This article is based on reporting from a variety of experts. Surrogacy is a journey fueled by a strong desire to become parents for those who choose it. It’s a one-of-a-kind contribution when a woman carries an embryo and goes through pregnancy to help someone else have a kid.
According to the National Assisted Reproductive Technology Surveillance System Group, gestational surrogacy accounts for only around 2% of all medical procedures used to treat infertility in the United States. Treatments like intrauterine insemination or fertility medications are far more common.
However, having a child is a feasible alternative, and in some situations, the only option for an individual or couple. Experts explain what happens during the surrogacy procedure between intended families and gestational carriers.
Surrogacy Terminology
It helps to understand the language used in this field:
Types of Surrogacy
Gestational surrogacy- Dr. Dorette Noorhasan, the medical director and co-founder of CCRM Fertility in Dallas–Fort Worth, explains that “gestational surrogacy typically means that an embryo is implanted into the uterus of a gestational carrier.”
“That person’s primary purpose is to carry the pregnancy to term and deliver birth nine months later.” The embryo’s mother has no biological ties to the egg or sperm that gave birth to it.
Compassionate surrogacy.
A surrogate does not receive financial compensation for carrying a child for someone they know – a family member or friend. Surrogacy for a cost. Dr. Jamie Massie, an OB-GYN, reproductive endocrinologist, and infertility specialist at the ORM Fertility Clinic in Bellevue, Washington, explains, “This is when the gestational carrier earned paid for her time and effort in carrying the pregnancy.”
Traditional surrogacy.
Traditional surrogacy is when a surrogate uses her own egg and is artificially inseminated with sperm from a donor or the intended father, making her the biological mother. It is rarely used in the United States due to its legal and emotional complexities.
Carriers
Gestational carrier
This woman, also called a gestational surrogate, carries and gives birth to a baby for another person or family. Surrogacy, both compassionate and paid, falls under this category.
Medical Terms
Carrier cycle.
An in vitro fertilization cycle (see definition below) is used to produce the embryo, which is then transferred to the gestational carrier at the appropriate time. The next stage in pregnancy.
In vitro fertilization (IVF).
The embryo is created using the egg and sperm of the intended parents in a laboratory procedure.
Embryo transfer.
The embryo is implanted in the uterus of the gestational carrier in this process, which is usually performed in a fertility clinic.
Third-party reproduction.
Through egg donation, sperm donation, or an embryo-gestational carrier arrangement, someone other than the intended parents is involved in the process of reproduction.
Other Terms
Intended family/parents.
Intended parents are those who want to have a child through gestational surrogacy. “A lot of people do surrogacy because they have to,” says Noorhasan, author of “Miracle Baby: A Fertility Doctor’s Fight for Motherhood,” a book on her own experience as an intended parent that was released in 2019.
Reproductive attorney.
Attorneys that specialize in assisted reproduction are educated about legal problems such as gestational carrier contracts, parental rights, and the many different state laws that govern surrogacy arrangements.
Surrogacy agency.
This type of business screens prospective gestational carriers and matches them with their intended families. Agencies serve as a liaison between all parties, including clinics and surrogacy attorneys, and mediate contracts between intended parents and surrogates, as well as providing counseling and support.
Pathway to Parenthood
According to Massie, there are two main paths that lead people to a reproductive clinic to consider surrogacy. One is the inability to carry a baby at all, as in the case of same-sex male partners. “As a result, they’ll need someone to help them build their family.” Similarly, some people visit a fertility clinic already knowing that they are unable to carry a pregnancy due to a medical problem.
“The second group of parents are those who have tried fertility treatments on their own, using their own eggs, sperm, and uterus, and have failed to carry a baby, whether it’s due to recurring pregnancy loss or failed implantation,” Massie adds.
“They decide to start on a gestational carrier journey.” Furthermore, “women in heterosexual relationships” In addition, “women in heterosexual relationships will use surrogates if, for example, the woman can’t carry the pregnancy due to chronic medical problems, is taking a medication that would be dangerous to a growing fetus, or she’s had a history of multiple miscarriages where her uterus is seen to be the reason for those miscarriages,” according to Noorhasan.
“Or she has a terrible chronic disease and being physically pregnant would cost her the pregnancy or her life.” Surrogacy may be an option for women who have had a hysterectomy or a uterine ablation procedure. If you’re a patient or thinking about using a surrogate, the first thing you should do is obtain an infertility workup,” Noorhasan explains. “It’s not normal for someone to require the services of a surrogate mother.
You should get some testing done, get a positive assessment, and talk to your doctor to see if you need one.” Surrogacy preparation is a time-consuming process. “These types of travels require a significant amount of planning,” Massie explains. “This pathway can take anywhere from eight to eighteen months to complete with all of the parts.
Families must address major challenges of access to care, such as the absence of insurance coverage for fertility services and the shortage of gestational carriers.”
Chance for Success
The overall live birth rate using a patient’s own egg and a gestational carrier was about 52 percent for a first embryo transfer, and nearly 57 % for a second or later embryo transfer (if a first embryo transfer fails) among younger women, according to the SART Final National Summary Report for 2018. SART (Society for Assisted Reproductive Technology) member clinics are represented in the statistics.
