogacy, intended parents and clinics alike consider this method the gold standard in the industry. Thus, using gestational surrogates has been promoted as an ideal fertility solution since the first successful gestational surrogacy in 1985

This birth changed the industry and was a reference for surrogacy-related legislation and parental protections. Legal and surrogacy agency requirements also became more standardized and defined so that intended parents and surrogates feel comfortable with the process. 

For example, this is when pre-birth and post-birth contracts became fully developed in many states to declare rightful parental rights. Family planning and surrogacy clinics also became more experienced, helping individuals seeking surrogacy services learn more about them.

Considering gestational surrogacy?

Educating yourself is one of the most important factors to being prepared and comfortable if you’re relying on a gestational carrier to grow your family. To help you decide if you are interested in gestational surrogacy, let’s discuss the benefits and possible downsides during this fertility journey:

The benefits and costs of gestational surrogacy

Surrogacy brings some of the greatest blessings in life--the gift of a baby, a chance to become a parent, the ability to raise a family, and a future of happiness and fulfillment. Many parents who have successfully started their families through surrogacy will confirm that its benefits greatly outweigh any drawbacks. 

However, it is crucial to analyze if you are ready to take on the responsibility of using surrogacy as a fertility service to reach parenthood. To help you determine if this is the right decision for you and your partner, consider the following:

The benefits of opting for surrogacy are that it:

  • Is a solution to infertility 
  • Empowers members of the LGBTQ+ community and individuals with medical-related pregnancy risks with the ability to start a family
  • Offers a biological child to the intended parents
  • Fosters a strong bond between the surrogate and the intended parents
  • Can include a legally binding contract prior to the embryo transfer so all parties are in agreement and protected (this is dependent on the location of the surrogacy and the identification and marital status of the intended parents)
  • Provides the opportunity to be present for pregnancy appointments and milestones, such as the delivery of the baby
  • Has a high success rate due to requirements that surrogates have a history of healthy pregnancies and deliveries (surrogacy fertilization rate is as high as 75% with IVF, and once pregnant, the rate of a successful delivery rises to 95%)

On the flip side, although a positive and successful experience for many, gestational surrogacy is a long and intensive process that requires effort and commitment. 

Some downsides of surrogacy you should consider include:

  • Legal processes that require negotiation and agreement 
  • Medical procedures that, no matter how industry-trusted, always offer a risk of result variation
  • Normal pregnancy risks the surrogate may experience
  • High costs due to the staff and services needed to complete a successful surrogacy
  • The necessary trust that occurs when a surrogate is carrying your pregnancy

If you are contemplating gestational surrogacy, these benefits and potential complications will likely be obvious from early on in the process and it’s important to consider both. However, once families complete surrogacy, most will say the same, which is that the advantages and ability to have a baby easily surpass any downsides.  

Additionally, when you choose a top-rated fertility clinic and egg donor & surrogacy agency, your doctors and clinicians will take standardized steps towards reducing possible complications or confusion during a life-changing fertility journey.

For example, some egg donor & surrogacy agencies develop their network of surrogates (and egg donors) through hand-picked selection, using intentional requirements to help you achieve your fertility goals with the service. 

Requirements for gestational surrogates

To provide individuals pursuing gestational surrogacy services peace of mind, agencies can improve pregnancy success rates with fertility-related surrogate requirements. This ensures that the agency helps you choose your best surrogate and donor match.

Surrogate mother requirements that should be prioritized are:

  • An optimal age below 40 for increased fertility
  • A previous and healthy pregnancy history
  • Medical requirements declaring no presence of illnesses that could affect pregnancy
  • Fewer than 2 consecutive pregnancy losses
  • Fewer than 2 Cesarean sections
  • A BMI below 35

Implementing and upholding these requirements provides safety for the gestational carrier and the baby. However, surrogacy requirements also provide intended parents with reassurance during the process and ensure their financial costs are conducive to a healthy, happy baby.  

The Costs of choosing Gestational Surrogacy

Speaking of costs, gestational surrogacy is an expensive service due to many factors such as requirement checks, medical appointments, a long timeline, and surrogate compensation. However, many clinics strive to keep upfront gestational carrier costs as affordable and transparent as possible.

To help make surrogacy more inclusive, program fees can be split by stages within the service, such as by service sign up, surrogate matching, etc. However, overall costs can be expected to range anywhere from $90,000 to $200,000 by the end of the pregnancy.

Gestational surrogacy processes are also often split between two different establishments--a donor & surrogacy agency, and a fertility clinic to perform medical procedures related to the IVF treatment. Cost comparisons between clinics and agencies are also offered to help you decide the best price package for your budget. 

Fertility clinics and donor & surrogacy agencies have vast networks and resources to point you in the right direction if you’re unsure about where to go for fertility services and vice versa. Furthermore, choosing a clinic that provides fully integrated fertility services and its own network of donors and surrogates makes this journey much smoother and more cost-effective.

Finding a surrogate as intended parents

Choosing a surrogate can be a difficult decision that requires a lot of back-and-forth with many women willing to become your gestational carrier. 

