If you want a biological baby but can’t carry a pregnancy for any number of reasons, there are ways to make your dream a reality. With a surrogate mother, who can carry your pregnancy for you, you and your partner can still have a biological child of your own — with a genetic connection to at least one of you.
What is surrogacy?
Surrogacy is when a woman, called a surrogate mother, carries a pregnancy for you and your partner because you’re unable to — perhaps because you can't sustain a pregnancy, don't have a uterus or have a medical condition that makes pregnancy dangerous or impossible. (The word "surrogate" means "substitite.")
There are two types of surrogacies:
- Gestational surrogacy: Gestational surrogacy is when a woman, called the gestational carrier, carries a baby who is not biologically related to her. In gestational surrogacy, your embryo — formed in vitro with your eggs or with a donor’s eggs and your partner’s or a donor’s sperm — is transferred to the gestational carrier’s uterus, where it grows until the baby is ready to be born.
- Traditional surrogacy: In traditional surrogacy, the surrogate mother is either artificially inseminated with sperm from the male partner of a couple that has infertility issues or impregnated through IVF using the surrogate’s own eggs. Traditional surrogates are used much less often than gestational surrogates, and surrogacy programs rarely offer them because of ethical and legal implications. In fact, some states prohibit traditional surrogacy. Surrogacy pregnancy and births are governed by individual state laws.
Who uses surrogate mothers?
Both individuals and couples can use a surrogate mother. Here are a few people who may want to use a surrogate:
- Women who don't have any viable eggs
- Women for whom being pregnant poses too great of a health risk
- Women who don't have a uterus or who may have a problem with her uterus (for example, those with a history of miscarriage)
- Couples (like same-sex male couples) in which a female partner is absent
- Lesbian couples who want to opt for reciprocal surrogacy, in which an embryo created with the egg of one mom is implanted in the uterus of the other mom
How do you find a surrogate mother?
Some people will ask a close friend or family member to be a surrogate mother, while other people will find a surrogate mother through a surrogate agency or an online matching site.
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1. Surrogacy agencies
Going through an agency is more expensive than asking a family member or friend to be the surrogate mother, but agencies will offer you valuable help and support as you navigate this very complex process.
The agency will screen potential surrogates and provide you with candidate profiles to review. They’ll also mediate initial conversations between you and the surrogate, recommend fertility clinics and mental health professionals who are experienced in surrogacy, and steer you to attorneys who specialize in surrogacy and who are familiar with the legal issues particular to your state.
When you work with surrogacy programs, the screening process for your potential surrogate includes a full medical exam, a check to make sure she’s up to date on all necessary immunizations, an infectious diseases screening (including sexually transmitted diseases) and a psychological evaluation to ensure she won’t have any emotional difficulties handing your baby over to you after delivery. Also on the screening agenda: a criminal background check.
Your surrogate won’t be the only one to undergo screening. You and your partner will also need to meet the agency’s requirements for intended parents, and may undergo a medical exam and a mental health check, a home assessment and/or a criminal records check.
2. A friend or family member
Choosing a relative or friend to be your surrogate mother has some benefits. You already know a lot about the woman who will be carrying your baby and likely already have a rapport with her.
But you should still go through a screening process, follow all the mental health evaluation guidelines and meet all the health requirements that an agency would advise and that laws may mandate.
Specifically, your best bet is to look for someone who fits the criteria set out by the American Society for Reproductive Medicine (ASRM): a woman who is between ages 21 and 45 with a healthy BMI, who has a healthy lifestyle (no smoking, no drugs and a willingness to abstain from alcohol during the pregnancy), is in a stable living situation, and has already given birth to at least one healthy baby. There may also be limits on the number of previous vaginal births and/or C-sections (ASRM requires a history of no more than five previous vaginal births and two prior C-sections).
What happens once you find a surrogate mother?
Have you been matched with a surrogate and are you ready to move forward with her? Now it’s time to get to know each other. After all, you’ll want to feel comfortable with the woman who’s carrying your baby, since you may be spending a lot of time together over the next several months (agencies estimate it can take between 18 and 24 months from start to finish).
And you’ll want her to be comfortable with you too, because you may be right next to her in the delivery room as she gives birth to your child.
Where to begin? Consider an initial call, online meeting session or face-to-face meeting — a chance for both of you to ask questions, get answers and gauge your compatibility.
Ask about the surrogate’s background, interests, day-to-day activities and work. Are her partner and family members supportive of her plan to be a surrogate? Ask, too, what made her decide she wanted to be a surrogate — every woman’s story is unique.
Once you’re past the initial meet-and-greet, it’s a good idea to schedule a counseling session where you, your partner, your surrogate, her partner if she has one and a therapist can sit down together.
A variety of emotional and logistical issues may come up over the course of the pregnancy, so it’s a good idea to address some of the potential ones during this counseling session. Talk through expectations for the relationship between the surrogate and you, for instance, and the impact her pregnancy might have on your surrogate’s family, partner, children and friends.
