What is Gestational Surrogacy
Gestational surrogacy allows a person or couple who can’t become or stay pregnant to have a child that is biologically theirs. Through in vitro fertilization (IVF), a doctor combines sperm from the intended father (or a sperm donor) with eggs from the intended mother (or an egg donor) in the lab. These embryos are then tested to make sure that they are genetically normal then frozen. They are later transferred to the uterus of a very special third person, a gestational surrogate, who will take excellent care of herself and the baby that grows within her womb. In about nine months, the gestational surrogate will deliver the baby on behalf of very grateful intended parents. The entire process usually takes 15 to 24 months.
Before the advent of IVF, the only type of surrogacy available was what is now referred to as “traditional surrogacy” where the woman who carried the baby was also the source of the egg. Thanks to IVF, today’s “gestational surrogacy” arrangements are possible ensuring that the surrogate is not the source of the egg and has no genetic link to the baby she carries. She knows from the start the baby is not hers, so she isn’t “giving up” her own child. From a legal view point, parental rights and responsibilities are clear with gestational surrogacy – the baby is the child of the intended parents and they have the all legal rights and responsibilities. Family Forward Surrogacy only works with gestational surrogates.
Understanding the Process
It takes a special woman to become a surrogate. Our surrogates are motivated primarily by the desire to help others, their love of family, and having easy and uncomplicated pregnancies. Financial reward is a secondary motivator. Agreeing to take on the physical and emotional commitment of bearing a child for another family is a major life decision and sacrifice for the surrogate and her family. She’ll need to go through an intense screening process, undergo multiple invasive medical procedures, limit travel at the end of the pregnancy, contend with time away from her family and/or job, and endure the pain and recovery of giving birth.
We’re extremely selective about our surrogates, and as a small agency, we have the luxury of taking the time to get to know each one personally. Most of our surrogates are lifelong givers. Many FFS surrogates foster animals, and quite a few have chosen caregiving in a medical setting as their profession. FFS has worked with many surrogates who are nurses or medical professionals. We only work with women we’d trust to care for our own children and who are “all in” for the ups and downs of the 15-18 month journey. We ensure that our surrogates are well prepared medically, emotionally and financially to undertake surrogacy.
The surrogacy journey is a mutually beneficial arrangement. Surrogates and intended parents are parties to a binding legal contract that benefits and is fair to both. Intended parents realize their dream of having a baby and surrogates realize dreams of their own, such as staying at home with their children for another year or two, getting a head start on an college fund, or earning a down payment for a new house.
Gestational Surrogate Screening: FFS requires surrogates to submit an extensive application. We perform a criminal background check and an in-person home visit with the surrogate and her spouse or partner, if applicable. We also require and coordinate psychological evaluations of the gestational surrogate and her partner conducted by a mental health professional specializing in surrogacy and Assisted Reproductive Technology (ART). The surrogate will undergo medical screening and both she and her partner will have infectious disease and drug testing at the IVF clinic chosen by the intended parents.
Matching: We work with both surrogates and intended parents to understand personal preferences. Do you want to go to every doctor’s appointment or only milestone visits like the 20-week sonogram? Do you prefer to communicate via text or video conference? Would you rather partner with a married or single surrogate? We match you with a surrogate who has similar expectations for the journey. And, if for some reason you don’t feel the first woman you’re matched with is the perfect fit, we’ll match you with another surrogate.
Clinic Selection: FFS will work with the IVF clinic that you choose, or we can help you to identify a clinic that aligns with your particular needs. We are familiar with the programs and pricing of many clinics, including Shared Risk and other cost-guarantee programs, and would be happy to help you find the one that’s right for you.
Donor Egg: If donor eggs are needed, our clients usually obtain them from an IVF clinic, most of which have prescreened donors. Larger clinics typically have 75 to 100 medically pre-qualified donors going through the egg retrieval process at any one time, along with banks of thousands of frozen donor eggs.
Legal: Because laws differ from state to state, we accept surrogates only from “surrogacy-friendly” states. We work hand-in-hand with a network of experienced ART attorneys to determine which states are appropriate for a particular client from a legal perspective. Some states are surrogacy-friendly only for traditional married couples, others to couples or singles regardless of marital status or sexual orientation, and a handful are not appropriate for surrogacy at all. The good news is that the laws governing surrogacy agreements are determined by where the surrogate lives. So no matter where you live, you can be matched with a surrogate in a friendly state.
