Frequently asked questions by surrogate applicants

What are the requirements for being a surrogate?

1. You must be between the ages of 21 and 40. 2. Your height to weight ratio BMI should be below 32. 3. You should not have any personal health issues that would be exacerbated by pregnancy. 4. You must have experienced a full-term pregnancy and delivery of a child of your own and are raising that child. 5. You cannot have had any major complications in any of your previous pregnancies. Examples include toxemia, pre-eclampsia,preterm labor, incompetent cervix, and pregnancy-induced hypertension. If you have a question about a complication, feel free to call our office to discuss. 6. We ask that our surrogates refrain from the use of tobacco for at least the previous 6 months. 7. We ask that all surrogates avoid exposure to second-hand tobacco use/smoke. 8. You must reside in a surrogacy-friendly state and are not permitted to move into another state once the pregnancy has commenced. 9. You must be a U.S. Citizen or possess a Green Card that is valid for at least the next 3 years. 10. You cannot have a criminal history. Blissful Fertility does not accept surrogate applicants who have been convicted of a felony or whose partner has been convicted of a felony (we will do a complete background check). 11. We ask that our surrogate applicants be financially stable and no surrogate applicant can have a history of bankruptcy in the last 24 months. Surrogacy should not be a sole source of income for any woman/family seeking to become a surrogate. In turn, we perform regular household income verification. 12. You cannot have been diagnosed with any psychiatric illness, post-partum depression, or have used prescribed anti-depressants or anti-anxiety medication in the last 4 years. 13. Surrogates should provide medical records from both their treating OB/GYN and the hospital where all babies were delivered for all previous pregnancies. Also, our agency will require that you obtain a clearance letter from your current OB/GYN approving you as a surrogate. 14. Having a good support system in place is very important. We ask that our surrogate applicants have the support of their spouse or partner. We also ask that you create a support network of friends or family members you can lean on during this journey (you will need a strong support network). 15. Surrogate applicants must be willing to adhere to all contractual obligations throughout the process and attend all appointments as scheduled. 16. Surrogate applicants must have a valid driver’s license in their state of residency and have available reliable transportation to travel to all medical appointments. 17. Surrogate applicants must agree to STD and drug testing. Surrogates who test positive for certain STDs or who are found positive for drug consumption including marijuana will be unable to proceed.

What are the medical risks of being a surrogate?

While the method used to get pregnant as a surrogate is unique, many of the medical risks related with a more traditional pregnancy remain, such as mood swings, nausea, heartburn, weight gain, swelling, increase or decrease in appetite, irritability, back pain, bleeding, sensitivity to certain foods or smells, as well as more serious but rare complications like hypertension or the loss of reproductive organs. You may also experience post partum symptoms such as post partum depression or changes in blood pressure. It is important to note that side effects and risks will be increased if you are carrying multiples. You should discuss all risks with your own OB/GYN as well as the fertility doctor and we recommend that all surrogates be completed with their families prior to commencing this journey as with all pregnancies, there is always a risk that you could lose your ability to carry in the future. You will likely be asked to take medications to prepare the uterus for the transfer and these medications can carry some risks and side effects such as mild bruising at the injection site or temporary allergic reaction, some shots may sting or burn, or you may experience hormonal side effects such as mood swings, headaches, an increase or decrease in appetite, or being more emotional than usual. The risks of the embryo transfer procedure will be discussed with you in detail with the fertility physician. The most common side effects are mild cramping, light bleeding, or in rare cases, an infection which may require antibiotic treatment. All surrogates will have an extensive screening done by the fertility physician and psychologist prior to being approved. During these screenings, they will evaluate your own and your partners psychological and physical health to determine if it appropriate for you and your family to proceed with this journey. In addition, you will be monitored closely throughout your pregnancy to make sure that you and the baby or babies are doing well. Your wellbeing is always our top priority. Please note that this is not intended to be medical advice and should you discuss all risks with your doctor directly as your individual risks may vary based on many factors.

How much is a surrogate compensated?

There is no amount of money that equates to all that you are giving to a family by becoming their gestational surrogate and we hope that you will receive so much more than just monetary gain through this experience. That being said, in several states, surrogates can be legally compensated for their time, energy, risks, and efforts. There are some states where surrogacy is not legal or enforceable. We will let you know if you are in a state that is surrogate friendly or not. We allow our gestational surrogate mothers to set their own individual compensation requests and we do not cap what a surrogate can request. This is your body and we feel this should be your decision. For some surrogates, they may feel passionate about taking as little compensation as possible as they really want to make this an affordable journey. For others, they may have goals that they want to accomplish with the funds from surrogacy and the rate may be more important to them. Surrogacy compensation in the US ranges from $35,000 to $60,000 plus addititonal compensation and benefits for related expenses with the average surrogate earning about $42,000. Compensation tends to be a little higher for proven surrogates or those with insurance that covers surrogacy. Payments are made in installments each month of pregnancy and there is usually an additional payment made to the surrogate for her efforts and time related to the transfer.

