Your Bun - Their Oven: Gestational Surrogacy

Surrogacy Process

Gestational Surrogacy

The Surrogate Mother undergoes in vitro fertilization (IVF) and embryo transfer to become pregnant. The eggs used under a Gestational Surrogacy are not that of the Surrogate Mother. The sperm used is from the Intended Father or a sperm donor. The Surrogate Mother has no genetic relationship to the child born from a Gestational Surrogacy.

The tests that accompany Gestational Surrogacy include but are not limited to std testing, psychological evaluation, blood work to determine estrogen/progesterone levels, hysteroscopy, mock cycle, and mock transfer. The clinic used will prescribe fertility medication such as Lupron, Estrogen, progesterone, etc.

The Process

If using an agency - after the Intended Parents contract with they agency, they provide Surrogate profiles to them based on their needs. They choose a Surrogate and that Surrogate will review their profile and decide if she would like to speak to them. The agency will arrange a phone conversation or in-person meeting between all parties to make sure they are compatible. The agency also conducts a background check on all parties. After the IP’s and Surrogate decide they would like to work together, the agency will contact legal representation on their behalf and guide them through drafting a contract between them. The agency will also open an escrow account on their behalf, and the IP’s will sign a escrow management agreement. After the contract is drafted, the money will be deposited into escrow and the medical process will begin.

If not using an agency - similar to above except the Intended Parents need to find the surrogate and facilitate the process on their own.  This can be A LOT more risky and difficult, but will save on agency fees (often around $20K - $25K). There is also an opportunity to save on the surrogate's fees.  Through and agency the surrogate generally makes between $25K - $35K depending upon experience.  We found that unless you have a friend or family member who offers to be your surrogate, do not plan on saving on the surrogate fees by sourcing on your own.  Most agencies advertise on surrogate boards so most of these women are well aware of the going rates.

Medical Testing

The surrogate will undergo medical and psychological screening with the Intended Parents’ reproductive endocrinologist to determine they are healthy and able to carry a pregnancy. Medical screening includes but is not limited to:
  • Hysteroscopy/HCG — visualization of the uterine cavity thru a thin scope inserted through the cervix or dye introduced into the uterus and fallopian tubes to determine the shape and size of the uterus and whether or not the fallopian tubes are clear.
  • Infectious Disease Testing to ensure that all parties are clear of transmittable disease such as AIDS, Herpes, Hepatitis, etc.
  • Current pap smear and annual physical
  • A mock cycle in which they are on all the same drugs you would be for a real transfer (except Lupron maybe), so they can check her uterine lining’s response to estrogen replacement.
  • Trial transfer where they check the angle of the cervix and the length of the uterine cavity so they know how far to insert the catheter loaded with the embryos for exact placement.
  • Psychological testing and evaluation by a psychologist familiar with surrogacy issues including MMPI2 test and a minimum one hour one-on-one session with the program psychologist exploring your motivations, attitudes and commitment to the surrogacy process.
Some of these tests will also be required of their partner/spouse where applicable.

Legal Contract

When the screening process is complete, the surrogate and Intended Parents will work with an attorney to put together a contract.  The parties will negotiate all fees on the contract and set up an escrow account for the Intended Parents (the surrogate will be paid their compensation and all other miscellaneous expenses from this account). After the contracts are signed and the escrow account is created, then the Medical process can begin.

General Medical Process

Once the contracts are complete and testing has finished, the Surrogate and the Egg Donor (who can be the Intended Mother or a donor) synchronize their cycles. This is usually with birth control pills. About 14 days into the birth control pills, both Surrogate and Egg Donor will start Lupron. Lupron is a subcutaneous (just under the skin) injection to shut down the body’s normal hormone production used to control the cycle and ensure the Surrogate’s uterus is ready to receive the embryos at the exact time for the best chance of success.

The Surrogate is usually about a week or so ahead of the Egg Donor to ensure her uterus will be ready when the eggs are retrieved and fertilized, and because they can keep the SM in a holding pattern for up to 2 weeks once her uterine lining is at optimum.

