What is gestational surrogacy?
Who are surrogates?
Who works with a surrogate?
Is surrogacy legal where I live?
The Surrogacy Process
From Consultation to Surrogate Selection
To become a surrogate, you will begin by completing our online written application where you will be asked to provide demographic information, pregnancy history, personal and family health information, and we will ask you about your desires in becoming a surrogate.
You will have your first phone interview with one of our coordinators who will introduce our agency to you and go over what you can expect. During this call, we will also review your submitted application and discuss your pregnancy history and try to better understand what you are looking for in your journey. We will also ask you to provide your insurance details to us during this consultation.
We will assist you in gathering your records from all of your previous pregnancies including records from your OB/GYN who managed your care as well as the records from the delivery hospital for each of the previous cycles.
Once you have submitted all of your requested records, your driver's license, and have signed all of the pre-consent forms, we will create a custom profile which we will start to share with Intended Parents who meet your description of the type of experience you are looking for.
Once we have identified a possible match, we will contact you and let you review the profile of the Intended Parent. You may then confirm whether or not you are available and interested in working with then. You are then pre-matched and the screening process begins.
Pre-Screening to Medical Clearance
We will ask you to submit a recent pap smear within the last 12 months with HPV cultures. This must be normal without any concerns. If you have not had this testing done within the last year, we will ask you to complete this in order to move forward. If you have an abnormal pap, you will not be able to proceed until you are medically cleared by your OB and the fertility doctor.
We will then send your current pap smear report, previous medical records, and surrogate profile for review and approval by the fertility doctor selected by the Intended Parents. This includes records from all of your previous pregnancies including both the records from the OB/GYN who managed all of your pregnancies and the records from the hospital where you delivered.
We will schedule a conference call or Skype meeting between our agency, the gestational surrogate, and the Intended Parent. On this call, we will first introduce you to each other to make sure you are comfortable and allow you to get a sense of the other person's personality. During this call, we will also go over all of the details related to a possible match.
Our agency will outline everything discussed on the phone call in a pre-match agreement detailing the agreed to terms which you will both need to review, sign, and return. A formal agreement will be prepared by independent attorneys after you pass all of your screening tests but since there is a lot of money and time spent on this testing, we want to make sure that all major items have been agreed to between the parties before this has been begun. This pre-match agreement will be provided to the reproductive attorney's when it is time for formal contracts.
Once approved, we will the Intended Parents to put a specified amount of money into an escrow account to cover the estimated costs related to the prescreening requirements.
Our agency requires that you and your partner and the parents all have a criminal background search done. We also will do a residency history. Please note that the findings of these reports are shared with our agency and the other party to make sure that everyone is comfortable moving forward.
We typically do some very basic labwork before you are sent to the fertility clinic. This is done at a local Lab Corp and pre-paid by our agency out of the escrow funds. We usually ask you to complete a STD panel, drug screen, CBC, CMP, Hormone Panel, TSH, and iron check. These lab results are sent to the fertility physician for review. If approved, you will be scheduled for your psychological and full medical evaluation. We do these basic labs first as they are relatively inexpensive compared to a full screening
We require that all surrogates be evaluated by a mental health professional for a psychological clearance. We require that this testing be done in-person. We also ask the mental health professional to consult and speak with the surrogate's partner though we allow the partner to appear by Skype if an in-person evaluation is difficult. We also require all of our Intended Parents to have a psychological consultation. After completion of the psych evaluation, a report will be prepared which will be shared with the
You will go to the fertility clinic for an evaluation with the doctor. If travel is required for this, our agency will make these arrangements and bill the escrow account. Most fertility physicians will perform a physical, a pelvic ultrasound, infectious disease screening, saline sonogram, and a sonohysterogram. Depending on the protocol of the clinic, they may require a mock cycle or a uterine biopsy to be done, or additional testing. The goal of all of this testing is for the fertility doctor to determine if you are a medically appropriate candidate to proceed.
