Surrogacy FAQs – 12 Common Questions for Intended Parents

Surrogacy is a complex procedure that involves many parties and several steps to make sure that everything goes as expected. When a person or couple decides to pursue surrogacy and starts looking for options to get started, they can become a bit overwhelmed due to the high number of phases involved.

To help you clear some of the most common doubts and queries concerning surrogacy arrangements, we have gathered the most common frequently asked questions by intended parents so that you can put your best foot forward when starting your surrogacy journey.

How does the surrogacy process work?

To put it simply, surrogacy or surrogate motherhood is a process where two main parties take part: a woman (the surrogate or surrogate mother) offers herself to carry a baby for someone else (the intended or commissioning parents, often abbreviated as IPs).

Potential surrogates have to make an application at an agency or fertility clinic in order to be pre-screened and included in the pool of surrogates. Intended parents will do the same: applying at an agency to be matched with the most adequate surrogate. If both parties agree, the next step is to draw and sign the surrogacy contract.

The surrogate, also known as gestational carrier or GC, gets pregnant through IVF embryo transfer. If everything goes as expected, the IPs will be in continuous contact with the GC during the 9 months of pregnancy to stay up-to-date. After the birth of the baby, the IPs will be the legal parents of the child and that's where the surrogacy journey ends.

Although it varies on a case-by-case basis, the surrogacy process can take up to 20 months. The process starts with the preliminary assessments (1-2 months), followed by the matching process (1-4 months), doctor and attorney visits (2 months), medical and IVF visits (2-3 months), and the pregnancy itself (9 months).

Read: Guide to the Surrogacy Process – The 7 Steps of Surrogacy.

Surrogate vs. gestational carrier, what's the difference?

Indeed, although they are often used interchangeably, these terms are not synonyms. In fact, surrogate or surrogate mother should be used when we talk about traditional surrogacy arrangements, in which she is also the genetic mother.

A gestational carrier, as the name itself suggests, is just a carrier, that is, the woman that carries the baby during the 9 months of pregnancy, and is the term that should be used when talking about gestational surrogacy arrangements.

Recommended for you: What Are the Different Types of Surrogacy? – Names & Definition.

Where can I find a surrogate mother?

Most intended parents contact a surrogacy agency to be matched with the right surrogate, which can take considerable time and effort, hence the importance of working with an experienced team.

Others, however, choose to work with a woman they already know, like a friend or family member. A third group of IPs prefers to do it on their own, a choice that we don't recommend in any case, as the risks for complications may be higher.

How to find a surrogate mother

If you don't already know a surrogate or gestational carrier that is willing to help you, we recommend that you look for surrogacy agencies. They can match you with a woman who has been screened and approved to carry surrogate pregnancies.

You will work closely with a surrogacy specialist, who will match you with a woman who fits into your plans and shares your expectations and goals.

Can you choose a family member to be your gestational carrier?

Yes, it is an option. However, the American Society for Reproductive Medicine (ASRM) recommends this option (which they refer to as intrafamilial surrogacy) only in cases of gestational surrogacy; otherwise, a traditional surrogacy arrangement done between family members may replicate incestuous unions, which are not socially acceptable.

Although intrafamilial surrogacy arrangements may offer various advantages over the use of unknown women, it also has some downsides that should be considered, including issues of apparent incest or consanguinity, confused parentage for resulting children, undue influence to participate...

In short, the Ethics Committee concludes that using family members is ethically acceptable, but surrogacy specialists should pay special attention and spend additional time counseling participants.

What are the pros and cons of having a surrogate mother?

For straight couples with a history of recurrent miscarriage, medical complications or impossibility of carrying a pregnancy, surrogacy is a major advantage, as it allows them to become parents by using a third party to bear the pregnancy until birth. Moreover, it allows them to have a child that has the genes from one or even both IPs.

For gay couples and single parents, surrogacy is their unique solution. Given that they cannot get pregnant, using a gestational carrier is the only option for them to have a child. Furthermore, IVF surrogacy allows them to use their sperm for the creation of the embryo—in the case of same-sex couple, they'll have to choose or decide to mix sperm.

Surrogacy for gay couples

Various time considerations are involved as well. Before the actual pregnancy begins, intended parents should spend time exploring the available options. This can entail not only contacting an agency and looking for the right surrogate, but also becoming familiar with the legal and medical procedures involved.

Finally, there are many financial obligations concerning surrogacy in addition to the medical costs for the surrogate mother. Hiring a surrogate can cost $30,000-$50,000 plus other costs derived from the legal and medical processes.

How are surrogate mothers screened?

Surrogates are screened thoroughly in all cases. The process includes several services, such as: review of medical, social and drug history; birth records, background checks, medical workup, and in-home assessment. It should be noted, however, that the services may vary from agency to agency.