“The quality of the eggs is the most important factor in terms of reproductive success, followed by the quality of the sperm and the uterine environment,” Massie explains. “Per-cycle success rates for gestation carrier cycles are quite high if we’re using an egg from a young, reproductive-age female, as we could see in a donor-egg cycle.”
“If you’re taking eggs from an older ovary, or perhaps from an ovary that we know produces low-quality eggs, or from a couple that we know produces low-quality embryos,” Massie says, “success rates really reflect that more strongly.”
Becoming a Gestational Carrier
“Before a gestational carrier can be certified to carry someone else’s pregnancy, they first must go through a thorough evaluation,” Massie explains. “The most important component in the medical record review, in which a physician or nurse practitioner examines the medical record for any signs or warning flags that could put the gestational carrier or the baby at risk if they carry another pregnancy.”
So, a gestational carrier must be in good health, have at least one successful pregnancy and live birth in the past, have an unremarkable medical history, and have no substantial pregnancy-related difficulties.” As part of the initial screening, gestational surrogates are given a psychological evaluation. “The surrogate, and typically her husband, will visit with the therapist for a psychiatric screening to ensure they’re happy with the process before completing agreements,” Noorhasan adds.
“So, make sure she has support from her family structure and that he’s comfortable with her being pregnant and that it’s not his child.” After delivery, most women who become gestational carriers are able to stand aside and relinquish the child without regret. “Most of the time, they just want to be pregnant, birth (the baby), and go,” Noorhasan adds.
“If you do everything correctly – you picked the perfect surrogate, there’s a contract, there’s a great relationship – most of the time they just want to be pregnant, deliver (the baby), and go.” “Time and time again, seasoned carriers tell us that in a gestational carrier surrogacy, they have an entirely different mindset toward the kid than in a pregnancy of their own,” says Britta Dinsmore, clinical director of psychological services at ORM Fertility.
“They aren’t relating to the baby in a maternal way throughout the pregnancy by visualizing a future mothering this child or imagining what it will be like to bring the baby home to meet siblings, even though they commonly describe feeling warm, loving, and protective toward the baby.”
Making the Match
Surrogacy agencies help intended parents in matching them with gestational carriers. Choosing a compatible surrogate is a significant decision for the family. “What I’ll tell them is that it’s a perfect match,” says Noorhasan. She goes on to explain that having someone you can relate to is crucial when making such a big commitment. She explains, “It’s like you’re going to be dating this person for nine months.”
“We’re all wonderful people, but not everyone is meant to be with specific others.” Finding the right person who is a good match for you will be important.” Negotiations and legal documents are written once a potential match is found. “It’s essential for intended families and gestational carriers to have legal representation to help them,” adds Massie. A legal directory is available from the Academy of Adoption and Assisted Reproduction Attorneys.
Pregnancy Process
IVF is used to produce the embryo by the intended parents. The embryo transfer marks the start of the pregnancy. “That’s where we put an already-created embryo into the uterus of the gestational carrier,” Massie explains. “The procedure is actually quite simple — it only takes 10 to 15 minutes.” “Under ultrasound guidance, we place it into the uterus and the embryo is placed into the uterine cavity,” she says, referring to a floppy plastic catheter about the size of a pen tip.
“The pregnancies are really the same as they are when people conceive on their own,” Massie adds after embryo transplants. “There’s a wide range of people who feel great and people who don’t, as well as people who have morning sickness and those who don’t.”
After the initial evaluation visits, the surrogate’s maternity care is similar to that of a full-term pregnancy. “She goes to a fertility clinic for a few ultrasounds to make sure the pregnancy goes well,” Noorhasan explains. “Then they send her to the obstetrician when she’s about two months pregnant.”
Hurdles and Challenges
Intended parents have a significant financial challenge. “The surrogacy path can be incredibly costly,” says Massie.
A gestational carrier cycle and pregnancy costs on average between $90,000 and $150,000. Intended parents may be responsible for the following fees and compensations:
• Fertility treatments (such as embryo creation, IVF).
• Surrogacy agency fees.
• Gestational surrogate screening (medical and psychological) costs.
• Gestational surrogate compensation.
• Mental health costs for surrogate and intended parents.
• Legal fees, expenses, and establishment of parenting rights.
Extra costs may occur, such as medical/pregnancy procedures and maternity insurance for the surrogate’s pregnancy-related health care.
Financial assistance may be offered in some situations for families who are unable to afford infertility treatments such as gestational surrogacy. RESOLVE: The National Fertility Infertility Organization’s website contains a plethora of information and resources, including insurance coverage, financial relief for fertility treatments, infertility treatment grants, and scholarships.
In addition to the financial limitations, there is a growing scarcity of available gestational surrogates.
“The limited number of individuals who are willing and medically fit enough to participate as gestational carriers is the second major hurdle,” Massie explains. There has been a “pretty significant decline” since the COVID-19 pandemic, she adds.