What are the next steps after submitting an application?

1. Phone interview with director. After you have completed the initial surrogacy application, we will schedule you for a phone consultation with our agency director to introduce you to our program and answer any questions you may have. 2. Submit previous records. We will ask you to collect and submit all medical records related to your previous pregnancies including the records from your treating OB/GYN and the delivery hospital. 3. Pap Smear. We will ask you to submit a recent pap smear report from the last 12 months which includes HPV testing. If you have not had one done, we will help you arrange to have this performed. 4. Lab Work. We will provide you an order and ask you to go to a local lab where we will have a drug screen, STD panel, CBC, CMP, and other basic screenings completed. 5. Background Search. We will ask you to sign paperwork and provide your legal name, drivers licence, other names used, and your social security number so that we can have the authority to perform a criminal background search on you and your partner, as well as a residential history (spouse or partner is required to complete a background check as well). 6. Psych Evaluation. We will ask you to complete a psychological evaluation with a PhD psychologist. We do require that your spouse or partner be available to attend as well. 7. Home Visit. We may ask that you arrange a day for one of our agency representatives to come for a home visit where we can meet your family and see the home where you will reside during the pregnancy and who else will reside with you. This visit usually takes about 1 hour.

Can I be a surrogate if I have had a c-section?

The simple answer is yes, you can be a surrogate as long as you have not had more than two c-sections but obviously the physician will evaluate each surrogate on a case-by-case basis. In some very special cases, a surrogate may be approved if she had three c-sections but this is not our standard agency protocol. Why do we limit the number of c-sections? The simple answer is that we care about your wellbeing and want to make sure that this is as safe of a journey as possible. With each pregnancy after a c-section, new risks are introduced, both for mother and for child. Each time you are cut open, new scar tissue forms, and this can pose increased concerns related to proper implantation of the egg in the lining of the uterus which can result in miscarriage or serious complications. Also, previous c-sections can increase your risk of bleeding, especially when the bleeding is associated with conditions such as placenta accreta, placenta increta and placenta percreta. There are additional risks associated with these three conditions, such as premature birth and delivery complications. Sometimes bleeding can be life-threatening, and also can result in a blood transfusion or in a hysterectomy. Also, bladder and bowel issues are more likely to result in women who have had repeat c-sections. Because your safety is the most important priority for everyone involved and due to the severity of the risks associated with pregnancy after c-sections, it is important that each surrogate applicant be considered individually based on their own pregnancy history, age, and health factors to see if your OB/GYN and the fertility physician feels this is something that would be appropriate for you to proceed with.

Will I need health insurance that covers surrogacy?

Prior to commencing with any embryo transfer, our agency will need to verify that you have an insurance policy in place that does not have exclusions to surrogacy-related pregnancy. If you do not already have an insurance plan that would qualify, one can be purchased for you. The first step is for you to submit your insurance details including an explanation of benefits. We can then work with an insurance specialist in order to look at your policy to see if there are any existing exclusions related specifically to surrogacy pregnancy. We may need to have a phone call with your insurance company together with you in order to obtain all of the necessary details. If we find your insurance is acceptable, we will then gather information on the premiums, co-pays, and out of pocket maximum associated with your policy. This will help the agency to know how much to collect from the Intended Parents to put in escrow for your journey. If you do not have an appropriate policy, we will work with you to go through the application process with an insurance provider so that we can hopefully obtain an insurance policy on your behalf that will cover the pregnancy-related costs with the surrogacy. We will also assist you in finding in-network providers so that your care will be covered appropriately by the policy. One added bonus of surrogacy is that since the Intended Parents will be paying for all of your co-pays and deductibles related to your maternity care, it is very likely that your deductible will be met through surrogacy related expenses. This also means that, your remaining non-surrogacy expenses (for which you are always responsible) for the duration of the calendar year may cost you nothing! If you have any questions about how bills are submitted or what you are responsible for, please give our agency a call to discuss further.

Am I in a surrogate friendly state?