Assuming all labs come back and look acceptable, the doctor will give you the good news that you are medically cleared to proceed forward as a surrogate. Sometimes, the surrogate may be given a list of immunizations or follow up work the physician wants to be done in order to medically clear you. We will assist you in completing anything necessary.
Legal to Confirmed Pregnancy
Final Insurance Check
At this point, we will assign your case to an insurance specialist so that we can make sure that all of the necessary insurances and their supplemental applications are complete and insurance is in place. These include life insurance, disability insurance, transfer insurance in case there are complications with the transfer or cycle-related medications, and health insurance for the pregnancy.
We will now refer both you and the Intended Parents to separate reproductive attorneys who are licensed to practice in the state where you reside and will deliver. We will send them the pre-match agreement so that the terms for the contract are clear and then we will allow your attorneys to negotiate any details until there is a clear arrangement. Once legal is finalized, the attorney will send the clinic and our agency a letter of legal clearance.
The parents will be asked at this point to make any final payments to the fertility clinic for the cycle and will also be asked by our agency to fund the escrow account in full.
At this point, the fertility clinic will finalize the cycle and transfer calendar which will outline in detail the medical plan and proposed calendar for the cycle. We will make sure that this calendar works for both you and your Intended Parents and will make sure that monitoring appointments are arranged at a location convenient to you and also make all necessary travel arrangements for you as needed.
Some clinics may require that you complete what is known as a mock transfer prior to the actual transfer procedure. In a mock cycle, the fertility doctor will put you on the same medical protocol you will have when you are doing the real transfer. During this mock cycle, the doctor will check your hormone levels and watch your uterine lining with the assistance of ultrasounds to make sure that the planned protocol is the right one. The doctor may also do a trial transfer where he will check the angle of your cervix and the length of the uterine cavity to help prepare the doctor for how to insert the catheter when it is time for the transfer of the embryos.
You are now ready to prepare for the actual embryo transfer. You will usually be put on birth control and possibly Lupron injections with a goal of shutting down the hormone production in the body, which offers the doctors more control. Once you are fully suppressed, you will start medications to prepare your body for the transfer which includes progesterone and estrogen. Progesterone is a natural hormone produced in the body. It is given to a surrogate to help thicken and prepare the uterine lining. Progesterone may be given by intramuscular injection, gel, lozenge, or suppository. The physician will decide which option is most appropriate. Estrogen is also a normal hormone produced in the body and is usually administered by a patch, oral pill, vaginal tablet, or injection. Progesterone and estrogen are usually used together leading up to transfer and throughout the first trimester. You may also be given a light steroid to prevent any inflammation in the uterine lining and will almost always be given an oral antibiotic to ensure the uterus is free of any bacteria before the transfer procedure takes place. In addition, you will be asked to take special supplements such as a prenatal vitamin, folic acid, baby aspirin, a probiotic, etc. Every physician has a unique patient protocol and they may use or avoid some of the medications outlined above. You should discuss the exact protocol he or she will be using to answer any questions you may have.
You are now ready to prepare for the actual embryo transfer. You will usually be put on birth control and possibly Lupron injections with a goal of shutting down the hormone production in the body, which offers the doctors more control. Once you are fully suppressed, you will start medications to prepare your body for the transfer which includes progesterone and estrogen. Progesterone is a natural hormone produced in the body. It is given to a surrogate to help thicken and prepare the uterine lining. Progesterone may be given by intramuscular injection, gel, lozenge, or suppository. The physician will decide which option is most appropriate. Estrogen is also a normal hormone produced in the body and is usually administered by a patch, oral pill, vaginal tablet, or injection. Progesterone and estrogen are usually used together leading up to transfer and throughout the first trimester. You may also be given a light steroid to prevent any inflammation in the uterine lining and will almost always be given an oral antibiotic to ensure the uterus is free of any bacteria before the transfer procedure takes place. In addition, you will be asked to take special supplements such as a prenatal vitamin, folic acid, baby aspirin, a probiotic, etc. Every physician has a unique patient protocol and they may use or avoid some of the medications outlined above. You should discuss the exact protocol the fertility doctor will be using to answer any questions you may have.
