Long gone are the days when the woman providing eggs was also the one to carry the child on behalf of intended parents. As a result, one typically needs to find a gestational carrier in addition to an egg donor. The carrier will have the embryos (a combination of a donor’s eggs and man’s sperm) transferred into her uterus, and carry the child through birth.
Typically, the search for a gestational carrier is a more involved process than the search for an egg donor, and can takes many months. There’s a lot at stake when selecting a gestational carrier. This is a relationship that lasts for the better part of a year and the carrier can squander the process if they don’t have responsible habits. Additionally, the carrier has a strong legal claim to the child if that baby is born in a number of states or countries. For that reason, there are a handful of states where enlisting a surrogate can be a wonderful idea (e.g. California, Maine, Nevada), or a terrible idea (e.g. New York, New Jersey, Louisiana).
As with egg donation agencies, surrogacy agencies are typically small, unregulated businesses. Many full-service agencies serve two roles: the first is to pair you with a well-matched surrogate. The second role is to shepherd along the relationship during the gestational period: checking in on the surrogate, providing updates to the intending parent(s), helping to disperse cash, and playing the “bad cop” if the situation becomes tense. Roughly 72% of surrogacy arrangements are made through an agency with the remaining 28% of arrangements made through online channels or pesonal arrangements.
The spectrum of service and experience amongst agencies is astonishing, and so are their fees. They will all claim their methods for sourcing wonderful surrogates are proprietary (though many surrogates are accessible through multiple agencies), and that they have done the work, and have the experience, to screen out any candidates who may become problematic.
Agencies will typically charge $15,000 - $30,000 in total, and it is incredibly important to be clear what their fee covers, and what it doesn’t. Some agencies will require you to pay extra if something goes awry during your surrogacy process and a new match must be found (often, $5,000 in new charges). This happens in about 10 – 25% of all circumstances.
As with egg donation, most agencies will institute a “pay-to-play” approach whereby they will not start showing you profiles of surrogates until you have paid a deposit. You can certainly push back on this, and work to spread out the costs to align with milestones (for instance, at the time of match, or the end of the first trimester).
As for screening the gestational carrier, here are some basic guidelines any respectable agency should adhere to:
A carrier has passed, or will pass, psychological screening
She has delivered at least one healthy child to term (verified by medical records provided to the agency)
She has not birthed more than five children
Her most recent pregnancy was incident-free
Her family is complete and she is finished having her own children
A birth certificate indicates she is 21 – 45 years of age
She has passed tests showing she does not smoke, use drugs or drink (though this is difficult to verify)
She lives in a calm, stable, domestic environment with plenty of help (verified by an on-site visit) involving people with no criminal history (ascertained with a criminal background check)
Who validates each of these, and when, can vary from agency to agency. A fair number of agencies do a poor job vetting these particulars before putting a surrogate in their catalogue, so you might think you have a match but it’s actually a dead-end if there’s an issue like failing a psychological screening
Next, the intended parents and the carrier need to have an understanding on a few key points. First, is the surrogate comfortable with the circumstances into which the child will be born? Some surrogates will not carry for a gay couple, or a single father, while others are happy to.
Second, the surrogate needs to be in agreement with the intended parents on the number of embryos to be transferred — a third of surrogates refuse to bear twins). Along similar lines, what will the plan will be if the doctor suggests “selective reduction” of a pregnancy, or aborting one or more fetuses in the case of either higher order multiples or birth defects that come to light.
Third, the surrogate needs to be comfortable with the level of interaction the intended parents want to have with her during the pregnancy. In some circumstances, the surrogate feels she does not need advice or surveillance during pregnancy, while the future parents are often intent on tracking her progress.
Fourth, both parties need to have an understanding of what the level of communication will be after the child is born. Will she be providing breastmilk? Will there be any contact going forward?
While agencies claim to be in the business of “matchmaking,” in some regards, this is simply a process where the next available surrogate chooses to work with you, or passes. Good surrogates are in short supply, and the imbalance has intended parents feeling like they are the ones being chosen. This process may feel less like “being matched” and more like “getting picked off the conveyer belt.”
Once the intended parents and gestational carrier meet and agree to go into contract, both sides retain an attorney (you will pay for hers), to work through the specifics. Many experts will tell you the contract in-and-of-itself is not really enforceable as outside parties cannot decide a woman’s reproductive prospects. In the words of some, when it comes to these contracts, “when you’re using, your losing.” Even if you are awarded monetary damages, many surrogates are not in a position to make you financially whole.
Thereafter, her OBGYN will need to clear her for childbirth, and your reproductive endocrinologist will want to assess her health and history to ensure the surrogate is a good candidate to carry a healthy pregnancy. Your RE will take a close look at the surrogate’s medical file to ensure there is no evidence to suggest she will have a hard time having a healthy pregnancy. For instance, if there was a previous birth that went poorly (especially if it was the most recent), your RE will pay special attention to those details.
Around this time, money for the surrogate’s base compensation and health insurance premiums are put into a trust to be dispersed after she hits key milestones. We typically see a range of what surrogates get paid, depending on the state they live in (the better the laws, the more they are paid), the number of times they have been successful surrogates (each time the cost rises about $5,000) and their willingness to carry twins ($10,000 more if they are). On average you can expect the surrogate to be paid $20,000 - $50,000.
How, and when, cash gets dispersed from the escrow account to the surrogate varies. Tranches can include roughly 10% per month after a positive pregnancy test, or be based on a few major milestones (e.g. confirmation of a heartbeat), and normally include a few post-birth disbursements.
Typically, you will pay the health insurance costs for your surrogate’s treatment and delivery. Roughly 85% of health insurance policies deny coverage for gestational carriers, which means neither your insurance, nor your surrogate’s insurance, will pick up the tab. Typically, this is orchestrated through the surrogacy agency.
You will likely need to arrange for a new policy which, given the associated complexity (e.g. increased risk from multiple embryo transfer), dramatically raises the average cost of treatment. You can typically expect to be covering premiums in the $5000 - $3,000 per month range.
If a surrogate has health insurance that allows her to be covered as a gestational carrier, it’s commonplace for that surrogate to be paid slightly more than she otherwise would be.
Many experts will tell you to be prepared to make the surrogate feel appreciated. Most surrogates see themselves as going “above and beyond,” and to ensure the relationship goes well, continually providing thoughtful touches (sending flowers after a doctor’s appointments) goes a long way. As some experts recommend, “treat your surrogate like a wife who is carrying your child.”