GESTATIONAL SURROGACY:
IS THIS THE RIGHT CHOICE FOR YOU?

By Sharon LaMothe

If you are exploring having someone help you by carrying your child to term, you probably have a lot of questions. This form of assisted reproduction is generally called surrogacy. It is a path that should not to be taken lightly. First of all this process is costly. Second, the woman who chooses to act as a surrogate is agreeing to involve her family with yours as well as putting her life on hold for the next year or more.

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What is a Surrogate?
A surrogate is a generous woman who is willing to be impregnated using InVitro Fertilization (IVF) or Intrauterine Insemination (IUI) procedures and then carry the resulting baby for the Intended Parents so they can complete their family.

There are two types of surrogacy: traditional and gestational. Traditional Surrogacy is where the Surrogate uses her own eggs AND carries the child for her Intended Parents. This procedure is done in a doctor's office through IUI. This type of surrogacy obviously includes a genetic connection between the surrogate and the child. Legally speaking, the Surrogate will have to disclaim any interest in the child to complete the transfer to the Intended Parents.

A gestational surrogacy occurs when the Intended Mother's or a donor egg is fertilized outside the body and then the embryos are transferred into the uterus. The woman who carries the child is often referred to as a Gestational Carrier. The legal steps to confirm parentage with the Intended Parents are generally easier than in a traditional because there is no genetic connection between child and Carrier.

What is the average age of a potential surrogate?
Reproductive endocrinologists prefer to work with surrogates who are between 21 and 39 years of age. Exceptions have been made in the past but this is an average.

Does a woman have to have had a child of her own before she may act as a surrogate?
Yes. Most clinics will require the surrogate have at least one uncomplicated pregnancy and birth. C-sections are usually acceptable.

What about the health of a potential surrogate?
A potential surrogate must be healthy, for her benefit as much as for the child she will carry. Additionally, she will be screened for STD's (sexually transmitted diseases), and addictions such as drug, alcohol and tobacco. Certain medications, thyroid replacements may be acceptable to the clinic. Another factor most clinics take into consideration is BMI (height/weight ratio) and prefer that to be under 30.

What if the potential surrogate had her children but put them up for adoption?
Most psychologists and surrogacy agencies require you to be parenting your child/children. A previous adoption with a baby since then may be acceptable. The psychologist will speak with her about these issues to be sure she will be comfortable giving up the baby.

What do I need to know about Health Insurance?
Having health insurance will reduce the Intended Parent's out of pocket payment for a surrogate’s medical care. The best possible surrogate candidate will have her own health insurance with maternity coverage. This does mean Medicare or state insurance coverage for a surrogacy would be prohibited by law. If she does not have a health policy, in some cases the agency or Intended Parents can provide policy for her.

What do I do once I have found a surrogate?
There are several steps that need to be taken before and after you locate your surrogate. Before your search, you need to have an idea of how much the entire process is going to cost and then assess your financial situation. You need to know if you are going to use your eggs or need an egg donor. Do you know the laws in your state, or do you need to go to another state? Do you have a clinic to assist you and an attorney to assist you with contracts? After you have educated yourself on these issues, you need to have your surrogate medically and psychologically screened through the clinic of your choice. Contracts need to be drawn up, and support needs to be in place for the rest of the surrogacy pregnancy.

Are there legal issues surrounding surrogacy, or can I just orchestrate this on my own without legal counsel?
States regulate assisted reproductive technology procedures in a variety of ways. For example, some forty-two states have a statutory scheme that addresses artificial insemination. But only thirty-five of those 42 states clarify parentage. There are only five states which recognize some regulation of egg donation. Most states permit reasonable compensation for egg donation, but there is one state which prohibits compensation of any form.

Surrogate or gestational arrangements are addressed to some degree by at least twenty-three states, with one state prohibiting such arrangements. Health insurance coverage for ART is required in twelve states. And finally, Federal law provides some regulation of ART laboratories and requires that pregnancy rates for in vitro fertilization and egg donation cycles be reported to the Centers for Disease Control. Further, professional societies like the ASRM lay out professional standards and guidelines for their professional members.

So you see, there are many issues surrounding assisted reproduction, not the least of which is ensuring that the contract confirms to state law so that the intended parents' names are placed on the birth certificate. There are independent surrogates who have orchestrated these arrangements on their own. However, when you research the web you can see many arrangements where carriers have withheld infants or Intended Parents have failed to pay medical bills and/or compensation. Either of these behaviors are unacceptable.

A surrogacy arrangement is a two sided arrangement where problems can and will arise. When a problem arises, your best protection will be a contract that provides a road map to resolve that problem. We believe that the best interests of the parties and the baby is ensured before the transfer by using an attorney who is skilled in this area.

What are my rights once the surrogate is pregnant?
Your rights are limited by the contract you have with your surrogate. She is pregnant with your baby but retains full control of her body. That is why mutual trust and the legal agreement are so important.

How involved will I, the Intended Parent, be with the growing pregnancy?
You are as involved as you and your surrogate agree to be. Often times you can be fully involved by attending all doctor's appointments and having several visits with your surrogate and her family. When time constraints and geographic location make that type of closeness impossible, you can use the telephone and email as alternate forms of communication.

Can I be present at the birth?
If you and your surrogate have agreed that you can attend the birth then that is what you can expect. All of these issues are agreed to and placed on your legal agreement before the surrogate goes to transfer.

What if the surrogate won't give up the child?
You hardly ever hear of a gestational surrogate trying to keep a child. In a gestational surrogacy, with no genetic connection to the infant, there is a presumption that the court will automatically place the baby with the Intended Parents. A traditional surrogacy is different because the Carrier is biologically related to the child. A court of law will have to terminate her rights, replacing her name with that of the Intended Mother. The intended father, meanwhile, being biologically related to the child, will have his name immediately placed on the birth certificate.

Will the surrogate have any rights to the child once the baby is born?
A traditional surrogate will go through a termination and thus will lose any rights. In most states, a gestational carrier never had rights because she has no genetic connection to the child.

How do I tell my child about the surrogate mother?
The answer depends on the child and the family structure. Just as in an adoption, the determinate will be when the child possesses the maturity to understand the implications of surrogacy. Most likely it will be many years to come before you are faced with that question. There is a book called Mommy, Did I Grow In Your Tummy? Where Some Babies Come From (Em Greenberg Press, November 1992) that is very good in explaining the different ways that families are made.

What is the cost of a Surrogacy arrangement?
Below are the estimated costs for utilizing a Gestational Carrier. Beyond any agency fee, these are certain standard costs that you should anticipate paying. Actual fees will be determined when you are matched with a carrier and a contract is written. The estimate ranges from $65,000 to $80,000 depending on the number of IVF cycles needed to achieve pregnancy, potential complications with the pregnancy and other factors such as travel, lost wages, co-pay's and insurance deductibles. If you are utilizing an egg donor, these costs could be higher. *Please note all fees are approximate estimations only and are different depending on the clinic or agency you choose to contract with.

INSURANCE

Medical Insurance - $300-$400 / month, if needed
Medical insurance premiums are paid directly to the insurance company for approximately fifteen (15) months. A fee to the insurance agent may be required for assistance in locating a policy for the surrogate.
Life Insurance - $300 / year
A $250,000 term life policy is reasonable to cover the carrier in case of death during the surrogacy process. The cost will vary depending on the age, health status and residence of the carrier.

SCREENING EXPENSES

Psychological Evaluation & MMPI - $400 - $500
The carrier and her husband/partner will attend a clinical interview with a licensed therapist to determine her suitability to act as a carrier. She may also take the MMPI test which is a personality test.
Medical Evaluations - $1,000 to $1,500
This testing will determine the surrogate's suitability for pregnancy and STD testing of spouse.

LEGAL EXPENSES

Intended Parent Legal Representation - $2,500 to $3,500
The attorney will draft, negotiate and review the surrogacy contract for the Intended Parents. This is necessary to ensure that the Intended Parents are named as the legal parents on the birth certificate as well as to provide an orderly administration of how money will be transmitted between the parties.
Carrier Legal Representation - $600 to $1,000
The attorney will review the surrogacy contract with the Carrier and negotiate changes on her behalf. The attorney fees will be paid by the Intended Parents.
Parental Establishment & Court Proceedings - $155.00 to $3,000
The Intended Parents' attorney will draft, review, obtain signatures and file legal pleading papers with the Court. The exact cost will be determined by the state where the baby is to be born. Most attorneys will include these fees in their original representation bill.
Escrow - $1,000 to $1,500
An escrow account is held by the Intended Parent's attorney or a bonded third party to provide the Carrier security with the reimbursement which she expects to receive for carrying the baby to term.

