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Becoming a Surrogate

What You Need to Know Before You Become a Gestational Surrogate

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Updated September 03, 2011

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

Why Do Women Decide to Be Surrogates

Women who decide to become surrogates often say they love being pregnant and experiencing the miracle of birth, but they are finished having their own children. They also genuinely want to help a couple have a child.

Some women become a surrogate because a friend or family member asked them, but even surrogates who are friends or family should be positive about pregnancy and childbirth. There should be no pressure to agree to a surrogacy arrangement.

While surrogates are paid for their time, it's rare to find a surrogate who is only in this for the money. Due to psychological screening, women who are thinking primarily about compensation are likely to be turned down early in the process.

The surrogate fee of $20,000 to $35,000 may sound like a lot. But when you take into consideration the time and effort involved and the nine-month, 24-hour dedication to the pregnancy, a woman would make more per hour working at a fast food restaurant than by being a surrogate. Surrogacy is not a get-rich-quick scheme; it's a compassionate way to help bring life into this world and build a family that could not be without your help.

What Is the Difference Between a Traditional Surrogate and a Gestational Surrogate?

If you are a traditional surrogate, you will be genetically related to the baby, because your eggs are used. You are both an egg donor and surrogate, in this case. The sperm may be donor sperm or may come from one of the intended parents. The sperm is transferred to your uterus via insemination, usually intrauterine insemination, or IUI.

In gestational surrogacy, also known as IVF surrogacy, you will not be genetically related to the baby. The intended mother may be the genetic parent or an egg donor or embryo donor will be used.

Because of legal and emotional complications that can arise during traditional surrogacy, gestational surrogacy is the preferred option.

Who Will You Help as a Surrogate

Surrogacy can help a couple have a child who cannot otherwise carry a pregnancy or give birth.

For some, this is due to uterine complications, including untreatable uterine adhesions, abnormal uterine shape or a complete absence of the uterus, either due to prior hysterectomy or a congenital defect known as müllerian agenesis.

Some women may have experienced repeated miscarriages or repeated failure of IVF embryo implantation.

Another reason a couple may need a surrogate is because the intended mother has a medical condition that makes pregnancy life threatening to her or her baby. This may include severe heart disease, severe kidney disease, history of breast cancer, severe diabetes, lupus, cystic fibrous or a history of severe pre-eclampsia with HELLP syndrome.

Surrogacy may also be used to help a male gay couple have a child.

Qualifications to Become a Surrogate

Some surrogacy qualifications will be specific to the fertility clinic the intended parents are working with, so these should only be considered general guidelines. Surrogates must:
  • Already have children and, ideally, be currently raising them. Also, ideally, a surrogate should be finished having children of her own.

  • Already have experienced complication-free pregnancy and childbirth.

  • Be generally healthy (no sexually transmitted disease or serious health complications that could threaten the health of you or the baby you'll carry).

  • Be at a healthy weight.

  • Not have given up a child for adoption in the past.

  • Have health insurance that covers maternity and childbirth and does not have a surrogacy exclusion clause. State or federal insurance, like Medicare, is an absolute no-no for surrogacy.

  • Have life insurance, should any rare, life-threatening complications occur.

  • Have a stable income that will not be threatened if bed rest or pregnancy issues prevent working.

  • Be older than 21 but younger than 35. (Age guidelines will vary from clinic to clinic.)

  • Not have a history of drug abuse or alcoholism.

  • Have the support of a husband or partner. The surrogate's partner may also need to agree to be tested for a sexually transmitted disease.

  • Live in a surrogacy-friendly state (or country.)

  • Be able to get to and from doctor appointments (for the fertility clinic monitoring and embryo transfer) and then later for prenatal appointments.

  • Have a flexible schedule with reliable childcare, especially for the insemination or embryo transfer elements of surrogacy.

  • Be open to fertility screening, general medical screening, psychological screening, intense time commitment (especially during the IVF process), and willing to take hormonal medications (including injections or suppositories) to help start or support the pregnancy.

  • Be willing to maintain open communication between herself, her doctors and the intended parents or an agreed-upon mediator. She must also be willing to attend counseling, either individually or with the intended parents, should a communication problem arise.

  • Understand that bed rest (especially if multiples are likely) may be involved.

  • Be willing to abstain from sexual intercourse with her partner until pregnancy is established, and be open to genetic testing of the baby during or after pregnancy.

  • Understand that pregnancy is not guaranteed to occur.

This should not be considered a complete list, but it should give you an idea of how involved surrogacy is.

Can I Receive Payment for Providing Surrogacy Services?

In America, most surrogacy arrangements are commercial surrogacy, meaning the surrogate receives payment for her services. Compensation varies, but is generally between $20,000 and $35,000.

There are states and countries where commercial surrogacy is illegal and the surrogate can only receive compensation for expenses. What expenses are included will depend on the surrogate's specific situation. It's best to speak to a lawyer to learn what this may include.

When a friend or family member agrees to be a surrogate, compensation is usually not involved. The intended parents, and not the fertility clinic, pay the surrogate for her services. So if a friend or family member expects payment, it's important they understand the intended parents are the ones who will pay.

Payment is usually given in installments, agreed upon before a surrogacy contract is signed. (It should be outlined in the contract.) The total fee is deposited in an escrow account before surrogacy begins. Usually, once a heartbeat is detected, confirming pregnancy, the first payment is given. The rest of the fee is given in installments, as the pregnancy progresses.

Is Surrogacy Legal?

Surrogacy is legal in many states in the United States and in many countries. There are, however, some states and some countries where surrogacy is illegal. There are also places where surrogacy isn't necessarily illegal, but the contracts are not recognized in court, which can lead to serious problems should something go wrong.

In some places, only commercial surrogacy is illegal, but surrogacy that does not involve compensation for the surrogacy itself is acceptable.

Due to the complex nature of surrogacy, it's important you speak to a lawyer before agreeing to any surrogacy arrangement. There are couples and surrogates who hope to arrange things privately, without the help of lawyers or an agency, in an effort to save money. This can lead to disastrous results.

For the couple's and surrogate's best interests, using a reputable agency (when using an unknown surrogate) and experienced lawyers (one lawyer for the couple and one for the surrogate) is the best course of action. Speak to your local RESOLVE, American Fertility Association, or fertility clinic for guidance.

Sources:

Brinsden, Peter R. "Gestational surrogacy." Human Reproduction Update, Vol.9, No.5 pp. 483±491, 2003 http://humupd.oxfordjournals.org/content/9/5/483.full.pdf

Brisman, Melissa B. What to Consider when Considering Gestational Surrogacy. The InterNational Council on Infertility Information Dissemination. Accessed August 29, 2011. http://www.inciid.org/article.php?cat=thirdparty&id=786

Sharon LaMothe. http://lamothesurrogacyconsulting.com/ Email Correspondence/Interview. August 16 and 17, 2011.

Surrogacy. Human Fertilisation and Embryology Authority. Accessed August 29, 2011. http://www.hfea.gov.uk/fertility-treatment-options-surrogacy.html

Third Party Reproduction (Sperm, egg, and embryo donation and surrogacy). American Society of Reproductive Medicine. Accessed August 29, 2011. http://www.asrm.org/uploadedFiles/ASRM_Content/Resources/Patient_Resources/Fact_Sheets_and_Info_Booklets/thirdparty.pdf

Surrogacy Programs (#17). Questions to Ask Series. RESOLVE. Accessed August 29, 2011. http://familybuilding.resolve.org/site/DocServer/Surrogacy_Programs.pdf?docID=544

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