People may come to surrogacy after exhausting other options and learning that they cannot carry a pregnancy to term, and it is often a first choice for single men, male couples, or women who have had medical complications. Some people are wary because of myths about surrogacy and stories in the popular press, but the press usually focuses on those cases that go wrong. Sharing a pregnancy with a gestational carrier (the woman carrying the child) allows the intended parents to retain a genetic link to their child if their sperm and eggs are viable (donor embryos or donor eggs and/or donor sperm may also be used). Parents are usually closely involved with the prenatal care and are present for the child’s birth.

“We chose a sperm donor based on his medical history, characteristics, and a photo. We met our gestational carrier through an online surrogacy board, then got to know her. She had been a carrier before.”

—A PARENT through sperm donation and gestational surrogacy

Some families still pursue traditional surrogacy, a less-expensive option whereby the surrogate’s own eggs are fertilized with sperm from the intended father. But most couples who build their families through surrogacy today choose gestational surrogacy. In gestational surrogacy, the intended mother (or an egg donor) provides the egg and the intended father (or a sperm donor) provides the sperm, or the couple may use a donor embryo. The resulting embryo (or, in some cases, multiple embryos) is transferred to the gestational carrier, who has no genetic connection to the child.

Emotional considerations

• Before deciding to use a surrogate, you (and your partner) should
  consider the following questions:
• Are you ready to move on from current infertility treatments?
• How do you feel about someone else carrying your child?
• Are both partners ready to do this?
• How will you explain the pregnancy and birth to others and, eventually,
  to your child?

It is important that you and the carrier speak to a mental health professional specializing in infertility about these and other concerns. A mental health screening can ensure that all parties have considered all matters. It will also help to determine if you and your carrier are compatible.

Finding your service providers and carrier

Some families are fortunate enough to have a close friend or relative, such as a sister or sister-in-law or a cousin, who volunteers to be a carrier. Most families pursuing gestational surrogacy, however, are matched with a surrogate through a surrogacy center. When selecting a surrogacy center, take the time to make a decision that feels right to you. Ask for referrals from your doctor. Speak with the staff at the center, ask about the fees and the process, and seek testimonials from current or past clients.

You should also hire a reproductive attorney to help you navigate the complex laws surrounding surrogacy and obtaining a pre-birth order recognizing you as the legal parents. Those laws vary from state to state. Some states don’t recognize surrogacy agreements, some prohibit compensated surrogacy, some bar unmarried couples from hiring a surrogate, and some don’t have statutes that address surrogacy at all. The most experienced ART attorneys will be members of the American Academy of Assisted Reproductive Technology Attorneys.

Surrogacy centers generally screen prospective surrogates carefully, requiring a full medical history and a psychological evaluation. Intended parents select their carrier after reviewing several profiles. It is recommended that a carrier:

• Has had one or more successful pregnancies that were free of complications.
• Is parenting one or more children.
• Is in a stable, supportive relationship.
• Enjoyed the experience of being pregnant and/or would like to help someone who
  cannot carry a pregnancy.
• Is financially stable.
• Has health insurance that will cover her prenatal care and delivery. (If the carrier does not have health insurance or her policy excludes surrogacy, specialty coverage is available, but it will add substantially to the costs.)
• Is emotionally stable, with no criminal history.
• Has no history of drug or alcohol abuse and doesn’t currently smoke.

The surrogacy process

Surrogacy is guided by state law. Not all states allow intended parents to obtain a pre-birth order, and in some states this is dependent on whether the parents have a genetic connection to the child. If you live in a state that does not allow pre-birth orders, or are matched with a gestational surrogate who lives in such a state, you should be sure to work with an experienced ART attorney. The legal contract the carrier and intended parents sign sometimes requires dietary or other lifestyle changes during the pregnancy, and may outline future contact, if any.

If using their own gametes, the intended parents will complete an IVF cycle; the intended mother must take rounds of hormones to prepare for the egg retrieval procedure, which is usually an outpatient surgery. The eggs are fertilized with the intended father’s sperm (or donor sperm) and one or more embryos are transferred to the carrier. No medical procedures are necessary for the intended parents if they are using donor eggs or a donor embryo.

Many intended parents are in close contact with the carrier throughout her pregnancy, speaking regularly and accompanying her to ultrasounds—and some continue to have a relationship after the child is born. Most intended parents are present for their child’s birth.