There are many paths to parenthood. While generations before us often had to accept infertility and pursue adoption or remain childless, this generation has many more options available for those wishing to become a parent.
As a woman who had a straightforward experience conceiving my own children, as well as relatively comfortable pregnancies, I frequently felt this sort of reverse “Why me?” reaction when friends spoke of their infertility struggles. It often felt like a stroke of luck that I was able to get pregnant and carry children without medical assistance. I couldn’t imagine why I got so lucky and so many of my friends struggled. And when I saw one particular friend struggling for years as I grew my own family, I was moved to action and pursued surrogacy for a friend.
Surrogacy is the practice of a woman carrying and birthing a baby for another person or couple. There are a few types of surrogacy:
- Traditional surrogacy is defined as the surrogate’s egg being fertilized with a male’s sperm.
- Gestational surrogacy or full surrogacy may be more common for cisgender couples. This involves a couple’s fertilized egg being implanted in the gestational carrier’s uterus and thus the carrier has no genetic tie to the fetus.
Another differentiation between types of surrogacies is that of “altruistic” vs. “commercial” surrogacy.
- Altruistic surrogacy, as the name implies, is done without any financial compensation beyond medical expenses.
- Commercial surrogacy, on the other hand, involves compensation for the surrogate. Agencies for commercial surrogacy, such as Hatch, Circle Surrogacy, and Same Love, continue to thrive, with the demand for surrogates climbing in record numbers in the last several years.
How To Become a Surrogate
Because surrogacy is a complex and emotionally heightened topic, it can be difficult to find resources that share the many different details needed to make a decision. In this article, we’ll talk about the many ins and outs of surrogacy from start to finish. This guide intends to help women understand what the experience of being a surrogate might be like. And how they might determine that being a surrogate is the right step for them.
The first thing you need to know about being a surrogate is that simply the fact that you’ve come this far, that you’re even entertaining the idea of carrying a baby for someone in need, means you know the impact parenthood can have on a person. You’re considering the most selfless and priceless act that a person can take on. And the gravity of what you’re willing to do will bring so much to the life of the intended parents you’re giving this gift to, as well as to your own life. Here’s what to expect:
Step 1: Research
The first step in the process of becoming a surrogate is all about research. Before you offer to be a surrogate, you need to make sure you have all the information you need to make an educated decision.
- Talk with your family first. Before you bring this idea to your friend or approach an agency, you should be sure you have your closest circle of family on board with the idea. If you have a partner, their support is necessary. In my experience as an altruistic surrogate, my husband and I both had to go through a psychological evaluation with a surrogacy therapist before we had the green light to move forward. The conversations we had in that session were invaluable for preparing us for the experience and for facilitating us thinking about a number of things we hadn’t yet considered: what we would do if I miscarried, who would be in the delivery room, whether I would pump milk for the baby.
- Prepare for the time commitment. Surrogacy, much like fertility in general, can be a long and unpredictable process. While you may have a timeline in your head, it is likely that there will be delays throughout. Many legal contracts for surrogates and Intended Parents (IPs) estimate the length of time involved as between 18 months and 2 years.
- Do your research. I learned a LOT from Facebook surrogacy groups. Whatever question you may have, you will get an answer from someone who has been there before. I listened to podcasts that gave me an invaluable perspective. I asked my friends who had been through IVF about the experience. Having had two spontaneous pregnancies, I didn’t have a clue about the doctor’s visits, medications, and shots that would be involved in carrying a baby for someone else. It helped to have someone to ask specific medical questions.
Step 2: Evaluations
Once you’ve decided to help someone through altruistic surrogacy or are matched with intended parents, from here on out, this is a group experience. To be sure, there’s a period of adjustment. Because suddenly you’re sharing medical discussions and even appointments with a third party. My biggest piece of advice is communicate everything with the intended parents, and specifically the Intended Mother (IM). Anything left unaddressed could cause issues down the line. And it’s great to set a precedent of open communication early. Here’s what you can expect from this phase of the surrogacy process:
- Medical Screening: whether you’re pursuing altruistic or commercial surrogacy, you’ll go through a medical evaluation to determine you’re able to carry a baby. This typically involves a trip to your OB-GYN, as well as an appointment with the fertility clinic. You’ll be asked about previous pregnancies, have bloodwork done, a physical exam, and a transvaginal ultrasound. It’s likely that the intended parents have an established clinic where you’ll need to go for these appointments.
