Surrogacy – The Whys and Hows of Using a Gestational Carrier

Gestational surrogacy has been in the spotlight in recent years.  A number of celebrities have used gestational carriers to carry their biological child, including Sarah Jessica Parker and Matthew Broderick, Kim Kardashian and Kanye West, Jimmy Fallon and Nancy Juvonen, and Nate Berkus and Jeremiah Brent.  Using surrogacy is not a decision made lightly.

Surrogacy can be expensive and has legal implications.  But for a growing number of people who otherwise could not be biological parents, gestational carriers make it possible for them to start or add to their family.

Why You May Need Surrogacy

Any male same-sex couple or single male who want to have a biological child need an egg donor and a gestational carrier to carry the child.  Heterosexual couples and single women may choose to use a gestational carrier for many reasons.  Some women have a first child naturally and then find they can’t carry another baby to term.  Others have problems with their uterus that make getting pregnant and carrying a baby difficult or impossible.  Some women are born without a uterus, and others have had a hysterectomy for medical reasons.  If a woman has a serious health condition like lupus, severe heart disease or diabetes, or has experienced severe pre-eclampsia in the past, getting pregnant could endanger her life.  Older women are more prone to these conditions and may consider surrogacy.

IVF treatment is essential to using a gestational carrier.  Eggs from the female partner or an egg donor are fertilized in the IVF lab with the male partner’s sperm or donor sperm.   An embryo or embryos are then transferred to the gestational carrier.  If they implant and she becomes pregnant, she carries the baby to term.  In some cases, couples will use donated embryos, which have no genetic tie to either partner, and a surrogate carries the baby.

The Legal Side of Surrogacy

Traditional surrogacy, where the egg donor and the gestational carrier are the same woman, is illegal in some states.  Various states mandate that the egg donor and the gestational carrier must be different people, while other states do not allow surrogacy at all.  In those cases you may be able to contract with a surrogate in a state where it’s legal, if your state recognizes your parentage.  It’s important to consult an attorney experienced in reproductive law to find out about the legal definition of “parent” in your state, whether the surrogate has any rights in the child, and if/what kind of agreement you need with the surrogate.

Finding a Gestational Carrier

You may have a family member or friend who volunteers to be a surrogate for you.  This is known as compassionate surrogacy.  In many cases people find their gestational carrier through an agency that specializes in recruiting women to be commercial surrogates.  Reputable agencies use a rigorous screening process similar to that for egg donors.  You will know the identity of your gestational carrier.  Any carrier should be at least 21 years old, have already delivered a healthy child, and be screened for her physical and emotional health.  Younger carriers have less risk of losing a pregnancy or developing health problems than older carriers do.

Surrogacy Costs

For a gay couple, the costs of having a child with a surrogate include the surrogate’s fee, the cost of fertility drugs and IVF treatment for the surrogate, the egg donor’s compensation, fertility drugs, and all medical treatment for the surrogate.  For heterosexual couples, the costs include the surrogate’s fee, the cost of fertility drugs and IVF treatment for the surrogate and the couple themselves, and all medical treatment for the couple.  In either case this may run to $100,000 or more, and health insurance may not cover the costs.

Some people find surrogates in other countries in an effort to lower the cost.  Many countries have banned commercial surrogacy as being exploitative to low income women.  There are also issues with the quality of health care in some countries.   RESOLVE, the National Infertility Association, has more resources about surrogacy here.