Episode 2 Transcript
Episode 02. Surrogacy 101: When It Takes a Village To Start a Family

INTRODUCTION

The surrogacy journey doesn’t look the same for every person or every couple. Here’s one woman’s story…

“From very early on in life, we learned about normal societal roles and the family structure. As a little girl, many of us played with Barbie, who also had Ken, and a beautiful dream house that they lived in. They even drove a fancy pink sports car too. Needless to say, Barbie had a beautiful life. The standard perspective of the “American Dream,” and what that looks like is given to us early, and finally, I had found the “Ken” of my dreams. He represented all of my hopes for love, marriage, and a beautiful future. We spent the first few years together getting to know each other and we fell deeper and deeper in love. 

We wanted to do things in “proper order,” as some would call it, and I wanted to ensure my career was off the ground and stable. I truly enjoy what I do, and he enjoys his career as well. Once we felt comfortable in our careers, we bought a home and made sure there was enough room for us to grow in this home. Our conversations about kids and how many we wanted was a constant conversation. We decided that we wanted to have three kids. While he’s an only child, I come from a very large family. I am extremely close to my family, and we wanted our children to have siblings that they could grow up with and experience a close bond with and so that they could have each other throughout life. 

Finally, after we checked off the boxes for career, home, and finances, we decided we were ready to start adding to our family. We were very hopeful, but it was taking longer than we had thought it would to get pregnant. We kept at it, trying month after month the old fashioned way. Everything else in our lives had gone as planned, and with enough hard work and determination, having a baby should fall right in line, right? Wrong. Unfortunately, after months of trying, we still weren’t having any luck. Then, one day, I started feeling really sick. I scheduled a doctor’s appointment to see what might be going on with me. Neither of us were ready to hear what the doctor said to me that day. We learned that my sickness was a result of breast cancer. 

Hearing the doctor utter these words to me in my mid 30s, was unbelievable to me. Cancer? How was this even possible? There is no history of breast cancer in my family or cancer at this age. And as if learning that I had breast cancer wasn’t hard enough, the doctor quickly followed the news by informing us that I shouldn’t try having kids….well at least not right now and maybe not for quite some time, if ever. The cancer treatment needed to take top priority over parenthood. And the treatments needed to save my life would ultimately kill any chance of carrying a baby of my own.  The Dr. said that my best bet would be to find someone who would be willing to carry our baby for us. Our only option to have a genetic child was through gestational surrogacy. As questions came flooding into my head, I felt lost and Confused. I mean who could I possibly trust that much to carry my baby for me? And how do I even begin? Where do I start? 

Welcome to Fertility Cafe – I’m Eloise Drane, and today we are talking about Surrogacy. Let’s lay the foundation of what surrogacy is, how the process works, and how to become a surrogate. In this episode, I want to minimize your stress and clear up the mysteries surrounding the surrogacy journey from the perspective of both the gestational surrogate and the intended parents.

SURROGACY DEFINED

Surrogacy isn’t new. For thousands of years, women have been called on to carry children for others. It’s easy to think that surrogacy is a fairly new process, especially given all the medical technology involved. And to a certain extent you are right – surrogacy as we know it today, utilizing IVF and embryo transfers, has only been around since 1980. Clearly, times have changed. But in all cases of surrogacy up until about 30 years ago when IVF and other Assisted Reproductive Technology was introduced on the medical front, the surrogate would use her own egg, and be inseminated by the sperm of the intended father. This is called traditional surrogacy, and was the only way intended parents could create a child through surrogacy for years. In the early ‘80’s, the first gestational surrogacy took place – where an embryo was implanted in a woman’s uterus, with no genetic ties between the pregnant woman and the baby she carried. Fast forward three decades and surrogacy is now a significantly advanced and evolved method of having a child. The combination of rapidly advancing technology and medical techniques make it easier than ever for intended parents to complete their family and for gestational surrogates to change a family’s legacy forever.