- Psychological Evaluation: Additionally, a therapist specializing in surrogacy may administer a psych evaluation for the surrogate. And if you have a partner, your partner as well. I completed a 300+ question test that we then talked through in detail. We had a 2-hour session with my partner and I. And then another scheduled Zoom call with the intended parents as well. That session helped us establish any preferences for the pregnancy, from diet and exercise during pregnancy, to number of attempted embryo transfers, to delivery experience and everything in between.
- Legal Contracts: In any surrogacy agreement, you’ll need to have a surrogacy contract signed by all parties. In my experience, the fertility clinic had a list of surrogacy attorneys that we were able to use for a one-time fee. This included an initial conversation, the contract, and then any additional revisions and conversations that took place until the contract was finalized. The legal contract will confirm all of the discussions that have happened up until this point. So not only that the surrogate will, in fact, hand over the baby after birth, but also that the IPs will pay for medical expenses, maternity clothes, and any travel or missed work as necessary. Even if you think you don’t need a legal contract, you definitely need a legal contract. Our fertility clinic would not begin the process toward embryo transfer without a legal letter in place.
Step 3: It’s time to get pregnant!
When I look back at my experience, this is where the anxiety really ramped up for me. Despite all of the careful planning, things will go wrong in this step. Whether it’s medical, legal, or just regular life stuff, there will be delays and stress. My best advice is again, to communicate with your IPs and your partner. And, as much as possible, remember that you can only control a small portion of the details here. Try to go in with a positive mindset. And give yourself grace for all the stuff in between.
Appointments, Blood Draws, Medication, Repeat
You’ll be seeing a lot of the fertility clinic at this stage. In preparation for the embryo transfer, you’ll be starting medication and seeing the doctor regularly. Medication regimens certainly differ between clinics. And some doctors may even try an “unmedicated” cycle if you want. Meaning, they go exactly by your natural cycle instead of controlling it through medication. For most surrogates using medicated cycles who I spoke with, there was some combination of the following:
- Baseline Ultrasound: This ultrasound occurs around day three of your period and will show whether your ovaries are suppressing egg production, allowing you to move forward with the transfer cycle.
- Estradiol: Daily for 2-3 weeks prior to transfer, morning and night, either in pill form or suppository. This medication helps prep your endometrium for accepting embryo implantation.
- Progesterone in oil shots: Daily for one week prior to transfer through 12 weeks of pregnancy, morning and night. This helps thicken the lining of the uterus, making it easier for the embryo to implant and grow in the uterus. In spontaneous pregnancy, progesterone is naturally created within the body. In IVF, it needs to be given in intramuscular shots.
- Prenatal vitamins with Folic Acid: Daily pills.
- Weekly appointments: Blood draws and labs to check estradiol and progesterone levels.
- Sonogram and Lining Checks: 5-10 days prior to transfer. Lining checks will determine that your endometrial lining is thick enough for embryo transfer within the next few days.
- Abstaining from sexual activity: Throughout this process, they will tell you to abstain from sex.
When all of the labs and lining checks show that the body is responding properly, doctors will confirm it’s safe to implant an embryo! I’ll never forget the day I got the call from the nurse at the fertility clinic, telling me I was already clear to move forward with the embryo transfer. It feels like the start of a 5K sprint, in the middle of a marathon. We had been prepping for this all for weeks. And now it was time to go full-speed ahead. Here is what that day looked like:
- The transfer was scheduled for 1 p.m. that day to give the lab time to defrost the frozen embryo.
- There were no special instructions other than to continue my medication and come in with a full bladder.
- The embryo transfer itself took less than 10 minutes.
- My instinct was to lay horizontal all day, but the doctor assured me I could go about my normal daily activities.
At-Home Pregnancy Tests, And The Official Blood Test
While doctors have differing opinions on taking at-home pregnancy tests, the main point is universal: do not stop taking your medication, no matter what! While many surrogates I talked with started testing within 3-5 days post-embryo transfer, early negative tests can do unnecessary harm to your mental state. I waited until day 8 post-transfer to test and I found that assuming the best was right for my mindset. My clinic scheduled my HCG blood test 2 weeks post-transfer. But I’ve heard of other offices letting women test as early as 8-10 days after the transfer. They followed up with another blood test a week later to confirm that HCG levels continued to climb as necessary to support a pregnancy.
Heartbeat Confirmation Ultrasound
At 6 weeks post-transfer, with continued progress in HCG levels, my clinic scheduled the heartbeat confirmation ultrasound, AKA the biggest relief I’ve ever felt in my life.
Step 4: Pregnancy
Pregnancy as a surrogate can be a really beautiful, affirming, and life-changing experience. Your relationship with the IPs will continue to grow and change. And as long as you’ve established open-communication throughout the experience, hopefully you’ll feel supported and cared for by everyone involved. Check in with your emotions frequently. And maintain therapy if you think it would be helpful. It’s impossible to predict so many things about the surrogacy journey. But hopefully your preparation has set you up for a successful, comfortable, and exciting experience. Here are some things to consider for this stage:
- After the first 6-8 weeks of pregnancy, they will transfer your care back to your own OB-GYN. Your doctor and your hospital will likely be the default for the duration of your pregnancy and delivery.
- Continue taking care of yourself first. And consulting with the intended parents for anything baby-related. Remember that your health is the top priority. It can be easy to think that the baby should be first. But without your health, the baby can’t thrive.
- Establish an expectation for all doctor’s appointments, baby-related events, and post-delivery visits. The more you discuss these things and become comfortable talking about them, the better the delivery and post-delivery experience will be.
- Think about ways to include the IPs in the pregnancy, if you’re comfortable. I was able to use a heart beat doppler throughout my pregnancy, to record the baby’s heartbeat in voice memos and send them to the IPs. I took videos of my belly moving during the later weeks so the IPs could see when we weren’t together. Additionally, my IPs got me a set of belly headphones and sent me voice recordings of themselves. I stuck the headphones to my belly and played their audio for the baby. There are all sorts of ways to feel connected to the IPs and let them feel connected to the pregnancy as well.
If I had to give one piece of advice to sum up the entire experience of being a surrogate for a friend, I would say this: Remember your inspiration. Remember the moment the thought first dawned on you that maybe you could do something to help someone else. In every difficult moment, in every uncomfortable conversation, in every painful pregnancy symptom, remember what you’re doing it for. If you always come back to that baby, that life, that family that you are creating, it will empower you to stay the course.
Surrogate Mother Qualifications
When I first started thinking about offering to be a surrogate for a good friend of mine, there were a few points that I knew were important to be sure of before I offered. First, I wanted to be sure my husband and I were done growing our own family. Because of the risks that come along with pregnancy and childbirth, it is suggested that surrogates be finished with their biological family before carrying a child for someone else. Additionally, I knew that feeling complete with my own family would help with the complex emotions of carrying a baby for another family. All along, though, I knew that I was truly motivated to help by the desire to see my friends with their baby. Whatever it took, that was the finish line I was constantly focusing on.
Most agencies and fertility clinics will have a set of requirements for anyone pursuing surrogacy. Here is a general list of things that would qualify you to become a surrogate:
- You are between the ages of 21-40
- You have carried at least one pregnancy to term, and are raising the child(ren)
- You have had uncomplicated pregnancies and deliveries
- You are not on anti-depressants or anti-anxiety medication within 12-months of the surrogacy
- You are a non-smoker and do not use illicit drugs
- You live in a surrogacy-friendly state
- You are done having children of your own, or are comfortable with the potential of no longer having children
Whatever the relationship between a surrogate and intended parents, these qualifications will be important. The experience can be as informal or formal as both parties are comfortable with. But the health of the surrogate and the likelihood of a healthy baby should be considered first and foremost before beginning the surrogacy journey.