Episode 4 Transcript
Episode 04. 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 perspec

Podcast: Egg Donation 101

PODCAST INTRODUCTION

Compelling lead-in audio excerpt from podcast.

-Intro Music-

STANDARD INTRODUCTION

Welcome to Fertility Café – I’m Eloise Drane. With the world of social media, people tend to believe almost anything that pops up on their timeline with no thought to the resource that provided the news or information. There’s information constantly storming the internet, making it hard to know what’s true and what’s false. And, as you can imagine, there are lots of myths and misconceptions surrounding egg donation and the world of alternative family building.

As founder of Family Inceptions, a surrogacy and egg donation agency and a 6-time egg donor, I’ve heard my share of misinformation. Today, I’ll share the specifics of egg donation, how its evolved over time, key terms to know and the different types of donation programs. The information I’ll share, will provide a snapshot on egg donation that will help egg donors and recipient parents understand what they’re getting into and why many people choose this option to create their families. So, sit back as we explore the ins and outs of the egg donation journey.

 

EGG DONATION

What’s there to know about egg donation?

Let’s start with the obvious. What is egg donation? Egg donation is defined as a safe, tested, and relatively non-invasive medical procedure that allows eggs to be retrieved from a healthy and fertile donor. The fertile woman, known as the egg donor, donates her eggs, or oocytes, to another woman to help her conceive. The recipient of the eggs can be either the intended mother also known as the recipient mother or it could be a gestational carrier. Egg Donation provides the option in which the recipient mother can carry her own pregnancy or in which it can be used in tandem with surrogacy.

Egg Donation was developed in order to help infertile couples, LGBTQ families and single individuals who wished to start a family. The first successful egg donation pregnancy was in Australia in 1983. The US had the first successful transfer in 1983, that led to a birth in Feb of 1984. Luckily through technology it’s a common practice now throughout the world and has very successful outcomes.

I know we’re speaking about egg donation in this show, but I wanted to point out that if a women is completing IVF and using her own genetic material to carry herself or with the assistance of a gestational carrier, she’ll complete the same process as what a donor must go through. And if she’s working in tandem with a gestational carrier, she’ll also need to complete similar medical screening as well.

It’s important to note egg donation is highly regulated. It is treated just like any other tissue or organ that gets donated and the FDA has strict rules and regulations that must be followed by all fertility clinics.

EGG DONATION TERMINOLOGY

Do you remember biology class? Honestly, until I got in this field, I sure didn’t. Truth be told, when I started hearing terms that aren’t really used on a regular day to day conversation, I had to look up some definitions. So, bear with me, I’m going to give you a quick rundown. I’ve already shared one of the terms, oocyte, which is the immature eggs that would be retrieved from the egg donor. Often, you’ll hear professionals in the industry refer to the donor’s eggs as oocytes, ova or ovum.

I spoke about this previously, when seeking alternative family building, it’s impossible to do anything without the use of IVF, or in vitro fertilization which is a series of procedures and techniques where a woman’s eggs and man’s sperm are combined in a lab in order to create an embryo(s).

A woman’s eggs develop inside fluid-filled sacs inside the ovaries called follicles.

Controlled ovarian hyperstimulation is the technique used by taking hormone medications that stimulate the ovaries to produce multiple eggs.

After the IVF cycle, hopefully a number of viable eggs are produced. To freeze the eggs or even the embryos – also referred to as cryopreservation – it goes through vitrification or flash freeze which is freezing the egg or embryo with extremely rapid cooling so that ice crystals never form around it. The egg or embryo is literally frozen in time – whatever stage it was in, it will stay in until thawed.

Then we have a gamete, which is a mature sexual reproductive cell, such as an egg or sperm, that unites with another cell to form a new organism. And when the male gamete and female gamete meet it’s called a zygote. The single-celled zygote begins to divide and eventually becomes a blastocyst. In the medical clinics, you’ll hear reference to blastocyst embryos. Almost all clinics do the extended 5 or 6 day blastocyst transfer as they believe it produces a more successful outcome. Embryos that survive to this stage of development have a high implantation potential once transferred into the uterus.

OHSS is ovarian hyperstimulation syndrome and I will go into detail later in the show about what that is

FET is the acronym for frozen embryo transfers. The majority of clinics are all doing FETs, and in all honesty, would prefer to do if possible. I’ll share why shortly.

Have I lost you? Bored? Sorry. Why does all this matter? Well because knowing the foundation of this process can better help you visualize the process. And when the time comes when your speaking to a medical or legal professional and they begin using some of this terminology, you can easily follow what they’re talking about.

If your embarking on this journey, regardless of your role as an egg donor or a recipient parent, there’s several decisions you’ll need to consider on how you want to complete your journey. What type of arrangement you’re comfortable with? What program would work best for you? Are you going to work with a fertility clinic, frozen egg bank, egg donation agency, or go the independent route when it’s time to find your egg donor or when you’re ready to donate your eggs? What about a fresh vs. frozen embryo transfer? Is one better than the other?

Type of Egg Donation Arrangements

One of the first decisions made in the egg donation process is the relationship that will exist between the donor and the recipient parents. Currently, the most common egg donation arrangement is an anonymous or closed egg donation. Information from both parties is kept confidential. Typically, you’ll see these arrangements through the fertility clinic or frozen egg bank. Recipient Parents will see a donor’s profile (which would include her genetic and medical history, her family’s medical history, education level, her personality and physical description). There won’t be any adult photos and is often limited to her baby pictures. Her full name will never be disclosed. So, to determine which donor would be a good fit, recipient parents choose donors with similar features like hair color, eye color, and blood type to name a few.

An FET is always anonymous, and the egg donor has no say to whom would get her eggs. Nor will she know who received it or if a pregnancy or child resulted from the donation.

Given new technology with programs such as 23 and Me and Ancestary.com, anonymity is quickly becoming a thing of the past. And because of this, donors and recipient parents alike are opting to do semi-anonymous donations. This arrangement is when only specific information is provided to each party and each party would agree on what information would be shared which is normally, first names, and what state they live in. It’s also possible for the parties to speak over the phone.  However, no one is obligated to stay in touch with the other party once the donation is complete.

Its more common to find semi-anonymous arrangements when working with egg donation agencies or fertility clinics that have donors willing to complete fresh cycles.

For quite some time it was assumed by many, the only way someone could have an open/known egg donation arrangement was if the egg donor was a family member, or friend.  That’s no longer the case. Open donations are becoming more common. Recipient parents and egg donors are agreeing to disclose their identifying information such as names, address etc. And many times, they meet in person and agree to have a long-term relationship. What that relationship looks like, will be something all parties agree to upfront. But now recipient parents can work with a donor they didn’t have a relationship with prior.

Often, you’ll find open donation arrangements through egg donation agencies or if you go the independent route. It’s very unusual at this current time anyway, to have an open donation with an egg donor located through a frozen egg bank or even a fertility clinic.

Lastly, there is the Identifiable donor arrangement in which all parties agree the egg donor’s information will be identifiable to any child born using her eggs once the child turns 18 years of age.

There is a push for open donations or at the least identifiable donor arrangements, not just because of the development of DNA and genetic technology but ultimately for the sake of the child that will result from these donations. For most people, knowing their genetic history is important and helps with medical questions they might have. Over time, people conceived via donors have expressed the importance of understanding their genetics and knowing where they come from.

Regardless of the donor arrangement, egg donors have absolutely no parental rights of children that may result from their donation. Once the eggs are donated, there is nothing further an egg donor needs to do.

 

MY JOURNEY

In my own personal egg donor journeys, I experienced several different arrangements. I first learned about egg donation on my first trip to California. I had donated a kidney to my cousin and after our surgery, he wanted me to visit him and as you guessed it, he lived in California. While there, I saw an ad for egg donation. Definitely something I thought I could do. By that point, I already had 3 children and I didn’t have any issues getting pregnant. I kept it in the back of my mind and a little over a year later decided to reach out to the agency to see if I could apply. I submitted my application and I was told it would be near impossible to match me because I was African American and black women didn’t have infertility issues. Clearly, we know that’s not correct but information wasn’t readily available 20 years ago like it is now.

Eventually, I was matched. My first journey was an anonymous arrangement. I had no clue who the recipient families were. I assumed they were another black family and that they also didn’t receive any of my identifying information. Truth be told, it was not the greatest experience and honestly, I felt used. I didn’t get any guidance from the agency. Once I was matched, I pretty much had to figure it out on my own. Meds were shipped to me, I was monitored by a local clinic and when I was ready, I flew to the location where the fertility clinic was the day before retrieval, had the retrieval the next day and was handed a check after being dropped off at the hotel door by a clinic staff member and was told to take a taxi back to the airport and go home.

I just assumed to not do that again. But several years later I came across a site that advertised egg donation and surrogacy. I don’t know what possessed me to add my information, but I did, with really the mindset I was never going to be matched. Well wrong on that assumption. Within hours of submitting my profile, I was inundated with emails from families seeking a black donor. I was then able to choose whom I was going to donate for. My 2nd journey was semi-anonymous. I shared with the recipient couple my identifying information. However, I only knew them by first name and the state in which they lived.

The remaining 4 donations I did were all open donation arrangements. 2 of those donations were for the same family who wanted to complete sibling journeys. I was comfortable enough with the recipients, that I stayed in their homes while I was completing my journeys.

I’ve had the opportunity to meet the children from my open donations, and I’m friends with their parents to this day. My own children are aware that I was a donor and they’ve had the opportunity to meet one of the children that resulted from my donations as well.

 

EGG DONORS

Becoming an egg donor is a big ask. But what I’ve learned in my life is that the secret to living is giving. I know, that sounds corny as hell. But it’s true. Whether it’s your time, your money or in this case your eggs, it’s makes a significant impact for so many and you can’t even imagine how many lives you will touch by your willingness to do this for someone else. But it really does give you a gratifying feeling know you were the one who helped make that impact. Egg Donation is a choice that will benefit you significantly in exchange for a minimal amount of your time, while also changing the world for a family in need. But its not for everyone.

Perhaps the biggest part of becoming an egg donor is meeting the requirements. Not all woman can donate. Programs vary in the criteria they set to determine who would be a good candidate. The basic requirements to become an egg donor are to be between 21 and 32 years old, free from any sexual transmitted diseases, nonsmokers, nondrug users, and have no family history of genetic diseases or family history of mental illness.

You’ll be required to complete medical and psychological screening. The fertility clinic will screen you for general medical health (completing a physical and gynecological exam), infectious diseases through blood and urine tests and inherited disease screening through a blood test as well. Further, your required to meet with a licensed mental health professional to complete a psychological evaluation. Once the results are back from the screenings, you’ll be notified if your qualified to move forward with the actual donation process.

What’s fascinating is women are born with all the eggs we’re ever going to have, and we don’t make any new eggs during our lifetime. We’re born with approximately 2 million eggs but each month thousands die even before we reach puberty. By the time we become teenagers, we have about 350,000 remaining eggs and every month they gradually die off until we reach menopause.

When someone is considering becoming an egg donor, sometimes there’s a fear that you won’t have enough eggs for when you’re ready for your own family.  I don’t want to say it could never happen however, that would be an unusual case. In egg donation, the goal is to obtain several mature eggs. It’s difficult for anyone to know how many eggs you would produce because its different for everyone. Through the controlled ovarian hyperstimulation process, you’ll take various daily injection medications which will stimulate your ovaries to produce the eggs. Once the eggs are removed – or harvested, as it is also referred to – it can either be fertilized immediately or frozen to be used later. The goal is for you to produce several eggs, which increases the probability of healthy, fertilized embryos.