So what exactly is surrogacy? The formal definition of surrogacy is a method in which a woman agrees to carry a pregnancy for someone else who will be the child’s parent or parents after birth. According to the American Society for Reproductive Medicine, often referred to as ASRM, “a gestational carrier should only be used when a true medical condition precludes the intended parent or parents from carrying a pregnancy or would post a significant risk of death or harm to the woman or fetus.” Doctors consider surrogacy to be a medical necessity when a woman is faced with medical conditions that can have an impact on her ability to carry a child to term, while at the same time maintaining her own health.  

There a multitude of reasons why someone would need the assistance of gestational surrogate. Medical issues of course being one. Another primary reason a couple may need the assistance of a gestational surrogate is because they’re part of the LGBTQ community and are physically unable to carry. Their only other option is adoption. Adoption isn’t a bad option, as there are plenty of beautiful children who need a home. However, many want to have a child that shares their genetic makeup. 

The dynamics of today’s family structure are not biased and are more about providing a great, loving, and safe home from a great couple or single person who wishes to join the world of parenthood. Personally, I know several same-sex couples and individuals who would make great parents. They aren’t any different from others who wish to provide a loving and caring home. Who a person chooses to love is not a requirement for being a parent. It’s about the hearts and kindness of the individuals who wish to embark upon the journey of parenthood. 

Today’s society is not fixed on societal norms and traditional beliefs systems we’ve carried over from year-to-year. Times are changing, and so are the perspectives of people. More and more people are choosing to live their lives the way they feel best fits their own personal desires and needs. The days of allowing people to dictate your journey are far gone for a lot of people who simply do not allow others to define them. 

TYPES OF SURROGACY

Now, let’s take a look at the types of surrogacy. There are two types of surrogacy – traditional surrogacy and gestational surrogacy. 

Often terminology can get confusing. Although the word surrogate is used all the time, the proper term for when a woman is non-genetically related to the child she is carrying would be gestational carrier or gestational surrogate. The proper term for when a woman is genetically related to the child she is carrying would be a surrogate. You will hear many professionals in the industry use the acronym GC or carrier. And throughout this show, I will refer to the Gestational Carrier as the carrier. 

Traditional surrogacy is not popular as it was in the past, Again, this is when the surrogate’s eggs are used, making the baby genetically related to her and then of course to the intended father. Previous court rulings have made this option not as attractive as it was many years ago because of its legal complexities. As you can imagine, there is a much greater chance of a maternal bond developing between the surrogate and baby in a traditional surrogacy case. And while it would be rare for any surrogate to challenge a surrogacy agreement to keep the child, traditional surrogacy does pose a greater legal risk than gestational surrogacy for that reason alone. If a traditional surrogate were to change her mind or challenge the agreement after the fact, the intended parents would be forced to win custody in court, which could lead to a lengthy, expensive, and stressful legal battle. However, one upside of traditional surrogacy is that it is significantly more affordable than gestational surrogacy, as you’d be able to bypass embryo creation through IVF. 

Gestational surrogacy is the most popular form of surrogacy since the carrier is not genetically related to the child. In vitro fertilization, or as people know it, IVF,  is the technology method used to create an embryo using the intended mother’s – or donor’s – egg and intended father’s – or donor’s – sperm, which is then transferred to the carrier. Because of the modern technology and medical procedures involved, gestational surrogacy is more expensive. 

You will find that in most cases, US-based agencies only service Intended Parents seeking Gestational Surrogacy assistance due to the legal and emotional complexities involved with traditional surrogacy.

Now within the realm of gestational surrogacy, people typically fall into two categories: compassionate, also known as altruistic, or compensated.

A compassionate carrier does not receive any or receives very little compensation for her services beyond reimbursement for medical costs and other reasonable pregnancy-related expenses. Many of these arrangements are between family members or close friends and are completed as independent journeys. And since the GC isn’t receiving compensation, it’s obviously much less expensive than the alternative, which is compensated surrogacy.

Typically in a compensated surrogacy journey, the GC prior to the match, was not known to the Intended Parents. She is compensated for her time and discomfort. Some who oppose surrogacy will refer to compensated surrogacy as “baby selling.”  This couldn’t be further from the truth, and is honestly, an ignorant and uneducated mindset. The compensation a GC receives is a fair exchange for a person who has volunteered to help a family in need. The sacrifice involved with surrogacy is far beyond what anyone could ever pay. If you’ve ever carried a child, you understand the mental, emotional, and physical labor of the process to parenthood. Surrogates find purpose and reward in helping intended parents have the families they’ve always wanted. 