Around day nine or ten after the embryo transfer, you will have a blood test done to measure your HCG levels which is the pregnancy hormone. Usually, the doctor will hope to see a count of 50 or higher to indicate a positive pregnancy. Two days later, the doctor will do another repeat HCG level and we will want to see the levels going up. The levels usually double about every two days. It is too soon to determine if it is a twin or singleton pregnancy. For some surrogates, they may learn that this transfer attempt was not successful. This can be very emotional news to receive. It is usually not a surrogate's fault if a transfer attempt fails. In this case, the doctor would give you and your body time to recover before attempting another transfer.
6 week ultrasound
If the HCG test was positive and levels have continued to increase, you will be scheduled for a six-week heartbeat check. During this ultrasound, the technician will look to identify a heartbeat in the developing embryo or embryos.
Pregnancy to Parenthood
Transfer to OB/GYN
Somewhere between eight and twelve weeks, if everything is going well, the fertility doctor will start to phase you off of the hormonal medications and will transfer care to your OB/GYN to manage the pregnancy through delivery.
Boy or Girl?
If you do not already know the gender of the baby as your parents either did not do gender identification on the embryos, preferred to not be told, or in the event that they transferred two embryos (one boy and one girl) and you are expecting a singleton, at around the 16-20 week mark, an anatomy scan will often be able to identify the gender for you. Typically this decision is left to the Intended Parents as to whether they want to know the gender or prefer to wait.
Since IVF pregnancies are always considered slightly higher risk, the OB/GYN may ask that you be monitored by a maternal-fetal specialist who will do an advanced scan of the baby or babies anatomy to monitor their development. This does not necessarily mean anything is wrong with the baby. It is also not uncommon for the MFM to order a special scan to check the development of the heart.
Finalization of Parentage
The lawyer will start the process to finalize the parentage for the offspring and to obtain the orders that are available in the state where the baby will be born. This is a relatively simple process as long as you reside in a surrogate friendly state and respond promptly to your attorney as requested. Once this is finalized, a copy of this legal paperwork will be sent to the hospital where you will be delivering.
Birth Plan Preparation
Around the 26 week mark, our agency will reach out to both you and the Intended Parents in order to create a very clear birth plan that will detail how everything is to be handled on the big day including both your preferences and the Intended Parent's desires with regards to care, photos, and contact post-birth. We want this clear in the event that the baby comes earlier than expected and the parents cannot get there right away. The agency will make this into a very clear report which we will share with the hospital.
We will discuss with the Intended Parents the options regarding cord blood and tissue banking and genome testing. Genome testing is relatively new but it uses cord blood to determine what actionable diseases the child may be at an elevated risk for. If the Intended Parents want either of these options for their baby, we will make arrangements for a kit to be sent to your address to bring with you to the hospital on the day of delivery. We will manage the pickup details with the hospital so you don't have to worry about that.
We will discuss with you and the surrogate what the plan is with regards to providing breast milk. If you desire to provide milk, we will arrange for a breast pump to be ordered through your insurance and make sure you have all the supplies you will need.
We ask that you notify our agency as soon as possible if you begin having regular contractions or if your water breaks. You also may be scheduled for a c-section or induction. Regardless, we will make sure everything is in place so that everything will go as smooth as possible. After the delivery of the baby, many Intended Parents will request a private room where they will able to bond with their baby. If this is something they desire, we will try to work with the hospital to see what they can offer. Depending on the arrangement you have with the Intended Parents, you may be able to spend some special time with the baby after the delivery and introduce your children to the new arrival. Once the baby is cleared for discharge or you are released from the hospital, you will go home and rest knowing you changed a family's life forever!
You will likely have a few follow up checks with your OB/GYN after delivery and our agency will check in on you for the next few months. It is very important that you continue to attend these scheduled appointments as there are some serious pregnancy complications that can occur post-pregnancy and your safety is our top priority.