You'll also need to sign a legal contract outlining all the financial responsibilties and other particulars of your surrogacy agreement.
What is the process of surrogacy?
After the preliminaries are out of the way, the surrogacy process can begin. If you're using a gestational surrogate, your surrogate may be asked to take birth control pills to sync her cycle with your cycle or the egg donor’s cycle. Then she’ll start taking estrogen and progesterone to get her uterus ready for pregnancy.
Regular blood draws and ultrasounds will ensure that the surrogate’s cycle is on target and ready for the embryo to be transferred.
Once all surrogate systems are go, the embryo is transferred into your surrogate’s uterus as it is in an IVF cycle — with a healthy pregnancy and a healthy baby the hopeful outcome.
If you are using a traditional surrogate and taking the intrauterine insemination (IUI) route, the surrogate’s cycles will be monitored and the donor sperm from the intended father will be used for insemination when she’s ovulating.
How much does hiring a surrogate mother cost?
Surrogate mother costs vary depending on where you and the surrogate live — and choosing a friend or relative to be your surrogate can be less costly than going through an agency — but you can expect to pay anywhere between $70,000 and $150,000 (and sometimes as high as $200,000). These costs include:
- the price of IVF and egg donation, if needed
- payment to the surrogate mom, if needed
- agency fees
- legal fees
- medical expenses (including, possibly, health insurance)
- food so she can eat well while she’s expecting your baby
- travel costs associated with getting to and from appointments
- maternity clothing
Does insurance cover surrogacy?
A surrogate mother’s own health insurance may cover the medical costs of her pregnancy (depending, of course, on whether she already has that coverage in her own policy). As the intended parents, you will be responsible for all out-of-pocket medical and other pregnancy-related costs.
Specific surrogacy insurance may also be available to purchase in your state, and can typically range from $25,000 to $30,000. Your attorney can walk you through your options. Discuss the financial issues in detail with your lawyers early on, so there are no misunderstandings later.
What are the possible risks of using a surrogate mother?
A surrogate mother can experience the same medical complications during pregnancy as other expectant women. Some of these health complications include:
- Gestational diabetes
- Preeclampsia
- Eclampsia
- HELLP syndrome
The surrogate mother will be the only one who can give consent to any medical care decisions that arise during the pregnancy.
There are also potential legal risks, in particular surrounding parental rights when traditional surrogates are used. For gestational surrogacy, you and your partner will be the legal parents after your baby is born, but you'll need to consult a lawyer in advance to check the laws in your state.
What are the legal implications of using a surrogate mother?
Conceiving a baby may seem as easy as sperm and egg getting together, but when that conception involves a surrogate, it also involves lots of legalese.
You’ll need to hire two lawyers — one for you and one for your surrogate, but you’ll be paying for both — to make sure all the legal paperwork is in order.
A surrogacy contract should outline all issues that you’ve worked out in advance: contact during and after the pregnancy, confidentiality, views on abortion (if testing reveals a problem with the pregnancy) and how many embryos you plan to transfer if you’re doing IVF.
Expectations for prenatal care, prenatal and genetic tests and other pregnancy-related care should also be laid out contractually in advance.
Be sure, too, to check the laws in your state regarding surrogacy, since they differ from state to state and can include restrictions on certain aspects of the process.
Many states don’t allow traditional surrogacy and a few don’t allow either type of surrogacy. If you live in a state that doesn’t allow surrogacy, you may have to find a surrogate from another state where it’s legal.
Other legal considerations include whose name goes on the birth certificate, and whether adoption is necessary, both of which depend on your state’s laws.
With a gestational carrier, the baby is genetically yours, meaning that in some states there’s no need to go through an additional adoption process after birth. Many states will arrange for a pre-birth order that allows your names to go directly on your baby’s birth certificate. In other states, the birth certificate is amended after your baby’s birth.
In states that allow traditional surrogacy, the couple is required to legally adopt the child after birth (though again, laws vary from state to state).
What about for same-sex couples? In some states, gay couples will be able to put both their names on the birth certificate. In other states, the nonbiological parent will have to go through a second-parent adoption. Hire an attorney who is an expert in reproductive laws in your state to help guide you through the necessary steps.
Can a surrogate mother change her mind and keep the baby?
A gestational carrier — i.e. a surrogate mother who isn't biologically related to the child — doesn't have the legal right to keep the baby if legal parenthood is established prior to the birth with a signed contract.
Traditional surrogacy, in which the woman also provides the egg, is much more legally complicated because she's also the biological parent, and one reason many surrogacy programs no longer offer it.
Despite these legal protections, it's very important that you and your partner protect your rights as the intended parents by working with a lawyer who specializes in reproductive rights and who is familiar with your state's surrogacy laws.
Likewise, your surrogate mother should also work with her own lawyer to ensure that her rights — say, for example, her ability to choose her preferred type of delivery — are also protected.
Despite its cost and legal obstacles, surrogacy is an option to consider for hopeful parents who aren’t able to carry a pregnancy themselves.
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