THE SURROGACY PROCESS

In general, the surrogacy process could take up to 15-18 months. Of course, this time frame can vary greatly depending on your circumstances. And if you need to find an egg or sperm donor or create embryos, this may add an additional 3-4 months to the process. The bottom line is that surrogacy is not a quick process. But, up ‘til this point, has anything in your journey to parenthood been quick?  So you know what it takes to be patient. The surrogacy process will be long, but well worth it in the end.

I’m a visual person and visualizing a process helps me to better understand how something works.  So, in the case of gestational surrogacy, there are 3 phases. The first is the preparation. If you are working with a surrogacy agency, this will involve a consultation, so they can get to know you and what you are looking for. They should be answering any questions you have about the process, learning your goals, your values, your lifestyle, your challenges, your expectations, and the type of relationship you desire with your Gestational carrier.

If you’re completing an independent surrogacy journey – or managing the process without an agency – you’ll need to set aside some time to prepare. Utilizing a tool like Surrogacy Roadmap will help organize the process and make sure you are ready to move forward when the time is right. You’ll need to assemble your team of professionals to assist you in your journey – a fertility clinic and reproductive endocrinologist, attorneys for both you and your GC to ensure all legal aspects are covered, and a mental health professional. You’ll also need to sort out your budget and prepare financially. 

After you’ve hired an agency or researched and organized for an independent journey, the next step is finding you’re GC. It’s not online dating, but the comparison can be made. You are, after all, searching for a match where mutual characteristics and desires meet. Depending on how your looking, it could take anywhere from a few weeks to years to find a compatible match. If you are working with an agency, they should provide you with options of pre-screened and pre-approved GCs. Or, depending on what your specific goals and requirements are, the agency may need to seek out and recruit someone for you. And to be clear, most agencies don’t always have carriers at the ready. Surrogacy is much more common and the demand for intended parents looking for a carrier far exceeds the qualified candidates willing to carry now-a-days.

For an independent journey, its best to start thinking through who you know that meets the general qualifications to become a carrier, and if they would even consider doing this for you. Then, of course, comes the big ask – will you be my gestational carrier? If you’re unable to find a friend or family member, you’ll have to start searching on your own. Many intended parents turn to online groups and forums to find a match. We’ll take a deep dive into what to look for in a candidate in a future episode – as you can imagine, it’s a much longer and in-depth process and will require its own episode to cover all the details.

Once you’ve found your match, it’s time for her to undergo a thorough medical screening as required by your fertility clinic. Her screening will be comprehensive to ensure she’ll be able to carry and have a safe and healthy pregnancy. 

If you decide to go the agency route, you’ll want to ensure the agency completed a pre-screening on the GC to ensure she is healthy enough to be a carrier. Her pre-screening should at least include review of her medical health records, her past prenatal and delivery records, she should have an updated PAP as well as an updated physical, STD-screening, and a psychological evaluation. This pre-screening only ensures she is ready and able to move to act as a carrier – it will not replace the medical evaluation by your reproductive endocrinologist and fertility clinic. 

Next week we’ll be speaking with Atlanta based Reproductive Endocrinologist and Fertility Specialist, Dr. Monica Best about all the medical aspects of surrogacy and becoming a gestational surrogate. It’s an episode you won’t want to miss!

After the medical screening is complete, the legal process is next. As you can imagine, the legality of surrogacy is definitely something that has to be in place. There are a plethora of laws and regulations and personal commitment from all parties involved to abide by during this journey to parenthood. The legal process with an expert legal team is an important step to ensure legal contracts are signed and everyone is clear on the terms of the partnership. Each state has varying laws and regulations surrounding surrogacy and its important to work with legal counsel who know the laws in the respective states. 

