Understanding the Surrogacy Process
The highly personal journey to parenthood looks different for everyone. And sometimes, that pathway involves a fertility clinic.
After choosing the fertility clinic that is right for you, you and your team will sit down together and devise a plan. At Reproductive Medicine Associates of Connecticut we feel it is our job is to help you navigate your options and collectively determine the best plan to achieve your personal family goals.
One of the ways in which we can help you build a family is through surrogacy. We’ve helped many people reach their dreams of parenthood that way, and while it might not be how you envisioned having a child (let’s face it – using a fertility clinic at all is not how you anticipated any of this going!), it is a wonderful option for many people.
What Exactly is Surrogacy?
In the simplest of terms, surrogacy involves a woman who carries a pregnancy for another person or couple. The person or couple who will raise the child are referred to as the intended parent(s) (IP).
Individuals and couples choose surrogacy for a number of reasons, including the absence of or an impaired uterus, ongoing fertility struggles, health problems, single parenting paths, LGBTQ+ family building, or the presence of cancer. No matter what your situation, we’re here for you, with an experienced third-party reproduction team that is dedicated to your needs.
There is much misinformation and confusion that exists surrounding the surrogacy process, so we’re here to break it down for you, step-by-step.
What are the Different Types of Surrogacy?
Surrogacy is a path to parenthood for many couples that can allow one or perhaps both partners to biologically participate, or be linked to, that child without an intended parent actually being the one to carry the child. So how does that process work? There are two types of surrogacy: gestational surrogacy and traditional surrogacy.
The most common practice, gestational surrogacy, can be carried out in a number of ways. Whether you use your own biological eggs and/or sperm, or donor eggs and/or sperm, any combination of those can be used to create a viable pregnancy carried by a surrogate, or gestational carrier.
A gestational carrier is the person who helps to grow a pregnancy and deliver the baby, but is not biologically connected to your child. While the gestational carrier is not related to the child, many surrogates maintain a beautiful, close relationship with their intended parents during pregnancy.
In a gestational surrogacy arrangement, pregnancy is achieved through in-vitro fertiliziation, or IVF, a process that requires that the cycles of either the patient or an egg donor and the recipient (gestational carrier) are synchronized. During the IVF process, the intended parents’ own sperm and egg (or donor sperm and/or egg) are combined to produce embryos. These embryos are then grown in the laboratory for 3-6 days, and are then either frozen for future use, or transferred into the uterus of the gestational carrier. If pregnancy occurs, she carries the pregnancy to term and delivers the child for the intended parents.
The Surrogacy Opportunity Plans at RMA of Connecticut are designed to help individuals and couples who use a surrogate have more control over the cost of treatment, including this IVF cycle.
Interested in knowing more about the IVF process?
Traditional surrogacy is not commonly practiced due to the numerous legal hurdles involved. In this scenario, the egg donor and surrogate are the same person, so the carrier is genetically linked to the child that she carries and delivers. While this may seem like an easier, less expensive, or an even quicker way to achieve family building dreams, most clinics and reproductive attorneys will caution you against it due to the lack of legal protection for all involved.
Who is Involved in the Surrogacy Journey?
Taking the time to establish your surrogacy support team is an essential part of the journey. First, you’ll want to find a trusted fertility clinic and reproductive endocrinologist. Look for a provider who is experienced in surrogacy. If you are receiving a referral from another type of doctor, such as an oncologist, it’s a good idea to ask them if they have suggestions for a clinic with a strong record of surrogacy success.
Your surrogacy team will likely consist of the following:
- Fertility Doctor: this may or may not be someone to whom you are already connected.
- Fertility Clinic Staff: including nurses, administration staff, and the lab team.
- Designated mental health professionals
- Surrogacy agency staff
What Does the Surrogacy Journey Look Like?
Step One: Meet with Your Physician
The first step in the surrogacy process is having a thorough conversation with your physician about your family building plan, along with your personal and family medical history. With this new era of Covid-19, meeting with a physician can be as easy as opening your laptop!
Make sure to let your doctor know of any prior fertility assistance or preservation. For instance, if one partner has frozen eggs in the past, your physician will personalize your plan based on that medical and health history.
If a male partner is involved, they will conduct an easy semen analysis test, and you will receive results quickly. The female partner may be asked to undergo standard fertility tests if she’s hoping to contribute her eggs, or gametes (and did not already freeze eggs prior to seeking a surrogate). Additional genetic testing may also be conducted at this time.
Step Two: Find an Egg Donor or Sperm Donor
Choosing a donor is the next step for couples where the female partner is not going to use her own eggs or the male partner is not going to use his own sperm. Your egg or sperm donor will be genetically linked to your future child, so this may seem like an overwhelming decision. Clinical and mental health professionals will help you choose the donor that is right for you.
In the case of egg donation, once you match with a donor, most clinics will conduct a fresh donor egg cycle. This is basically the first half of IVF, in which the donor will take medication to optimize her ovaries and will ultimately undergo an in-office egg retrieval procedure.