Likely a completely foreign process, knowing how to choose a gestational carrier that is a good match for you, your partner, and your fertility journey preferences goes a long way in ensuring a positive experience. It can also be made easier with informative networks, research, and open communication.

Where to look for a gestational carrier

Gestational carrier profiles can be sent to individual(s) pursuing surrogacy. Surrogates will be matched based on compatibility, which is assessed through a program consultation. This match sets the foundation for a great surrogate-intended parent relationship throughout the pregnancy. 

This is a professional-guided process to ensure that you are set up with a trustworthy surrogate who is a mother herself and feels confident in the experience.

To determine if there could be a match, detailed profile information and pictures of the surrogate will be made available to you. You often also get the opportunity to meet a surrogate to further determine if a good relationship could grow during the experience.

Surrogacy and intended parent communication best practices

Once a match has been determined, it can still be difficult to trust someone you don’t know with a costly and emotional investment. That’s why it’s important to establish open lines of communication. This communication seeks to satisfy and comfort both the intended parents and the surrogate, while still respecting the boundaries of the surrogate. 

When working with a well-established agency that has a long history within the surrogacy field, the medical specialists and staff are highly experienced and know what conversations need to be had in the beginning to build a great relationship with the surrogate. This is valuable because it can avoid communication problems down the road. The agency will facilitate these conversations for you, so nothing important is overlooked.

Some of the dialogues (and helpful communication tips) the agency will facilitate to promote a great relationship with your surrogate are:

  • Predetermine agreed upon dietary restrictions and lifestyle choices the surrogate can follow during the pregnancy and delivery
  • Ask questions and discuss your concerns to establish trust with your surrogate
  • Remain flexible in both your expectations and the pregnancy process (this is true even for naturally-conceived pregnancies)
  • Understand the role of empathy in learning one another’s perspective and worries
  • Respect boundaries so surrogates are not overwhelmed while the intended parents still remain informed 
  • Express your communication expectations
  • Determine times to offer regular updates
  • Decide on a form of communication that everyone is comfortable with
  • Predetermine answers to difficult questions that may arise. Such as whether to terminate in certain circumstances. 

Additionally, you can always consult the professionals from your chosen egg donor & surrogacy or fertility clinic to gain additional support and discuss any uncertainties throughout the process.

Laws that affect the surrogacy process

In states where surrogacy services have many or complete restriction(s), surrogacy can be a dangerous and stressful process to pursue. 

The state where a surrogate resides heavily impacts the laws surrounding surrogacy, so it is crucial that you choose clinics and surrogates within a surrogate-friendly state. Doing this means you can better support your surrogate during her pregnancy and prevent legal problems throughout the process.

If you live in a state that prohibits surrogacy or makes it difficult, your best option is to choose a surrogate who is in a state with an easier legal process. Once this match is determined, 2 attorneys, one representing you and the other representing your surrogate, will discuss the implications of this relationship, draft a contract, and determine the best path forward. 

To demonstrate the legal differences between state and country lines, learn how surrogacy practices differ between California and China:

Surrogacy in California

California, the most surrogacy-friendly state in the nation, has surrogacy practices that are defined by the California Family Code § 7960. Confirmed in 2013, this legal code has a straightforward and well-structured process led by professionals to regulate surrogacy.

Gestational surrogacy is also highly popular (and competitive) within California, meaning that getting a carrier may be a little more expensive than in other states. However, the benefit of working within California is that the process is inclusive, and open for same-sex or opposite-sex couples, members of the LGBTQ+ community, or single individuals. This also reduces difficult legal processes because legal parentage is contracted pre-birth to establish the intended parents as the rightful legal parents.

Surrogacy in China

Although surrogacy is becoming more common in China with approximately 10,000 children born as a result every year, surrogacy in China looks very different from California. 

Gestational surrogacy is not highly regulated or managed within the Chinese legislature because all forms of surrogacy, including gestational, are banned. 

This means that legal parentage is not enforceable or transferable, and the gestational carrier is regarded as the natural mother, a policy that can create emotional and legal complications. Pursuing a surrogacy within a country or state that offers little guidance can be highly stressful for intended parents and surrogates. 

This is why most only pursue surrogacy family planning agencies and fertility clinics within surrogacy-regulated states and countries. This offers a safe and reliable surrogacy and will ensure that it is one of the best experiences of your life. 

Your next steps for pursuing gestational surrogacy

Unsure where to start next? That’s completely normal. 

Surrogacy agencies are prepared to handle all your questions. Some first steps towards gaining confidence in your fertility journey could be to:

It’s great to learn as much as you can about the process of IVF and gestational surrogacy so that you can commit to using a surrogate with confidence and preparedness if you decide it’s the right option for your fertility journey.

Contact our EDSP fertility experts

Reach out to our family planning clinic, the Egg Donation & Surrogacy Program, to fulfill your dream of starting a family with our top-rated egg donor and surrogate selection. We want to ensure you experience compassionate, all-encompassing services that make you excited to take the next step towards having a baby of your own. 

Click here to request a consultation with one of our fertility experts. Our team is excited to help you with your fertility journey and blessed to be a part of such a life-changing experience. 

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