Now, let’s talk about the risks. It would be extremely partial of me to only share one side of the egg donation process and pretend as if there aren’t any risks involved. I’m not here to be misleading in any way. I believe the more information people are equipped with, the better they can decide what best fits their own lives.

As with everything in life, especially in the medical arena, there are some risks involved with egg donation. It’s common to feel some discomfort during the egg donation process. Some women develop soreness or mild bruising around the injection site. You may even experience breast tenderness, mood swings and even mild fluid retention just like you would when you have your menstrual cycle every month. These are considered normal symptoms.

Occasionally, the medications can cause more hyperstimulation than intended (known as “ovarian hyperstimulation syndrome,” or OHSS). This occurs when the ovaries have an exaggerated response to the hormones given to increase egg production. There are varying levels to OHSS; mild, moderate and severe.

Mild OHSS, will cause abdominal pain and swelling. It normally goes away after your next period. Moderate OHSS, are similar symptoms as mild, however more intense where pain meds may have to be taken. But again, should go away after your next period. Severe OHSS is the rarest but can cause serious medical complications such as blood clots, kidney failure and fluid build-up in the lungs. Severe cases have occurred in about 2% of the population completing an egg retrieval process.

Fortunately, in order to govern this risk, the fertility clinics take every precaution and monitors the cycle very closely. You’ll be required to attend doctor’s appointments every other day while you’re on medications. And if there is a concern that there would be OHSS, the fertility clinics will cancel the cycle and not move forward. It’s actually happened to me.

I’ll share the step by step egg donor process and go much more in depth about what the egg donor journey looks like in a future episode.

Just like in surrogacy cases, there are compassionate or altruistic donors as well as compensated donors. In a compassionate egg donation situation, you would not receive or receive very little compensation for your time and discomfort. In a compensated journey, you would receive compensation and that compensation will vary. Different programs offer different comps. All costs for the entire journey are paid for by the recipients, not the donor.

Egg donors can receive anywhere from $5,000 to $10,000, and even more if there is a greater demand for their specific genetics. The compensation a donor would receive is not based on how many eggs are retrieved or based on the number of embryos created. The compensation is based on the time involved, her pain and suffering and the risk.

Compensation from the various programs are similar. However, donors that are in higher demand, often receive higher premiums.

 

Donor Cycles

Egg Donation has evolved since I first started 20 years ago. Recipient parents were given the option on whether they wanted to do fresh or frozen cycles as there was concerns that the success rate would be different depending on which method you used. Fresh versus frozen eggs or even embryos aren’t really much of a thing anymore. Thanks to the freezing technology, vitrification or flash freeze, frozen embryo success rates are now as high as that of fresh embryo transfers. More clinics are opting to complete frozen over fresh transfers and some no longer even offer fresh embryo transfers.

It used to be if you wanted a fresh cycle, and you were completing egg donation, you had to have patience and flexibility from both the egg donor and the recipients. Fresh cycles were completed real time. The donor didn’t begin her cycle until after she was selected, so there was more lead up time to get her eggs and ultimately, to having an embryo transfer. There was a synchronization of menstrual cycles that occurred between the donor’s and the recipient mothers or gestational carriers’ cycles.  The hope was that the eggs could be retrieved and fertilized just in time to be transferred directly to the uterus without having the need to be frozen.

But then technology was vastly improved with vitrification. And screening such as PGS (Preimplantation Genetic Screening) or PGD (Preimplantation genetic diagnosis) was vastly improved. These tests are preformed after an embryo is created to check for genetic abnormalities and chromosomal disorders. If testing is desired on the embryos prior to transfer, you wouldn’t be able to do a fresh embryo transfer. The embryos need to be frozen to complete these tests.

