What’s Gestational Surrogacy?
Gestational surrogacy involves a woman carrying a child for whom she is not the intended mother. Most often, it is chosen because the intended mother wishes to be genetically related to her child, but is not able to carry a pregnancy herself. In that case, eggs are retrieved from the intended mother, fertilized, and then transferred into the gestational surrogate. Sometimes, the surrogate herself or another woman donates the eggs. Typically, the intended father’s sperm are used to fertilize those eggs, but donor sperm may also be used.
A gestational surrogate may receive compensation for her time and effort, or she may act as a “compassionate surrogate,” meaning that she donates her time and effort free of charge to the intended parents. Compassionate surrogacy is most common when the surrogate is a family member or friend of the intended parents. Surrogates who receive compensation are most often found through a surrogacy agency.
If you’re choosing gestational surrogacy, make sure you’re choosing it because you really want it, not to please someone else or to fit an imagined ideal. No one else can make the choice for you; it’s your body, and you’re in charge of it. After you do your research and understand the procedure, if you believe that gestational surrogacy is right for you, then proceed. To help you in your decision-making process, we have some information about the risks and benefits of gestational surrogacy at Gestational Surrogacy: Risks and Benefits.
Please note that this page is for informational purposes only, and is not a substitute for qualified, individualized medical advice. You should discuss your potential elective procedure with your own doctor(s), including your primary care physician and the doctor who will perform your procedure if you decide to proceed.
How it’s done
The first step in a surrogate pregnancy is to find the surrogate. It’s important to determine whether the surrogate will also be an egg donor. Some surrogates are willing to be egg donors, while others only wish to carry fetuses to which they are not genetically related. (For more on egg donation, see its separate page.)
A surrogate may be found among family or friends of the intended parents. Usually, the surrogate does not receive compensation for gestating the baby; this is called “compassionate surrogacy.” The compassionate surrogate may or may not be willing also to be an egg donor. When searching for surrogates among family and friends, keep in mind that relationships can become very complicated by this situation, and it’s important for everyone involved to have very clear expectations before beginning the process.
If not using a compassionate surrogate, then an agency is used to find the gestational surrogate. This surrogate will expect to be compensated for her time, effort, and risk in carrying the pregnancy for the intended parents. Typically, an assisted reproductive clinic does not find a surrogate for you, though they may refer you to an agency to find your surrogate.
Once the surrogate is located, the process depends on whether the surrogate will also be an egg donor. If the surrogate will provide the egg, she will often become pregnant through IUI with donor sperm or with the intended father’s sperm. This situation is called “traditional surrogacy,” and it is very complicated legally, because the surrogate will give birth to a child to whom she is genetically related. Proceed with extreme caution if you choose this route; it’s rarely used because of the potential for legal and psychological complications.
If the surrogate will be carrying a child to whom she is not genetically related, she’s known as a “gestational carrier.” Then the next step is usually to retrieve the eggs that will be used to create the embryos with which the surrogate will become pregnant. If the intended mother will provide the egg, then she will undergo an egg retrieval process; see the page on IVF for more information about this part of the procedure. If a third-party donor will provide the egg, then the egg retrieval process will be done on that donor. The eggs will then be fertilized using the intended father’s sperm or donor sperm; the resulting embryos will be incubated in the laboratory for several days. Alternatively, donated embryos may be used, or embryos that were previously created for the intended parents.
The embryos are then transferred to the gestational surrogate’s uterus. See the IVF page for information on the fertilization, incubation, and transfer procedures. The surrogate is usually given hormones to prepare her body for the transfer. If she becomes pregnant, she will then carry the pregnancy to term (if possible); after she delivers the baby, the baby is legally adopted by the intended parents.
Surrogacy is a legally complex process. Ensure that well-written legal contracts are drawn up before starting this process, and that everyone involved has clear expectations. Also, keep in mind that surrogacy is very expensive. All of the expenses of the pregnancy, the legal expenses, and the compensation to the surrogate must be covered by the intended parents, and medical insurance rarely provides any coverage for surrogacy. The costs can be up to $100,000 or even higher.
Preparing for the procedure
Choosing your clinic
When choosing an assisted reproductive technology clinic (sometimes called a fertility clinic), there are several factors you may want to take into consideration. One is the physician(s) and others who will oversee your care. Make sure that your physician is board-certified; you may want to know that a board-certified reproductive endocrinologist (a specialist in the hormones involved in reproduction) is on the staff, as a consultant if necessary. You should also expect that your clinic will be a member of the Society for Assisted Reproductive Technology (SART), and follows the guidelines of the American Society for Reproductive Medicine (ASRM). You might also want to consider the clinic’s success rates, which are collected and published by the Centers for Disease Control (CDC), but you should be aware that interpreting this data is more complicated than you might think.
For more help in your search for a reproductive medicine specialist, visit our How to Find the Best Assisted Reproductive Technology Clinic page. At Doctor Review, you can also search providers for patient reviews to help you find the very best.
Getting ready for the procedure
Before entering into any surrogacy arrangements, everyone involved (the intended parents and the surrogate herself) must undergo psychological screening. This ensures that all parties are competent to undergo this complex and demanding process. Legal agreements must also be written by lawyers, clearly understood by all parties, and signed. Expect this process to take months or even years.
The intended mother may need some recovery time from the egg retrieval procedure, although this is usually minimal (involving rest for the day after the procedure). It may also take some time for the hormonal effects of the ovulation induction medications to wear off.
The psychological recovery is likely to be more difficult. It will be around two weeks after the transfer procedure before the surrogate can be tested for pregnancy. Then, the intended parents may feel anxious throughout the surrogate’s pregnancy. The usual worries about health, that often occur when a woman is pregnant with her own child, will likely occur and may be magnified; additionally, the intended parents may worry that the surrogate will change her mind at delivery and keep the child (though, in many states, the law makes the intended parents the legal parents of the child, rather than the surrogate; check your state’s laws if you want to learn more), or that she is using drugs or engaging in other behaviors harmful to the developing fetus. There is little control during this process, and this can be very difficult for the intended parents.