The Intended Parents attorney will draft a Gestational Surrogacy Agreement, which is the agreement between intended parents, the carrier and her spouse. It outlines all aspects of the rights and responsibilities of each party. Once there’s a pregnancy, the other legal documents will be establishing the parental order. This could be either a Pre-Birth Order or a Post-Birth Order, depending on the state the baby will be born in. These Orders enforce your parental rights over the child, informs the hospital and vital records on who is legally and medically responsible and whose name should go on the birth certificate. In some of the less surrogacy-friendly states, you may need to go through the adoption process to secure your parental rights. Adoption may also come into play if you have used donor eggs or donor sperm. Working with an experienced attorney who is knowledgeable with family formation law is an absolute must!

Phase 2. Of screening and legal is now complete, once medical and legal clearance are received. The final phase for embryo transfer and pregnancy begins once the clinic prepares the GCs cycle schedule and preps her for embryo transfer. Assuming everything goes smoothly, this can take as little as 30 days. The clinic will prescribe a series of medications to the GC that will prepare her uterus for transfer. While she is on medication, they’ll monitor her progress and readiness.

And FINALLY – after months of prep and matching and jumping through the medical and legal hoops – your GC is pregnant! Her bump, your baby.  It’s probably going to feel like the longest nine months of your life – but you’ve been through SO much getting to this point in your journey to parenthood, what’s another 9 months? Your GC will maintain doctors’ appointments – first with the fertility clinic, and then with her OB-GYN, and should check in regularly with you. 

By this point, you’ve already established how involved each party will be in the day-to-day lives of the other – some parents and GCs like to communicate regularly via text, email, and video, others like to maintain a healthy distance and only check in after medical appointments or at big milestones. Either way, the surrogacy journey is yours, and these nine months can unfold however works best for you. Closer to delivery you should also consider developing a birth plan with your carrier to map out exactly how you each see the day of the baby’s birth going. Questions like who is allowed in the delivery room and who will hold the baby first will all be determined well in advance of the delivery.

SURROGACY – THE INTENDED PARENTS’ PERSPECTIVE

Ok so Now that we’ve reviewed what surrogacy is, and how the process unfolds from start to finish, it’s important to acknowledge that the experience of the parents and the experience of the GC can be very different. You are each playing different roles in this process, and your thoughts, feelings, perspectives and actions may vary greatly.

You’ve heard me use the term Intended Parents throughout the show. This is the industry term for the soon to be parents. And often you’ll also hear reference to possibly “intended mother” and/or “intended father” depending on your status. The intended parents are a couple or individual who enters into an agreement with a carrier under the terms that they will be the parent or parents of any child born to the carrier through assisted conception regardless of the genetic relationships. No matter what the biological relationship is between the parents-to-be and the baby – whether you are genetically related to the child or not – you will be referred to as the “intended mother”, “intended father”, or “intended parent” if you are the person responsible for the baby after his or her birth.

Intended parents may at times experience a range of emotions throughout the surrogacy journey. They can go from feeling empowered and in control of their lives to fear of what lies ahead. It’s normal to find some level of anxiety. After all, having a baby is no small endeavor, and finding a carrier can be even more challenging than expected. The process requires complete involvement from the intended parents on a physical, spiritual, and emotional level. Finding and trusting someone to bring your reality of parenthood to fruition, is an exciting but also worrisome challenge.  

And it’s important to note, just as the intended parents may have some doubts and fears, so may the carrier they work with. All these feelings are completely normal. This journey isn’t to be taken lightly, but it can also be an enjoyable experience if armed with the right professionals, resources, tools, and technology. And the fastest way to ensure a smooth journey is having an open line of communication which is a must. As we all know, but sometimes fail to do, clear communication can make a world of a difference.  

Oftentimes, the carrier is married or has a partner. Not only will the intended parents need to create a strong line of open communication with her but also will need to have a healthy communication with her partner. Be sure to consider the perspective of the Carrier throughout the process and pose questions about desired relationship (or desired boundaries) with her. Can’t stress this enough. One of the most important aspects of the surrogacy journey, is communication. Ensuring the level of involvement is discussed in advance provides a great space for all parties involved. 

Because of the many challenges and concerns that could arise, it is vital for intended parents and carriers to have a great support system. Before starting the surrogacy journey, all parties should consider any emotions that may be present or that may present itself in the future, and how to work through them. Surrogacy isn’t a one-size-fits-all solution, and it’s important to address concerns, questions, and fears openly and honestly. There’s lots of great resources online and in the surrogacy community. 

