The practice of surrogacy is still rare, partially because we have a huge surrogate shortage in the U.S. "There are many international patients coming from countries where surrogacy is illegal to the U.S. to use surrogates," says Dr. Shahin Ghadir, fertility specialist at the Southern California Reproductive Center, which is only making our shortage worse.
That's probably why it's so hard to find reliable information about being a surrogate — it's hard to make heads or tails of what's going on, in no small part because parents don't often come out and talk about such a personal decision. The Counsel for Responsible Genetics confirmed in 2008 that there are no set surrogacy statistics available to the public, meaning there's no way to know exactly how many children have been born via surrogate. Modern Family Surrogacy Center says that an average of nine babies may be born to surrogates in each state in the U.S. every year. But considering how many celebrities announce the arrival of babies born thanks to a surrogate each year (Jimmy Fallon, Giuliana Rancic and Ellen Pompeo are just a few), the number seems to be even higher.
Certainly the demand for surrogacy is high — possibly even more so now that same-sex marriage has been legalized — but the process still isn't easy. Surrogacy laws are complex at best, with serious problems arising in international surrogacy cases that have made headlines. Close to half of the states in the U.S. don't have clear surrogacy laws established.
The only way to make sense of this mess and help the couples so desperate to start a family is by clearing up misinformation. If you have ever thought of being a surrogate, or if you are in need of a surrogate, here's what you're not being told.
1. There are different kinds of surrogacy
This brings us back to the made-for-TV-movie scenario, where surrogacy is presented as a one-size-fits-all solution. That's not the case. Staci Swiderski, co-founder of Family Source Consultants and surrogate user, says there is a distinct difference between a traditional and gestational surrogate. "One of the most common misconceptions that I often hear about being a surrogate is that she will be genetically-related to the child. Traditional surrogates utilize their own genetics (i.e., their own eggs), while gestational surrogacy... sees the embryo created with either the intended mother's genetics or an egg donor; or in some circumstances, a donated embryo could be utilized," says Swiderski.
2. The screening process is intense
Getting approved as a surrogate requires so much more than completing an online quiz. Sarah Harris, two-time surrogate and blogger at Oven Rental, says her first venture into surrogacy was far more complicated than she anticipated. Harris tells SheKnows: "When I first decided to become a surrogate, I had no idea what I was getting myself into. I just knew I wanted to do something for a family that could not do it for themselves. I began looking online for surrogacy agencies, and while there are quite a few out there, one stuck out for me."
She continues, "I filled out their initial online questionnaire via their website. It was 10 pages long, asking questions, like: 'How old are you, how many kids do you have and why do you want to do this?' Then, questions like: 'How do you feel about selective reduction or terminating a pregnancy due to a chromosome abnormality such as Down syndrome or trisomy 18?' I was six months pregnant with my daughter when I applied and was pre-approved. When my daughter was a year old (the wait was due to breastfeeding), it was time for the matching process."
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3. You don't have to be young
It's common knowledge that a woman's fertility begins to decline at 35, but this may not hurt your chances of being a surrogate. Dr. Ghadir says this "magic number" does not apply to a surrogate since she is not donating her eggs. "As long as the surrogate is in good health, she can continue doing this up until the late 30s, even 39 years of age," says Dr. Ghadir.
Marla Neufeld Esq., legal chair of Greenspoon Marder’s Family Law practice group who used a surrogate, qualifies: "Some states have legal requirements for the qualifications of a surrogate (i.e., age). However, there are many practical and medical considerations to consider including, but not limited to, whether she has her own children and experienced an uncomplicated birth, lives in a stable and healthy environment with supporting family/friends, not receiving any form of governmental assistance and free of any criminal history."
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4. There are perks
Surrogacy isn't the type of job you choose for the benefits, but a few perks don't hurt either. Compared to being an anonymous egg donor, Dr. Ghadir says the biggest benefit of being a surrogate is the freedom to form a relationship with the intended parents. He explains: "We have some parents that even pay for special diets, healthy diets, organic food and specific gynecologists to monitor the surrogates during the time that they are carrying their children."
5. You need a lawyer
The surrogacy red tape may be one of the biggest obstacles you face if you are interested in becoming a gestational carrier. Before you even think of sacrificing your body, you need to know your interests are protected. A reputable agency will provide you with a surrogacy lawyer, says Dr. Jane Frederick, reproductive endocrinology and infertility specialist and medical director of HRC Fertility. "This is to protect yourself and confirm that the agency you are working with is in compliance with state regulations and laws. Surrogacy lawyers help you avoid being taken advantage of," says Dr. Frederick.
Dr. Frederick describes a worst-case scenario that could benefit from legal protection: "Surrogacy is prohibited in Arizona. If surrogacy does occur, the state declares the surrogate as the legal mother, and if she is married, her husband is the legal father and they are entitled to custody of the child."
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6. Both parties have to agree
To enter into a successful surrogacy agreement, both parties have to feel comfortable — the surrogate and the intended parents. Neufeld describes her experience in choosing a surrogate after struggling with infertility for more than four years: "My husband and I interviewed multiple candidates before selecting our amazing surrogate. The first surrogate we disqualified based on moral differences. The second potential surrogate was excluded for she did not pass physical screening requirements. The third time was most delightfully the charm. Her husband and she were warm, friendly, positive and genuinely excited to help us expand our family."
From a surrogate's perspective, Harris says, "Matching with a couple is extremely sensitive for both parties. Based on my answers, my profile is reviewed and compared to other profiles of intended parents. Once there is preliminary legal clearance, such as comparing laws in the state in which the surrogate and intended parents live, we get each other's profiles for review. We are asked to take a few days and think about it, and if everyone agrees, we have a Skype meeting. If everything goes well from our Skype meeting, we are considered matched."
7. You don't get paid up front
Just like any other job, surrogacy fees are doled out in monthly payments — you don't get one lump sum with a positive pregnancy test. Harris explains that when working with an agency, payment is direct deposited, normally over nine months. "On my last surrogacy journey, I was compensated $27,000. The first payment was distributed once there was a confirmation of the heartbeat at six weeks, and the last payment was at 40 weeks. If I worked outside the home, there would be reimbursement for lost wages for all the requirements of a surrogate such as doctor's appointments, travel to and from the clinic for medical screening and transfers," she adds.
From the intended parent's perspective, Neufeld says, "Financial concerns are of paramount importance as surrogacy can range from $60,000 to $150,000. Some expenses include medical costs for [in vitro fertilization], medications, two attorneys (one to write the contract and one to review for the surrogate), surrogate agency fee, medical insurance for the surrogate and reasonable living expenses of the surrogate."
8. You don't always get attached
There's no mother on earth who could bear the thought of parting with her new baby, but surrogacy is a different ballgame, says Harris: You're going into it with both eyes open. Most surrogates prepare for the emotional risks and understand that a baby is simply "on loan." Harris says she never felt any attachment, comparing surrogacy to taking care of a baby for a friend. "The emotional connection is not there like it is when you carry your own child," she says.
Harris continues, "The birth for my last surrogacy journey was emotional, but not because I was sad. It was because I had set a goal for myself, and even though the pregnancy was mostly tolerable, the last few months and the birth were difficult. I accomplished my goal and the emotional side was seeing the parents finally get their baby. The one they had tried so long for."
