Understanding the Surrogacy Process
There are many reasons to consider growing your family through surrogacy. Whether you are an individual or couple who has struggled with infertility, you have a medical issue that precludes you from carrying a pregnancy, you are a member of the LGBTQ+ community, or you’re looking to expand your family as a single parent, surrogacy might be an option for you. Understanding the surrogacy process can be confusing, but we break it down for you.
What is Surrogacy?
Surrogacy is the process where a female carries a child for the intended parent(s). The child is typically not genetically related to the surrogate. The intended parent(s) undergo IVF to create embryos using their own egg and sperm or donor egg and/or donor sperm. The embryo is transferred to the gestational carrier and she carries the pregnancy.
During a surrogacy process, the intended parent(s) will have a number of costs such as: agency fees, advertising fees, matching services, psychological screening, legal services, medical expenses for the intended parents as well as the surrogate (including fertility services for the creation of the embryo), surrogate compensation, and surrogacy services. A total estimate for the surrogacy process ranges from $100,000 to $150,000. You can find more information about the cost of surrogacy here.
What to Consider
Surrogacy can be a complicated process and involves many different people:
- The intended parent(s): the person or couple who will parent and raise the child. Usually, one or both are genetically related to the child and have created the embryos for transfer.
- Egg/sperm donor: sometimes gestational surrogacy also involves an egg donor or sperm donor; anonymous or known. If the intended parent(s) are not using their own egg and sperm for creation of the embryo, they will be using a donor.
- Reproductive endocrinologist: a fertility specialist who will assist with creating the embryos and transferring the embryo to the gestational carrier.
- Attorneys for the carrier and intended parent(s): the attorneys are sometimes employed by the agency and work to create the agreement or contract for the entire process. Attorneys also hold the funds for expenses related to the surrogacy agreement in escrow.
- Surrogacy agency: a service that typically provides the screening and matching for the carrier as well as the egg donor in some cases. Agencies usually have all aspects of the process covered from legal to psychological evaluations.
- Social worker/psychologist: will conduct the screenings and evaluations for both the carrier (and her partner, where applicable) as well as the intended parents. The gestational carrier usually as an expanded psychological evaluation as well as a home visit as part of her screening. This is performed by the social worker/psychologist. Typically, ongoing support is provided.
- The carrier: after she is screened and matched and a contract is signed, she will have a frozen embryo transferred to attempt pregnancy. Once pregnant, she will undergo the typical pregnancy monitoring and keep in contact with the intended parent(s) as agreed upon in the contract.
Understanding the Surrogacy Process
- Create embryos using in vitro fertilization (IVF):
Whether you are using your own eggs or sperm for the creation of the embryo or you are using donor sperm and/or donor eggs you will start your journey at a fertility clinic to get information about the IVF process.
The clinic should know that you are creating the embryos for use with a surrogate so that they can ensure the appropriate FDA required tests are performed. The fertility clinic will complete the necessary medical evaluations for both the indented parent (s) and the surrogate.
If you are eligible for the Progyny benefit, you might be able to use a portion of your Progyny Smart Cycle for the IVF-related services to create embryos. For more information on how to use your Progyny benefit in your surrogacy journey, please contact your Patient Care Advocate (PCA).
- Choose a surrogacy agency or a surrogacy attorney:
A surrogacy agency may provide any or all surrogacy services, including matching, screening, case management, support, counseling, legal services, and more. The gestational carrier and parent(s) will both need to undergo psychological evaluations, as well as obtain separate legal counsel when creating the agreement. The agency will have referrals for all aspects of the surrogacy journey.
Surrogacy laws can vary state to state. It is important to find an agency or attorney who can help you navigate your state laws for both the surrogacy agreement as well as the legal recognition of the parent(s) at birth.
Your fertility clinic may have referrals for surrogacy agencies. We’ve compiled a small list of agencies that our members have worked with (please note that Progyny is not affiliated with any surrogacy agency):
- Reproductive Possibilities
- Circle Surrogacy: Circle Surrogacy- Financing Plans (Circle Surrogacy offers discounts to Progyny members who mention Progyny and offers free consultation too)
- Growing Generations (offers $5,000 surrogacy discount and $1,000 egg donor discount to Progyny members)
- Center for Surrogate Parenting
- Modern Family Surrogacy Center
A surrogacy attorney is required in any surrogacy to complete the legal work but may not provide other important services found with a surrogacy agency.
Here are some questions which will help you get your conversation started with your surrogacy agency and attorney.
- What is the agency’s fee for their services and what exactly do these fees cover? What does the payment structure/timeline look like?
- Does the agency charge differently if you pay cash, check, or credit card? Are there any discounts, sliding scale fees, or financing options available?
- What is included in the legal contract the donor/carrier/surrogate signs? What is included in the legal contract the recipient couple/intended parent signs?
- What kind of medical insurance coverage for the donor or carrier does the agency provide, and what are the terms?
- Are the donors/carriers screened before being listed as possible matches? If so, how (what type of evaluations), and by whom?
- How many donors/carriers has the agency matched with recipients/intended parents in the last year? How many donors/carriers/surrogates are available at any one time?
- Will the agency assist with finding a donor with specific characteristics or a carrier/surrogate with specified requirements (race, location, etc.)?
- What is your matching process like?
When choosing an attorney:
- How long have you been working in the surrogacy/ART field?
- How many cases do you do annually? What percentage of your cases are ART related?
- In which states are you licensed to practice?
- If we need to go to another state to use a surrogate, which state has jurisdiction?
- Find a match and satisfy legal requirements:
A surrogacy agency will assist the intended parent(s) with matching you to the right surrogate for you. Then you’ll need to create a contract and satisfy some state-specific legal requirements. You can read more about the legal aspects of gestational carrier agreements here.
Here are some questions to consider when choosing a potential surrogate.
- What were your previous pregnancies/deliveries like?
- How many babies are you willing to carry? Are you open to selective reduction? Would you be willing to terminate the pregnancy if we found out there were complications?
- What kind of communication would you like to maintain after birth?
- What concerns/questions/hesitations do you have about us or this process?
- Embryo transfer and pregnancy:
Once you have a match and an agreement in place, you will proceed with the treatment cycle. The surrogate will begin taking medication before the transfer to prepare her body. The reproductive endocrinologist will transfer a frozen embryo into her uterus. The transfer is similar to pap smear and will not require anesthesia.
You’ll have to wait two weeks to see if the embryo implanted correctly and the surrogate is pregnant. If not pregnant, another embryo can be transferred. It is not unusual for a surrogacy procedure to require two or three frozen embryo transfers. If the pregnancy test is positive, she will be monitored like any pregnancy.
There are many factors to consider when considering surrogacy and finding the right support is key to navigating the process. Today, many employers offer even surrogacy reimbursement programs to cover some of the costs of the process. Reach out to your HR team or dedicated Progyny PCA to learn more, or learn how you can advocate for stronger family building benefits within your own organization.
Understanding the surrogacy process can be confusing. If you’re a Progyny member, your dedicated PCA can help guide you through and answer any questions you have. If you’d like to do further reading, check out the resources below: