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
You will have a free 30-minute consultation with Blissful Fertility where we will discuss your goals, desires, and timeline. We will also advise you how/if we feel we can help you and outline a personalized plan for the next steps. If we don't offer services to clients in your area, we will try to refer you to someone who we know who does.
If it feels like a good match and we both wish to proceed, we will ask you to complete a pre-match interview and related forms to get a clear view of who you are and what you are looking for in an ideal surrogate. From this, we will create your custom parent profile to share with potential surrogates.
Using the information you provided us in your pre-match interview and intake forms, we will begin looking to find possible surrogate matches for you and your family. We may place custom ads, contact previous candidates, or post ads in surrogate groups to see if we can find you a good solution.
We will do our best to gather candidates that meet the majority of your criteria. You will be presented with their surrogate profile and agency notes. It is important that you let us know right away if you are interested in a specific candidate as they often are matched quickly.
Once you have identified a possible match, we will contact the surrogate and confirm that she is available and interested in working with you. You are then pre-matched and the screening process begins.
Pre-Screening of Surrogate
We will ask your surrogate to submit a recent pap smear within the last 12 months with HPV cultures. This must be normal without any concerns. If she has not had this done, we will ask the surrogate to complete this in order to move forward. If a surrogate has an abnormal pap, she will not be able to proceed until she is medically cleared by the OB and the fertility doctor.
We will then send the surrogate's current pap smear report, previous medical records, and her surrogate profile for review and approval by the fertility physician. This includes records from all of her previous pregnancies including both the records from her OB/GYN who managed the pregnancy and the records from the hospital where she 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 the surrogate passes her screening tests but since there is a lot of money and time spent on screening tests, 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 ask you to put between a specified amount of money into an escrow account to cover the estimated costs related to the prescreening of your surrogate. An exact estimate will be prepared for you at this point based on what the donor has already done and may still require.
Our agency requires that both the gestational surrogate and her partner and you and your partner all have a criminal background search done. We also will do a residency history on the gestational surrogate. 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 the surrogate is sent to your fertility clinic. This is done at a local Lab Corp and pre-paid by our agency out of the escrow funds. We usually ask the surrogate to complete a STD panel, drug screen, CBC, CMP, Hormone Panel, TSH, and iron check. These lab results are sent to your physician for review. If approved, the surrogate will be scheduled for her psychological and full medical evaluation. We do these basic labs first as they are relatively inexpensive compared to a full screening
We require that the surrogate 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 regarding your decision to use a surrogate and our agency will require a copy of the psychological clearance which we will also submit to the fertility physician.
Your surrogate will meet with your fertility physician. 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 on the surrogate. 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 the surrogate is a medically appropriate candidate to proceed.
Assuming all labs come back and look acceptable, the doctor will give you the good news that the surrogate is medically cleared to proceed forward as your surrogate. Sometimes, the surrogate may be given a list of immunizations or follow up work the physician wants done in order to medically clear her.
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 for the surrogate with an optional benefit to cover the costs you are investing, disability insurance for the surrogate in case she must be on extended bed rest, 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 gestational surrogate to separate reproductive attorneys who are licensed to practice in the state where the surrogate resides. 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.
You 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 surrogate and will make sure that monitoring appointments are arranged at a location convenient to the surrogate and also make all necessary travel arrangements for your surrogate.
Some clinics may require the surrogate to complete what is known as a mock transfer prior to the actual transfer procedure. In a mock cycle, the fertility doctor will put the surrogate on the same medical protocol she will have when she is doing the real transfer. During this mock cycle, the doctor will check her hormone levels and watch her 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 the surrogate's 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.
The surrogate is now ready to prepare for the actual embryo transfer. The surrogate 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 the surrogate is fully suppressed, she will start medications to prepare her 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. The surrogate 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, the surrogate 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.
Once the uterus is fully ready for retrieval, the surrogate will be scheduled for her embryo transfer. The fertility physician will begin by thawing the embryo or embryos that are planned for transfer. The surrogate will then have these embryos transferred into her uterus. To do this, the physician will insert a very thin, flexible plastic catheter which is connected to a syringe at the end through the vagina and cervix. Once in place, the doctor will press on the syringe to release the embryo into the uterus. The hope is that the embryo will then naturally implant into the uterine wall or endometrium. If this happens, the body will release a chemical known as beta-HCG which signals that the surrogate is pregnant. The transfer procedure is relatively quick and while the surrogate may have mild cramping or discomfort, it should not be anything significant. Post transfer, the surrogate will be asked to take a self-care day filled with rest and relaxation.
Around day nine or ten after the embryo transfer, the surrogate will have a blood test done to measure her 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 Intended Parents, they may learn that this transfer attempt was not successful. In this case, the doctor would give the surrogate time to recover before attempting another transfer.
6 week ultrasound
If the HCG test was positive and levels have continued to increase, the surrogate 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 the surrogate off of injectable medication and will transfer care to her OB/GYN to manage the pregnancy through delivery.
Boy or Girl?
If you do not already know the gender of the baby as you either did not do gender identification on the embryos, preferred to not be told, or in the event that you transferred two embryos (one boy and one girl) and are expecting a singleton, at around the 16-20 week mark, an anatomy scan will often be able to identify the gender for you.
Since IVF pregnancies are always considered slightly higher risk, the OB/GYN may ask that the surrogate be monitored by a maternal-fetal specialist who will do an advanced scan of the baby or babies anatomy to monitor their development. 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 surrogate lives. This is a relatively simple process as long as the surrogate resides in a surrogate friendly state. Once this is finalized, a copy of this legal paperwork will be sent to the hospital where the surrogate will be delivering.
Birth Plan Preparation
Around the 26 week mark, our agency will reach out to both the surrogate and the Intended Parent in order to create a very clear birth plan that will detail how everything is to be handled on the big day including both the surrogates preferences and the Intended Parents 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
We will discuss with you 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 your child may be at an elevated risk for. If you want either of these options for your baby, we will make arrangements for a kit to be sent to your surrogate so that she can bring this with her to the hospital on the day of delivery and will manage the pickup details for you.
We will discuss with you and the surrogate what the plan is with regards to providing breast milk. If you desire for the surrogate to provide milk, we will arrange for a breast pump to be ordered through her insurance and make sure she has all supplies she needs.
You will be notified as soon as possible if the surrogate begins having regular contractions or if her water breaks. She 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 your baby many Intended Parents will request a private room where they will able to bond with their baby. If this is something you desire, we will try to work with the hospital to see what they offer. Once the baby is cleared for discharge, you will finally be able to take your baby home and start your life together.
Your lawyer will make sure that you have all of the information you need in order to obtain the birth certificate and passports (for international clientele) needed for your baby so that you will not have any issues traveling home as a family. For international clients, you will also need to work with a lawyer in your country to get all of the documentation in place for your child post-birth.