There are common fears and questions that many face when considering surrogacy as an option to parenthood. Many intended parents wonder how they will be matched with a carrier, and how involved they will need to be throughout the pregnancy. And, if you’re considering surrogacy, chances are, one of your first worries is the cost. Surrogacy is costly, and with tabloids featuring stories of million dollar surrogates with celebrity clientele, the fear of the financial requirements of surrogacy can scare many people off. On top of that, it’s hard to get a firm number for how much your experience will cost. It all adds up to a lot of fear and anxiety, when, that’s the last thing that we want you to be feeling.

So let’s cut to the chase regarding the cost of surrogacy… Surrogacy will typically run from $110,000 -$200,000. And yes, I know that’s a wide window. There are many factors that can impact the cost of surrogacy, including whether you use an agency or go the independent route, as well as whether it’s a compassionate or compensated journey. Your costs will fall into three buckets – pre-conceptions costs, professional expenses, and surrogate expenses.

Pre-conception expenses refer to the cost of creating your embryos. This cost can vary based on your insurance coverage and how many rounds of medical treatment are needed to achieve success. Some typical expenses that fall into this category include medical screening, egg retrieval or donation, medications, and cryopreservation of the embryos.

The next bucket is professional expenses. You’ll be required to hire several professionals to make your surrogacy journey a successful one. First is a Mental Health Professional. You, your partner, the carrier and her partner will be required to complete psychological assessments. Although your assessment is a psych consultation, to ensure you understand the surrogacy process. The GC and her partner will be completing a psychological evaluation to ensure they are mentally sound and prepared to undergo such a rigorous emotional journey. It is also possible that all of you complete a joint psychological consultation just to make sure everyone is on the same page. This is a completely normal part of surrogacy. It’s an emotional undertaking and everyone needs to be supported and cared for, for the most successful outcome.

In addition to a mental health professional, as you know each party will be required to have separate legal counsel. Legal expenses will include drafting and review of the Gestational Surrogacy Agreement and managing the Pre-Birth or Post-Birth order with the courts.

Another highly recommended professional to work with is an Escrow services company. They’ll manage all the funds that are due to the carrier or on her behalf like her compensation and medical reimbursements, ultimately ensuring the financial aspect remains straight forward. The surrogacy journey is complicated and emotional at times, and the last thing you want to worry about is if a check was sent to your carrier or to field accusations of an unpaid medical bill. Putting an escrow account in place takes the burden of managing the financial aspect off your already-full plate.

Then there is the expense of the surrogacy agency if you go that route. An agency should handle all the details of your surrogacy journey, taking care of everything from matching, screening, and finding a carrier to assisting in locating and managing the professionals you will work with. 

The final bucket of expenses is those directly related to your carrier. If you are working with a compensated carrier, the significant part of your expenses will be her compensation. The compensation can vary, and the terms are collectively agreed upon by all parties. 

Keep in mind that the real cost of surrogacy includes, not just the financial aspect, the emotional and psychological toll that can occur for the intended parents, the carrier, her partner and her children. This can be expensive, stressful, and complex. It’s critical that you choose reputable fertility centers, doctors, mental health professionals, agencies, and attorneys that have the expertise in this field to help you through the process.

SURROGACY – THE SURROGATE’S PERSPECTIVE

I also wanted to share my thoughts from the carrier’s perspective. Taking on something as serious as bringing another human being into the world as a gestational surrogate may be one of the most life altering and altruistic gifts a woman could do for another. A GC is allowing a life to grow inside her for the benefit of another. This is truly compelling and does not go without some extreme sacrifices, both personally and professionally. 

As a GC you have to ensure your able to maintain relationships and continue on with your own personal life goals. You must consider your family and how your physical health may be compromised while carrying a child. How it will impact your job or career. And ultimately, what it will do for your own self-image. There are so many important things to consider when deciding to be a carrier, especially the time factor that this journey can easily take a year or 2 to complete.

Just because you want to be one doesn’t mean everyone qualifies to be a carrier. There are a lot of factors that are taken into consideration. Candidates are evaluated on their age, medical history, financial independence, location, their thoughts on termination and even their desire for contact and communication. 