Laws change often and we always recommend you speak to a reproductive attorney in the state you plan to give birth before proceeding with any arrangement to verify the current law, limitations, and related statutes at that time. This is not intended to serve as legal advice but just a basic overview of the laws in each state as of the time this was written. Surrogacy is permitted for all parents, pre-birth orders are granted throughout the following states, and both parents will be named on the birth certificate: California, Connecticut, District of Coumbia, Delaware, Maine, New Hampshire, New Jersey, Nevada, Rhode Island, Vermont, and Washington. Surrogacy is permitted but results may be dependent on various factors or venue. In some birth states additional post-birth legal procedure may be required.: Alabama, Alaska, Arkansas, Colorado, Florida, Georgia, Hawaii, Illinois, Kansas, Kentucky, Massachusetts, Maryland, Minnesota, Missouri, Mississippi, MOntana, North Carolina, North Dakota, New Mexico, Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, South Dakota, Texas, Utah, Wisconsin, West Virginia. Proceed with caution. Surrogacy is practiced, but there are potential legal hurdles; or results may be inconsistent: Alaska, Iowa, Idaho, Montana, Nebraska, Tennessee, Virginia, Wyoming, Arizona, Indiana Statute or published case law prohibits compensated surrogacy contracts, OR a birth certificate naming both parents cannot be obtained: Louisiana, Michigan, New York.

If I had preeclampsia, does that prevent me from becoming a surrogate?

Your safety is always our top priority. Unfortunately, you cannot be a surrogate if you have had preeclampsia in the past. Preeclampsia can pose serious added risks to both you and the baby and we do not want to take risks unnecessarily for either of you.

If I have or had endometriosis, can I still be a surrogate?

Endometriosis increases the likelihood of miscarriage and of complications during pregnancy, so depending on the severity, it is more than likely that this would disqualify you from becoming a gestational surrogate. That being said, we always encourage our surrogates to speak with a reproductive specialist so that they can advise you if they feel this would be something that is medically appropriate for you and the baby.

If I have had issues with depression or post-partum depression, does that disqualify me from becoming a surrogate?

Your wellbeing is very important to us and surrogacy, like other pregnancy, can cause an influx in hormones which can elevate moodiness, anxiety, and feelings of depression. Also, surrogacy pregnancy usually requires that you not take any medications such as anti-depressents, anti-anxiety medications, etc. Perinatal depression (depression while pregnant) and post-partum depression (depression after a pregnancy) can be severe and have serious consequences. As a result, if you have been diagnosed or treated for depression outside of a short situational event or if you have experienced perinatal or post-partum depression after a previous pregnancy, our physicians usually will not approve you to proceed forward as a surrogate.

Can I be a surrogate if I have diabetes?

Unfortunately, if you have either Type 1 or type 2 diabetes, you will not be able to be a surrogate with our agency. Both type 1 and type 2 diabetes make it more difficult to control glucose levels during pregnancy and pose increased risks to both the baby and your own personal health.

Is it mandatory that I agree to carry multiples?

You are not required to carry multiples but it definitely makes you available to a wider range of intended parents, therefore making it easier to match you. It is important to note that even with a single embryo transfer, you may end up pregnant with twins or even triplets as an embryo can split. At our agency, we had a case where one embryo was transferred and the carrier became pregnant with identical triplets. While is tremendously rare for triplets to occur, we have had a few cases of twins that resulted from a single embryo transfer as well. It is very important that you consider how you would feel if a single embryo was transferred and it resulted in twins. Would you be agreeable to carrying the babies to term in this case? Also, while a majority of intended parents do not opt to try for twins, depending on the embryo quality, the doctor or embryologist may suggest attempting a DET or double embryo transfer to increase the odds of having at least one of those embryos successfully come to term. And since IVF is such an expensive process, many parents want the option of having a surrogate who accepts more than one embryo to ensure that the cycle is a success. That being said, we have MANY surrogates who only want to have a single embryo transfer and we will honor your request and match you with an IP with similar desires.

How many embryos are usually transferred and how is that decision reached?

In about 70% of cases, doctors will prefer to transfer only one single embryo at a time thus reducing the chances of multiples and the complications associated with multiple gestation. Typically the number of embryos to be transferred will have been discussed and agreed to far before transfer day. If you are agreeable to a DET or double embryo transfer, the IPs along with the doctor will decide if they will transfer one or two embryos on transfer day. Whatever the decision, you should always be made aware of that number, knowing that all transferred embryos could take and result in multiple gestations.

What is elective single embryo transfer (eSET), and is it a good option?