Surrogacy agencies screen surrogates for a number of reasons:

1. To ensure that she understands the commitment she's making. They are psychologically evaluated to help educate potential gestational carriers, to make sure that they are truly prepared to commit to the process.
2. To determine that she's healthy for carrying a pregnancy. The evaluation process includes a medical screening in which close attention to her medical and pregnancy history is paid.
3. To evaluate her spouse or partner. If the surrogate is married or in a relationship, her husband or partner will be included in the screening process as well. The goal is to make sure that she has all the support she needs.

You may also enjoy some further information reading this: What Is a Surrogate Mother? – Everything You Should Know.

Is a surrogate mother the biological mother?

As long as it is a gestational surrogacy arrangement, the surrogate won't be the biological mother. In fact, this is the reason why gestational surrogacy is the preferred option nowadays: to prevent the creation of an emotional bond between the surrogate and the child as a consequence of being genetically linked.

In IVF surrogacy, the embryos are created using the eggs and sperm of both intended parents. In case one or none of them can use their gametes, your clinic may suggest you to use donor eggs and/or sperm. By no means will the surrogate be the egg donor as well.

Role of surrogate in gestational surrogacy

Although it has fallen into disuse today, traditional surrogacy is the only type of surrogacy through which the surrogate is the biological and the birth mother at the same time. Due to the number of legal and emotional complications involved, opting for a traditional surrogate is totally unadvisable.

How does a surrogate mother get pregnant?

The surrogate or gestational carrier gets pregnant as any woman does when she achieves pregnancy by In Vitro Fertilization (IVF).

In classical IVF, the resulting embryos are transferred back to the intended mother's uterus. In IVF surrogacy, the difference is that these embryos are transferred to the surrogate's uterus. The ultimate goal is, indeed, the same: to achieve a successful pregnancy and give birth to a baby within 9 months.

As one shall see, the surrogate is not the biological mother of the child because the embryos are created previously using the gametes of the intended parents or from donors.

So, for those who are wondering, there's no possible way for the resulting baby to look like the surrogate, as they don't share their genes.

How much does it cost to have a surrogate mother?

Actually, gestational surrogacy represent a significant cost for most intended parents. The wide number of parties, services and factors involved add to the overall price of this fertility treatment, which can cost ranges anywhere between $90,000 and $130,000.

This range typically includes agency fees, surrogate compensation, fertility clinic fees, and attorney fees, among others. However, IPs are strongly recommended to have an extra amount prepared for additional expenses and potential incidentals.

It should be noted that the cost of surrogacy can vary from state to state. Broadly speaking, surrogates from California, Nevada, Illinois, Colorado, and Maryland are in high demand, which increases the total cost of the procedure.

Related content: Surrogacy Cost Breakdown – Agency & Gestational Carrier Fees.

Does insurance cover a surrogate?

Oftentimes, pregnancy, maternity related matters and newborn care are usually funded under medical care, but this depends on your health insurance company and the plan you hired. Some insurance companies consider a surrogate pregnancy as a normal pregnancy, while others do not cover surrogacy or part of it.

So, in conclusion, our advice is that you check your individual policy whether there is a clause that explicitly excludes surrogacy from your coverage plan. If it is not explicitly stated, then legally your insurer must cover the cost of the surrogate pregnancy at the same rate of coverage of natural pregnancies.

Also, it is important that hopeful intended parents seek counsel from a legal professional who has experience in surrogacy arrangements and is well versed in issues related to health insurance when Assisted Reproductive Technology (ART) is necessary.

Is surrogacy legal in all 50 states?

No, surrogacy is banned in some states. Actually, surrogacy is not regulated by any federal law, but each state has its own set of regulations. Some states are more surrogacy-friendly than others, with statutes that explicitly approve surrogacy arrangements, while in others surrogacy is prohibited or even punishable.

We can distinguish three different groups: surrogacy-friendly states with an explicit law, surrogacy-friendly states with case law that is favorable to surrogacy, and states that forbid surrogacy. The friendliest states are California, Connecticut, Delaware, Maine, Nevada, New Hampshire, and Washington D.C.

See this for more: Surrogacy in the USA – Is It Legal in All 50 States?

Can surrogates decide to keep the baby?

It is highly unlikely for the following reasons:

• Surrogates have been previously psychologically screened and have usually completed their own family. In other words, they are mentally prepared to commit to the process.
• The baby is not genetically related to her, which reduces the emotional bond that often creates between pregnant women and the baby.
• And most importantly, they sign a legal agreement whereby they agree to relinquish the baby after the birth. Surrogacy agreements are carefully written by fertility attorneys to ensure the protection of all parties.

Hence the importance of working with an experienced attorney and signing a surrogacy agreement, as well as working with an agency. If you decide to do it on your own, without an attorney and a legal agreement, the risk of complications as such increases.