I referenced ASRM previously which is the governing body professionals seek to help develop the standard they use in their practices. 

According to ASRM – to be a surrogate or a gestational carrier, a woman… 

In addition to that, Clinics as well as agencies will have their own specific requirements that must be considered. 

If you’re like most women considering surrogacy, one of your first thoughts may be something along the lines of, “Can I handle this?” Surrogacy is indeed a big undertaking, but I promise you, it is so well worth it. After having been a gestational surrogate three times myself, and having worked with many carriers over the last decade, let me share some of the characteristics that would make a someone an ideal carrier: 

  1. You’re a mom already

Well we know that This is a requirement and there isn’t a way around it. Unfortunately, even if your heart is in the right place, if you’re not already a mom, you’re not ideal for candidate.

  1. You’re motivated by empathy

This is a long process that, while is incredibly emotionally satisfying, can be stressful and trying at times. If you’re in it for the money, you won’t stay in it long enough to make money. You’ll also be unhappy.

  1. You have your partner’s support

This person will be impacted by your choice to become a carrier as well, and you need them on board. Having a strong support system will help your journey be more fulfilling.

  1. You’re organized

Simply put, being a carrier can feel like a full-time job. Being organized makes this feel less overwhelming and much more manageable.

  1. You’re financially stable

In addition to not being motivated by fiscal gain, it also helps if you’re not in fiscal need. We aren’t saying that you need to be wealthy, but it is important that you’re not depending on this money to live because there’s no guarantee that it would even work and you would receive compensation.  

  1. You’re compassionate

If you’ve ever known someone who has struggled with infertility, it’s not hard to understand how difficult this process can be for intended parents. Surrogacy represents a lifelong dream for them, and on top of the emotional toll, this process can take a huge hit on a family’s finances as well. Being sensitive to their needs and concerns will make you a great candidate, and an even better friend.

  1. You love being pregnant

It’s the one thing carriers have in common. Not only do they love being pregnant, but they’re also pretty great at it! 

  1. You’re a great communicator

During the course of your journey, you’ll be asked to communicate with a lot of people. Your going to be responsible in keeping many people up to date on many things. Some very personal.

  1. You’re flexible

Here’s the thing about surrogacy. It’s all kind of a big waiting game. There’ll be a lot of hurry up and wait going on, as your dates will be dependent on things that we only have so much control over. You’ll have a much better experience if you’re able to be flexible and “go with the flow” as you progress through your journey.

So Do these qualities mirror you and your life? Looks like you’re in a great place to be considering surrogacy. The next step is often the scariest… making your first move and applying with a reputable surrogacy agency or saying “yes” to a friend or family member that has asked for your help. 

COMMON MYTHS AND MISCONCEPTIONS ABOUT SURROGACY

We’ve reviewed a great deal of information regarding surrogacy, and I wanted to touch on just a few of the many common myths and misconceptions surrounding surrogacy. 

Surrogacy is only for the rich or celebrities. The primary reason this myth exists stems from the cost of surrogacy and the fact that it is very expensive. Surrogacy is a very emotional and expensive process to have a baby, and it’s not only for the rich and famous. Yes, some celebrities look to surrogacy to start a family but that’s not the norm.

Another one I hear often, The surrogate may try to keep my baby. From the very beginning, the carrier is aware and agrees that she will not parent or have legal parental rights of the child. There are multiple legal processes in place that cement the legal parentage and negate any parental rights of the carrier. Plus, not to be insensitive, she could just have her own children. She’s already proven that she could.

I will have trouble bonding with my baby. True bonding typically happens after birth. As suggested earlier, a birth plan should be in place to detail how the parents will step in to care and bond with the child immediately after birth. The child is handed over immediately to the intended parents to begin the bonding process and once you have that baby in your arms, your will instantly fall in love. 

CONCLUSION

I hope that you’ve enjoyed today’s episode and that I’ve laid a great foundation for what surrogacy is, the surrogacy process and addressed some fears or concerns you have surrounding surrogacy. Check out our Resources page on TheFertiityCafe.com for links and tools to provide additional information. Thank you for joining me today on Fertility Cafe. I’m Eloise Drane. Remember… “Love has no limits, neither should parenthood.”

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