CARRIER BENEFITS

First-Time Carrier's Base Compensation (with insurance) - $15,000 to $20,000
First-Time Carrier's Base Compensation (without insurance) - $10,000 to 15,000
Experienced Carrier's Base Compensation (with insurance) - $20,000 and up
This compensation is paid to the carrier, via the escrow account, in installments over the course of the pregnancy beginning with the confirmation of pregnancy (confirmation of heartbeat at approximately six (6) weeks of pregnancy, via ultrasound). The exact amount is determined, in part, where the carrier resides.
Monthly Allowance - $100 / month
Carriers occasionally receive an expense reimbursement for approximately fifteen (15) months. Paid In lieu of itemized costs, this allowance includes reimbursements for mileage under thirty (30) miles, telephone calls, faxes, non-prescription vitamins, etc. This fee begins at the signing of the contract to one month after birth.

Travel Expenses - Airfare, rental cars, and lodging may be paid when a carrier is required to travel more than 30 miles for medical screening or embryo transfers.
Maternity Clothing Allowance - $500.00 (singleton)
Maternity Clothing Allowance - $750.00 (multiples)
This fee is paid at twelve (12) weeks for a singleton and eight (8) weeks for multiples and directly to the carrier through the escrow account.
Start of Medications fee - $500
Carrier may receive such a payment upon starting injectable medications to compensate them for having a foreign substance in their body.
Medicated Mock Cycle fee - $500
Some Reproductive Endocrinologists (RE) will require a mock cycle to stimulate a cycle to test for the thickening of uterine lining.
Embryo Transfer fee - $500
This fee is paid to compensate the carrier for discomfort and risk associated with the procedure.
Invasive Procedure fee - $500 to $1,500
Carriers may receive $500 per procedure for amniocentesis or other invasive prenatal diagnostic testing; and $1,500 for early termination procedures, fetal reduction, or ectopic pregnancy.
Miscarriage with a D&C fee - $1,500
Some carriers may be paid this fee to compensate her for additional pain, added risks and recovery time of this medical event.
C-Section fee - $1,500
If the carrier is required to deliver via c-section, she may receive this fee to compensate her for the additional pain, added risks and longer recovery time.
Multiples - $1,500 to $3,000 each
A carrier typically receives additional compensation for each additional baby carried.
Housekeeping Allowance - $300
A carrier may receive an allowance of $50 per week to help her at home if she is ordered to bed rest.
Lost Wages - actual costs
Occasionally a carrier will receive net lost wages (approximately eight (8) weeks) and spouse (three (3) to five (5) days) when she is ordered to bed rest. If carrier is a stay-at-home mom or unemployed, no lost wages are paid. The Carrier must provide proof of actual lost wages.

NOTE: Some carriers may be subject to additional screening and all co-pays and insurance deductibles are the responsibility of the Intended Parents. Medical costs for egg retrievals, IVF embryo transfers and all pharmaceutical costs are determined by your reproductive endocrinologist; clinic utilized and preferred drug company.

All of the above fees are subject to change as the professionals you work with may increase or lower their costs, and individual carriers may have fees that reflect their circumstances.

As with any program or even working with a carrier independently, you will incur most of the above-mentioned fees such as the "benefit package", which is in addition to the carrier's base compensation. Some carriers are willing to reduce or waive some of the benefits, thus reducing the costs to you.

Sharon LaMothe, Co-Owner of Infertility Answers and is the author of two blogs, Surrogacy 101 and The Making of a Surrogacy Agency. Sharon is also on the advisory board for Parents Via Egg Donation (PVED), a founding member of the Egg Donor and Surrogacy Professional Association (EDSPA) and an advisor for the OBGYN.net Women's Health Forum. Sharon has also been a Gestational Surrogate, giving birth to twin girls in March of 2000 for a Florida couple, and in January 2005, gave birth to girl/boy twins for a New York couple. Sharon has shared her first hand knowledge and expertise by holding round table discussions and speaking on the topic of Surrogacy for SMART ART, RESOLVE, Fertile Dreams etc. and by arranging staff development luncheons and meetings with various clinics, hospitals and law offices. Sharon is married with two children and currently resides in Seattle, WA.