Some intended parents prefer a DET or double embryo transfer in order to improve the odds of one embryo taking and a resulting live birth. That being said, the vast majority of physicians now recommend an eSET or elective single embryo transfer due to the relatively high success rates and the reduced risks associated with this type of gestation. New research out of Duke University and the University of Colorado suggests that elective single embryo transfer (eSET) may be a better option for success than originally thought. In an eSET cycle, just one embryo is chosen and transferred into the uterus. Any remaining embryos are frozen for later use. This joint study was the first detailed comparison of the two methods, sampling outcomes for 30,000 patients who went through IVF between 2012- 2014. It revealed that transferring multiple embryos often leads to multiple gestations, and it is quite common for these babies to be born prematurely and encounter additional medical needs. It’s also common for multiple births to cause longer recovery times and there are higher incidences of pregnancy complications for the woman giving birth. But when transferring a single embryo, contrary to expectations, there was no significant drop in the number of successful pregnancies. In the instances of eSET, the outcome was an improved probability of a full-term pregnancy and healthy live birth. In fact, researchers said that transferring just one embryo doubles the probability of a healthy live birth. In addition, this held true for both fresh and frozen embryos. This is just the first study of its kind, so you and your doctor’s plan will be based on a wide variety of factors. But you may want to mention this to your doctor and the intended parents to come up with the best course of action to bring about the highest probability for a successful journey.

What is the legal process for a surrogate?

The legal process does not begin until you are medically cleared and we have confirmed you and your intended parents are a match. It is necessary to establish the legal terms of the surrogacy with a contract between you and the intended parents so that there is a plan and a road map that will cover any possible circumstances that may come up during this process. No two surrogacies are the same, so it is important to have these contracts drawn up by an experienced fertility attorney in your state so that all foreseeable circumstances are covered and your desires are clearly outlined. We have veteran attorneys you can use or we can help you find another attorney that you are comfortable with. The timetable on the legal process varies, but it typically takes about 3 weeks. You can’t begin injectable medications until after your legal clearance is complete. Once completed, we will work together with your IVF doctor to create a calendar outlining your medication protocol and your embryo transfer date. If your embryo transfer is successful and you become pregnant, your attorney will help you with additional legal processes such as parental establishment, when the intended parents are legally named the parents (usually done in the 2nd trimester) and outlining a birth plan together with you, the intended parents and the hospital where you will give birth so that there is a detailed plan in place for what will take place on the actual birth day.

What is a surrogacy pregnancy like?

Once it is confirmed that you are pregnant, you will continue with the medications as prescribed by your IVF physician until approximately 10-12 weeks into your pregnancy. Then you will be transferred to the care of your OB/GYN. At this point, your pregnancy will be much more routine and will largely resemble your past pregnancy(ies). Your appointments with your obstetrician will take place about every 4 weeks and will become more frequent in the final stages of the pregnancy. Since all IVF pregnancies are considered slightly higher risk, you may have a few more appointments then you did in your previous pregnancies as we will likely be under the care of a MFM or maternal fetal medicine doctor who will do an advanced scan of the anatomy of the baby and closely monitor his or her development. We will be there with you through every step of this process to help you through both the emotional and physical aspects of this journey, and we will check in with you at key mile posts along the way to help prepare you for your upcoming delivery.

What can I expect on delivery day?

This is the big day that we all have been working for! It is not unusual for surrogates to describe this day as life-changing! You will deliver the baby and fulfill your promise to the intended parents who have entrusted you with their child. This is typically a very rewarding feeling for the surrogate. Most surrogates will arrange for a special visitation period with the baby and their family prior to leaving the hospital or in the first few weeks after delivery. After delivery, the baby(ies) will be discharged from the hospital with the parents, and you will be discharged as well. It’s natural to feel a little sad after being separated from the child you’ve carried, but we will be here to support you in the postpartum period to ensure you’re recovering and have everything you need.

Does the ACA provide benefits for surrogates?

The ACA policies change annually and since we are not insurance specialists, we will always have insurance options evaluated by a licensed professional. There are instances where surrogate applicants may be asked to apply for coverage under the Affordable Care Act (ACA). The ACA is an alternative for surrogates who have individual insurance that doesn’t cover surrogate pregnancies or for surrogates that do not have health insurance at all. The ACA provides a wide range of coverage and may offer more in-network providers than some of the more surrogacy-specific policies out there, and it is pretty widely understood by most medical billing departments. One of the major downsides to ACA coverage is that there is only a small window each calendar year within which to apply for this coverage. Our agency specialists will help walk you through this process if we feel it is a good fit for you and will make sure that you and your Intended Parents are presented with a good variety of options for insurance from a licensed insurance broker.