When the menstrual cycle starts while on Lupron, the Lupron dose is usually decreased by half and the Surrogate will start adding Estrogen replacement to the mix (in the form of pills, patches, or shots depending on the doctor). Some doctors have you take other medications as well (Dexamethasone to suppress male hormones to increase implantation, antibiotics to guard against any infection that might have gone undiagnosed, etc.)

The Egg Donor starts on injectable fertility hormones on her cycle day 3 to stimulate her ovaries to produce several eggs as opposed to just 1 or 2. Fertility hormones continue anywhere from 7 to 12 days depending on the Egg Donor’s response to the hormones. The Egg Donor is checked about 3 times a week via ultrasound and blood tests to determine her response to the drugs.

Once the follicles are the right size (about 18-20mm) she is given an HCG shot which induces an LH surge which also matures the eggs. Thirty-six hours after the HCG shot the egg retrieval is performed. Up until this time, the date/time of the transfer is flexible.

The eggs retrieved are fertilized with sperm from either the Intended Father or a sperm donor and incubated for 2-5 days. Lupron usually stops the day before egg retrieval in the Surrogate. Progesterone replacement (most often in the form of intramuscular injections, but sometimes with suppositories or Crinone gel) starts the day of the retrieval and continues until the 12th week of pregnancy or a negative pregnancy test. Estrogen replacement also continues until the 12th week of pregnancy (when the placenta takes over hormone production). Because the Surrogate was on Lupron and had natural hormones were suppressed, The Surrogate will need to take external sources of these very important hormones in order to maintain any pregnancy that occurs.

When the fertilized embryos are at the proper stage, they are loaded into a special syringe with a thin flexible catheter at the end. The catheter is inserted thru the cervix into the uterine cavity (sometimes with the assistance of abdominal ultrasound to ensure EXACT placement of the embryos) where the embryos are “injected”. Most doctors will only transfer three to four 2-day old embryos or two 5-day embryos. Any unused embryos are frozen for a future attempt if a pregnancy doesn’t result from the fresh cycle. Bed rest of anywhere from 2 hours to 3 days is usually required immediately following embryo transfer.

A Quantitative HCG in which the amount of pregnancy hormone is measured is usually done 14 days post egg retrieval. At that time they are looking for the HCG level to be about 50 or better. Anything over 200 is usually indicative of a multiple pregnancy. The Surrogate will have a second quantitative HCG test two days later to verify that the pregnancy hormone numbers are going up (they should double about every 2 days). If the quantitative HCG is negative, all external hormones are discontinued and a menstrual cycle will usually start within 5 days.

If a pregnancy has occurred (Congratulations!), an ultrasound is usually done about 6-7 weeks to check for a heartbeat and again around 12 weeks before being released to a regular OB/GYN. Usually during this time, hormone levels are checked several times to ensure that the proper levels are being maintained to ensure the pregnancy continues. Once the placenta starts taking over the hormone production, the Surrogate is weaned off the hormone replacements.

The rest of the pregnancy would be the same as any other pregnancy.

The Birth

Close to the expected due date you will need to make travel plans for the birth.  This is obviously more complicated when using a surrogate our of state or out of country.  Many states or countries will not allow for induced labor expect for medical reasons, making the due date harder to target.  You should have some flexibility on travel plans for this reason and/or in case of pre-term labor.

The Birth Certificate

Once your baby is born, as long as there is a genetic link (citizenship by descent), the process is typically straight-forward in most countries in gaining home citizenship for your child and in bringing your baby home.  Each country has specific rules around this, but typically a DNA test, a birth certificate, and the surrogate contract will be needed to prove descent.

Each country has specific requirements.  It is highly advised to have communication early in the process with immigration officials in your country to ensure a smooth process after birth. You will often receive your new home passport for your baby in about 3 weeks.  At this time, you can travel home with your child.  

The pre-birth order, or pre-birth parentage order, has had a significant influence on the growing acceptance of gestational surrogacy in the United States. It has allowed intended parents of children born through gestational surrogacy to have their names listed on the child’s birth certificate, thus granting them full parental rights to the child.  The particular laws of each state and the circumstances of the intended parent(s) involved will dictate when a petition for a pre-birth parentage order is appropriate and how it should be handled. Qualified legal counsel should have a firm understanding
of this process.