Infertility and Surrogacy

When we think of a “typical” surrogacy, most of us believe that it's as simple as a woman carrying a baby for a couple who cannot conceive on their own. We don’t realize the multitude of factors and the magnitude of choices that are made, long before the transfer of the embryo and its conception.

It's no longer the “traditional” surrogacy that we envision; it has grown to include all types of families: couples, singles and homosexuals. There are decisions to be made depending on each diagnosis, circumstance and the multitude of possibilities. They’re endless.

Not only are there new and improved traditional technologies, but when there is no longer a viable option, third-party reproduction offers an exciting and promising way to start a family.

What Exactly is a Surrogate?
A surrogate is a woman that has entered into an agreement to foster a pregnancy in her uterus with the intentions of relinquishing the child to the requesting parents after delivery. Though this is a blanket sort of answer, there are different types of surrogacies in which yours will undoubtedly fall under and each has their own specific applications and concerns.

Traditional Surrogacy
Traditional surrogacy, also known as "straight" surrogacy, is a situation in which the surrogate would be inseminated with the sperm of the biological father. The surrogate makes available her uterus and a viable egg in traditional surrogacy, and the child that is produced is genetically related to the surrogate mother. Some of us may remember the struggle in the 1980's over the custody of "Baby M". This type of surrogacy is much less prevalent today than in decades past, and has much more legal and psychological controversy surrounding it than gestational surrogacy.

Gestational Surrogacy
This form of surrogacy is also known as uterine borrowing, or carrier surrogacy, and is currently the most popular form of surrogacy in the United States. This type of surrogacy, in a nutshell, allows those who can create their own embryos to do so and subsequently "plant" the embryo into the uterus of the surrogate. This method can also be employed with donor genetic material, such as with egg and/or sperm donation. The surrogate will have no genetic relationship to the successful pregnancy produced via gestational surrogacy.

Altruistic Surrogacy
Though the medical expenses and incidentals (maternity clothing, birthing class, etc.) are generally covered by the expectant parents, altruistic surrogacy is an arrangement by which the surrogate receives no compensation for their physical services. The actual embryo transfer, gestation, and relinquishment of the child have no financial award attached to them.

Commercial Surrogacy
Contracting a pregnancy for financial reward is known as commercial surrogacy. The expectant parents are responsible for all medical costs and incidentals, as above, but they also are paid for the use of their uterus and relinquishment of the child. Surrogates are often paid tens of thousands of dollars for the use of their uterus, which hopefully will enable couples to become parents, who would otherwise be unable to conceive or safely carry a pregnancy to term.

Where to Find a Surrogate
Surrogates can almost be any healthy woman with a normally functioning uterus that must also be willing to host a pregnancy, which will ultimately result in a child that will be relinquished to the requesting future parents. Some find that they have a family member or friend that is willing to donate the use of their uterus. Others seek out the assistance of an agency that specializes in matching surrogates with couples. Some are arranged through alternative third-parties that do not normally function as surrogate agents, and some are arranged by the couple themselves with or without the assistance of a reproductive lawyer. Finding someone that is willing and able can be difficult, but no matter how you find your surrogate, there is more to surrogacy than their willingness.

Selecting the Right Surrogate
When you are selecting your surrogate, there are many factors that you will need to consider, as surrogates themselves play a large part in the success of the embryo transfer and healthy pregnancy.

How old is the surrogate? A surrogate for traditional surrogacy is ideally between the ages of 21 through 34. Fertility starts to decline in the mid-thirties. Gestational surrogacy has less of a focus on age, since their eggs are not typically used. Women are able to carry a child into their late fifties, but early to mid-forties is usually the age when doctors become seriously concerned with the complications, which often result from pregnancy.

Is she overweight? A BMI of 30 is the highest that most doctors will approve as a “good” surrogate. A surrogate that's very overweight or obese is subject to the same risks in pregnancy that all other overweight or obese pregnant women are; such as gestational diabetes, elevated birth weight, heightened risk of preeclampsia, and increased risk of miscarriage or c-section.

What is her uterine and overall physical health? The surrogate that you select should be screened for their current physical health, including a full screening by a fertility clinic of her medical history and blood testing. It's typically necessary that a surrogate has delivered at least one, healthy, full-term child of her own.

Is she psychologically stable? Your surrogate, as well as her husband, should be screened by a psychologist to ensure that they are stable and is able to enter into such an agreement. They both should understand the impact that surrogacy can have on their marriage,  children and other social/familial relationships.

Background check! It's important that all parties involved in the surrogacy undergo a complete background check. This will not only give peace of mind to the intended parents, but will also reassure the surrogate that the family, in which she is carrying a child for, is safe. Unlike personal arrangements, most surrogates are found online, in advertisements, and through third-party agencies. Having a background check completed on all parties will only add comfort to a sometimes uncomfortable arrangement.

What's she like? In consideration of an agency-supplied surrogate, some parents are more comfortable when they are aware of what the surrogate is like outside of their reproductive health. You may prefer to be aware of their personal habits, physical characteristics, personality, education, hobbies, educational level and even their family history, prior to your selection.

Will she be available to you again? If you are anticipating having more than one child through surrogacy, an important question to ask is if the surrogate is available for more than one pregnancy. This is commonly referred to as a  "sibling project".  Not only does it cancel out the need to start the process over again, when you are ready for your second child, but it is also psychologically comforting that they will be born from the same womb.

What about down the road? You may want to know if your surrogate would be available to your child later in life, should they be curious about them. There will come a time in your child's life when he/she will want to understand the details of his/her conception, and the identity of their surrogate,  will most likely be of great interest.

The Connection
Parents may be concerned primarily with two questions: what if the surrogate is attached and what if I'm not. These concerns are understandable; however, studies have shown that healthy surrogates are able to successfully distance themselves from the pregnancy. Surrogates may even engage in activities meant to encourage emotional closeness between the intended parents and their pregnancy. Families that seek surrogates have often given more thought and planning to their pregnancy, than most others. Through this visualization and simply "wanting it more", couples often bond with their child born  through surrogacy and the surrogate with exceptional warmth.

When You Decide
You will want to consult a psychologist for yourself and your partner to ascertain if surrogacy is something that your partnership can support. You may want to continue routine counseling to help adjust to your new life, as parents, upon delivery of your child.

Consultation with a lawyer that specializes in reproductive law is highly recommended. The lawyer will be able to give you guidance as to what you can expect and what you should prepare for; including what possible difficulties you may encounter. Surrogacy can be the means to a happy, healthy family for you and your partner when carefully pursued and thoughtfully executed.