Best practices dictate that you should work with an ART/surrogacy attorney in the state where the surrogate lives. We’ll refer you to these ART attorneys and make introductions. You can choose the attorney you prefer to draft the Gestational Surrogacy Agreement (GSA) contract between you and your surrogate. In most states, at about 20-weeks’ gestation your attorney will also assist in obtaining the court order required to ensure you have full legal parental rights to your child. To protect both you and the surrogate, you’ll be required to provide a stipend for the surrogate to have independent representation during the contracts process. We’ll help the surrogate find an experienced ART attorney in her state as well.
The ballpark cost of a surrogacy journey is $130,000 to $170,000. Please see our Intended Parents Costs Worksheet. The biggest variables in determining cost are 1) the surrogate’s fee, and 2) the cost of health insurance for the surrogate. We’ll let you know both of these variables before you accept a match with a surrogate so that there are no surprises.
Please register your email to have access to our Surrogate Compensation Guidelines.
Healthcare and Insurance Costs: Your surrogate will need to have health insurance that covers the pregnancy. Insurance is a very complicated issue. We’ll work with you to evaluate health insurance options available for the surrogate pregnancy.
Please provide your email address and we will send you the FFS Health Insurance Scenarios white paper.
INTENDED PARENTS FAQs
The total cost of a surrogacy journey, excluding IVF treatment, is about $120,000 to $160,000.
Yes, unfortunately, there is a wait. Over the past several years, demand for surrogates has risen sharply, but the pool of qualified candidates has not expanded at the same pace. At FFS, we will not lower our standards in order to match you more quickly. We will only match you with a woman we would trust with our own children.
You can reduce your wait time by being flexible. To match more quickly, you should consider being flexible about the following surrogate preferences:
- Type of Health Insurance
- Number of embryos you would like to transfer at one time (e.g. do you want to have twins?)
- Education level
- Marital status
Unfortunately, many potential surrogate candidates are reluctant to travel and/or to commit to a long-term, complex medical process in these uncertain times. To qualify to become a surrogate, one has to have had children and to be younger than 43 years old. So, almost all surrogate candidates have school age children. The uncertainty about whether children will physically be in school makes it difficult for surrogate candidates to commit to one more demand on their time. We are finding that the wait for surrogates during COVID is 9-12 months.
The time to match is usually four to six months, but recently because of the COVID pandemic, we believe it will take about nine to 12 months to introduce you to a match, then about two to three months to get through the final screening and legal processes, and, of course, nine months of pregnancy. You should be prepared for the whole process to take 18 to 24 months in the current climate.
The laws governing surrogacy agreements are determined by where the surrogate lives. So no matter where you live, you can be matched with a surrogate in a surrogacy-friendly state. We also consider your specific circumstances when deciding with whom to match you, as some states are surrogacy-friendly only for traditional married couples, others for couples or singles regardless of marital status or sexual orientation, and a handful are not appropriate for surrogacy at all. We’ll be sure to match you with a surrogate from a state that will recognize you as the legal parents to a baby born through surrogacy.
Some surrogates have health insurance policies that will cover a surrogate pregnancy, and others have a plan that has a specific exclusion for surrogacy or no insurance at all. If the surrogate has surrogacy-friendly health insurance, you pay only the copays and deductibles for treatments related to the pregnancy. If she doesn’t have a surrogacy-friendly policy, then we can get her a plan through the Affordable Care Act (ACA), also known as Obamacare. If we use the ACA, you would have to pay the monthly premiums in addition to the copays and deductibles. The ACA can be obtained only during open enrollment (typically November through January), so we have to be strategic about the timing of the transfer(s). There are also other solutions to “bridge the gap” between open enrollment windows. We’ll let you know about your surrogate’s insurance situation before you accept a match with her.
Does the fact that we are a same-sex couple make it more difficult for us to become parents through surrogacy?
No. In fact, some surrogates request to work with a same-sex couple. Just as we allow IPs to request certain surrogate preferences, we also allow surrogates to specify characteristics that they would like to see in their IPs. Some surrogates request a traditional married couple, while others request two intended fathers. These requests are made at approximately the same rate, so we don’t have a very high demand for one or the other, and this should not affect your time to match.
FFS takes the following steps to screen each surrogate:
- Web-based initial screening focusing on lifestyle and health issues
- Detailed written application including chacter references and medical records for all previous pregnancies
- Video conference interview conducted by an FFS representative
- Criminal background check of the surrogate and her partner
- Psychological screening and evaluation of the surrogate – and her partner, if applicable
- In-person visit to the surrogate’s home by FFS
- Thorough medical screening by the IVF clinic chosen by the IPs
If a surrogate doesn’t pass initial psychological or medical screening, FFS will match you with another surrogate free of charge.