Frozen embryo cycles are more routine because it does offer more benefits. One of course it’s ready to go as soon as recipient mother or the gestational carrier are ready to go. There is no lag time spent trying to align menstrual cycles. It provides a lot of flexibility in coordinating schedules, travel and could speed up the time for transfer. Not to mention, frozen embryo transfers are also less expensive than fresh embryo transfers.

For many the concern with completing a frozen transfer is if they embryo would survive the thaw process. I wouldn’t be concerned with that to much. Frozen embryos are still high quality and have very good success rates. In some clinics, even better than fresh.

 

PROGRAMS

I know, all this information is all fine and good but how do you know where to find an egg donor or where you want to donate? This is the start of your decision making; do you work with a fertility clinic in-house donor database, frozen egg bank, egg donation agency or go the independent route? Its best to inquire with the fertility clinic while doing your research as to what options they have.

The easiest program would be through a frozen egg bank. Banks can be standalone facilities and or part of a fertility clinic. If it’s a standalone facility, the bank can ship the eggs to the fertility clinic of choice. Generally, if a frozen bank is part of fertility clinic, you may only access available eggs if you’re working with that facility or that clinic’s network. Now that’s not always the case, but it’s currently the most common. Frozen egg banks are also the most cost-effective option for recipients.

There are still many fertility clinics that only offer in-house egg donor database options, were they have pre-screened candidates, but she doesn’t begin the full medical screening or actual medication and retrieval process until after she has been selected.

Egg Donation agencies are often separate from a clinic. If you find an egg donor through an agency, the agency will work directly with the fertility clinic of choice and manage the process with the individual chosen.

Independent journeys are when the egg donor and recipient have found themselves directly and agree to work with each other. You still must go through the fertility clinic to complete the medical process but there are no middlemen connecting you.  There are various platforms in which individuals advertise that they are either looking to become or looking for a donor.

 

Pros and Cons

Each program offers different options for your family building needs. As a recipient parent, it’s important to consider what your family goals are regarding how many children you would like to have. You must take into consideration these factors especially if you would like to have more than 1 child and want your children to be genetically related. You’ll want to take it into consideration, how likely will the eggs produce embryos and how many embryos will be produced. Unfortunately, a transfer doesn’t always take on the first attempt. If you only have one embryo, would you start the process all over again?

Frozen egg banks are the quickest and the least expensive way to find donor eggs which are already produced and ready to be fertilized. Banks sells eggs in lots of 6 per batch. Provided there are enough eggs, you may purchase more than 1 lot from the same donor. You can rest assured that the facility has fully screened the donor and you’ll be able to select the eggs produced by a donor who meets your desired criteria. You’ll receive medical and genetic history on her and her family, education level and information on her physical characteristics and personality. You’ll likely only see childhood photos but sometimes you may see adult photos. This will vary on the bank. If you’re working with a fertility clinic that offers a frozen egg bank, usually their donors are local and for anonymity purposes will only share the childhood photos. However, if you work with facilities that are nationwide, you may see adult photos.

If you’re an egg donor, a bank once your selected, can move you through the process fairly quickly. You undergo medical screening, sign consent forms, start your meds, have your retrieval, receive your compensation, and you’re done. But remember, you’ll have no say who gets your eggs or how many people they’re offered to. It’s, understandably, a personal choice. If you’re a woman who wants information or more detail on who your donating to, a frozen egg bank may not be the best option. If you’re ok with not knowing, then you may find donating through a bank is quick, efficient, and fulfilling.

Frozen egg banks also have a stricter guideline on the donors they allow into their program.

As mentioned earlier, if you decide to work with a Fertility Clinics with an in-house donor program, the donor is usually pre-screened, but may not have completed all her screening and no eggs have been retrieved yet. Once recipient parents select a donor, the clinic will complete her medical cycle and retrieve the eggs. Unlike, frozen banks, usually you will receive all the eggs produced by the donor.

