Should I Use a Gestational Carrier (Surrogate)?
In the last 50 years, gestational surrogacy has emerged as a good solution for many types of people looking to build their families, including people with infertility challenges, same-sex couples, and single parents by choice. In the US today, building your family through surrogacy involves working with a gestational carrier and utilizing IVF. This article provides an overview of the IVF + Surrogacy (Gestational Carrier) process.
What Is a Traditional Surrogate?
A surrogate is a person with a uterus who agrees to carry a baby for another.
A traditional surrogate carries a baby for another individual or couple and is also the egg provider for the pregnancy and genetically related to the baby. A traditional surrogate typically becomes pregnant via intrauterine insemination (IUI) with sperm from the intended parent or a sperm donor.
Due to legal and emotional implications, traditional surrogacy is far less common than gestational surrogacy.
What Is a Gestational Carrier?
A gestational surrogate or gestational carrier (GC) is a person with a uterus who uses IVF to carry a baby that is unrelated to them genetically.
Gestational surrogacy first came about in the 1980s with the introduction of in-vitro fertilization (IVF), a multi-step medical process that makes it possible for a person with a uterus to be implanted with an embryo created outside of the body. IVF has been a boon for surrogacy as it separates the gestational process – the act of carrying a baby in the womb – from the genetic parentage of the child.
Who Should Consider Gestational Surrogacy?
Gestational surrogacy has become a widely-accepted option for those wishing to have a child who shares their genes. Celebrities that have a child from a gestational carrier include Elon Musk, Kim Kardashian, Anderson Cooper, Lucy Liu, and Ricky Martin.
Those looking to grow their family through the help of a GC are known as the intended parent(s). There are many reasons why people utilize surrogacy as a part of their family-building journey.
Some women may be able to conceive but unable to carry a child due to health issues, such as a hysterectomy, injury, or congenital condition. Others may have experienced the heartbreak of pregnancy losses. Still, other people may have medical issues that make pregnancy a health risk. Using a gestational carrier may be a safer, healthier option for having a child.
Gestational carriers (surrogates) have also become a popular solution for LGBTQ+ families and single parents by choice. Gay partners are able to grow their family and have a child that is genetically related to one partner through a gestational carrier cycle. Some gay parents will opt to have embryos created from each parent with the same donor in the hopes of having at least two children, each that are genetically related to one parent and both genetically derived from their donor, to further genetically link their family. Single parents by choice are another category of intended parents who may choose to work with a GC.
How Much Does IVF Cost?
There are two central levels of costs built into a gestational surrogacy journey: the IVF process and the cost of the carrier.
The IVF process may cost from $12,000-$40,000+. The main reason for this wide range in possible costs is that IVF cycles are not always successful. It can take multiple attempts to yield a viable pregnancy, and sometimes IVF does not work.
For women under 35, the IVF success rate for the first IVF cycle may be 30-55%. IVF success rates decrease with each successive attempt.
- The Centers for Disease Control (CDC) offers an online calculator called the IVF Success Estimator that can be used to predict IVF success rates.
- The CDC also offers complete statistics for all IVF attempts in the U.S.
Most statistics for IVF success rates do not differentiate between surrogacy cycles and non-surrogacy cycles. This may result in a lower average IVF success rate because the majority of the people pursuing IVF may be experiencing fertility issues. Gestational carriers, by contrast, are pre-screened for optimal health and fertility (e.g., already having carried at least one pregnancy.).
How Much Does a Gestational Carrier Cost?
A gestational carrier in the United States may run between $40,000 -$150,000+ (including IVF).
This wide variation in price reflects the type of arrangement, the individual GC, the state in which the surrogacy takes place, and other factors, including:
- Agency fees or cost of private search
- Gestational carrier compensation
- Health care
- Legal fees
- Expenses during pregnancy
- Cost of possible medical complications
- How Do I Find a Gestational Carrier (Surrogate)?
The critical first step — finding a gestational carrier — may be accomplished through a private contract or by working with a surrogacy agency.
Private contracts are often entered into by the intended parent(s) with a pre-selected surrogate – for example; they may have a friend who has agreed to carry a pregnancy. Other intended parent(s) use their personal network to search for a surrogate. While private contracts may save some money initially, they often lack the built-in procedures and safeguards of an agency.
Surrogacy agencies help the intended parent(s) find a gestational carrier, set guidelines for the pregnancy, and formalize a contract. The agency recruits potential surrogates, carries out background checks and screenings, and maintains a database of candidates. The agency sets up introductions with potential GC candidates that meet the search criteria of the intended parent(s). The agency can also help coordinate medical and legal components of the surrogacy process.
What Happens During the IVF Process?
The first step of IVF is to gather the eggs and sperm for the intended child.
The female partner or the egg donor will take fertility-boosting medications to produce extra eggs prior to the retrieval. The eggs are then collected from the ovaries and sent to the lab for fertilization.
Having multiple eggs available increases the likelihood of fertilization and may yield multiple embryos. To further increase the likelihood of fertilization, a microscopic technique called intracytoplasmic sperm injection (ICSI) can be used to inject a single sperm into an egg.
Once the embryos form, they may be screened using preimplantation genetic testing (PGT). This test helps identify embryos that have a normal number of chromosomes. It can be used to identify embryos that are at increased risk for some genetic diseases. PGT also makes it possible to choose the sex of the embryos that will be transferred.
The gestational carrier’s role in IVF is more basic: the embryo(s) are transferred at the optimal time in the carrier’s menstrual cycle using a cervical catheter. In some cases, doctors may transfer multiple embryos to improve the chances of one successfully attaching to the uterine lining and establishing a pregnancy. This strategy can cause a greater likelihood of twins or triplets. The American Society for Reproductive Medicine (ASRM) strongly advises the transfer of a single embryo in gestational carrier cycles due to the health risks associated with multiple gestations for the GC.
IVF usually takes a few months. Not only do the eggs, sperm, and embryos have to be collected, but the process has to be synchronized with the menstrual cycle and may involve multiple attempts.
Working With a Gestational Carrier
Finding the right gestational surrogacy is more than finding a candidate to carry a healthy baby. It’s important to find a gestational carrier that is a mutually good fit for your needs and desires throughout your surrogacy journey.
Each gestational carrier will have their own goals and conditions vis-à-vis the relationship. Some will be amenable to regular contact with the intended parents during — and sometimes after – the pregnancy. Others will prefer their privacy. Some may agree to breastfeed. Some may be OK with carrying twins. Each relationship is different, and there is a lot to consider.
The actual requirements of the surrogacy all need to be set forth in a surrogacy agreement. These tend to be long, detailed contracts that aim to articulate and foresee all possible dimensions of the relationship.
Surrogacy agreements typically include:
- The IVF Process
- Parental rights
- Labor and birth plan
- Health insurance
- Communication expectations
- Legal terms
- Mental health counseling
- Lifestyle during pregnancy
- Twins and multiples
- Miscarriage, stillbirth, abortion
- Death, disability, or dissolution of intended parents
While surrogacy agreements can be a lot to take in, they are an excellent way to get an overview of how a gestational surrogacy journey could work for you. There are many surrogacy agreement-related resources online. Here are a few to get you started:
- Sample Gestational Surrogacy Contract from Surrogate Mothers Online.
- Checklist for what should be included in a surrogacy agreement from FindLaw.
- Elements of a Gestational Carrier Agreement from the American Society for Reproductive Medicine.
- A law review article that explains surrogacy agreements from the Child and Family Law Journal.