If you haven’t yet chosen an IVF clinic or reproductive endocrinologist, FFS can assist you in finding one. Some clinics are more familiar with surrogacy and have dedicated personnel who specialize in surrogacy and egg donation. We’re familiar with many of the major clinics and are happy to make introductions if needed. We’ll work with any clinic that is a member of the Society for Assisted Reproductive Technology (SART). www.sart.org
The SART website also can provide you with success rates of all the clinics that report their statistics to SART. In most cases, the IVF cycles take place in the IPs’ geographic area, and the birth takes place near the surrogate’s home.
FFS only works with gestational surrogates, meaning that the surrogate does not contribute her genetic material (eggs) to the creation of the embryo. Her only role is to carry the baby for the period of gestation. The surrogate knows that the baby is not related to her, so she is not giving up her own baby. In fact, most surrogates ask, “How can I be sure that the IPs will take the baby?” Gestational surrogates become involved in surrogacy because they want to help others and generate additional income for their families. A surrogate’s desire is not to have another child or to take on additional financial responsibilities a new child would bring.
Who decides which IVF clinic we use, which OB/GYN we will see, and the hospital at which we will deliver? Where are these located?
The IPs choose the IVF clinic, and the surrogate travels, at the IPs’ expense, to the IPs’ clinic for initial testing and then later for the transfer. At about eight to twelve weeks gestation, the IVF doctor will hand over primary responsibility to an OB/GYN near the surrogate’s home. Many times, the surrogate will continue to use the OB/GYN she already sees, but in some cases, the IPs will want her to have a different OB/GYN (for instance, if her current OB does not have a favorable view of surrogacy). She also may be followed by a high-risk OB/GYN or Maternal Fetal Medicine (MFM) doctor if the pregnancy is or becomes “high risk” (all twin pregnancies are considered high risk). The hospital where she will deliver is usually dictated by where her OB/GYN has privileges, but if the pregnancy is high risk, the hospital may be chosen based on the level of its Neonatal Intensive Care Unit (NICU).
In almost all cases, the IPs would like to be in the delivery room to experience the birth of their child and to support the surrogate. In the case of a C-section, only one support person is allowed to be in the operating room. Will that person be Mom, Dad or the surrogate’s husband? We encourage you to talk with your surrogate about preferences before you match in order to be sure that you have similar expectations. Many surrogates actually prefer that the intended mother (or in same-sex couples one of the Intended Fathers) be in the operating room. They’re doing this for you and want to see the joy in your eyes when you see your baby for the first time. Many surrogates say that moment is the one they cherish and remember for the rest of their lives.
After the birth, you’ll have all parental rights and responsibilities and will make all medical decisions regarding your baby. The baby will be covered under your health insurance from the moment of birth. The surrogate will be compensated for lost wages for up to four weeks after a vaginal delivery or up to six weeks after a C-section. Most often, the surrogate and the IPs will see one another a few times in the following weeks and will continue to communicate via email or video conference, depending upon how the relationship developed during the pregnancy. Almost every IP will occasionally send pictures of the baby and almost always send holiday cards in December or January. Some Intended Parents visit with the surrogate on an ongoing basis.
The Fee Guarantee Program (FGP) was created to work in concert with Shady Grove Fertility’s Shared Risk Program. The Shared Risk program allows IPs to go through multiple rounds of IVF for a set fee. This fee is higher than one or two a la carte cycles, but less than three or more cycles. The principle is that the clinic is sharing the risk of paying for multiple cycles with the IPs. The FGP uses the same principle of “sharing the risk” between two entities, in this case, the IPs and the agency. You may utilize the FGP if you participate in Shady Grove Fertility’s Shared Risk Program. Other IVF Clinic guarantee programs will be evaluated on a case-by-case basis.
We had been struggling with infertility for almost a decade. Once we started down the surrogacy road with FFS we finally had hope again. FFS helped us through the surrogacy process with empathy and kindness. Now we have our sweet baby girl! We couldn’t be more thankful! - K and E
Dear Valerie, We wanted to thank you for joining us on this journey and for introducing us to J and M. As we sit and stare at our perfect little girl we are endlessly grateful for the people who supported us during this process and helped us create our family. You will always have a warm place in our hearts and home. Thank you for everything. -E and P
Dear Sandra, C and I are over-the-moon happy (though a bit sleep deprived) now that we are home with young D. We cannot thank you enough for all you did to make our dreams a reality. – B and C
We began our journey to start a family several years ago working with Family First Surrogacy (FFS). Many families have unique challenges and we certainly had ours as we were transferred to several different states during the process. As a gay couple, we needed to find a surrogate located in an area of the country amenable to gay parental rights. FFS was very patient with our career relocations and FFS succeeded in finding us the most caring, thoughtful, and loving surrogate. After our first try, we were blessed with a healthy son, who each day makes us smile and expands the compass of our love." -J & W