Frozen egg banks are also an option, but because eggs are single-celled units and do not always thaw well after freezing, your clinic will probably suggest a fresh donor cycle.
Egg donors are typically young, healthy women whose goal is to help someone complete their family. They are usually compensated anywhere from $8,000-15,000 for donating their eggs.
Choosing a donor is a highly personal experience. Many choose a donor who has a similar ethnic background or phenotype to themselves, so they have something that they can share with their child. The selection also goes beyond appearances, as you can take personality traits, hobbies, and more into consideration. Remember, for sperm or egg donation, you’re not just accessing the genetic makeup of that one donor but his/her entire genetic tree.
Step Three: Complete an IVF Cycle
To complete the IVF cycle, the male partner will give a sperm sample (or donor sperm may be used) at your medical provider’s office. The good news is that this doesn’t have to happen on the same day as the partner or donor’s egg retrieval. In fact, sperm can stay safely frozen for years.
On the day of egg retrieval, the clinic staff will complete the procedure, letting you know how many eggs were retrieved. The sperm and egg will then be combined in the laboratory to form embryos. Over the next few days as the embryos develop, the medical team will communicate with you to let you know how many embryos mature and the grade of those embryos.
It’s important to remember that there is a natural rate of attrition when it comes to the IVF process. Not all eggs retrieved will be mature, and not all eggs that are fertilized will develop into Grade A embryos, which is completely normal.
Why don’t all eggs become embryos?
You may also undergo a preimplantation genetic testing for aneuploidies (PGT-A) at this time to help select the best embryo. Chances for chromosomal abnormalities are rare with a young, healthy donor, but this test can also allow you to determine sex of your embryos. Embryos are usually cryopreserved until your surrogate’s uterine lining is ready for implantation.
Step Four: Find a Surrogate
Surrogates can be found in all states where surrogacy is legal, and are typically healthy women who have had prior pregnancies and uncomplicated births. Their goal is to help others have the family that they desire. Surrogacy agencies help to source, screen, and match surrogates with intended parents.
Remember to communicate with your agency about any specific requests you have in regard to your surrogate. Like you, your agency wants the match to go smoothly. Let them know if you have preferences regarding the location of your surrogate, dietary requests, or the amount of contact you wish to have with your carrier.
Your agency will take great care in providing mental health counseling to make sure you, your surrogate, and her partner (if applicable) are all on the same page throughout the process. Expect for the surrogate matching process to take some time, in some cases six months or longer.
Surrogates are typically compensated $40,000-60,000, as well as having their health insurance, travel expenses, and other maternity costs covered.
At RMA of Connecticut, we leave the choice of a gestational carrier to the patient(s), although the clinic does screen the potential gestational carrier using guidelines established by the American Society for Reproductive Medicine (ASRM) before proceeding with the arrangement.
Step Five: Undergoing the Embryo Transfer
The embryo transfer is a surprisingly quick procedure, and most intended parents attend the clinic for this experience with the surrogate. The transfer is performed on an ultrasound, so everyone can see the procedure take place. Most surrogates travel home right after the procedure.
Everyone will wait eight to ten days after the transfer for a pregnancy test. Once the pregnancy is confirmed, the surrogate will undergo eight to ten weeks of monitoring at her local office with fertility clinic supervision. She will then regularly visit her local OB-GYN’s office for observation. Once pregnant, expect to connect with your surrogate at least weekly through video, phone call, and/or text.
Step Six: Completing Legal Paperwork
Your surrogacy agency will help you to navigate necessary legal paperwork. Documents include a pre-birth order, parentage documents for intended parents, and a formal birth plan. These documents ensure that everyone’s rights and wishes are known and protected throughout the entire process.
Step Seven: Delivery
Thanks to modern technology and the ability to quickly jump on a plane, most parents are present for the birth of their child, with many choosing to be in the delivery room (pending COVID-19 safety guidelines set forth by your hospital).
There is a common fear among intended parents that their gestational carrier will want to keep their baby, but vetted surrogates will have signed legal documents stating that this child belongs to the intended parents. Additionally, surrogates have their own families and are happy to help you achieve your dreams of parenthood. They may even wish to receive occasional updates or photos throughout the baby's life.
Reach Out to Learn More
The decision to pursue a gestational surrogacy arrangement should be made thoughtfully after due consideration and counseling. Your RMA of CT fertility specialist can help sort out your options and offer his or her professional advice.
We are here to help you navigate the process and to help you make the best decision for everyone involved. If you’d like more information or have questions regarding gestational surrogacy, please reach out to us.
Interested in learning more about surrogacy?
About Emma Lott
Emma is the brand specialist for Gay Parents To Be, helping to build awareness of the brand not only as a direct path to parenthood, but also as a general resource for fertility information in the LGBTQ community. She loves the chance to attend conferences on LGBTQ health and family building, and meet prospective patients.