If you’re an egg donor, the downside to working with a fertility clinic in-house program, would be the waiting to be matched period before you can start the process. More than likely, once your chosen, you’re completing a donation for one family. Sometimes, the clinic may ask you to complete a shared cycle, which means the eggs produced would be split between 2 families to help with cost. But that doesn’t happen all the time. And through an in-house program through a clinic, it’s still an anonymous arrangement. So, keep that in mind. Also, some in-house programs, pay a lower compensation to the egg donor. And if having more control of the process is important to you, then perhaps you should consider going through an egg donation agency. Through an agency, you get to decide who you will donate for. Once your selected, you can ask the agency to provide you with information on the recipient. Of course, how much information is shared will be dependent on the type of arrangement everyone agrees to.

Also, different then a frozen egg bank or clinic in-house program, your required to have an Egg Donation Agreement between the egg donor and the recipient parents when you work with an agency program. This agreement stipulates the rights, responsibilities and desires of all parties. It will also detail the outcome of the type of relationship and contract going forward. And sometimes it also discusses the outcome on the remaining eggs being shared with another family, if the recipient family decided they no longer need them.

If you decide to go through an egg donation agency, be aware there may be a waiting period. There’s no time frame on how quickly you will be matched.

For the recipient parents, an agency egg donor program offers more options to personalize the journey. In addition to the same information you would get from a bank or clinic in-house program, agencies normally offer a lot more photos, more about the donor’s personality and the ability to decide what type of arrangement you want with the donor, choosing from the anonymous, semi-anonymous, open, or informational arrangements I discussed earlier.

Often, agencies can offer recipient parents a wider variety of donors, including donors with a specific ethnicity, race, or education level. Agencies specialize in recruiting these donors and build a network of donors to choose from. Its ordinarily why recipient parents choose to work with an agency.

Because you do receive all the eggs produced by the donor, donor eggs through an agency can be utilized in various ways. You will have to ensure your fertility clinic allows for these options, but you can choose to cryopreserve the eggs, or fertilize them and cryopreserve the embryos. And if you’re a same sex male couple, split the eggs and each partner fertilizes eggs so that your children share genetics through the egg donor.

Having excess eggs can minimize any anxiety over finding the same donor in the future to complete sibling journeys or to complete additional attempts if need be. Thanks to technology, excess eggs or embryos are still able to be frozen. The clinic usually selects the embryo to transfer, then freezes the remaining embryos for future transfers, or if all goes well, a future sibling.

Working with agency donors also has downsides. The most obvious is that nothing is guaranteed. You are using a live donor and a fresh donation cycle, and there is always the chance the donor won’t produce enough viable eggs.

Financially, an agency donor will cost more than a frozen bank or even fertility clinic’s in-house donor program. Unless it’s a shared donor cycle, you’re paying the full cost for the donor’s medical and psychological screening, travel if needed, legal costs, compensation, agency fees and the clinic’s cost to complete the IVF.

Regardless of the program, the medical process for the donor, once she is selected will be the same. As mentioned previously, all donors must go through a medical and psychological screening, genetic screening, infectious disease screening, genetic testing and drug screen.

The difference will be the timeframes. Frozen banks will be about two to three months. Fertility clinic and egg donation agency will vary. Once selected, it could take about 3 to 5 months.

So, there you have it. I know it’s a lot of information and we only touched the surface. In future episodes, I’ll get into greater detail on the medical process, how to find and become a donor, the debate on nurture vs. nature when it comes to determining the must-have qualities in your donor, and the enigma of ethnic egg donors. You won’t want to miss these episodes, so be sure to subscribe to Fertility Café on whatever platform you are listening on.

 

Conclusion

I hope you’ve enjoyed today’s episode and that I’ve given you better insight into egg donation and the considerations for both donors and recipients. If you’ve enjoyed this episode of Fertility Café, we’d love you to leave us a Review on iTunes, Stitcher, or your listening platform of choice. We’d also love you to share Fertility Café with friends and family members who would benefit from the information shared. Thank you for joining me today. I’m Eloise Drane. Remember… “Love has no limits, neither should parenthood.”

Life 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 was 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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